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Xie Q, Xie Y, Shi Y, Quan X, Yang X. Impact of haemostasis methods during ovarian cystectomy on ovarian reserve: a pairwise and network meta-analysis. J OBSTET GYNAECOL 2024; 44:2320294. [PMID: 38406841 DOI: 10.1080/01443615.2024.2320294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/02/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Haemostasis during ovarian cystectomy is reported to damage the ovarian reserve, but the comparative impacts of three haemostasis methods (bipolar energy, suture and haemostatic sealant) on ovarian reserve in patients with ovarian cysts are not well known. METHODS The Cochrane Library, PubMed and Web of Science databases were searched from the date of inception of the database to June 2022 for literature exploring the impact of haemostasis methods during ovarian cystectomy on ovarian reserve. A traditional meta-analysis was performed using Review Manager software. A network meta-analysis (NMA) was performed using Stata and GemTC software. RESULTS The direct meta-analysis comparison indicated that the mean postoperative reduction of anti-Müllerian hormone (AMH) level was significantly higher in the electrocoagulation (bipolar) group than suture and haemostatic sealant group, both in the overall group and subgroup of women with ovarian endometrioma. In NMA, the reduction of postoperative AMH levels in the electrocoagulation (bipolar) group was higher than the suture group at 6 months with a statistical significance, and at 1, 3 and 12 months without a significant difference. The difference in the postoperative decrease of AMH level did not reach statistical significance between suture and sealant, coagulation and haemostatic sealant. The comprehensive ranking results revealed that suture treatment was, with the highest probability, beneficial to the protection of the ovarian reserve. CONCLUSIONS There was insufficient research to detect the optimal haemostasis method for ovarian reserve preservation in ovarian cystectomy. Nevertheless, haemostasis by electrocoagulation (bipolar) should be avoided when possible, and the suture might be considered as the best choice.
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Affiliation(s)
- Qin Xie
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, PR China
| | - Yue Xie
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, PR China
| | - Ying Shi
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, PR China
| | - Xiaozhen Quan
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, PR China
| | - Xuezhou Yang
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, PR China
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Paik H, Jee BC. Comparison of ovarian reserve after cystectomy of ovarian endometrioma by bipolar coagulation, suture method, or hemostatic sealants: An updated meta-analysis. J Obstet Gynaecol Res 2024; 50:1020-1031. [PMID: 38504428 DOI: 10.1111/jog.15925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/07/2024] [Indexed: 03/21/2024]
Abstract
AIM The purpose of the study was to compare the ovarian reserve after cystectomy of ovarian endometrioma by bipolar coagulation, suture method, or hemostatic sealants (HSs). METHODS We performed a meta-analysis of studies in which post-cystectomy serum anti-Müllerian hormone (AMH) values were compared between bipolar coagulation and suture method or between bipolar coagulation and HSs. Through a literature search, we retrieved 14 articles which met inclusion criteria and were eligible for final analysis. The articles included 10 randomized trials, 3 prospective studies, and 1 retrospective study (n = 1435). The primary outcome was post-cystectomy serum AMH values. RESULTS Both bipolar coagulation and suture methods showed significantly lower post-cystectomy AMH values at 3, 6, and 12 months. However, post-cystectomy serum AMH values at 12 months were significantly higher in the suture method group compared to the bipolar coagulation (weighted mean difference [WMD]: -1.10, 95% confidence interval [CI]: -1.83, -0.38, p = 0.003, I2 = 89, n = 3). The suture method also showed a lower decline rate at 3 months post-cystectomy compared to the bipolar coagulation group (WMD: -25.13%, 95% CI: -49.56 to -0.70, p = 0.04, I2 = 95%, n = 2). Overall, pregnancy rates were similar between the two groups. Between the bipolar coagulation and HSs group, serum AMH values at 3 months post-cystectomy were similar (WMD: -0.46, 95% CI: -1.04 to 0.13, p = 0.13, I2 = 0%, n = 3). However, the HSs group showed a less decline rate at 3 months post-cystectomy compared to the bipolar coagulation group (WMD: -17.02%, 95% CI: -22.81, -11.23, p < 0.00001, I2 = 0%, n = 3). CONCLUSIONS Both the suture method and HSs may have potential benefits in the preservation of ovarian reserve over the bipolar coagulation method when cystectomy for ovarian endometrioma is performed.
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Affiliation(s)
- Haerin Paik
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Hayes KG, French AV. Topical Hemostatic Agent May Be Mistaken for Ovarian Teratoma. J Pediatr Adolesc Gynecol 2022; 35:512-515. [PMID: 34871792 DOI: 10.1016/j.jpag.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ovarian teratomas are common, as is use of topical hemostatic agents in ovarian surgery. CASE Following laparoscopic right ovarian cystectomy, a flowable hemostatic agent was placed in the ovarian bed. Postoperative ultrasound demonstrated an enlarged heterogeneous right ovary with solid and cystic components interpreted as residual or recurrent teratoma. Visual inspection during repeat laparoscopy revealed an irregularly shaped, enlarged right ovary with a smooth cortex. A cavity inside the ovary contained brown, shaggy material. Pathological evaluation demonstrated normal ovary and fibrin. SUMMARY AND CONCLUSION We report the first case of a hemostatic agent routinely used in ovarian cystectomy postoperatively, mimicking a teratoma. Consideration of this finding is important when planning surgery in adolescent patients to optimize fertility preservation and minimize ovarian follicle damage.
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Affiliation(s)
- Katherine G Hayes
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Amanda V French
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts.
