2019 journal article
Evaluation of a Chitosan Hemostat in a Porcine Laparoscopic Partial Nephrectomy Model: A Pilot Study
JOURNAL OF ENDOUROLOGY, 33(11), 887–894.
author keywords: chitosan; plasma sterilization; hemostasis; hemostatic agents; nonthermal nitrogen plasma; laparoscopic partial nephrectomy; LPN; electron beam; e-beam
MeSH headings : Animals; Blood Loss, Surgical; Chitosan / therapeutic use; Hemostasis; Hemostasis, Surgical / methods; Hemostatics / therapeutic use; Kidney / pathology; Laparoscopy / methods; Nephrectomy / methods; Pilot Projects; Postoperative Hemorrhage / prevention & control; Sterilization / methods; Swine; Urography
TL;DR:
Chitosan pads alone provided safe and effective hemostasis in a porcine laparoscopic partial nephrectomy model and plasma sterilization may enhance hemostatic efficacy and resorption compared to e-beam.
(via Semantic Scholar)
UN Sustainable Development Goal Categories
3. Good Health and Well-being
(Web of Science)
Source: Web Of Science
Added: November 25, 2019
BACKGROUND AND OBJECTIVES The ideal hemostatic agent for laparoscopic partial nephrectomy would provide complete hemostasis and sealing of the collecting system at a low cost. Chitosan is an established topical hemostatic agent, but standard sterilization techniques affect its functional and biological properties thereby preventing parenteral uses. This study sought to characterize the safety and efficacy of an implanted chitosan hemostat sterilized with either a standard technique, electron beam irradiation, or a novel technique, non-thermal nitrogen plasma, in a porcine laparoscopic partial nephrectomy model. METHODS Laparoscopic partial nephrectomies were performed on 6 farm pigs and hemostasis achieved using only a chitosan hemostatic agent (Clo-Sur P.A.D.) that was e-beam (n=3) or plasma sterilized (n=3). Number of pads needed to achieve hemostasis, estimated blood loss, operative time, mass of kidney resection, and warm ischemia time were measured. Animals were monitored for 14 weeks and at harvest retrograde ureteropyelography and histologic analysis were performed. RESULTS Complete hemostasis and collection system sealing was achieved in both groups. There was a trend toward less pads required for hemostasis (p = 0.056) and reduced blood loss (p = 0.096) with plasma-sterilized pads although this did not achieve statistical significance. No complications were observed over 14 weeks and gross examination showed the implanted chitosan was encapsulated in a fibrous capsule. Histologic analysis revealed a healed nephrectomy site with residual CS and associated chronic inflammation, reactive fibrosis and foreign body giant cell formation. Importantly, the adjacent renal parenchyma was intact and viable with no residual inflammation or cytologic damage. CONCLUSION Chitosan pads alone provided safe and effective hemostasis in a porcine laparoscopic partial nephrectomy model. Plasma sterilization may enhance hemostatic efficacy and resorption compared to e-beam.