Real-world surgical outcomes of a gelatin-hemostatic matrix in women requiring a hysterectomy: a matched case-control study

A case report of troubleshooting against bleeding from inferior vena cava injury

Introduction

We report a case of troubleshooting against bleeding from an inferior vena cava injury using a gelatin-thrombin matrix.

Case presentation

A 58-year-old man underwent robot-assisted partial adrenalectomy for a right adrenal adenoma causing subclinical Cushing's syndrome. During the surgery, while dissecting between the adrenal gland and the inferior vena cava, bleeding occurred secondary to an inferior vena cava injury. Despite attempts at hemostasis, applying a human fibrinogen-thrombin patch and suturing were both difficult because of poor vision secondary to the bleeding. Hemostasis was ultimately achieved using a gelatin-thrombin matrix, which was accurately placed on the bleeding point using gauze. Open conversion was hence avoided, allowing the completion of the surgery as planned.

Conclusion

Gelatin-thrombin matrix may be effective for managing relatively small inferior vena cava injuries.

Salpingectomy at the time of hysterectomy for benign gynaecological disease: A comparison of surgical approaches

Given that a significant percentage of high-grade serous cancers develop in the fallopian tube, it has been suggested that salpingectomy may prevent some of these malignancies. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists guidelines recommend prophylactic salpingectomy to be discussed with or offered to patients undergoing hysterectomy for benign indications. This study compares rates of salpingectomy at the time of hysterectomy for benign indications across different surgical approaches among Australian and New Zealand gynaecologists. Data were collected via SurgicalPerformance, a web-based surgical outcomes review and feedback software used by independent gynaecologic surgeons. Of 11 477 hysterectomy records available, 6608 were eligible for analysis. Rates of salpingectomy at vaginal hysterectomy (13%) were significantly lower (P < 0.001) compared to open abdominal (65%), laparoscopic (70%), laparoscopic-assisted vaginal (78%), or robotic hysterectomies (73%) and also lower than in hysterectomies converted to an open abdominal approach (73%).

Electric- Field-Modified In Situ Precise Deposition of Electrospun Medical Glue Fibers on the Liver for Rapid Hemostasis

Precise deposition of nanofibers is still an important issue in the applications of electrospinning (e-spinning), especially in rapid hemostasis of organs such as the liver, lung, and kidney. In this study, we propose an electric field-modified e-spinning technique with a metal cone attached to the spinning nozzle to realize controllable precise deposition of fibers. The deposition range of the e-spun fibers is tunable by changing the size of the metal cone, and the mechanism is attributed the focused electric field verified by theoretical simulations. This electric field-modified e-spinning method was further used to in situ precisely deposit medical glue N-octyl-2-cyanoacrylate (NOCA) fibers onto the resection site of rat liver to realize rapid hemostasis within 10 s. Postoperative pathological results indicate that less inflammatory response and tissue adhesion are observed in this electric field-modified e-spinning group compared with that of traditional airflow-assisted group. This technique combined with our designed handheld e-spinning device could be used in emergency medical treatment, clinics, field survival, and home care for its portability and precise deposition characteristics.