Microporous polysaccharide hemospheres for management of laparoscopic trocar injury to the spleen

• Published in: The American journal of surgery Vol. 195; no. 1; pp. 99 - 103
• Main Authors: Humphreys, Mitchell R., M.D, Castle, Erik P., M.D, Andrews, Paul E., M.D, Gettman, Matthew T., M.D, Ereth, Mark H., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2008; Elsevier; Elsevier Limited
• Subjects: Abdominal Injuries - etiology; Abdominal Injuries - surgery; Animals; Biocompatible Materials - administration & dosage; Biological and medical sciences; Digestive system. Abdomen; Disease Models, Animal; Endoscopy; Experiments; Female; General aspects; Hemorrhage; Hemostasis, Surgical; Hemostatic agents; Hemostatics; Injuries; Investigative techniques, diagnostic techniques (general aspects); Laboratory animals; Laparoscopic hemostasis; Laparoscopy - adverse effects; Medical sciences; Microspheres; Molecular weight; Mortality; Polysaccharides - administration & dosage; Spleen - injuries; Spleen - surgery; Splenic injury; Surgery; Surgical Instruments - adverse effects; Swine; Hemostatic agents; Splenic injury; Laparoscopic hemostasis; Spleen; Hemostatic; Splenic disease; Laparoscopy; Medicine; Clinical management; Treatment; Hemostasis; Surgery; Endoscopy; Lesion; Polysaccharide; Splenic trauma
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2007.03.006

Abstract Background Management of iatrogenic injuries during laparoscopy can be arduous. Recent advancements in surgical hemostatic agents have provided beneficial therapeutic alternatives. This project evaluates microporous polysaccharide hemospheres (MPH), with demonstrated efficiency achieving topical hemostasis, in the setting of intracorporeal laparoscopic splenic injury. Methods Four domestic female pigs were subjected to reproducible laparoscopic 12-mm and 5-mm trocar splenic injuries. Each surgery was an identical transperitoneal hand-assisted laparoscopic procedure. Hemostasis, or no bleeding after treatment, was achieved by measured dose applications of MPH. Results The MPH successfully achieved hemostasis for all splenic injuries except in 1 case, where a 12-mm lesion transected the splenic artery. The mean time to hemostasis, applications of MPH, and estimated blood loss for the 5- and 12-mm injuries were 165.3 ± 45.7 and 200.7 ± 106.5 seconds, 1.3 ± .5 applications for both, and 12.0 ± 4.6 and 17.7 ± 9.1g, respectively. Conclusions MPH represents a powerful hemostatic agent that demonstrated complete hemostasis for iatrogenic splenic injury.