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Yu J, Qi YL, Lu DW, Fang QJ, Li L, Sang L. Multiple Protocols Combined with Hyperbaric Oxygen Therapy on the Maintenance of Ovarian Function in Patients After Ovarian Cystectomy. Front Surg 2022; 9:877114. [PMID: 35669250 PMCID: PMC9163415 DOI: 10.3389/fsurg.2022.877114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to explore the effect of adjuvant hyperbaric oxygen therapy on ovarian function after laparoscopic ovarian cystectomy. Methods A total of 60 patients with ovarian cysts treated at our hospital from January 2018 to August 2020 were enrolled. According to the different treatment modalities, the patients were divided into the control and observation groups. Patients in both groups underwent laparoscopic ovarian cystectomy with oral administration of Chinese patent medicine Kuntai capsules after surgery. Hyperbaric oxygen therapy was added to patients in the observation group in addition to the treatment in the control group. The anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and antral follicle count (AFC) serum levels were detected in both groups before the operation and at the first and third menstrual cycles postoperatively to evaluate ovarian function. Results At the first and third menstrual cycles after surgery, the AMH, E2, and AFC serum levels in the two groups were significantly lower than before surgery, and the FSH and LH serum levels were higher than before surgery. The differences were statistically significant (P < 0.05). After the operation, AMH, E2, and AFC serum levels in the observation group were significantly higher than in the control group. FSH and LH serum levels were significantly lower than in the control group, and the differences were statistically significant (P < 0.05). Conclusion For patients undergoing laparoscopic ovarian cystectomy, the adjuvant hyperbaric oxygen therapy could significantly improve the postoperative ovarian reserve function with remarkable effects.
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Affiliation(s)
- Jie Yu
- Department of Obsterics and Gynecology, The Second People's Hospital of Hefei (Hefei Hospital Affiliated to Anhui Medical University), An Hui, China
| | - Yin-Liang Qi
- Department of Hyperbaric Oxygen, Hefei Second People’s Hospital, An Hui, China
| | - Da-Wei Lu
- Department of Obsterics and Gynecology, The Second People's Hospital of Hefei (Hefei Hospital Affiliated to Anhui Medical University), An Hui, China
| | - Qian-Jin Fang
- Department of Obsterics and Gynecology, The Second People's Hospital of Hefei (Hefei Hospital Affiliated to Anhui Medical University), An Hui, China
| | - Lan Li
- Department of Obsterics and Gynecology, The Second People's Hospital of Hefei (Hefei Hospital Affiliated to Anhui Medical University), An Hui, China
| | - Lin Sang
- Department of Obsterics and Gynecology, The Second People's Hospital of Hefei (Hefei Hospital Affiliated to Anhui Medical University), An Hui, China
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Chung JPW, Law TSM, Mak JSM, Sahota DS, Li TC. Ovarian reserve and recurrence 1 year post-operatively after using haemostatic sealant and bipolar diathermy for haemostasis during laparoscopic ovarian cystectomy. Reprod Biomed Online 2021; 43:310-318. [PMID: 34193356 DOI: 10.1016/j.rbmo.2021.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/25/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022]
Abstract
RESEARCH QUESTION Is there a difference in the ovarian reserve 1 year post-operatively in those who used a haemostatic sealant or bipolar diathermy for haemostasis during laparoscopic ovarian cystectomy for ovarian endometriomas? DESIGN This was an extended follow-up observational study of a previous randomized controlled trial where women aged 18 to 40 years with 3-8 cm unilateral or bilateral endometriomas were randomized to receive haemostasis by a haemostatic sealant or bipolar diathermy following ovarian cystectomy. The primary outcome was the ovarian reserve as assessed by antral follicle count (AFC) 1 year post-operatively. Secondary outcomes included the recurrence rate of ovarian endometrioma, the change in anti-Müllerian hormone (AMH) and FSH concentrations, and reproductive outcomes. RESULTS The significant increase in AFC at 3 months after initial surgery (P = 0.025) in the haemostatic sealant group compared with the diathermy group was sustained at 1 year (P = 0.024) but there was no difference in AMH or FSH concentrations between the groups throughout the follow-up period. The recurrence rate in the FloSeal group was 7.7% (n = 3/39) compared with 22.2% (n = 8/36) in the diathermy group (P = 0.060). The recurrence rate in women who had bilateral lesions was significantly higher than those with unilateral lesions (risk ratio 5.33, interquartile range 1.55-18.38). No difference in reproductive outcomes was found between the two groups. CONCLUSIONS Applying haemostatic sealant after laparoscopic cystectomy of ovarian endometriomas produces a significantly greater improvement in AFC, which was apparent at 3-month follow-up, and was sustained at 1-year follow-up without compromising the recurrence rate.
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Affiliation(s)
- Jacqueline Pui Wah Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin New Territories, Hong Kong SAR.
| | - Tracy Sze Man Law
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin New Territories, Hong Kong SAR
| | - Jennifer Sze Man Mak
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin New Territories, Hong Kong SAR
| | - Daljit Singh Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin New Territories, Hong Kong SAR
| | - Tin Chiu Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin New Territories, Hong Kong SAR
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Park EY, Hwang KH, Kim JH, Lee SH, Park KS, Choi SJ, Cha SK. Epinephrine minimizes the use of bipolar coagulation and preserves ovarian reserve in laparoscopic ovarian cystectomy: a randomized controlled trial. Sci Rep 2020; 10:20911. [PMID: 33262411 PMCID: PMC7708492 DOI: 10.1038/s41598-020-77781-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 11/12/2020] [Indexed: 11/15/2022] Open
Abstract
We propose a novel method, the epinephrine compression method (Epi-pledget), as a hemostasis method for ovarian cystectomy. A total of 179 patients undergoing laparoscopic ovarian cystectomy with stripping were randomly allocated into three groups: the bipolar coagulation group, the Epi-pledget group, and the coagulation after Epi-pledget (Epi & Coagulation) group. Serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) by ultrasonography were measured to determine the preservation of ovarian function. To evaluate the postoperative ovarian cellular proliferative activity and tissue damage in a mouse model, we operated on the ovaries of mice with an artificial incision injury and applied two hemostatic methods: coagulation and Epi-pledget. Eight weeks after surgery, the AMH rate significantly decreased in the bipolar coagulation group compared with the Epi-pledget group. The AFC decline rate was also significantly greater in the coagulation group than the Epi-pledget group. Specifically, patients with endometrioma had a significantly greater decline of serum AMH in the coagulation group than the Epi-pledget group. In a histopathological analysis in mice, the Epi-pledget group showed ameliorated fibrotic changes and necrotic findings in the injured lesion compared with the bipolar coagulation group. The Epi-pledget method for ovarian stripping has an additional benefit of maximizing the preservation of the ovarian reserve, especially for the endometriotic ovarian cyst type.
