Skip to main content Accessibility help
×
Hostname: page-component-77f85d65b8-8wtlm Total loading time: 0 Render date: 2026-04-16T09:28:12.436Z Has data issue: false hasContentIssue false

Chapter 27 - Hemostatic Agents in Minimally Invasive Surgery

Published online by Cambridge University Press:  06 November 2025

By
Leandro Fusaro ,
Pavan Ananth  and
Ceana Nezhat
Edited by
Camran R. Nezhat ,
Farr R. Nezhat ,
Ceana Nezhat ,
Nisha Lakhi  and
Azadeh Nezhat
Camran R. Nezhat
Affiliation:
Stanford University School of Medicine, California
Farr R. Nezhat
Affiliation:
Nezhat Surgery for Gynecology/Oncology, New York
Ceana Nezhat
Affiliation:
Nezhat Medical Center, Atlanta
Nisha Lakhi
Affiliation:
Richmond University Medical Center, New York
Azadeh Nezhat
Affiliation:
Nezhat Institute and Center for Special Minimally Invasive and Robotic Surgery, California
Get access

Summary

Bleeding is one of the main complications during surgery, and may lead to transfusion and/or an increase in morbidity or mortality.[1,2] To understand the utilization of the different tools available today, here we explain the general concept of hemostasis.

Hemostasis is the process of blood clot formation at the site of vessel injury. As soon as the continuity of the endothelial layer is disrupted, a coordinated series of events are set in motion to seal the defect.[3] There are two pathways to hemostasis that may occur: intrinsic and extrinsic.

Information

Type
Chapter
Information
Nezhat's Textbook of Minimally Invasive Surgery
Including Hysteroscopy, Vaginoscopy and Robotic-Assisted Procedures
 , pp. 831 - 838
Publisher: Cambridge University Press
Print publication year: 2025

