Hanyang Med Rev.  2018 Mar;38(1):3-15. 10.7599/hmr.2018.38.1.3.

Era of Bloodless Surgery: Spotlights on Hemostasic Materials and Techniques

• Park J
• Koh JW

• KMID: 2407797
• DOI: http://doi.org/10.7599/hmr.2018.38.1.3

Abstract

Ever since mankind has had blood, efforts to stop bleeding have never ceased and so numerous methods for hemostasis have been developed. In recent decades, minimally invasive surgical techniques have led patients to less-bleeding surgery but, hemostatic agents, devices and techniques still play an important role in medical side. A number of hemostatic agents and devices have been developed and they can be classified by their mechanism of action. That classification of the coagulants includes mechanisms with physical, caustic, bio-physical, biologic actions. Hemostatic devices are divided into categories such as dressings, glue, clips, electrocoagulations and so on. Based on the concept of minimally invasive surgical procedures, variously developed surgical techniques are divided by the number of ports used and auxiliary instruments. However, there are advantages and disadvantages to each of the hemostatic agents and minimally invasive methods, and the belief in the classical method also prevents the application of new hemostatic methods. The knowledge and understanding of the benefits and costs of these newly developed hemostatic methods will make it easier for medical personnel to manage patient's blood.

Keyword

Hemostasis; Electrocoagulation; Minimally invasive surgical procedures

MeSH Terms

Adhesives
Bandages
Bloodless Medical and Surgical Procedures*
Classification
Coagulants
Cost-Benefit Analysis
Electrocoagulation
Hemorrhage
Hemostasis
Humans
Methods
Minimally Invasive Surgical Procedures
Adhesives
Coagulants

Figure

• 

  Fig. 1 (A) Arteriolar vasoconstriction occurs immediately by the reflex mechanism of the nervous system right after vascular injury, which can be enhanced by endothelin, a potent vasoconstrictor released from the endothelial cells constituting the vessel wall. (B) Platelets bind to the von Willebrand factor and attach to the extracellular matrix at the site of injury, after that, they change their appearance and promote further recruitment and aggregation of platelets by releasing granules such as ADP and Tx A2. (C) Tissue factor released from vascular endothelial cells expresses the platelet phospholipid complex. Through the coagulation cascade, they eventually activate thrombin and ultimately make the fibrin polymer to form thrombus. (D) During this period, the platelet plug contains trapped neutrophils and RBCs in the blood vessels, showing permanent plugs and preventing further bleeding. In the absence of vascular injury or complete thrombus formation, the endothelial cells secrete t-PA and thrombomodulin, which inhibit platelet adhesion and aggregation, to exert antithrombotic effects that lead limitation of hemostasis.

• 

  Fig. 2 The main role of extrinsic pathway that follows green arrows is generation of thrombin burst and thrombin burst is processed by thrombin, the most important coagulation factor of the coagulation cascade. It starts with tissue factors from damaged tissue and coagulation factor VII that moves around in blood plasma in a higher concentration than any other factors. The intrinsic pathway of red lines is activated by the primary complex formation on collagen with prekallikrein, high-molecular-weight kininogen (HMWK) and coagulation factor XII, known as Hageman factor. This intrinsic pathway seems to have association with inflammation and innate immunity. These two courses of coagulation pathway are the intrinsic pathway and the extrinsic pathway which both are concluded in the same common pathway along the black line to form cross-linked fibrin fibers from fibrinogen. SPCA, Serum prothrombin conversion accelerator; AHF, antihemophilic factor; AHG, antihemophilic globulin; PTC, plasma thromboplastin component; PTA, plasma thromboplastin antecedent.

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