The use of haemostatic agent TachoComb® in management of splenic capsular tears during nephrectomy done for renal cancer
Article published in Urologia Polska 2007/60/4.
Henryk Zieliński, Bohdan Pawlicki, Jacek Anusik, Leszek Bortnowski, Grzegorz Piotrowicz, Marek Gałka
- Klinika Urologii Centralnego Szpitala Klinicznego MON, Wojskowy Instytut Medyczny w Warszawie
Oddział Urologii Szpitala Specjalistycznego im. G. Narutowicza w Krakowie
kidney, nephrectomy, splenic injury, TachoComb
Introduction. Left radical nephrectomy is the second most common cause of splenic injury during transabdominal oncological surgery in the upper left quadrant of the abdomen. It is important to preserve spleen because of its role in some immunologic and reticuloendothelial functions. Preservation of the spleen is clearly possible, particularly with minor capsular tear which is the most common type of splenic injury. Haemostatic agents may be very useful in such minor injuries. TachoComb® is such a new ready-to-use haemostatic agent.
The aim of the study. The aim of this study was to evaluate efficacy of TachoComb® in management of splenic capsular tears during left nephrectomy done for renal cell carcinoma.
Material and methods. Left radical nephrectomy was performed in 768 consecutive patients for renal cell carcinoma. The mean patient age was 52 years (34-88). The mean tumor size was 58 mm (28-230). Depending on tumor size or surgeon’s preferences transabdominal or retroperitoneal approach was performed. We managed splenic injuries by sutures, tissue glue or haemostatic agent TachoComb®.
Results. Of the 768 left nephrectomies 34 (4.4%) resulted in splenic injury. Splenectomy was required in 18 cases (2,3%). Splenic injuries were more common during transperitoneal approach. Capsular tears represent 65% of all splenic injuries. In 47% cases of splenic injury the organ was preserved. In 3 cases splenorrhaphy was performed, in 2 cases we used tissue glue, in 11 cases TachoComb® was used. There was no reoperation after management of splenic injuries required.
Conclusions. 1. TachoComb® is a very efficient agent in management of capsular tears during left nephrectomy done for renal cell carcinoma and in our opinion TachoComb® can be used as a first choice treatment in such injuries. 2. The treatment of deeper spleen trauma with TachoComb® in our material was unsuccessful.
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