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de Wilt JHW, Verhoef C, de Boer MT, Stommel MWJ, van der Plas-Kemper L, Garms LM, van der Zijden CJ, Head SJ, Bender JCME, van Goor H, Porte RJ. Clinical Safety and Performance of GATT-Patch for Hemostasis in Minimal to Moderate Bleeding During Open Liver Surgery. J Surg Res 2024; 298:316-324. [PMID: 38640617 DOI: 10.1016/j.jss.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/30/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Intraoperative blood loss and postoperative hemorrhage affect outcomes after liver resection. GATT-Patch is a new flexible, pliable hemostatic sealant patch comprising fibrous gelatin carrier impregnated with N-hydroxy-succinimide polyoxazoline. We evaluated safety and performance of the GATT-Patch for hemostasis at the liver resection plane. METHODS Adult patients undergoing elective open liver surgery were recruited in three centers. GATT-Patch was used for minimal to moderate bleeding at the liver resection plane. The primary endpoint was hemostasis of the first-treated bleeding site at 3 min versus a prespecified performance goal of 65.4%. RESULTS Two trial stages were performed: I (n = 8) for initial safety and II (n = 39) as the primary outcome cohort. GATT-Patch was applied in 47 patients on 63 bleeding sites. Median age was 60.0 (range 25-80) years and 70% were male. Most (66%) surgeries were for colorectal cancer metastases. The primary endpoint was met in 38 out of 39 patients (97.4%; 95% confidence interval: 84.6%-99.9%) versus 65.4% (P < 0.001). Of all the 63 bleeding sites, hemostasis was 82.7% at 30, 93.7% at 60, and 96.8% at 180 s. No reoperations for rebleeding or device-related issues occurred. CONCLUSIONS When compared to a performance goal derived from state-of-the-art hemostatic agents, GATT-Patch for the treatment of minimal to moderate bleeding during liver surgery successfully and quickly achieved hemostasis with acceptable safety outcomes. (ClinicalTrials.gov Identifier: NCT04819945).
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Affiliation(s)
- Johannes H W de Wilt
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marieke T de Boer
- Department of HPB Surgery, University Medical Center Groningen, The Netherlands
| | - Martijn W J Stommel
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Linda M Garms
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Charlène J van der Zijden
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Harry van Goor
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert J Porte
- Department of HPB Surgery, University Medical Center Groningen, The Netherlands
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D'Hondt M, Roozen EA, Nuytens F, Bender J, Mottrie A, Bauwens K, Head SJ. NHS-POx-loaded patch versus fibrin sealant patch in a porcine robotic liver bleeding model. BMC Surg 2023; 23:257. [PMID: 37641071 PMCID: PMC10463878 DOI: 10.1186/s12893-023-02159-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The management of bleeding is paramount to any surgical procedure. With the increased use of less invasive laparoscopic and robotic methods, achieving hemostasis can be challenging since the surgeons cannot manually apply hemostatic agents directly onto bleeding tissue. In this study, we assessed the use of a pliable hemostatic sealant patch comprising fibrous gelatin carrier impregnated with poly(2-oxazoline) (NHS-POx) for hemostasis in robotic liver resection in a porcine bleeding model. METHODS The NHS-POx-loaded patch (GATT-Patch), was first evaluated in a Feasibility Study to treat surgical bleeding in 10 lesions, followed by a Comparative Study in which the NHS-POx patch was compared to a standard-of-care fibrin sealant patch (TachoSil), in 36 lesions (superficial, resection, or deep injuries mimicking metastasectomies). For each lesion type, the NHS-POx and fibrin sealant patches were used in an alternating fashion with 18 lesions treated with NHS-POx and 18 with the fibrin patch. Animal preparation and surgical procedures were consistent across studies. The primary outcome was time to hemostasis (TTH) within 3 min for the Feasibility Study and within 5 min for the Comparative Study. RESULTS In the Feasibility Study, 8 of the 10 NHS-POx-treated lesions achieved hemostasis at 30 s and 3 min. In the Comparative Study, all 18 NHS-POx patch-treated lesions and 9 of the 18 fibrin sealant patch-treated lesions achieved hemostasis at 5 min. Median TTH with NHS-POx vs fibrin sealant patch was 30 vs 300 s (P < 0.001). CONCLUSIONS In this animal study, hemostasis during robotic liver surgery was achieved faster and more often with the NHS-POx loaded vs fibrin sealant patch.
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Affiliation(s)
- Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
| | | | - Frederiek Nuytens
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
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Farinha R, De Groote R, Zondervan P, Paciotti M, Roozen E, Head S, Sarchi L, Bravi CA, Mottaran A, Puliatti S, De Backer P, De Naeyer G, Mottrie A. Will Renorrhaphy Become Obsolete? Evaluation of a New Hemostatic Sealant. J Endourol 2023; 37:105-111. [PMID: 36006369 DOI: 10.1089/end.2022.0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: In robot-assisted partial nephrectomy (RAPN) renorrhaphy is used to achieve hemostatic control of the tumoral resection bed, with detrimental impact on renal function. Hemostatic agents are used to achieve rapid and optimal hemostasis. GATT-Patch is a new hemostatic sealant that has already demonstrated promising results. Objective: Compare GATT-Patch and standard renorrhaphy in terms of hemostatic capacity, ischemia time, and prevention of urinary leakage after RAPN in a porcine model. Design, Setting, and Participants: In this preclinical randomized controlled trial, four pigs underwent 32 RAPNs. After resection, GATT-Patch application and performance of classic renorrhaphy were randomized. After the procedure, the resection bed was reinspected. A necropsy study evaluated the adhesiveness of the patch, and retrograde pyelography was performed to determine the leakage burst pressure. Intervention: Application of GATT-Patch and performance of classic renorrhaphy were randomized and surgeons blinded to the hemostatic technique to be performed. Outcome Measurements and Statistical Analysis: Warm ischemia, hemostatic control, active bleeding during hemostatic control, total procedure time, bleeding at reinspection, and presence of urinary leakage on retrograde pyelography were recorded. Continuous variables were compared using the Student t-test. Categorical variables were compared using the Chi-square or Fisher's exact test. Results and Limitations: GATT-Patch reduced warm ischemia time (WIT), time to achieve hemostatic control, active bleeding time, and total procedure time, achieving hemostasis in 100% of the cases. Rebleeding at reinspection occurred in 0% of the GATT-Patch group. Renal parenchyma damage was observed in 100% of renorrhaphy cases and in 0% of GATT-Patch cases. Conclusions: GATT-Patch guaranteed optimal hemostasis and urine sealant effect after RAPN in porcine models. Compared to renorrhaphy, we observed a reduction in WIT, total procedure time, and potential reduction in healthy parenchyma loss. Patient Summary: GATT-Patch stops bleeding and provides hemostasis faster than suturing after resection of portions of the kidney in pigs. It might be tested in patients undergoing partial nephrectomy for kidney cancer.
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Affiliation(s)
- Rui Farinha
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Urology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,Urology Department, Lusíadas Hospital, Lisbon, Portugal
| | - Ruben De Groote
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Patricia Zondervan
- Department of Urology, 26066 Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marco Paciotti
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Edwin Roozen
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.,GATT Technologies BV, Nijmegen, The Netherlands
| | - Stuart Head
- GATT Technologies BV, Nijmegen, The Netherlands
| | - Luca Sarchi
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Carlo Andrea Bravi
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Angelo Mottaran
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Pieter De Backer
- ORSI Academy, Melle, Belgium.,Department of Urology, University of Ghent, Ghent, Belgium
| | - Geert De Naeyer
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
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