Versatility and clinical effectiveness of a synthetic sealing hemostatic patch as alternative to parenchyma suturing in laparoscopic partial nephrectomy

• DOI: 10.1007/s00464-021-08333-0
• Publication Date: 2021-02-19T12:33:09Z
• Authors: Eva Erne; Stephan Kruck; Tilman Todenhoefer; Stefan Aufderklamm; Bastian Amend; Jens Bedke; Arnulf Stenzl; Steffen Rausch
• Keywords: Sutures; Nephrectomy; Article; Hemostatics; Kidney Neoplasms; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Laparoscopy/methods [MeSH] ; Veriset ; Laparoscopic partial nephrectomy ; Hemostatics/therapeutic use [MeSH] ; Humans [MeSH] ; Sutures [MeSH] ; Treatment Outcome [MeSH] ; Kidney Neoplasms/surgery [MeSH] ; Retrospective Studies [MeSH] ; Kidney Neoplasms/pathology [MeSH] ; Hemopatch ; Complication ; Article ; Nephrectomy/methods [MeSH] ; Hemostasis; Humans; Laparoscopy; Retrospective Studies

Abstract Background Improvements in laparoscopic partial nephrectomy (LPN) in order to minimize perioperative warm ischemia time (WIT), complications, and consequently patient outcome are desirable. Veriset™ is a ready-to-use hemostatic patch of absorbable oxidized cellulose and hydrogel components that has earlier been implemented in vascular and hepatic surgery. We report our experience using this device in LPN.

Methods Patients with a solitary malignant renal mass suspicious for renal cancer underwent LPN with either the use of Veriset™ hemostatic patch (n = 40) or conventional suture technique (n = 40). Patient characteristics, operation time and WIT, postoperative course and complications were recorded retrospectively. Tumor complexity was calculated according to the R.E.N.A.L. score. Outcome was determined according to the “trifecta” criteria (negative surgical margin, WIT < 25 min, no complications within 30 days).

Results No significant differences with regard to clinical parameters and median R.E.N.A.L. score (6) were observed between both groups. Operation time (mean 127.1 min vs. 162. 8 min; p = 0.001) and WIT were both lower in the Veriset™ group (14.6 min vs. 20.6 min; p = 0.01). No differences in surgical margins (p = 0.602) and overall complication rates at 30 (p = 0.599) and 90 days (p = 0.611) postoperatively were noticed. The surgical outcome according to “trifecta” was achieved in 65% of patients using Veriset™ and in 57.5% of patients by suture closure, respectively.

Conclusion The hemostatic Veriset™ patch can successfully be implemented in LPN. Handling and application appear favorable, thereby reducing operation time and WIT. The present results suggest that the device may represent an alternative to parenchyma suturing in LPN.