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Stokes, ME, Ye, X, Shah, M, et al. Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients. BMC Health Serv Res 2011;11:135. Published online 2011 May 31. doi: 10.1186/1472-6963-11-135.CrossRefGoogle ScholarPubMed
Ye, X, Lafuma, A, Torreton, E, Arnaud, A. Incidence and costs of bleeding-related complications in French hospitals following surgery for various diagnoses. BMC Health Serv Res 2013;13:186. Published online 2013 May 22. doi: 10.1186/1472-6963-13-186.CrossRefGoogle ScholarPubMed
Rumbaut, RE, Thiagarajan, P. Platelet-Vessel Wall Interactions in Hemostasis and Thrombosis. San Rafael, CA: Morgan & Claypool Life Sciences; 2010.CrossRefGoogle ScholarPubMed
Furie, B, Furie, BC. Mechanisms of thrombus formation. N Engl J Med 2008 Aug 28;359(9):938–949. doi: 10.1056/NEJMra0801082.CrossRefGoogle ScholarPubMed
Sundaram, CP, Keenan, AC. Evolution of hemostatic agents in surgical practice. Indian J Urol 2010 Jul-Sep;26(3):374–378. doi: 10.4103/0970-1591.70574.CrossRefGoogle ScholarPubMed
Arista™ AH Absorbable Hemostat. Summary of safety and effectiveness. Medafor, Inc. www.accessdata.fda.gov/cdrh_docs/pdf5/P050038b.pdf. 04/19/2019Google Scholar
US Food & Drug Administration. Vaccines, blood and biologics. www.fda.gov/vaccines-blood-biologics.Google Scholar
Mandell, SP, Gibran, NS. Fibrin sealants: surgical hemostat, sealant and adhesive. Expert Opin Biol Ther 2014 Jun;14(6):821–830. doi: 10.1517/14712598.2014.897323. Epub 2014 Mar 13.CrossRefGoogle ScholarPubMed
Dhillon, S. Fibrin sealant (Evicel® [Quixil®/Crosseal™]): a review of its use as supportive treatment for haemostasis in surgery. Drugs 2011 Oct 1;71(14):1893–1915. doi: 10.2165/11207700-000000000-00000.CrossRefGoogle ScholarPubMed
Pfizer GELFOAM package insert. http://media.pfizer.com/files/products/uspi_gelfoam_sponge.pdfGoogle Scholar
Guzzo, TJ, Pollock, RA, Forney, A, et al. Safety and efficacy of a surgeon-prepared gelatin hemostatic agent compared with FloSeal for hemostasis in laparoscopic partial nephrectomy. J Endourol 2009 Feb;23(2):279–282. doi: 10.1089/end.2008.0535.CrossRefGoogle ScholarPubMed
Patel, R, Caruso, RP, Taneja, S, Stifelman, M. Use of fibrin glue and Gelfoam to repair collecting system injuries in a porcine model: implications for the technique of laparoscopic partial nephrectomy. J Endourol. 2003 Nov;17(9):799–804.CrossRefGoogle Scholar
David, G, Lim, S, Gunnarsson, C, Kocharian, R, Roy, S. Similar patient outcomes yet different hospital costs between flowable hemostatic agents. J Med Econ 2015;18(9):735–745. doi: 10.3111/13696998.2015.1044994. Epub 2015 Jun 8.CrossRefGoogle ScholarPubMed
Landi, A, Gregori, F, Marotta, N, Efficacy, Delfini R., security, and manageability of gelified hemostatic matrix in bleeding control during thoracic and lumbar spine surgery: FloSeal versus Surgiflo. J Neurol Surg A Cent Eur Neurosurg 2016 Mar;77(2):139–143. doi: 10.1055/s-0035-1558413. Epub 2015 Sep 9.Google ScholarPubMed
Bannister, M, Ah-See, K. Safety of the haemostatic agent Surgiflo® in excisions of the submandibular gland: our experience in 17 cases. Br J Oral Maxillofac Surg 2014 Nov;52(9):e134–135. doi: 10.1016/j.bjoms.2014.05.014. Epub 2014 Jul 21.CrossRefGoogle ScholarPubMed
Obermair, H, Janda, M, Obermair, A. Real-world surgical outcomes of a gelatin-hemostatic matrix in women requiring a hysterectomy: a matched case-control study. Acta Obstet Gynecol Scand 2016 Sep;95(9):1008–1014. doi: 10.1111/aogs.12924. Epub 2016 Jun 10.CrossRefGoogle ScholarPubMed
Mısırlıoğlu, S, Türkgeldi, E, Yağmur, H, Urman, B, Ata, B. Use of a gelatin-thrombin hemostatic matrix in obstetrics and gynecological surgery. Turk J Obstet Gynecol 2018 Sep;15(3):193–199. Published online 2018 Sep 3. doi: 10.4274/tjod.90217.CrossRefGoogle ScholarPubMed
Raga, F, Sanz-Cortes, M, Bonilla, F, et al. Reducing blood loss at myomectomy with use of a gelatin-thrombin matrix hemostatic sealant. Fertil Steril 2009 Jul;92(1):356–360. doi: 10.1016/j.fertnstert.2008.04.038. Epub 2009 May 6.CrossRefGoogle ScholarPubMed
Watrowski, R. Hemostatic gelatine-thrombin matrix (Floseal®) facilitates hemostasis and organ preservation in laparoscopic treatment of tubal pregnancy. Arch Gynecol Obstet 2014 Sep;290(3):411–415. doi: 10.1007/s00404-014-3273-x. Epub 2014 May 10.CrossRefGoogle ScholarPubMed
Baxter. FLOSEAL. www.floseal.com/int/pdf/FLOSEAL_IFU_EU.pdf. 04/22/2019.Google Scholar
