Thrombin and Gelatin

The combination of thrombin and gelatin, either Gelfoam™° or SurgifoaTMp, is commonly used to establish hemostasis. To ultimately form a fibrin clot, the thrombin has to interact with an in vivo circulating fibrinogen, which is required for this method of hemostasis. In general, during laparoscopic surgery, the thrombin is delivered to the desired area by saturating gelatin sponges. By routinely using a thumb portion of a sterile surgical glove as a delivery bag to place the thrombin-soaked sponges through the laparoscopic ports, we prevent the fragmentation of the sponge and its premature contact with blood prior to final application. This method of hemostasis has been widely utilized during laparoscopic partial nephrectomy. In addition to a delivery mechanism for thrombin, the bulk of the gelatin within the parenchymal defect may provide compression on the surgical bed and aid in hemostasis.

Hemostatic action of collagen requires an intact coagulation system with functional platelets and clotting factors. Therefore, collagen has little effect in patients with inactivated platelets (e.g., aspirin) or compromised clotting pathways (e.g., heparin and coumadin).

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