First report of a combined hemostatic technique using Hydrofit® and SURGICEL ABSORBABLE HEMOSTAT TM for intraoperative hemorrhage in gynecologic oncology surgery: a video article

Objective: To report the first use of Hydrofit® (Sanyo Chemical Industries, Kyoto, Japan), a polyurethane prepolymer sealant, combined with SURGICEL ABSORBABLE HEMOSTAT™ (COMPANY, CITY, STATE, COUNTRY) as an oxidized cellulose carrier, for intraoperative hemorrhage control in gynecologic oncology surgery, with video documentation. Methods: Two patients who underwent open gynecologic oncology surgery at our institution experienced hemorrhages refractory to conventional hemostatic measures. SURGICEL ABSORBABLE HEMOSTAT™ (COMPANY) coated with Hydrofit® (Sanyo Chemical Industries) was applied to the bleeding site with 3 minutes of manual compression. Surgical findings and postoperative courses were retrospectively reviewed. Ethics committee approval (number S26-06) and written informed consent were obtained from all participants. Results: Case 1 involved a high-grade serous carcinoma of the fallopian tube with neuroendocrine features and total blood loss of 4,439 g. Hemostasis at the tumor resection surface was visually confirmed, and the patient was discharged on postoperative day 7. At interval debulking surgery 4 months later, a fibrous mass with adhesion to the sigmoid colon and foreign body giant cells were identified at the application site, and R0 resection was achieved. Case 2 involved cervical squamous cell carcinoma staged as FIGO (2018) IIB, with a total blood loss of 886 g. Hemorrhage from the right internal iliac vein was controlled within three minutes and the patient was discharged on postoperative day 11 without complications. Conclusion: This combined hemostatic technique may serve as an adjunctive option when conventional measures fail during gynecological oncology surgeries. The adhesions observed during reoperation warrant caution. A prospective evaluation using site-specific blood loss measurements is required to establish its efficacy and safety.