Use of TachoSil ® in Laparoscopic Enucleoresection of Renal Masses Smaller than 4 cm: Our Preliminary Experience of 41 Cases

Introduction

In nephron-sparing surgery the use of new and various hemostatic materials has provided a significant support in the control of intraoperative hemostasis of resection bed. Objective of this study is to demonstrate the use of hemostatic material TachoSil^® in laparoscopic treatment of renal masses < 4 cm.

Materials and Methods

41 patients underwent laparoscopic renal enucleoresection. In all patients one or more hemostatic TachoSil^® sponges were used, affixed to the bed of resection; we retrospectively evaluated the efficacy and safety of this technique.

Transperitoneal access in 39 patients with antero-lateral mass and retroperitoneoscopic access in 2 patients with middle-posterior mass.

After performing a warm ischemia, we proceeded to mass enucleoresection by cold blade, and to hemostasis control by suturing open vessels on the resection bed with “central suturing” technique. After unclamping the renal artery, one or more hemostatic sponges of TachoSil^® were always used (fibrinogen and human thrombin) affixed to the bed section.

Results

No significant variations of Hb, BUN and Crs. 3 cases (6.9% of renal units) of intraoperative hemorrhage requesting blood transfusion, 2 cases (4.6% of renal units) of urinary leakage at low pressure, treated conservatively with retrograde application of ureteral stent DJ for 21 days; 2 patients underwent new laparoscopy and suture.

The mean time to hemostasis, evaluated in terms of the absence of macroscopic intraoperative bleeding after the application of TachoSil^®, was 5.5 (3–16) minutes.

Average hospital stay: 5.5 (4–11) days. Follow-up: 37.6 (5–84) months.

Discussion

The control of hemostasis is the key problem inherent to laparoscopic technique and can be approached using hemostatic agents.

Currently hemostatic agents such as TachoSil^® are used increasingly as an adjuvant agent in the control of bleeding, having an excellent application in laparoscopic renal enucleoresection, and proving safe and effective in the treatment of tumors below 4 cm.