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Affiliation(s)
- Eun Young Park
- Department of Obstetrics and Gynecology, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwondo, 26426, Republic of Korea
| | - Kyu-Hee Hwang
- Department of Physiology, Department of Global Medical ScienceMitohormesis Research Center, Institute of Mitochondrial Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwondo, 26426, Republic of Korea
| | - Ji-Hee Kim
- Department of Physiology, Department of Global Medical ScienceMitohormesis Research Center, Institute of Mitochondrial Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwondo, 26426, Republic of Korea
| | - San-Hui Lee
- Department of Obstetrics and Gynecology, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwondo, 26426, Republic of Korea
| | - Kyu-Sang Park
- Department of Physiology, Department of Global Medical ScienceMitohormesis Research Center, Institute of Mitochondrial Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwondo, 26426, Republic of Korea
| | - Seong Jin Choi
- Department of Obstetrics and Gynecology, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwondo, 26426, Republic of Korea.
| | - Seung-Kuy Cha
- Department of Physiology, Department of Global Medical ScienceMitohormesis Research Center, Institute of Mitochondrial Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwondo, 26426, Republic of Korea.
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Topical hemostatic and tissue-sealing agents in gynecologic surgery. Curr Opin Obstet Gynecol 2020; 32:285-291. [PMID: 32324712 DOI: 10.1097/gco.0000000000000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW To review current topical hemostatic agent use and how it pertains to gynecologic surgery. RECENT FINDINGS Recent literature suggests some benefit of topical hemostatic agents (THA). THAs confer reduced bleeding and shorter operating room time in women undergoing hysterectomy for cancer and in abdominal myomectomy. THA use in women undergoing ovarian cystectomy is associated with a decreased reduction in ovarian reserve. Potential complications of THA use include abscess formation, small bowel obstruction, inflammation, allergic reaction, and transmission of blood-borne pathogens. Evidence for use of THA in benign minimally invasive gynecologic surgery (MIGS) procedures is lacking. SUMMARY Although evidence exists for the efficacy of THA in reducing blood loss and operating times across surgical subspecialties, specific, appropriate, and efficacious use of THAs in gynecologic surgery remains ill-defined. Knowledge of their mechanisms of action and potential complications should enable surgeons to optimize desired effects and minimize harm.
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Abstract
Uncontrolled surgical bleeding can have significant clinical and economic consequences including advanced medical expenses and impairment of the outcomes. Effective and safe local hemostatic agents based on a fluid active hemostatic matrix are reviewed in the article. The use of this agent is followed by reduced hospital-stay, number of redo interventions for bleeding, reduced time of surgery, intra- and postoperative complication rate and high economic efficiency.
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Affiliation(s)
- A B Zemlyanoy
- Pirogov National Medical and Surgical Center of Ministry of Health of Russia, Moscow, Russia
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9
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Chung JPW, Law TSM, Chung CHS, Mak JSM, Sahota DS, Li TC. Impact of haemostatic sealant versus electrocoagulation on ovarian reserve after laparoscopic ovarian cystectomy of ovarian endometriomas: a randomised controlled trial. BJOG 2019; 126:1267-1275. [DOI: 10.1111/1471-0528.15807] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2019] [Indexed: 12/23/2022]
Affiliation(s)
- JPW Chung
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong, SAR
| | - TSM Law
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong, SAR
| | - CHS Chung
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong, SAR
| | - JSM Mak
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong, SAR
| | - DS Sahota
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong, SAR
| | - TC Li
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong, SAR
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Ito TE, Martin AL, Henderson EF, Gaskins JT, Vaughn VM, Biscette SM, Pasic RP. Systematic Review of Topical Hemostatic Agent Use in Minimally Invasive Gynecologic Surgery. JSLS 2019; 22:JSLS.2018.00070. [PMID: 30662251 PMCID: PMC6328362 DOI: 10.4293/jsls.2018.00070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background and Objectives: To perform a systematic review of articles evaluating hemostatic effectiveness and peri-operative outcomes when topical hemostatic agents (HA) are used in minimally invasive gynecologic surgeries (MIGS) for benign conditions. Methods: Studies published through March 31, 2017 were retrieved through PubMed, EMBASE, Cochrane, and ClinicalTrials.gov to identify all eligible studies. No studies were excluded based on publish date. All comparative studies or case series with >10 participants reporting use of at least one topical HA in MIGS for benign conditions were included as long as full-text articles were available and written in English. Studies were excluded if surgery was done for malignancy or completed via an open approach. Articles that included multiple surgical subspecialties were excluded if data related to MIGS was unable to be isolated. Evaluation for eligibility and data extraction was performed by three independent reviewers. Quality of evidence was also assessed by each reviewer. Results: From 132 articles, a total of 8 studies were included in this systematic review. We found that use of fibrin sealant decreased time to hemostasis, postoperative hemoglobin drop, and estimated blood loss (EBL) compared with bipolar energy and reduced the overall operative time in laparoscopic myomectomy. When fibrin sealant use at time of myomectomy was compared to bipolar energy there was no significant difference in the rate of postoperative complications. Furthermore, there was less of a decrease in anti-Mullerian hormone (AMH) level when a thrombin-gelatin matrix was used compared to bipolar energy on ovarian tissue. Conclusion: Application of topical HA in MIGS can reduce operative time, blood loss, and ameliorate damage to ovarian function. However, more data needs to be gathered for use of HA during different types of gynecologic procedures (adnexal surgery, myomectomy, and hysterectomy) to provide better quality evidence to guide their use.
