Ces Urol 2007, 11(3):147-153 | DOI: 10.48095/cccu2007023

Potential use of tissue adhesives during kidney-sparing surgery for kidney cancer

M. Hora, V. Eret, T. Ürge, J. Klečka

Urologická klinika LF UK a FN, Plzeň

Objective: To present an overview of recent knowledge of tissue adhesives in general as well as with an emphasis on where they are most widely used in urology, i. e., during both open and laparoscopic kidney resections.

Results: A wide variety of tissue adhesives are commercially available. For kidney resection, fibrin (containing fibrin, thrombin, and other components) and thrombin sealants (containing thrombin dissolved in gelatin which activates the patient's fibrinogen) are mainly used. Fibrin sealants require a dry resection surface which cannot be achieved particularly in laparoscopic kidney resections; therefore, fibrin sealants cannot be routinely used. This applies to liquid forms; fibrin sealants combined with a collagen sponge have been used in open kidney resections. By contrast, thrombin sealants require active bleeding to be activated which currently makes them most suitable for use in kidney resection. However, they fail to glue tissues and are only intended for haemostasis. The gelatin-thrombin matrix FloSeal?, a commercial company product, can be used in both open and particularly laparoscopic resections where the possibilities of haemostasis are limited compared to open surgery. There have been three reports of successful use of albumin with glutaraldehyde (Bioglue?), however, it needs to be applied on a dry resection surface. Oxidized cellulose (Surgicel?) is used to fill a defect after resection or to cover the suture line. Cellulose has been combined with thrombin sealants with success. Results of animal studies with cyanoacrylate and adsorbents seem promising. Reports of their clinical use have not been published yet. The other tissue adhesives such as polyethylene glycols or collagen are currently not being used in kidney resections.

Conclusion: In kidney resection, tissue adhesives are mainly used to improve haemostasis. In open resections, tissue adhesives are used in more complex procedures including centrally located tumours. Commonly used tissue adhesives include gelatin-thrombin matrix FloSeal? as well as Tachosil?, a fibrin sealant applied as a collagen sponge. In laparoscopic resections, FloSeal? delivered by means of a special applicator has routinely been used. A disadvantage is an increase in price of the procedure.

Keywords: kidney resection; tissue adhesives; fibrin; thrombin; gelatin; cellulose

Published: June 1, 2007