Clinical application of the Nd:YAG laser bipolar dissector in intra-abdominal surgery.

A laser bipolar dissector (LBD) using a 1064 nm Nd:YAG laser energy source that provides hemostatic dissection using low-powered laser energy (15-25 W) has been developed. Clinical applications have included a partial hepatectomy (n = 5), a cholecystectomy (n = 4), an appendectomy, lymphnode dissection, and division of adhesions. The LBD was effective in resection of noncirrhotic liver and reduced the number of ligations required. There were no direct complications related to using the LBD. Operative time and blood loss were difficult to compare to conventional methods. The LBD may have applications for partial hepatectomies and other intra-abdominal operations.     

Evaluation of a vessel sealing system,bipolar electrosurgery,harmonic scalpel,titanium clips,endoscopic gastrointestinal anastomosis vascular staples and sutures for arterial and venous ligation in a porcine model

PURPOSE: We assessed the usefulness of the LigaSure (Valleylab, Boulder, Colorado) vessel sealing system for vascular control during laparoscopic surgery and compared it with other available hemostatic modalities. MATERIALS AND METHODS: A total of 31 domestic pigs were divided into 5 groups. In groups 1 and 2 the vessel sealing system was compared with titanium clips and Endo-GIA (United States Surgical, Stamford, Connecticut) staples. In group 3 the vessel sealing system was compared with standard Klepinger (Karl Storz, Culver City, California) bipolar forceps. In group 4 the harmonic scalpel and Trimax (United States Surgical) bipolar forceps were compared. In group 5 in vivo laparoscopic application of the vessel sealing system was evaluated. RESULTS: The 5 mm. laparoscopic vessel sealing system sealed arteries up to 6 mm. and veins up to 12 mm. in diameter at supraphysiological bursting pressure. We evaluated 13 arteries with a diameter of 6 mm. or less at a mean bursting pressure of 662 mm. Hg (range 363 to 1,985) and 11 veins with a diameter of 12 mm. or less with a mean bursting pressure of 233 mm. Hg (range 63 to 440). Collateral tissue damage extended 1 to 3 mm. from the application site. Standard bipolar energy with Klepinger and Trimax forceps was less reliable and in some cases vessel sealing could not be accurately assessed before vessel division. Collateral tissue injury was 1 to 6 mm. The harmonic scalpel did not reliably seal vessels larger than 3 mm. but resulted in the least acute collateral tissue injury of 0 to 1 mm. CONCLUSIONS: In the porcine model the LigaSure system is a viable option for laparoscopic management of arteries up to 6 mm. and veins up to 12 mm. in diameter.     

Potassium-titanyl-phosphate laser assisted robotic partial nephrectomy in a porcine model: can robotic assistance optimize the power needed for effective cutting and hemostasis?

A potassium-titanyl-phosphate (KTP) laser through robotic endo-wrist instrument has been evaluated as an ablative and hemostatic tool in robotic assisted laparoscopic partial nephrectomy (RALPN). Ten RALPN were performed in five domestic female pigs. The partial nephrectomies were performed with bulldog clamping of the pedicle. Flexible glass fiber carrying 532-nm green light laser was used through a robotic endowrist instrument in two cases. Power usage from 4 to 10 W was tested. The laser probe was explored both as a cutting knife and for hemostasis. The pelvicalyceal system was closed with a running suture. Partial nephrectomies using KTP laser were performed without complications. Mean operative times and warm ischemia times for laser cases were 96 and 18 min, respectively. Mean estimated blood loss was 60 ml compared with 50 ml for non-laser cases. Complete hemostasis with the laser alone could be achieved with a power of 4 W and was found to be effective. In our hands the laser fiber powered up to 10 W was not effective as a quick cutting agent. Histopathologic analysis of the renal remnant revealed a cauterized surface effect with average laser penetration depth less than 1 mm and minimal surrounding cellular injury. The new robotic endowrist instrument carrying flexible glass fiber transmitting 532-nm green light laser is a useful addition to the armamentarium of the robotic urologic setup. Its control by the console surgeon enables quicker and more complete hemostasis of the cut surface in renal sparing surgery using a porcine model. Histologically proven lased depth of less than 1 mm suggests minimal parenchyma damage in an acute setting. Laser application as a cutting agent, however, requires further investigation with interval power settings beyond the limits of this preliminary study. We estimate that effective cutting should be possible with a setting lower than traditionally recommended for solid organs.     

