Fibrin Sealants Better Then Sutures

From the successful reattachment of limbs, to the latest lifesaving transplants, the science of surgery continues to progress dramatically. Although recent advances in the field have involved the use of lasers and other minimally invasive techniques, many of our most miraculous procedures still require an open incision. The surgeon’s greatest challenge remains how to close surgical wounds in a way that will minimize air leaks and the loss of blood and other fluids. For the thoracic surgeon dealing with the uniqueness of lung tissue this is always a concern. According to thoracic surgeons, “The conventional way to do this, the way we have always done it was to suture wounds and to use staples. In lung tissue especially, but in other tissue as well there are drawbacks to sutures and staples. Staples and sutures cannot be made completely airtight. So we are looking for something in addition to sutures and staples. To find that “something else” surgeons looked to the inner workings of the body itself, and realized a better idea would be to deal with the closure of wounds much the way the bodies own natural clotting ability does. “The adhesive effect in the blood can be used to make a sealant that can be used during surgery. In principal what is done we take the resources that the body itself uses to heal wounds and use that to seal the surgical wounds that are made during a procedure.” In effect creating a “surgical glue”.

These Fibrin Sealants as they’ve become known, work by forming an adhesive gel-like mass that can quickly stop internal bleeding, or seal air leaks. They have been clinically tested, and approved. However, until recently the only way to create these sealants was to use pooled plasma and animal proteins for the blood and binding components. A new technique creates the sealant using the patient’s own blood, withdrawn prior to surgery. Thus eliminating any possibility of cross contamination, typing errors, or transfer of infectious or prion diseases. A worldwide multi-disciplinary research team lead by specialists from various disciplines, has spent the last several years in developing what has become known as Vivostat. The process is currently being used throughout Europe and similar products have already been approved for use in the United States. This approach uses a unique preparation and application apparatus that can produce surgical sealant right in the operating room in less then 30 minutes, using a patient’s own blood.

In a randomized study of twenty-four patients scheduled for coronary bypass surgery, Dr. Henrick Kjaergard, Chief of Cardio-Thoracic Surgery at the Gentofte Hospital in Denmark, tested the system. “We can have bleeding problems in coronary by-pass grafting, so there is a need for the use of sealants in this type of surgery. It worked very well, we were of course a little nervous, but we were all excited when we saw it worked so well, even when the patients are clotting ability are intentionally suppressed as they are in cardiac surgery, it worked nicely and made a perfect clot. Another advantage of the new system discovered during the initial trials and in later practice, was the speed at which the solution solidifies to form a strong yet flexible seal. “It nearly polymerizes in the air and that’s what surgeons really want. If you have an oozing, bleeding problem and you want to seal something you don’t want to wait minutes for the sealant to polymerize or harden, here you have a nice seal in milliseconds. We followed the patients for more than one year and there was no sign of any adverse reactions to the Vivostat Sealant.

Another surgeon involved in the initials trials in Denmark had this to add. “It feels nice to be able to develop new things that we can see when we apply it on the patients how we help them, that we can do better for the people that come to our hospital. They have a very high expectation of being treated of being cured with as small a problem as possible, to be able to develop new techniques to do things easier for ourselves and safer for the patient is a very nice feeling.”

Our greatest medical breakthroughs continue to be those that use science and technology to imitate the inner workings of nature’s most perfect machine – The Human Body.