Fibrin Sealant in Minimally Invasive Thoracic Surgery: Indications and Early Results

Abstract

Advances in minimally invasive techniques have led to a continuous expansion of the diagnostic and therapeutic indications for thoracoscopy. For example, fibrin glue is now being used in various novel ways. We present our experience with tissue adhesives in thoracoscopy. Between January 1990 and October 1992, 287 videothoracoscopies were performed at the Department of Thoracic- and Cardiovascular Surgery, University of Bern and the Limmattal Hospital in Schlieren-Zürich. Fibrin glue was used 45 times. In patients with diffuse pulmonary pathology, the operative field was sealed with fibrin glue after extensive biopsy: six times after wedge resection and seven times after tissue ligature. In eight patients, fibrin glue was injected under the surface of the biopsied area after sharp dissection of the lung parenchyma. In all cases an airtight seal was achieved. After biopsy of a mediastinal tumor, hemostasis was successful after injection of fibrin glue. Fibrin glue was used in 11 patients with postoperative bronchopleural fistulas. Definite closure was achieved in 8 of these cases. A postoperative thoracic duct leak was sealed with fibrin glue. Endoscopic fibrin pleurodesis for malignant pleural effusion was successful in 7 of 11 patients. In summary, fibrin sealant was successful in 38 of the 45 cases (84.4%). There were no intra- or postoperative complications which could be attributed to the use of fibrin adhesive. In particular, there was no incidence of pleural infection or allergic reaction.