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Affiliation(s)
- Traci E Ito
- Department of Obstetrics and Gynecology, University of Louisville Hospital, Louisville, KY, USA
| | - Alexandra L Martin
- Department of Obstetrics and Gynecology, University of Louisville Hospital, Louisville, KY, USA
| | - Edith F Henderson
- Department of Obstetrics and Gynecology, University of Louisville Hospital, Louisville, KY, USA
| | - Jeremy T Gaskins
- Department of Biostatistics, University of Louisville, Louisville, KY, USA
| | - Vida M Vaughn
- Department of Obstetrics and Gynecology, University of Louisville Hospital, Louisville, KY, USA
| | - Shan M Biscette
- Department of Obstetrics and Gynecology, University of Louisville Hospital, Louisville, KY, USA
| | - Resad P Pasic
- Department of Obstetrics and Gynecology, University of Louisville Hospital, Louisville, KY, USA
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Mısırlıoğlu S, Türkgeldi E, Yağmur H, Urman B, Ata B. Use of a gelatin-thrombin hemostatic matrix in obstetrics and gynecological surgery. Turk J Obstet Gynecol 2018; 15:193-199. [PMID: 30202631 PMCID: PMC6127479 DOI: 10.4274/tjod.90217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/24/2018] [Indexed: 12/28/2022] Open
Abstract
Gelatin-thrombin matrix (GTM) is a hemostatic sealant consisting of bovine-derived gelatin matrix and human-derived thrombin, combining both mechanical and active mechanisms to achieve hemostasis. It was approved by the Food and Drug Administration in 1999. GTM has been used by several surgical specialties; however, it is a possibly an under-used tool in obstetrics and gynecology. A limited number of studies have been performed on its use during laparoscopic endometrioma excision and myomectomy. It may prove useful in endometrioma excision in reproductive aged women because it is likely to harm ovarian reserve less than electrocautery; however, this conclusion needs to be validated. The only study on GTM use in myomectomy included 50 women randomized into GTM and control groups, and showed decreased blood loss and shorter hospital stays in the GTM group. In gynecologic oncology, it was successfully used to reduce lymphocele cases in a cohort study. GTM has been used successfully in obstetrics in a handful of cases of uncontrolled bleeding from caesarean scar, placental site, ectopic pregnancy, rectovaginal hematoma, and venous plexus over the vaginal vault after emergency postpartum hysterectomy. Risk of viral transmission is a major concern about GTM, yet there are no reports on disease transmission with GTM use to date. Rare but serious adverse effects and complications have been reported such as fatal or near-fatal thromboembolism and small bowel obstruction. Although GTM is mostly a safe product, it is still not free of complications and risks. In conclusion, although routine use of GTM cannot be recommended due to concerns about its safety, cost, and availability, it may prove useful when conventional hemostatic methods such as suturing and electrocauterization fail or are not appropriate.
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Affiliation(s)
- Selim Mısırlıoğlu
- Koç University Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Engin Türkgeldi
- Koç University Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Hande Yağmur
- Koç University Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Bülent Urman
- Koç University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Barış Ata
- Koç University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
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12
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Gazzeri R, Galarza M, Morabito M, Alfieri A. Clinical Use and Hemostatic Application of Gelatin. POLYMER GELS 2018. [DOI: 10.1007/978-981-10-6083-0_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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13
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Choi C, Kim WY, Lee DH, Lee SH. Usefulness of hemostatic sealants for minimizing ovarian damage during laparoscopic cystectomy for endometriosis. J Obstet Gynaecol Res 2017; 44:532-539. [PMID: 29271052 DOI: 10.1111/jog.13542] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 10/08/2017] [Indexed: 12/23/2022]
Abstract
AIM We aimed to evaluate the impact of topical hemostatic sealants and bipolar coagulation during laparoscopic ovarian endometriotic cyst resection on ovarian reserve by comparing the rates of decrease in anti-Müllerian hormone (AMH). METHODS A randomized prospective data collection was made on women aged 19-45 years who planned to have laparoscopic ovarian cystectomy at one of two institutions (n = 80), Kangbuk Samsung Hospital, Seoul, Korea or National Health Insurance Service Ilsan Hospital, Goyang, Korea, from January 2014 to April 2016. Patients were randomly divided into two groups treated with either a topical hemostatic sealant or bipolar coagulation for hemostasis. The hemostatic group was randomized to the FloSeal or TachoSil subgroups. Preoperative and 3-month postoperative AMH levels were checked and the rates of decrease of AMH were compared. All patients enrolled were treated with dienogest (Visanne) for 6-12 months. None were lost to follow-up at postoperative 3 months, but about one-third of the patients had been lost to follow-up by 6-12 months. RESULTS AMH was significantly decreased in both groups 3 months postoperatively; however, the rate of decrease in the bipolar coagulation group was greater than that in the hemostatic sealant group, 41.9% (interquartile range [IQR], 22.29-65.24) versus 18.1% (IQR, 10.94-29.90), P = 0.007. Between the two hemostatic subgroups, there was no significant difference in AMH decrease rate, 14.95% (IQR, 11.34-21.21) versus 18.1% (IQR 9.76-40.70), P = 0.204. CONCLUSION Hemostatic sealants may be an alternative to bipolar coagulation for preservation of ovarian reserve after laparoscopic ovarian cystectomy for endometriosis.