Liver transection: a controlled study of four different techniques in pigs

The optimal method of transecting liver parenchyma has not been established and presently a variety of methods are in use. In a controlled study in pigs standard resections were performed with four different transection techniques: ultrasonic dissection, suction dissection, electrocautery, and sharp dissection. The blood loss, number of vessels identified before their division, need for additional hemostatic measures, and time for each procedure were evaluated. Also, the histologic appearance of the fresh and the healing cut surface of the liver was studied. The blood loss was the lowest when ultrasonic dissection was used (median blood loss of 58 ml per resection). The comparisons with suction dissection (median blood loss of 87 ml) and cautery (median blood loss of 79 ml) were not significant. The ultrasonic and suction dissection techniques were both effective in isolating vessels, but the ultrasonic dissector did this more atraumatically. Cautery and ultrasonic dissection had a hemostatic effect on the parenchyma in that a significantly smaller number of vessels needed to be clipped or tied. On histologic study of the fresh cut liver surface, a smooth surface was seen with ultrasonic dissection, parenchymal hemorrhage after suction dissection, and coagulation necrosis after electrocautery. Ultrasonic dissection was the only technique that combined lowered blood loss because medium- and large-size vessels were dissected free and ligated before transection and a hemostatic effect on small vessels.     

Combination of CUSA and neodymium:YAG laser for canine partial nephrectomy

A Cavitron Ultrasonic Surgical Aspirator (CUSA) was used to isolate and skeletonize parenchymal renal vessels during 20 partial nephrectomies performed on 10 dogs. After isolation of the renal vessels, hemostasis was obtained by direct application of neodymium:YAG laser energy. Blood loss and total operative time were reduced compared to a control series of partial nephrectomies performed with a scalpel. The combination of Cavitron Ultrasonic Surgical Aspirator plus a Nd:YAG laser appears to offer advantages compared to either modality used alone or to standard techniques for partial nephrectomy.     

Experimental treatment of thrombotic vascular occlusion

The role of laser energy in the treatment of thrombotic vascular occlusion was evaluated in two sets of experiments. First, 10 polytetrafluoroethylene grafts were used to replace segments of the superficial femoral arteries in dogs and were thrombosed by distal ligation. Occlusion was maintained for one hour, or for 7, 14, 21, and 28 days in each of two grafts. Patency was restored in all 10 grafts without perforation or anastomotic disruption using a 2 mm hot tip probe powered by an Argon laser. However, increased organization of thrombus related to the duration of occlusion lead to decreased laser channel diameters, and 75% of the 28 day thrombus remained in the graft after recanalization. The second experiments tested the added benefit of thrombolytic infusion following laser recanalization. Bilateral external iliac artery thrombosis was induced in dogs by operative vessel isolation, de-endothelialization, and thrombin injection. At 7 days the efficacy of laser-assisted thrombolysis (LAT) versus enzymatic thrombolysis (ET) alone was compared. Eight vessels underwent ET by urokinase (4000 I.U./min.); 14 vessels were laser recanalized prior to thrombolytic infusion. LAT was performed from a carotid artery approach in 8 vessels (antegrade) and from a femoral artery in 6 vessels (retrograde). In contrast to studies using the hot tip alone, both ET and LAT accomplished complete thrombus removal. However, LAT lead to significant iliac arterial flow in 9 +/- 8 min. (antegrade) and 25 +/- 8 min. (retrograde) while ET required 109 +/- 47 min (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Possibilities of preoperative studying of vascular anatomy in surgery of a periampullar zone tumors

In 115 patients, suffering malignant pancreatic tumors as well as those, localized in periampullar zone, a CT angiography was performed preoperatively to study up the variants of vascular anatomy. The data obtained were depicted by a surgeon, anatomic variants of truncus coeliacus and mesenterical vessels were recorded in accordance with classification of Michels, Hiatt. Individualized approach for surgical treatment, using CT angiography data, was applied. In 30 patients the operative intervention with the vessels resection was performed and in 6--a no-touch method. Distal pancreatic resection, using the RAMPS technology. was performed in 7 patients for malignant tumors. Complications have had occurred in 12 (10%) patients, 2 (1.7%) of them died. Lethality after operations with vessels resection have constituted 6.6%. The data on variants of vascular anatomy, obtained preoperatively, have permitted to escape massive intraoperative blood loss with subsequent irreversible necrotic changes in the abdominal cavity organs.     