Köhler, C, Kyeyamwa, S, Marnitz, S, et al. Prevention of lymphoceles using FloSeal and CoSeal after laparoscopic lymphadenectomy in patients with gynecologic malignancies. J Minim Invasive Gynecol 2015 Mar-Apr;22(3):451–455. doi: 10.1016/j.jmig.2014.12.007. Epub 2014 Dec 10.CrossRefGoogle ScholarPubMed
Clapp, B, Santillan, A. Small bowel obstruction after FloSeal use. JSLS 2011 Jul-Sep;15(3):361–364. doi: 10.4293/108680811X13125733356756.CrossRefGoogle ScholarPubMed
Suzuki, Y, Vellinga, TT, Istre, O, Einarsson, JI. Small bowel obstruction associated with use of a gelatin-thrombin matrix sealant (FloSeal) after laparoscopic gynecologic surgery. J Minim Invasive Gynecol 2010 Sep-Oct;17(5):641–645. doi: 10.1016/j.jmig.2010.03.024.CrossRefGoogle ScholarPubMed
Baxter. Advanced surgery. www.baxterbiosurgery.com/us/recothrom/efficacy.html. 04/22/2019.Google Scholar
Ito, TE, Martin, AL, Henderson, EF, et al. Systematic review of topical hemostatic agent use in minimally invasive gynecologic surgery. JSLS 2018 Oct-Dec;22(4):e2018.00070. doi: 10.4293/JSLS.2018.00070.CrossRefGoogle ScholarPubMed
Technicare. www.technicare.com.br/. 04/22/2019.Google Scholar
Ethicon. www.ethicon.com/na/epc/code/1985?lang=en-default. 04/22/2019.Google Scholar
Integra. Helestat® and Helitene® absorbable collagen hemostats. https://baroquemedical.com/wp-content/uploads/2017/06/Helitene.pdf. 04/23/2019.Google Scholar
Value Analysis Committee. HEMOBLAST™ Bellows product information kit. Biom’up. www.accessdata.fda.gov/cdrh_docs/pdf17/P170012C.pdfGoogle Scholar
Ito, TE, Martin, AL, Henderson, EF, et al. Evaluation of the safety and efficacy of a new hemostatic powder using a quantitative surface bleeding severity scale. J Card Surg 2019 Jan;34(1):50–62. doi: 10.1111/jocs.13982. Epub 2019 Jan 10.Google Scholar
Medafor. Arista™. www.accessdata.fda.gov/cdrh_docs/pdf5/P050038c.pdf. 04/23/2019.Google Scholar
Lewis, KM, Atlee, H, Mannone, A, Lin, L, Goppelt, A. Efficacy of hemostatic matrix and microporous polysaccharide hemospheres. J Surg Res 2015 Feb;193(2):825–830. doi: 10.1016/j.jss.2014.08.026. Epub 2014 Aug 22.CrossRefGoogle ScholarPubMed
Bruckner, BA, Blau, LN, Rodriguez, L, et al. Microporous polysaccharide hemosphere absorbable hemostat use in cardiothoracic surgical procedures. J Cardiothorac Surg 2014;9:134. Published online 2014 Aug 2. doi: 10.1186/s13019-014-0134-4CrossRefGoogle ScholarPubMed
Maisano, F, Kjærgård, HK, Bauernschmitt, R, et al. TachoSil surgical patch versus conventional haemostatic fleece material for control of bleeding in cardiovascular surgery: a randomised controlled trial. Eur J Cardiothorac Surg 2009;36:708–714.CrossRefGoogle ScholarPubMed
Rickenbacker, A, Breitenstein, S, Lesurtel, M, Frilling, A. Efficacy of TachoSil a fibrin-based haemostat in different fields of surgery – a systematic review. Expert Opin Biol Ther 2009 Jul;9(7):897–907. doi: 10.1517/14712590903029172.CrossRefGoogle Scholar
Baxter. Uniting to save and sustain lives. www.baxter.com.pr/healthcare_professionals/products/coseal.html. 04/24/2019.Google Scholar
Quinn, J, Wells, G, Sutcliffe, T, et al. A randomized trial comparing octylcyanoacrylate tissue adhesive and sutures in the management of lacerations. JAMA 1997;277(19):1527–1530.CrossRefGoogle ScholarPubMed
Singer, AJ, Perry, LC, Allen, RL. In vivo study of wound-bursting strength and compliance of topical skin adhesives. Acad Emerg Med 2008;15(12):1290–1294.CrossRefGoogle ScholarPubMed
Bhende, S, Rothenburger, S, Spangler, DJ, Dito, M. In vitro assessment of microbial barrier properties of DERMABOND® Topical Skin Adhesive. Surg Infect (Larchmt) 2002;3(3):251–257.CrossRefGoogle ScholarPubMed
Bahouth, Z, Halachmi, S, Shprits, S, et al. The use of bovine serum albumin-glutaraldehyde tissue adhesive (BioGlue®) for tumor bed closure following open partial nephrectomy. Actas Urol Esp 2017 Oct;41(8):511–515. doi: 10.1016/j.acuro.2016.12.003. Epub 2017 Mar 7.CrossRefGoogle ScholarPubMed
Bhamidipati, CM, Coselli, JS, LeMaire, SA. BioGlue® in 2011: what is its role in cardiac surgery? J Extra Corpor Technol 2012 Mar;44(1):P6–P12.Google ScholarPubMed
Baribeau, DA, Anagnostou, E. Oxytocin and vasopressin: linking pituitary neuropeptides and their receptors to social neurocircuits. Front Neurosci 2015;9:335. Published online 2015 Sep 24. doi: 10.3389/fnins.2015.00335.CrossRefGoogle ScholarPubMed
Cohen, SL, Senapati, S, Gargiulo, AR, et al. Dilute versus concentrated vasopressin administration during laparoscopic myomectomy: a randomised controlled trial. BJOG 2017;124:262–268.CrossRefGoogle ScholarPubMed
Dunn, CJ, Goa, KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999 Jun;57(6):1005–1032.CrossRefGoogle Scholar