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Affiliation(s)
- Chahien Choi
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Young Kim
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Hee Lee
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - San Hui Lee
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
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Alonso F, Rustagi T, Iwanaga J, Fisahn C, Oskouian R, Tubbs RS, Dailey A, Chapman JR. Self-Made, Cost-Reducing Hemostatic Agent for Use in Spine Surgery. World Neurosurg 2017; 108:90-93. [DOI: 10.1016/j.wneu.2017.08.154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
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Cai H, Guan J, Shen H, Han H, Yu X. Impact of surgery for endometriomas on pregnancy outcomes following in vitro fertilization-intracytoplasmic sperm injection. Who should be the preferred laparoscopists: gynecologists or reproductive surgeons? Arch Gynecol Obstet 2017; 296:263-268. [PMID: 28573406 DOI: 10.1007/s00404-017-4390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate whether laparoscopic excision of ovarian endometriomas pretreated with operation by gynecologists or reproductive surgeons exerts different effects on in vitro fertilization-intracytoplasmic sperm injection results. MATERIALS AND METHODS Retrospective case control study. Relevant information was collected from the electronic records of women who underwent IVF/ICSI from 01/01/2013 to 30/12/2015 in our unit. The study group consisted of 35 women who previously had laparoscopic endometrioma excision by reproductive surgeons in our unit; the control group included 36 patients who underwent surgery for endometriomas by gynecologists in our hospital. RESULT(S) There were slightly higher numbers of AFC and higher pregnancy rate in the study group, although differences did not reach statistical significance. For patients over 35 years old, there were more oocyte retrieved, mature oocytes and two pronucei (2PN) in the study group than the control group although observed differences did not reach statistical significance. CONCLUSION(S) Electrocautery is more deleterious on ovarian reserve than hemostatic suture. In procedure of patients who wish to conceive, surgeons should use hemostatic suturing technique preferentially.
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Affiliation(s)
- He Cai
- Obstetrics and Gynecology Department, Peking University People's Hospital, Beijing, China
| | - Jing Guan
- Obstetrics and Gynecology Department, Peking University People's Hospital, Beijing, China.
| | - Huan Shen
- Obstetrics and Gynecology Department, Peking University People's Hospital, Beijing, China
| | - Hongjing Han
- Obstetrics and Gynecology Department, Peking University People's Hospital, Beijing, China
| | - Xiaoming Yu
- Obstetrics and Gynecology Department, Peking University People's Hospital, Beijing, China
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Liu YC, Li YC, Kuo HH, Wang CJ, Wu KY. The use of fibrin sealant (Tisseel) in laparoscopic excision of ovarian endometrioma. Taiwan J Obstet Gynecol 2017; 56:342-345. [DOI: 10.1016/j.tjog.2017.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 02/08/2023] Open
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Peters A, Rindos NB, Lee T. Hemostasis During Ovarian Cystectomy: Systematic Review of the Impact of Suturing Versus Surgical Energy on Ovarian Function. J Minim Invasive Gynecol 2016; 24:235-246. [PMID: 28011097 DOI: 10.1016/j.jmig.2016.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Abstract
This systematic review compares the effect of suturing and surgical energy used for hemostasis during ovarian cystectomies on ovarian function. A search of Scopus, Embase, and PubMed databases was conducted through December 1, 2016 for prospective, retrospective, and randomized controlled trials that analyzed ovarian function after ovarian cystectomies where hemostasis was obtained using suturing versus surgical energy. Of the 25 studies identified, 12 with a total of 1133 subjects met the criteria and were included in this review. Analysis of the pooled data strongly supports the use of suturing rather than surgical energy (bipolar or ultrasonic coagulation) for hemostasis, because it provides improved preservation of ovarian function at the time of cystectomy. Four of 8 ovarian reserve markers (anti-Müllerian hormone, antral follicle count, peak systolic velocity, and ovarian volume) demonstrated a positive association using suturing, whereas the remainder of ovarian markers showed a positive trend toward suturing or noninferiority to bipolar energy. In conclusion, suturing for hemostasis after ovarian cystectomy is superior to surgical energy in preserving ovarian function. Further studies are needed to assess whether this difference is clinically relevant in regards to fertility and premature ovarian failure. (USPSTF Level II-1 Evidence).
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Affiliation(s)
- Ann Peters
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania
| | - Noah B Rindos
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania.
