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The haemostat advancing laparoscopic surgery

Posted 30th July 2020

The latest development in oxidised cellulose haemostats, Okcel S, is advancing the field of laparoscopic surgery by providing clinicians with a flexible, stronger and more absorbable haemostat.

In the 1980s laparoscopic procedures started to be performed on a regular basis in the UK, with surgeons utilising the minimally invasive technique to reduce hospital stays and to improve patient outcome. Oxidised cellulose haemostats had already been in use for 30 years at this point, so surgeons naturally adopted the products into their laparoscopic work. However, these haemostats hadn’t been specifically designed to meet the needs and demand of laparoscopic surgeries. For instance, the introduction of the haemostat through the portal always posed difficulties. The original oxidised cellulose haemostats were a flat textile format and were originally designed for open surgery where there is a lot of space to place the haemostat flat onto a bleed. During laparoscopic surgery, this isn’t necessarily possible. A surgeon is working in a much tighter space, with elongated instruments making it sometimes impossible to lay the haemostat flat to the wound, something which is needed to achieve maximum effect. Over time, manufacturers have been developing new formats of the haemostat to meet the needs of specific surgical disciplines.

The development of oxidised cellulose haemostats

Oxidised cellulose haemostats have gone through four stages of development to get to where they are today. The original format, and the most used type of oxidised cellulose gauze, is a knitted textile form, which has the indication to control capillary, minor venous and minor arteriolar bleeding. The next stage was to develop heavy-duty variations of the haemostat. This is still a knitted form, but it is thicker and provides improved endurance and efficiency, leading to more effective haemostasis. The first true advancement after the original oxidised cellulose haemostats came with the introduction of the cotton wool version of the product. The more dynamic cotton wool format had multiple benefits over its knitted counterpart, including higher area density, even more effective absorption a greater volume of absorption and the ability to separate layers. By being able to separate the layers, the product could be manipulated to cover large surface areas, thus meeting the exact requirement of many healthcare professionals. Now Synthesia, the manufacturers of an oxidised cellulose haemostat known as Okcel, have taken the haemostat to stage four, a strengthened cotton wool format of the product.

Designed to be used in laparoscopic procedures

This strengthened cotton wool format of Okcel, Okcel S, has been designed specifically with Laparoscopic surgeons in mind. The product boasts features that aid the clinician in ensuring bleeding is stopped quickly, efficiently and effectively. While other formats of oxidised cellulose are able to be used in laparoscopic surgery, they have the potential to be difficult to persuade through a laparoscopic portal. This could lead to the haemostat being applied in a less effective manner due to the properties of the material and therefore not working as effectively as possible. The potential of this issue has been significantly reduced with Okcel S. Its strengthened cotton wool threads are compact and tightly bound together to increase the strength of the haemostat, increasing the user’s confidence of achieving haemostasis. Another issue found when using the original products in laparoscopic procedures was determining the size of the piece used. Unlike, original, heavy-duty, and the cotton wool format, Okcel S is vacuum-sealed. This increases the strength of the product but also makes passage through the laparoscopic portal even easier as it’s compressed into a smaller size, which then expands slowly once exposed to air.

Figure 1:A graph to compare the absorption of Okcel H-T vs Okcel S

More effective haemostasis

Okcel S isn’t only a better haemostat for laparoscopic procedures than its original format predecessors, including Okcel H-T, it’s a better haemostat for almost all surgical procedures. Independent research has been carried out comparing the Okcel range for the key factors that affect haemostasis such as absorbency, structure, pH level, area density and more. Okcel S came out as the favourable product, dominating the field in almost all the experiments. An example of this can be demonstrated in figure 1, which shows a comparison of the weight of solution retained in a equal-sized piece of material when submerged in saline solution. Okcel S had over six times more solution absorbed into the material than Okcel H-T. This shows the vast absorption profile of Okcel S and the dominance it has over alternative haemostats.

Okcel S

Okcel S, like the rest of the Okcel range, is made from extra-long staple cotton meaning it’s a natural product. The absorbable haemostat is fully absorbed by the body in 14 days and can show antimicrobial effects, including against antibiotic-resistant bacteria such as MRSA, PRSP, VRE and MRSE. Okcel S comes in four sizes, 2.5cm x 5cm, 5cm x 5cm, 5cm x10cm and 10cm x 10cm, with the two smaller sizes being ideal for laparoscopic surgery. The properties of Okcel S mean it is easy to handle, position and reposition. The product also does not stick to the instruments being used and it has no memory effect, this significantly simplifies material handling during surgical procedures.

1. Jindřich Lahovský,(2019) Comparison of basic physiochemical parameters, USP parameters and mechanical and biological performance of regenerated and non-regenerated oxidized cellulose-based haemostats: A-Pharma s.r.o. contract research organisation, Study Report Ref. No.AP-SY-1901
2. Ing. Iveta Brožková, Ph. D. Department of Biological and Biochemical Sciences at the Faculty of Chemical Technology, University of Pardubice. Final report on testing the antimicrobial activity of the product OKCEL®

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