Ng, WCK, Jerath, A, Wasowicz, M. Tranexamic acid: a clinical review. Anaesthesiol Intensive Ther 2015;47(4):339–350. doi: 10.5603/AIT.a2015.0011. Epub 2015 Mar 23.CrossRefGoogle ScholarPubMed
Wang, D, Wang, L, Wang, Y, Lin, X. The efficiency and safety of tranexamic acid for reducing blood loss in open myomectomy: a meta-analysis of randomized controlled trials. Medicine (Baltimore) 2017 Jun;96(23):e7072. doi: 10.1097/MD.0000000000007072.CrossRefGoogle ScholarPubMed
Pacheco, LD, Hankins, GDV, Saad, AF, et al. Tranexamic acid for the management of obstetric hemorrhage. Obstet Gynecol 2017 Oct;130(4):765–769. doi: 10.1097/AOG.0000000000002253.CrossRefGoogle ScholarPubMed
Li, C, Gong, Y, Dong, L, Xie, B, Dai, Z. Is prophylactic tranexamic acid administration effective and safe for postpartum hemorrhage prevention?: a systematic review and meta-analysis. Medicine (Baltimore) 2017 Jan;96(1):e5653. doi: 10.1097/MD.0000000000005653.CrossRefGoogle ScholarPubMed
Ker, K, Shakur, H, Roberts, I. Does tranexamic acid prevent postpartum haemorrhage? A systematic review of randomised controlled trials. BJOG 2016 Oct;123(11):1745–1752. doi: 10.1111/1471-0528.14267. Epub 2016 Aug 24.CrossRefGoogle ScholarPubMed
Sentilhes, L, Lasocki, S, Ducloy-Bouthors, AS, et al. Tranexamic acid for the prevention and treatment of postpartum haemorrhage. Br J Anaesth 2015 Apr;114(4):576–587. doi: 10.1093/bja/aeu448. Epub 2015 Jan 8.CrossRefGoogle ScholarPubMed
Xu, J, Gao, W, Ju, Y. Tranexamic acid for the prevention of postpartum hemorrhage after cesarean section: a double-blind randomization trial. Arch Gynecol Obstet 2013;287:463–468. doi: 10.1007/s00404-012-2593-y.CrossRefGoogle ScholarPubMed
Movafegh, A, Eslamian, L, Dorabadi, A. Effect of intravenous tranexamic acid administration on blood loss during and after cesarean delivery. Int J Gynaecol Obstet 2011;115:224–226. doi: 10.1016/j.ijgo.2011.07.015.CrossRefGoogle ScholarPubMed
Sentürk, MB, Cakmak, Y, Yildiz, G, Yildiz, P. Tranexamic acid for cesarean section: a double-blind, placebo-controlled, randomized clinical trial. Arch Gynecol Obstet 2013;287:641–645. doi: 10.1007/s00404-012-2624-8.CrossRefGoogle ScholarPubMed
Srivaths, LV, Dietrich, JE, Yee, DL, Sangi-Haghpeykar, H, Mahoney, D Jr. Oral tranexamic acid versus combined oral contraceptives for adolescent heavy menstrual bleeding: a pilot study. J Pediatr Adolesc Gynecol 2015 Aug;28(4):254–257. doi: 10.1016/j.jpag.2014.12.012. Epub 2014 Dec 29.CrossRefGoogle ScholarPubMed
Sadeghi, N, Iacobelli, M, Vaziri, B, et al. Recombinant factor VIIa-mediated activation of prothrombin complex concentrates. Clin Appl Thromb Hemost 2017 Apr;23(3):211–220. doi: 10.1177/1076029616663848. Epub 2016 Sep 24.CrossRefGoogle ScholarPubMed
Roberts, HR. Recombinant factor VIIa (Novoseven) and the safety of treatment. Semin Hematol 2001 Oct;38(4 Suppl 12):48–50.CrossRefGoogle ScholarPubMed

Accessibility standard: WCAG 2.0 A

Why this information is here

This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.

Accessibility Information

The HTML of this chapter conforms to version 2.0 of the Web Content Accessibility Guidelines (WCAG), ensuring core accessibility principles are addressed and meets the basic (A) level of WCAG compliance, addressing essential accessibility barriers.

Content Navigation

Table of contents navigation
Allows you to navigate directly to chapters, sections, or non‐text items through a linked table of contents, reducing the need for extensive scrolling.
Index navigation
Provides an interactive index, letting you go straight to where a term or subject appears in the text without manual searching.

Reading Order & Textual Equivalents

Single logical reading order
You will encounter all content (including footnotes, captions, etc.) in a clear, sequential flow, making it easier to follow with assistive tools like screen readers.
Short alternative textual descriptions
You get concise descriptions (for images, charts, or media clips), ensuring you do not miss crucial information when visual or audio elements are not accessible.

Visual Accessibility

Use of colour is not sole means of conveying information
You will still understand key ideas or prompts without relying solely on colour, which is especially helpful if you have colour vision deficiencies.

Structural and Technical Features

ARIA roles provided
You gain clarity from ARIA (Accessible Rich Internet Applications) roles and attributes, as they help assistive technologies interpret how each part of the content functions.

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×