FloSeal® for Parenchymal Hemostasis in Robot-Assisted Partial Nephrectomy: Technical Description and a Report of Two Cases

Robot-assisted partial nephrectomy (RAPN) requires secure and efficient hemostasis at the resection margin to prevent bleeding-related complications while preserving renal function. Flowable gelatin-thrombin matrix sealants, such as FloSeal®, are useful adjuncts for hemostasis in partial nephrectomy; however, their use is limited in Japan. We report two cases of right-sided clinical T1a renal cell carcinoma treated with RAPN in which a gelatin-thrombin matrix sealant was applied. Standard tumor excision, meticulous coagulation, and inner-layer parenchymal renorrhaphy were successfully performed under renal artery clamping. A 14-Fr flexible feeding tube was then introduced through the assistant port to deliver an adequate amount of FloSeal® to the resection bed, after which the sealant layer was gently compressed with saline-moistened gauze. This procedure achieved complete parenchymal hemostasis after clamp release without the need for extensive cortical suturing. Both surgeries were completed without conversion and with minimal blood loss, negative surgical margins, uneventful postoperative courses, and preservation of early postoperative renal function. These two cases illustrate a practical technique for precise delivery of FloSeal® using a low-cost feeding tube during RAPN. This approach may serve as an option for standardized parenchymal hemostasis, particularly when the surgeon aims to minimize cortical suturing and warm ischemia time. Further studies are warranted to investigate the indications and long-term outcomes of this FloSeal®-assisted hemostatic strategy in nephron-sparing surgery.