| | - Ted Lee
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania
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Özdamar Ö, Doğer E, Arlıer S, Çakıroğlu Y, Ergin RN, Köpük ŞY, Çalışkan E. Exogenous cesarean scar pregnancies managed by suction curettage alone or in combination with other therapeutic procedures: A series of 33 cases and analysis of complication profile. J Obstet Gynaecol Res 2016; 42:927-35. [DOI: 10.1111/jog.13017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 02/07/2016] [Accepted: 02/26/2016] [Indexed: 01/17/2023]
Affiliation(s)
- Özkan Özdamar
- Department of Obstetrics and Gynecology; Istanbul Medeniyet University, Faculty of Medicine; Istanbul Turkey
| | - Emek Doğer
- Department of Obstetrics and Gynecology; School of Medicine, Kocaeli University; Kocaeli Turkey
| | - Sefa Arlıer
- Department of Obstetrics and Gynecology; Adana Training and Research Hospital; Adana Turkey
| | - Yiğit Çakıroğlu
- Department of Obstetrics and Gynecology; School of Medicine, Kocaeli University; Kocaeli Turkey
| | - Rahime Nida Ergin
- Department of Obstetrics and Gynecology; School of Medicine, Bahçeşehir University; Istanbul Turkey
| | - Şule Yıldırım Köpük
- Department of Obstetrics and Gynecology; School of Medicine, Kocaeli University; Kocaeli Turkey
| | - Eray Çalışkan
- Department of Obstetrics and Gynecology; School of Medicine, Bahçeşehir University; Istanbul Turkey
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Miller DT, Roque DM, Santin AD. Use of Monsel solution to treat obstetrical hemorrhage: a review and comparison to other topical hemostatic agents. Am J Obstet Gynecol 2015; 212:725-35. [PMID: 25577672 PMCID: PMC4457701 DOI: 10.1016/j.ajog.2014.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
Peripartum hemorrhage accounts for 8% of maternal deaths in the United States, and nearly 27% worldwide. A growing need exists for tactics to spare morbidity given a rise of abnormal placentation that contributes to excessive blood loss at the time of delivery. Approaches such as compression sutures, balloon tamponade, and pelvic artery embolization are not without side effects and potential implications for future fertility. The use of topical hemostatic agents has become widespread in gynecologic and obstetric surgery despite a paucity of distinct studies in the field, and may allow providers to increasingly avoid cesarean hysterectomy. A variety of topical hemostatic agents exist along a wide cost continuum, each characterized by specific efficacy, advantages, drawbacks, and often gaps in long-term data to support safety and impact on future fertility. Herein, we comprehensively review these agents and illustrate a nontraditional use of Monsel solution applied directly to the placental bed in a case of focal placenta accreta. This ultimately contributed to successful uterine preservation with no known adverse sequelae. Monsel solution may have a role in establishing hemostasis in the setting of abnormal placentation, and may be a particularly attractive alternative in resource-poor nations.
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Affiliation(s)
- Devin T Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Dana M Roque
- University of Maryland School of Medicine, Baltimore, MD
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
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Ata B, Turkgeldi E, Seyhan A, Urman B. Effect of Hemostatic Method on Ovarian Reserve Following Laparoscopic Endometrioma Excision; Comparison of Suture, Hemostatic Sealant, and Bipolar Dessication. A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2015; 22:363-72. [DOI: 10.1016/j.jmig.2014.12.168] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 10/24/2022]
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Echave M, Oyagüez I, Casado MA. Use of Floseal®, a human gelatine-thrombin matrix sealant, in surgery: a systematic review. BMC Surg 2014; 14:111. [PMID: 25528250 PMCID: PMC4289565 DOI: 10.1186/1471-2482-14-111] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 12/16/2014] [Indexed: 11/16/2022] Open
Abstract
Background Surgical bleeding can be associated with an increased risk of morbidity and mortality across all surgical areas. Thus, numerous products have been developed to achieve haemostasis. A flowable haemostatic matrix such as Floseal® can quickly and reliably stop bleeding across the full spectrum of bleeding scenarios. The aim of this study was to systematically review clinical and economic evidence regarding the use of Floseal® in surgical procedures. Methods An extensive literature search was conducted in PubMed, EMBASE, and the Cochrane Library over the period spanning 2003–2013 to identify publications related to Floseal® use in all types of surgical procedures. Case reports and case series studies were excluded. Results A total of 27 papers met the selection criteria and were analysed. In the studies, blood loss and the time to achieve haemostasis were the most reported outcomes used to assess the efficacy of Floseal®. The majority of published studies (64%) examined the use of Floseal® compared with conventional methods (such as electrocautery or suturing). The remaining 36% of the studies evaluated the use of Floseal® compared with other haemostatic agents, such as Surgicel®, Gelfoam®, and Hemostase®. FloSeal® has been demonstrated to be an efficacious method in surgical procedures to reduce the time to achieve haemostasis, the frequency of intra- and postoperative bleeding, and the length of hospital stay, among other primary outcomes, resulting in less consumption of health resources. Conclusions The majority of the selected studies confirmed that Floseal® showed improvements over other haemostatic agents in achieving haemostasis and reducing blood loss. Electronic supplementary material The online version of this article (doi:10.1186/1471-2482-14-111) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- María Echave
- Pharmacoeconomics & Outcomes Research Iberia, Pozuelo de Alarcón Madrid, Spain.
