WORLD JOURNAL OF SURGICAL ONCOLOGY Pace et al. World Journal of Surgical Oncology 2010, 8:37 http://www.wjso.com/content/8/1/37 Open Access TECHNICAL INNOVATIONS BioMed Central © 2010 Pace et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Technical innovations Haemostatics in surgery and our experience in the enucleoresection of renal cell carcinoma Gianna Pace* 1,2,3 , Pietro Saldutto 2,3 , Carlo Vicentini 2,3 and Lucio Miano 4 Abstract Background: 30 patients, with T1 renal cell carcinomas (RCC) who underwent open enucleoresection of the tumour, were randomized to the use of a topical haemostatic agent (Floseal) or to an infrared-sapphire coagulator (ISC), to compare their efficacy in achieving haemostasis. Methods: Successful intra-operative haemostasis, intra- and post- operative bleeding, operative time, hospital discharge were evaluated. Results: Statistically higher rates of successful haemostasis and shorter time-to-haemostasis (8,1 vs 12,9 min) were observed in the FloSeal group (p < 0.001 both). Patients operative time was not different between Group 1 vs 2 (58.7 ± 12 vs 62.4 ± 15; p > 0.05). The average blood loss during surgery was less (60 +/- 25.5 mL) for the FloSeal group than for the ISC group (85 +/- 40.5 mL) (p < 0.05). Postoperative blood loss was 25 +/- 5 mL and 40 +/- 45 mL for Floseal and ISC respectively, (p < 0.05). Length of the postoperative hospital discharge was 2.5 +/- 1.2 days for FloSeal group and 3.5 +/ - 1.3 for the Group 2 (p < 0.05). No major immediate or delayed complications were observed in either Groups. Conclusions: The use of Floseal and ISC offer a safe and efficacy haemostasis in the enucleoresection of RCC. Moreover, our results show a less intra-operative and post-operative blood loss as well as a shorter time to haemostasis of Floseal in respect to ISC. Background As the number of minimally invasive and laparoscopic procedures increases, haemostatic agents (HAs) are becoming more popular as a means of achieving rapid haemostasis. Although the recently widespread accep- tance, confusion still persists about their indications for use and the optimal agent choice. They comprise a wide range of components including topical hemostats, anti- fibrinolytics, fibrin sealants and matrix hemostats. Topi- cal HAs composed of a gelatin-based matrix and throm- bin have been reported to be effective, in addition to traditional means, in terminating bleeding during cardiac operations in comparison with haemostatic patches or sponges composed of either oxidized regenerated cellu- lose or purified porcine skin gelatin [1]. The haemostatic efficacy and handling of gelatin-thrombin matrix has been proven also in the uterine bleeding, during abdomi- nal myomectomy and, in thyroid surgery [2-5]. Adequate haemostasis is extremely important in neurosurgery. In patients with supratentorial intracerebral hematomas FloSeal, injected into the surgical cavity, has reduced brain exposure, damage to the surrounding tissue and the length of surgery. Furthermore, application of FloSeal at a laminectomy site may be useful to decrease adhesion at the interface between the dura mater and the epidural fibrosis [6,7]. Moreover, the management of intradural bleeding during extended endoscopic endonasal surgery has been challenged by applying a thrombin-gelatin hae- mostatic matrix, useful for both oozing and focal hemor- rhage and effective even for high-flow bleeding [8]. Recently, Izzo et al. reported a large prospective study with the use of HAs in patients undergoing major hepatic surgery providing a rapid and effective intra-operative control of mild to severe bleeding from the liver edge [9]. In animal models, comparing safety, efficacy, presence of residual material and foreign body reaction of commonly used agents such as microporous polysaccharide hemo- spheres (Arista), oxidized cellulose (Surgicel), microfibril- lar collagen (Avitene) and gelatin matrix thrombin sealant (FloSeal) emerged that Arista, Avitene, FloSeal, and Surgicel performed better haemostasis; residual material was not present with Arista, contrasting with its * Correspondence: giannapace@gmail.com 1 Department of Surgical Sciences, University of L'Aquila, San Salvatore Street, Palace 6 A, Coppito, 67100 L'Aquila, Italy Full list of author information is available at the end of the article