PTU - Polskie Towarzystwo Urologiczne
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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.

authors

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

keywords

kidney, nephrectomy, splenic injury, TachoComb

summary

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.

references

  1. Carmignani G, Traverso P, Corbu C: Incidental splenectomy during left radical nephrectomy: reasons and ways to avoid it. Urol Int 2001, 67, 195-198.
  2. Coon WW: Iatrogenic splenic injury. Am J Surg 1990, 159, 585-588.
  3. Cooper CS, Cohen MB, Donovan JF Jr: Splenectomy complicating left nephrectomy. J Urol 1996, 155, 30-36.
  4. Dhananjaya S: Iatrogenic splenic injury: Prevention and treatment. Indian J Surg 2004, 66, 146-151.
  5. Zieliński H, Szmigielski S, Petrovich Z: Comparison of preoperative embolisation
  6. followed by radical nephrectomy alone for renal cell carcinoma. Am J Clin Oncol (CCT) 2000, 23, 6-12.
  7. Zieliński H: Rola embolizacji tętnicy nerkowej u chorych z rakiem nerki poddanych nefrektomii. Rozprawa habilitacyjna. Wojskowa Akademia Medyczna, Warszawa, 1998.
  8. Stolarczyk J, Lorenz J, Otręba L, Dembowski J: Nefrektomia radykalna. Urol Pol 1980, 2, 161-165.
  9. Giuliano AE, Lim RC Jr: Is splenic salvage safe in the traumatised patient? Arch Surg 1981, 116, 651-656.
  10. Lang G, Csekeö A, Stamatis G et al: Efficacy and safety of topical application
  11. of human fibrinogen/thrombin-coated collagen patch (TachoComb) for treatment of air leakage after standard lobectomy. Eur J Cardiothorac Surg 2004, 25, 160-166.
  12. Klepetko W: Surgical aspects and techniques of lung volume reduction surgery for severe emphysema. Eur Respir J 1999, 13, 919-925.
  13. Porte HL, Jany T, Akkad R et al: Randomized controlled trial of a synthetic sealant for preventing alveolar air leaks after lobectomy. Ann Thorac Surg 2001, 71, 1618-1622.
  14. Suzuki Y, Itoh K, Tsukigi M et al: The use of a new haemostatic agent for controlling adrenal bleeding during posterior retroperitoneoscopic partial adrenalectomy. BJU Int 2002, 90, 351.
  15. Eaton MA, Valentine J, Jackson MR et al: Incidental splenic injury during abdominal vascular surgery: A case-controlled analysis. J Am Coll Surg 2000, 190, 58-64.
  16. Dowling RD, Ochoa J, Yousem SA et al: Argon beam coagulation is superior
  17. to conventional techniques in repair of experimental splenic injury. J Trauma 1991, 31, 717-720.
  18. Weber T, Hanisch E, Baum RP, Seufert RM: Late results of heterotopic autotransplantation of splenic tissue into the greater omentum. World J Surg 1998, 22, 883-889.
  19. Mejean A, Chretien Y, Vogt B et al: Coloepiploic mobilization during left radical nephrectomy for renal cell carcinoma is indicated to reduce the risk of iatrogenic splenectomy. Urology 2002, 59, 358-361.
  20. Macchiarini P, Wain J, Almy S, Dartevelle P: Experimental and clinical evaluation
  21. of a new synthetic, absorbable sealant to reduce air leaks in thoracic operations. J Thorac Cardiovasc Surg 1999, 117, 751-758.
  22. Rolle U, Schneider A, Bennek J: Atraumatic management of serosa defects in a rabbit model. Shock 2000, 13 (Suppl), 152.
  23. Vaughn CC, Vaughn PL, Vaughn CC et al: Tissue response to biomaterials
  24. used for staple-line reinforcement in lung resection: a comparison between expanded polytetrafluoroethylene and bovine pericardium. Eur J Cardiothorac Surg 1998, 13, 259-265.

correspondence

Henryk Zieliński
Klinika Urologii CSK MON
ul. Szaserów 128
00-909 Warszawa
tel. (022) 810 31 74
urologia@wim.mil.pl