PlasmaKinetic bipolar vessel sealing: burst pressures and thermal spread in an animal model

BACKGROUND AND PURPOSE: Laparoscopic bipolar instruments are commonly employed to cauterize and divide tissue. A next-generation bipolar device has been developed that employs vapor pulse coagulation energy. We assessed the vessel-sealing capability of this device and quantified thermal spread during application. MATERIALS AND METHODS: Bilateral laparoscopic nephrectomy was performed on six common swine >25 kg. Five-millimeter clips and surgical staplers (US Surgical, Norwalk, CT) were utilized to perform nephrectomy on one side, while the Gyrus PlasmaKinetic bipolar device (Minneapolis, MN) was employed for the contralateral nephrectomy. Vessel-sealing capabilities were assessed via burst-pressure studies. The extent of thermal spread was measured after tissue fixation and hematoxylin and eosin staining. RESULTS: Surgical clips/vascular staplers adequately controlled/sealed renal hilar vessels with burst pressures nearing 300 mm Hg. The Gyrus bipolar device reliably sealed and divided renal arteries 相似文献   

Nd-YAG laser for general surgery

We report here our clinical experiences with Nd-YAG laser on general surgery, and evaluate the results of this procedure. From December 1979 to December 1981, we applied Nd-YAG laser to various operations as a hemostatic and cutting tool. For hemostasis, we used conventional quartz fiber which was covered with sterile tube, and hemostatic efficacy was examined especially in the subcutaneous bleeding and the bleeding from solid organs. For cutting, we used special devices, ie, Medilas YAG surgical probe (noncontact-type probe), and a laser blade (contact-type probe), and performed four liver resections. It is concluded that the hemostatic efficacy of Nd-YAG laser to various bleeders was proved in general surgical procedures, and furthermore this laser can cut tissue if we utilize these devices. When comparing these two devices, we would prefer the contact-type probe.     

MR-derived renal morphology and renal function in patients with atherosclerotic renovascular disease

Appropriate selection of patients with atherosclerotic renovascular disease (ARVD) for revascularization might be improved if accurate non-invasive investigations were used to assess severity of pre-existing parenchymal damage. The purpose of this study was to evaluate the associations between magnetic resonance imaging (MRI)-measured renal morphological parameters and single-kidney glomerular filtration rate (GFR) in ARVD. Three-dimensional (3D)-MRI was performed on 35 ARVD patients. Renal bipolar length (BL), parenchymal volume, parenchymal (PT), and cortical thicknesses (CT) were measured in 65 kidneys. Thirteen kidneys were supplied by normal vessels, 13 had insignificant (<50%) renal artery stenosis (RAS), 33 significant (>or=50%) RAS, and six complete vessel occlusion. All patients underwent radioisotopic measurement of single-kidney GFR (isoSK-GFR). Overall, 3D parameters such as parenchymal volume were better correlates of isoSK-GFR (r=0.86, P<0.001) than BL (r=0.78, P<0.001), PT (r=0.63, P<0.001) or CT (r=0.60, P<0.001). Kidneys with >or=50% RAS did show significant reduction in mean CT compared to those supplied by normal vessel (5.67+/-1.63 vs 7.28+/-1.80 mm, P=0.002; 22.1% reduction) and an even greater loss of parenchymal volume (120.65+/-47.15 vs 179.24+/-86.90 ml, P<0.001; 32.7% reduction) with no significant reduction in BL. In a proportion of >or=50% RAS kidneys, a disproportionately high parenchymal volume to isoSK-GFR was observed supporting a concept of 'hibernating parenchyma'. 3D parameters of parenchymal volume are stronger correlates of isoSK-GFR than two-dimensional measures of BL, PT or CT. 3D morphological evaluation together with isoSK-GFR might be useful in aiding patient selection for renal revascularization. Kidneys with increased parenchymal volume to SK-GFR might represent a subgroup with the potential to respond beneficially to angioplasty.     

