Summary

■ Biologic hemostatic agents have the potential to be a useful adjunct to traditional means in controlling intraoperative laparoscopic complications.

■ The use of hemostatic agents implies potential risks of allergic reactions because bovine thrombin is immunogenic. Products containing bovine protein should be contraindicated in patients with known allergy hypersensitivity reactions.

■ Due to their excellent rheological properties (elasticity, tensile strength, and adhesiveness), fibrin sealants are excellent additions to standard methods of tissue approximation and help secure hemostasis.

■ To avoid thromboembolic complications, fibrin sealant should not be injected directly into large blood vessels.

■ Tranexamic acid is contraindicated during any surgical procedures with possible exposure to the cerebrospinal fluid or the dura mater because it can cause neurologic symptoms including trembling, involuntary head movements, and clonic contractions in rabbits.

■ Fibrin-sealant variants combining autologous fibrinogen with bovine thrombin and collagen have no risk of viral transmission. However, risk of bovine spongiform encephalopathy and allergic reaction remains.

■ Relying on endogenous fibrinogen, gelatin matrix hemostatic sealants are ineffective in fibrinogenemic patients. They are not adhesive and should be not used for collecting system sealing.

■ Gelatin matrix hemostatic sealants can work in cases of fairly active bleeding, whereas fibrin sealants and physical agents are better suited for diffuse bleeding or oozing.

■ Experimental and clinical data indicate that the sole use of fibrin sealant for ureteral anastomosis is unsafe.

■ Synthetic sealants are advantageous because allergic and viral transmission risks are nonexistent and because intact clotting pathways are unnecessary.

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