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23
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Song T, Lee SH, Kim WY. Additional benefit of hemostatic sealant in preservation of ovarian reserve during laparoscopic ovarian cystectomy: a multi-center, randomized controlled trial. Hum Reprod 2014; 29:1659-65. [DOI: 10.1093/humrep/deu125] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Shander A, Kaplan LJ, Harris MT, Gross I, Nagarsheth NP, Nemeth J, Ozawa S, Riley JB, Ashton M, Ferraris VA. Topical hemostatic therapy in surgery: bridging the knowledge and practice gap. J Am Coll Surg 2014; 219:570-9.e4. [PMID: 25151345 DOI: 10.1016/j.jamcollsurg.2014.03.061] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/02/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Aryeh Shander
- Department of Anesthesiology, Critical Care Medicine, and Hyperbaric Medicine, Englewood Hospital & Medical Center, Englewood, NJ; Department of Surgery, Englewood Hospital & Medical Center, Englewood, NJ; Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Lewis J Kaplan
- Department of Surgery, Section of Trauma, Surgical Critical Care and Surgical Emergencies, Yale School of Medicine, New Haven, CT; Tactical Medicine, Tactical Police Surgeon, Police Departments, South Central SWAT North Haven, North Branford, East Haven, CT
| | - Michael T Harris
- Department of Surgery, Englewood Hospital & Medical Center, Englewood, NJ; Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Irwin Gross
- Department of Transfusion Services, Eastern Maine Medical Center, Bangor, ME
| | - Nimesh P Nagarsheth
- Department of Obstetrics and Gynecology, Englewood Hospital & Medical Center, Englewood, NJ; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey Nemeth
- Department of Pharmacy, Englewood Hospital & Medical Center, Englewood, NJ
| | - Sherri Ozawa
- Institute for Bloodless Medicine and Patient Blood Management, Englewood Hospital & Medical Center, Englewood, NJ
| | - Jeffrey B Riley
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester MN
| | | | - Victor A Ferraris
- Division of Cardiothoracic Surgery, University of Kentucky, Lexington, KY
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A novel hemostatic sealant composed of gelatin, transglutaminase and thrombin effectively controls liver trauma-induced bleeding in dogs. Acta Pharmacol Sin 2013; 34:983-8. [PMID: 23645012 DOI: 10.1038/aps.2013.17] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 02/17/2013] [Indexed: 12/18/2022] Open
Abstract
AIM novel hemostatic sealant based on the in situ gel formation of gelatin catalyzed by thrombin and crosslinked by transglutaminase was designed. The aim of this study was to investigate the efficacy of the hemostatic sealant in control of bleeding caused by liver trauma in dogs. METHODS Hepatic trauma that mimicked the grade III-IV rupture of liver was made in 20 dogs. The traumatic lesion was topically administered the hemostatic sealant (treatment group, n=10), or a thrombin solution (control group, n=10). The time to achieve hemostasis and the blood loss were measured. Contrast-enhanced ultrasound (CEUS) examination was performed in each animal on d 3, d 7, and d 10 d postoperatively to study the healing of the lesions. RESULTS The mean time to achieve hemostasis in the treatment group was significantly shorter than that in the control group (1.20±0.33 vs 6.70±0.64 min, P<0.05). The mean blood loss in the treatment group was significantly less than that in the control group (47.22±8.61 vs 79.29±11.97 mL, P<0.05). In CEUS examination, the traumatic lesions in the treatment group became significantly smaller on d 3, and disappeared on d 7, whereas the lesions in the control group still existed on d 10. Ascites were never found during 10 d follow-up in the treatment group but were observed on d 3 and d 7 in the control group. CONCLUSION Compared with thrombin, the novel hemostatic sealant shows much better efficacy in hemostasis and may promote wound healing in dog liver trauma.
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Use of FloSeal Sealant in the Surgical Management of Tubal Ectopic Pregnancy. Case Rep Obstet Gynecol 2013; 2013:906825. [PMID: 23819082 PMCID: PMC3681223 DOI: 10.1155/2013/906825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/30/2013] [Indexed: 11/19/2022] Open
Abstract
Background. Surgery is sometimes required for the management of tubal ectopic pregnancies. Historically, surgeons used electrosurgery to obtain hemostasis. Topical hemostatic sealants, such as FloSeal, may decrease the reliance on electrosurgery and reduce thermal injury to the tissue. Case. A 33-year-old G1 P0 received methotrexate for a right tubal pregnancy. The patient became symptomatic six days later and underwent a laparoscopic right salpingotomy. After multiple unsuccessful attempts to obtain hemostasis with electrocoagulation, FloSeal was used and hemostasis was obtained. Six weeks later, a hysterosalpingogram (HSG) confirmed tubal patency. The patient subsequently had an intrauterine pregnancy. Conclusion. FloSeal helped to achieve hemostasis during a laparoscopic salpingotomy and preserve tubal patency. FloSeal is an effective alternative and adjunct to electrosurgery in the surgical management of tubal pregnancy.
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Can ovarian damage be reduced using hemostatic matrix during laparoscopic endometrioma surgery? A prospective, randomized study. Arch Gynecol Obstet 2013; 287:1251-7. [PMID: 23291972 DOI: 10.1007/s00404-012-2704-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 12/21/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare the effect of hemostatic matrix (HM) and electrosurgical bipolar coagulation (EBC) on ovarian reserve in patients undergoing endometrioma surgery. METHODS Thirty patients with single ovarian endometrioma ≥4 cm were randomized to two groups. Ovarian reserve after laparoscopic excision of endometrioma was assessed by serum anti-Müllerian hormone (AMH); preoperatively and in postoperative months 1 and 3. RESULTS The preoperative AMH levels were similar between the groups. Intra-group comparisons: the AMH levels were significantly lower in the first and third postoperative months as compared to basal levels in both groups. In each group, AMH levels were significantly higher in the third postoperative month as compared to first postoperative month. Inter-group comparisons: AMH levels were significantly lower in the EBC as compared to the HM at 1st postoperative month (1.64 ± 0.93 vs. 2.72 ± 1.49 ng/mL). However, the AMH levels were increased and became similar at 3rd postoperative month. CONCLUSIONS Although acute ovarian damage was more in EBC group, ovarian reserve was compensated at 3rd month. Further studies with long-term follow-up will clarify the importance of these findings.
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Brisk, Pulsatile Bleeding From the Anterior Mandibular Incisive Canal During Implant Surgery. IMPLANT DENT 2012; 21:368-73. [DOI: 10.1097/id.0b013e318264d70d] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Using platelet-rich plasma for the treatment of symptomatic cervical ectopy. Int J Gynaecol Obstet 2012; 119:26-9. [PMID: 22835570 DOI: 10.1016/j.ijgo.2012.05.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 05/07/2012] [Accepted: 06/25/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of autologous platelet-rich plasma (PRP) applications in the treatment of benign cervical ectopy. METHODS Symptomatic women with benign cervical ectopy (n=120) were randomized to a PRP or a laser group. In the PRP group, PRP was applied twice on the cervical erosion with a 1-week interval. In the laser group, an Nd-YAG laser was used once for tissue vaporization. RESULTS The complete cure rates were 93.7% for the PRP and 92.4% for the laser group (P>0.05). The mean time to re-epithelialization was significantly shorter in the PRP (6.41 ± 2.05 weeks) than in the laser group (8.28 ± 1.72 weeks) (P<0.01). The rate of adverse treatment effects (i.e. vaginal discharge or vaginal bleeding) was much lower in the PRP than that in the laser group (P<0.01) and the effects were milder. Eleven patients in the PRP group had mild or moderate vaginal bleeding after treatment but none had heavy bleeding. Of 25 patients with vaginal bleeding in the laser group, 2 had heavy bleeding necessitating tamponade. CONCLUSION Autologous PRP applications appear promising for the treatment of cervical ectopy in symptomatic women, as they generate a shorter tissue healing time and milder adverse effects than laser treatment.