CO2 laser and suture in splenic parenchyma: an experimental study

Hemisplenectomy was performed with the scalpel in 12 mongrel dogs. The blood vessels of the splenic pedicle were temporarily clamped. In a six-dog group, hemostasis was obtained by CO2 laser and residual bleeding was controlled by sutures. In the other six dogs, group hemostasis was performed only by sutures. The surgical procedure was free of mortality. No hematological changes were observed in both groups. Histological studies revealed a better hemostatic effect and intensive necrosis of the splenic parenchyma in the lasered group compared with the sutured group.     

Assessment of topical hemostats in a renal hemorrhage model in heparinized rats

Various topical hemostatic agents or devices have been employed to address the challenges associated with hemorrhage from parenchymal organs during surgery or trauma. Their relative efficacy, however, has not been assessed in a single animal model. The objective of this study was to develop a small animal renal hemorrhage model for comparing hemostatic efficacy of various topical agents, and then to compare fibrin sealant (FS) to an existing standard of care for topical hemostasis. A left heminephrectomy was performed in anesthetized adult male Sprague-Dawley rats. Animals were anticoagulated with 2000 IU/kg heparin IV and various topical hemostatic agents were applied to the injury. Treatment groups included FS applied as a spray; FS applied through a cannula; gelatin sponge (GS) soaked in 1000 IU/mL thrombin solution; GS soaked in 300 IU/mL thrombin; dry GS; and fibrinogen without thrombin applied as a spray. The main endpoints of the study were incidence of hemostasis, blood loss, acute survival trends, and maintenance of mean arterial pressure (MAP). Three treatment groups, the two FS groups and the GS soaked in 1000 IU/mL thrombin, afforded significant hemostasis compared to the controls (P < 0.01). Both FS groups had significantly less blood loss, longer survival times, and maintained higher MAPs than the GS-treated groups. Quantitative dose effects and functional deficiencies in topical hemostatic products could be assessed using this animal model. The study demonstrated that liquid FS was significantly more efficacious than a GS soaked in thrombin for abating hemorrhage from a renal excision in a heparinized rat.     

CO2 laser subcapsular orchidectomy in the treatment of metastatic prostate cancer

Hormonal manipulation remains the main method of treatment in metastatic carcinoma of the prostate. Traditional techniques of surgical castration may result in complications due to bleeding within the scrotum. Because of its cutting and hemostatic properties, superior to that seen with traditional scalpel incisions in vessels < 1.5 mm diameter [1,2], the carbon dioxide laser has been used in performing subcapsular orchidectomy in an attempt to reduce such complications. Postoperative hormonal assays have demonstrated a response identical to orchidectomy, and no treatment complications were encountered in our series. Subcapsular orchidectomy using the carbon dioxide laser may offer an advantage over traditional methods of surgical castration by reducing the frequency of postoperative hematoma. © 1994 Wiley-Liss, Inc.     

Influence of the bridging effect by sequential laser application on tissue ablation in an ex vivo model, taking organ perfusion into account

OBJECTIVE: To improve the efficacy of interstitial laser coagulation of tissue by causing a 'bridging' effect, using a sequential multiple-probe procedure on an ex vivo kidney model, as only a limited area of tissue is destroyed with a single probe and the coagulation takes longer when multiple punctures are used. MATERIALS AND METHODS: A laser beam was generated using a Nd:YAG laser and applied to kidney tissue by a diffuser tip (quartz glass cap 2 x 19 mm). For sequential laser application (SLA), three probes were placed through punctures into kidney tissue, at 5 or 10 mm apart. The laser energy was applied in different time-energy combinations through the three probes. The effect of SLA was compared with that from one probe delivering the optimal PowerMode 180 protocol (Dornier, Germering, Germany), which represents the standard energy protocol for the clinical treatment of parenchymal organs using this laser device. An isolated porcine kidney was chosen for laser coagulation under different conditions of perfusion. The ablative efficacy was defined as the volume of necrosis per minute. RESULTS: Applying various time-energy combinations to isolated unperfused porcine kidney caused extensive tissue ablation (5.6 mL). In trials with saline and blood perfusion for improved cooling, the necrotic volume was 2.5 and 3.9 mL, respectively (with no carbonization, 3.2 mL). Compared with a single-probe procedure, the ablation efficacy was 10 times better with SLA coagulation. This improvement was initiated by the bridging effect: coagulation in neighbouring areas affects perfusion and convection to an extent that induces the formation of bridges of necrosis between the probes. CONCLUSION: Tissue ablation is markedly improved by interstitial laser coagulation using a sequential multiple-probe technique.     

