While partial nephrectomy has demonstrated oncologic equipoise with radical nephrectomy, it remains a surgically daunting procedure that can be associated with significant complications, particularly related to hemostasis and prevention of post-operative urinary fistulae.
In this study by Hidas and colleagues, a new formulation of sealant, serum albumin glutaraldehyde tissue adhesive (BioGlue), was evaluated as an adjunct to hemostasis and collecting system sealant in partial nephrectomy. vOver a 12 year period, 174 patients were treated with partial nephrectomy for RCC with 31 patients undergoing a "suture-less" BioGlue procedure only. Traditional and BioGlue groups were compared for clinical, tumor, and surgical outcomes. Tumor and patient characteristics were similar between the two groups. The use of BioGlue significantly reduced the mean warm ischemic time by 8.8 minutes (17.2 versus 26 minutes, p=0.002) and mean blood loss (45.1 ml versus 111.7 ml, p=0.001). The need for blood transfusions was also significantly reduced in the BioGlue group (p=0.014). None of the patients in the BioGlue group developed urinary fistulae, whereas there were 3 (2%) in the traditional group (p=0.25).
Albumin glutaraldehyde tissue adhesive represents a novel method of obtaining hemostasis and preventing urine leak during partial nephrectomy that warrants further testing. It would appear that the main downside to this technique is the need for an absolutely dry tissue surface (which can be a problem in partial nephrectomy) and the need to protect adjacent tissue from fusing with the glue during application. The action of this agent is spontaneous and independent of the coagulation status of the patient. Further prospective studies are needed to ascertain the efficacy of this agent relative to the standard of care in renal surgery.