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Suzuki Y, Vellinga TT, Istre O, Einarsson JI. Small Bowel Obstruction Associated With Use of a Gelatin-Thrombin Matrix Sealant (FloSeal) after Laparoscopic Gynecologic Surgery. J Minim Invasive Gynecol 2010; 17:641-5. [DOI: 10.1016/j.jmig.2010.03.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 03/15/2010] [Accepted: 03/17/2010] [Indexed: 11/25/2022]
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Spotnitz WD, Burks S. State-of-the-Art Review: Hemostats, Sealants, and Adhesives II: Update As Well As How and When to Use the Components of the Surgical Toolbox. Clin Appl Thromb Hemost 2010; 16:497-514. [DOI: 10.1177/1076029610363589] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The goal of this submission is to describe how and when to best use hemostats, sealants, and adhesives as well as to compare their characteristics and to update the surgical toolbox with respect to any new products approved by the Food and Drug Administration (FDA) as of this date (November 2009). The materials will be presented in 3 major groups each containing specific categories: (1) hemostats; mechanical, active, flowable, and fibrin sealant, (2) sealants; fibrin sealant, polyethylene glycol polymer, and albumin and glutaraldehyde, (3) adhesives; cyanoacrylate, albumin and glutaraldehyde, and fibrin sealant. The categories will be used for comparisons based on safety, efficacy, usability, and cost. Recommendations with respect to how and when to best use these materials will be presented. A review of the recent literature is also provided with respect to the most recent uses of these materials in specific surgical specialties.
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Affiliation(s)
| | - Sandra Burks
- University of Virginia Health System, Charlottesville, VA, USA
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Pace G, Saldutto P, Vicentini C, Miano L. Haemostatics in surgery and our experience in the enucleoresection of renal cell carcinoma. World J Surg Oncol 2010; 8:37. [PMID: 20462437 PMCID: PMC2876157 DOI: 10.1186/1477-7819-8-37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 05/12/2010] [Indexed: 12/19/2022] Open
Abstract
Background 30 patients, with T1 renal cell carcinomas (RCC) who underwent open enucleoresection of the tumour, were randomized to the use of a topical haemostatic agent (Floseal) or to an infrared-sapphire coagulator (ISC), to compare their efficacy in achieving haemostasis. Methods: Successful intra-operative haemostasis, intra- and post-operative bleeding, operative time, hospital discharge were evaluated. Results Statistically higher rates of successful haemostasis and shorter time-to-haemostasis (8,1 vs 12,9 min) were observed in the FloSeal group (p < 0.001 both). Patients operative time was not different between Group 1 vs 2 (58.7 ± 12 vs 62.4 ± 15; p > 0.05). The average blood loss during surgery was less (60 +/- 25.5 mL) for the FloSeal group than for the ISC group (85 +/- 40.5 mL) (p < 0.05). Postoperative blood loss was 25 +/- 5 mL and 40 +/- 45 mL for Floseal and ISC respectively, (p < 0.05). Length of the postoperative hospital discharge was 2.5 +/- 1.2 days for FloSeal group and 3.5 +/- 1.3 for the Group 2 (p < 0.05). No major immediate or delayed complications were observed in either Groups. Conclusions The use of Floseal and ISC offer a safe and efficacy haemostasis in the enucleoresection of RCC. Moreover, our results show a less intra-operative and post-operative blood loss as well as a shorter time to haemostasis of Floseal in respect to ISC.
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Affiliation(s)
- Gianna Pace
- Department of Surgical Sciences, University of L'Aquila, San Salvatore Street, Palace 6 A, Coppito, 67100 L'Aquila, Italy.
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Nasso G, Piancone F, Bonifazi R, Romano V, Visicchio G, De Filippo CM, Impiombato B, Fiore F, Bartolomucci F, Alessandrini F, Speziale G. Prospective, Randomized Clinical Trial of the FloSeal Matrix Sealant in Cardiac Surgery. Ann Thorac Surg 2009; 88:1520-6. [DOI: 10.1016/j.athoracsur.2009.07.014] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Revised: 07/06/2009] [Accepted: 07/10/2009] [Indexed: 11/24/2022]
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Use of haemostatic matrix in management of rectus hematoma in an anticoagulated patient: a case report. CASES JOURNAL 2009; 2:6353. [PMID: 19829793 PMCID: PMC2740183 DOI: 10.4076/1757-1626-2-6353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 06/11/2009] [Indexed: 11/08/2022]
Abstract
Rectus sheath hematoma may present as a painful mass in the anterior abdominal wall. The underlying reasons may vary, while anticoagulant use and thromboembolism prophylaxis are documented causes. Treatment is mostly conservative however interventional procedures can be required. We herein present a case of 76-year-old patient with an uncontrolled rectus hematoma despite surgical hemostasis. The patient was treated succesfully by applying hemostatic matrix (Floseal).
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Ebert AD, Hollauer A, Fuhr N, Langolf O, Papadopoulos T. Laparoscopic ovarian cystectomy without bipolar coagulation or sutures using a gelantine–thrombin matrix sealant (FloSeal©): first support of a promising technique. Arch Gynecol Obstet 2009; 280:161-5. [DOI: 10.1007/s00404-009-0985-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 02/02/2009] [Indexed: 10/21/2022]
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