Open lung surgery with Nd-YAG Laser

We report on nineteen patients who successfully underwent open lung performance with a Nd-YAG laser in the period December 1987 to August 1988. Reasons for laser operations were lung metastases (twelve cases), lung fibrosis (five patients), one lung cyst and one tuberculoma. We used the Nd-YAG laser in non-contact mode, with focus hand-piece spot size of 1.5 mm, a continual 1064 nm wavelength and a power output 90 W. In these nineteen cases we performed 35 laser photoablations of lung tissue. All patients healed without any serious complications. The major advantage of Nd-YAG laser beam in open lung surgery is in the rapid sealing effect of small airways and of blood vessels up to 3 mm. The Nd-YAG laser seems to be very suitable for operations in lung periphery.     

New Simple Technique for Hepatic Parenchymal Resection Using a Cavitron Ultrasonic Surgical Aspirator® and Bipolar Cautery Equipped with a Channel for Water Dripping

We have developed a new technique to resect hepatic parenchyma without inflow occlusion by using the Cavitron Ultrasonic Surgical Aspirator (CUSA?) and bipolar cautery with a saline irrigation system. The significance of this method in hepatectomy was analyzed in comparison with historical control of hepatectomy using Pringle's maneuver. An ordinary bipolar cautery was remodeled with an infusion line to bring saline droplets down the inner surface of one arm of the tweezers through an opening about 1.5 cm proximal to its tip. The optimal flow rate of saline was approximately one drop per second. The power of bipolar cautery was adjusted to 50 watts. When the tweezer blades were approximated to 1 or 2 mm, saline droplets were directed to the tip of tweezers and could be immediately evaporated. After sonicating parenchymal cells, the tissue of small branches of Glisson's tree or small tributaries of the hepatic vein were coagulated by bipolar cautery. The coagulated cords were then easily cut by scissors. The impact of this technique on ordinary liver resections was evaluated by analyzing the postoperative clinical course in relation to the hepatic functional reserve necessary for major hepatectomy, duration of hepatectomy, and intraoperative blood loss. Hepatic resection without vascular occlusion using this technique could decrease the morbidity in patients who have less hepatic functional reserve. It could also decrease intraoperative blood loss. This new technique effectively decreased the surgical load of the remnant liver during parenchymal resection by avoiding ischemic stress. Consequently it extends the safety limits of major hepatectomy.     

Waterjet dissection in neurosurgical procedures: clinical results in 35 patients

OBJECT: Waterjet dissection represents a new minimally traumatic surgical method for dissection that can be used in various parenchymal organs, in which it allows highly precise parenchymal dissection while preserving blood vessels, resulting in reduced intraoperative blood loss. This study was performed to investigate the clinical application of this new technique in neurosurgical procedures, such as brain tumor resection and epilepsy surgery. METHODS: Thirty-four patients with gliomas (Grades II-IV), cerebral metastases, temporal lobe epilepsy, or cerebellar hemangioblastomas, and one patient with internal carotid artery (ICA) stenosis were treated surgically with the aid of the waterjet. Resection was performed using waterjet dissection in combination with conventional neurosurgical procedures. Intraoperatively, the waterjet was easy to handle, and no complications due to the device were observed. Dissection of tissue was possible for all pathological conditions, and pressures between 3 and 45 bars were used. In gliomas, metastases, epilepsy surgery, and hemangioblastoma, the tissue was dissected at pressures between 3 and 17 bars, which preserved blood vessels. Dissection of meningiomas and the ICA stenosis required higher pressures (between 20 and 45 bars); with these pressures, blood vessels were also dissected. CONCLUSIONS: These results indicate that the waterjet dissection procedure can be used intraoperatively without complications. This device appears to be particularly suitable for the dissection of highly vascularized gliomas or normal brain tissue, in which tissue dissection with sparing of blood vessels can be achieved. To prove that this is a useful addition to the neurosurgical armamentarium, reduction of blood loss or postoperative brain edema compared with conventional methods should be demonstrated in future studies.     

