Renal Injury and the Application of Polysaccharide Hemospheres: A Laparoscopic Experimental Model

Abstract

Microporous polysaccharide hemospheres (MPH) are hemostatic beads engineered from purified plant starch. MPH accelerates the natural clotting cascade by concentrating clotting factors and proteins on their surface while absorbing aqueous and low molecular weight components from blood. The purpose of this study was to determine the efficacy of MPH in achieving hemostasis in the setting of laparoscopic renal injury. In four domestic pigs, 16 laparoscopic renal trocar injuries were created (8 each of 12 and 5 mm). A standard hand-assisted laparoscopic approach was used to each kidney so that two lesions per kidney were randomly created. MPH was applied to each treatment lesion with light pressure maintained for 60 seconds. Four of the 16 lesions, two each of 12 and 5 mm, were allowed to bleed as controls. Hemostasis was defined as no active bleeding or oozing. The animals were sacrificed at the conclusion of the procedure. The mean time to hemostasis for the 12-mm MPH and control lesions was 196.2 +/- 53.3 and 372.0 +/- 225.6 seconds, while the average blood loss was 8.3 +/- 3.7 and 12.0 +/- 4.9 g, respectively. For the 5-mm MPH and control lesions, the average time to hemostasis was 100.2 +/- 24.8 and 247.0 +/- 134.4 seconds, while the average blood loss was 8.3 +/- 3.8 and 9.0 +/- 0.7 g, respectively. The median number of applications of the MPH for the 5- and 12-mm injuries was 1 and 2, respectively. MPH provided a rapid and effective means of hemostasis for laparoscopic renal parenchymal injuries in this model. Additional evaluation is warranted, however, before general application is advisable.