Use of a gelatin-thrombin hemostatic matrix in obstetrics and gynecological surgery
Journal Title: Turkish Journal of Obstetrics and Gynecology - Year 2018, Vol 15, Issue 3
Abstract
Gelatin-thrombin matrix (GTM) is a hemostatic sealant consisting of bovine-derived gelatin matrix and human-derived thrombin, combining both mechanical and active mechanisms to achieve hemostasis. It was approved by the Food and Drug Administration in 1999. GTM has been used by several surgical specialties; however, it is a possibly an under-used tool in obstetrics and gynecology. A limited number of studies have been performed on its use during laparoscopic endometrioma excision and myomectomy. It may prove useful in endometrioma excision in reproductive aged women because it is likely to harm ovarian reserve less than electrocautery; however, this conclusion needs to be validated. The only study on GTM use in myomectomy included 50 women randomized into GTM and control groups, and showed decreased blood loss and shorter hospital stays in the GTM group. In gynecologic oncology, it was successfully used to reduce lymphocele cases in a cohort study. GTM has been used successfully in obstetrics in a handful of cases of uncontrolled bleeding from caesarean scar, placental site, ectopic pregnancy, rectovaginal hematoma, and venous plexus over the vaginal vault after emergency postpartum hysterectomy. Risk of viral transmission is a major concern about GTM, yet there are no reports on disease transmission with GTM use to date. Rare but serious adverse effects and complications have been reported such as fatal or near-fatal thromboembolism and small bowel obstruction. Although GTM is mostly a safe product, it is still not free of complications and risks. In conclusion, although routine use of GTM cannot be recommended due to concerns about its safety, cost, and availability, it may prove useful when conventional hemostatic methods such as suturing and electrocauterization fail or are not appropriate.
Authors and Affiliations
Selim Mısırlıoğlu, Engin Türkgeldi, Hande Yağmur, Bülent Urman, Barış Ata
Keywords
Related Articles
- EP ID EP379385
- DOI 10.4274/tjod.90217
- Views 113
- Downloads 0
The significance of reverse flow in ductus venosus between sixteen and twenty weeks’ gestation
Objective: To evaluate the correlation between reversed a-wave in ductus venosus at 16-20 weeks’ gestation and trisomy 21 and adverse perinatal outcomes. Materials and Methods: Our study included 174 pregnant women who...
The oxidative/anti-oxidative effects of sevoflurane on reproductive system of females: An experimental study
Objective A permanent balance exists between the production and elimination of reactive oxygen species in all living organisms. The aim of this study was to evaluate the effects of sevoflurane possibly causing an imbalan...
Editorial
.
Laparoscopic repair of ureter damaged during laparoscopic hysterectomy: Presentation of two cases
Ureter injuries are uncommon but dreaded complications in gynecologic surgery and a frequent cause of conversion to laparotomy. Recently, a few papers reported the repair of gynecologic ureteral injuries using laparoscop...
Asymptomatic microperforated transverse vaginal septum presenting with primary infertility: a rare form of mullerian anomaly
Transverse vaginal septum is a rare type of mullerian anomaly resulting from failure of the canalization of the vaginal plate at the point where the urogenital sinus meets the mullerian duct and usually presents at menar...