Effect of epicardial fat on ablation performance: a three-energy source comparison

OBJECTIVES: To investigate the effect of epicardial fat on surgical atrial fibrillation ablation performance using an in vitro model. Two tissue models were employed to investigate standard penetration and maximal lesion depth performance of bipolar radiofrequency (RF), microwave, and laser energy sources. METHODS: Ventricular veal tissue was utilized in various thicknesses (3 mm, 5 mm, 7 mm, 15 mm). Epicardial fat was modeled by layering porcine fat (1 mm, 2 mm and 4 mm) on moistened tissue. In each group, 8 to 10 lesions were created. Post ablation, tissue samples were sectioned and ablation depth of each myocardial section measured using 1% tetrazolium tetrachloride dye solution. RESULTS: The laser energy source produced nearly 100% transmural lesions in almost all study groups irrespective of myocardium thickness and fat thickness. The microwave device maintained transmurality in all 3-mm and most 5-mm myocardium trials but fell to near zero with all 7-mm myocardium trials. The bipolar RF maintained transmurality only when no fat was applied. In the maximal lesion depth models, the laser was capable of producing lesions >8 mm with no fat and >6 mm with either 2 mm or 4 mm of fat present. The microwave produced lesions in the no fat (>6 mm) and 2-mm (>4 mm) fat group. The bipolar RF produced 83% transmurality with no fat and zero percent transmurality with 2 mm of fat present. CONCLUSIONS: Epicardial fat can severely limit transmurality in energy sources that utilize conductive heating. Laser energy was uniformly superior at producing both transmural and deep lesions irrespective of the presence of fat.     

Non-ischemic laparoscopic partial nephrectomy using 1318-nm diode laser for small exophytic renal tumors

Purpose

Warm ischemia (WI) and bleeding constitute the main challenges for surgeons during laparoscopic partial nephrectomy (LPN). Current literature on the use of lasers for cutting and coagulation remains scarce and with small cohorts. We present the largest case series to date of non-ischemic LPN using a diode laser for small exophytic renal tumors.

Methods

We retrospectively evaluated 29 patients with clinically localized exophytic renal tumors who underwent non-ischemic laser–assisted LPN with a 1318-nm wavelength diode laser. We started applying the laser 5 mm beyond the visible tumor margin, 5 mm away from the tissue in a non-contact fashion for coagulation and in direct contact with the parenchymal tissue for cutting.?

Results

The renal vessels were not clamped, resulting in a WIT (warm ischaemic time) of 0 min, except for one case that required warm ischemia for 12 min and parenchymal sutures. No transfusion was needed, with a mean Hemoglobin drop of 1,4 mg/dl and no postoperative complications. The eGFR did not significantly change by 6 months. Histologically, the majority of lesions (n?=?22/29) were renal-cell carcinoma stage pT1a. The majority of malignant lesions (n?=?13/22) had a negative margin. However, margin interpretation was difficult in 9 cases due to charring of the tumor base. A mean follow-up of 1.8 years revealed no tumor recurrence. The mean tumor diameter was 19.4 mm.

Conclusion

The 1318-nm diode laser has the advantages of excellent cutting and sealing properties when applied to small vessels in the renal parenchyma, reducing the need for parenchymal sutures. However, excessive smoke, charring of the surgical margin, and inability to seal large blood vessels are encountered with this technique.

     

Application of a fibrinogen-thrombin-collagen-based hemostyptic agent in experimental injuries of liver and spleen

FTCH is a recently developed material which consists of a collagen fleece containing fibrinogen, thrombin, and aprotinin integrated into its surface. FTCH is highly effective in sealing of tissues and in establishing hemostasis. We evaluated FTCH in experimentally produced liver (n = 6) and splenic (n = 12) injuries in 18 adult mongrel dogs. The stability of the parenchymal seal of the splenic injuries was tested by splenic tissue pressure elevation after temporary ligation of the splenic vein. No breakthrough bleeding occurred up to a parenchymal pressure of 16.3 +/- 5 mm Hg. Complete hemostasis was easily achieved in all animals before closure. When the dogs were re-explored postoperatively at intervals of either 14 or 30 days, there was no gross evidence of recurrent bleeding. Histologic examinations demonstrated a partially regenerated capsule covering an unspecific fibrovascular granulation tissue and progressive resorption of FTCH without significant inflammatory response. We conclude the following: FTCH provides adequate hemostatic control of experimental liver and splenic injuries. FTCH has excellent tissue compatibility and can be applied easily and safely to hemorrhaging parenchymal wounds. It will not replace adequate surgical techniques, but could be useful as a quickly available and easily applicable hemostatic means in diffuse or acute bleeding of liver and spleen.