Article
Cotton-derived oxidized cellulose in minimally-invasive thoracic surgery. A clinicopathological study
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Published: | October 14, 2013 |
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Objective: Persisting deposits of resorbable hemostatic material applied during minimally-invasive oncologic thoracic surgery procedures interfere with staging and follow-up. Therefore, resorption, of a commercially available cotton-derived oxidized cellulose gauze has been studied.
Methods: Pilot prospective non-comparative observational human in-vivo study. A piece of cotton-derived oxydized cellulose gauze measuring 5 x 20 cm was inserted into the subcarinal space of patients with potentially resectable lung carcinoma at the time of video-assisted mediastinoscopic lymphadenectomy (VAMLA), and re-examined several days later for macroscopic and histologic evaluation at the time of subsequent lung resection. Primary endpoint: the local situation at the implantation site described by cellulose remnants, fluid collections and adhesions. Secondary endpoint: safety, described by the number of adverse events and surgical re-interventions.
Results: 25 consecutive eligible patients with potentially resectable lung carcinoma were included. The desired hemostatic effect was achieved in all cases. No adverse events were observed. At re-exploration 10.5 (5–28) days later, the cellulose gauze was found to loose its solid structure from the fifth day on. Remnants were last detected 14 days after insertion. The implantation site exhibited no inflammatory changes, and a remarkable small amount of fluid collections and adhesions.
Conclusion: Mediastinal application of cotton-derived oxidized cellulose is safe and effective. A piece of gauze measuring 5 x 20 cm seems to be absorbed completely within 15 days, thus precluding any interference with oncologic re-staging and follow-up. The absence of relevant adhesions facilitate further surgical procedures. Larger comparative confirmatory studies are required. For large-scale resorption studies, our clinical model should be translated into a porcine model.