Role of Oxidized Regenerated Cellulose Gauze in Managing Intraoperative Bleeding During Myomectomy

 

oxidized regenerated cellulose gauze

Uterine fibroids are a common health condition affecting millions of women globally, often leading to symptoms such as heavy menstrual bleeding, pelvic pain, and infertility, which significantly diminish a woman’s quality of life [1]. For women who seek to preserve fertility or alleviate these distressing symptoms, myomectomy—the surgical removal of fibroids—is a preferred treatment. However, a critical challenge during myomectomy is the management of intraoperative bleeding, which can be life-threatening if uncontrolled [2]. Excessive blood loss can prolong the surgery, complicate recovery, increase the risk of infection, and potentially require blood transfusions. As a result, addressing intraoperative bleeding efficiently is essential for improving surgical outcomes and reducing postoperative complications. This blog explores how advanced hemostatic agents, particularly oxidized regenerated cellulose gauze (ORCG), are transforming the way surgeons manage bleeding during myomectomy, making these procedures safer and more effective for patients.

The Challenge of Hemostasis in Myomectomy

Myomectomy is a specialized procedure designed to remove uterine fibroids, and it can be performed through various approaches, including laparotomy (open surgery), laparoscopy (minimally invasive surgery), or hysteroscopy. Studies indicate that blood loss in laparoscopic myomectomies can reach 100 ml, while open surgeries may experience double this amount [3]. Excessive bleeding not only complicates the surgery but can also delay recovery and increase the risk of postoperative complications, such as infection or the need for blood transfusions.

Myomectomy ProcedureFig. 1: Myomectomy Procedure (IHH Healthcare Singapore)

Surgeons have implemented several interventions to reduce bleeding during myomectomy, which can be categorized into three main approaches:

  1. Interventions Targeting Uterine Arteries: techniques such as laparoscopic uterine artery dissection, uterine artery embolization, and hormonal tourniquets like vasopressin and terlipressin.
  2. Uterotonics: medications like ergometrine, oxytocin, misoprostol, and sulprostone.
  3. Myoma Dissection Techniques: these involve tools such as lasers and chemical dissectors like sodium-2-mercaptoethanesulfonate (mesna) [4, 5].

Despite these advancements, managing bleeding remains a significant concern for gynaecological surgeons, leading to the development and use of advanced hemostatic agents such as oxidized regenerated cellulose gauze, which has proven to be highly effective in reducing bleeding and promoting clot formation.

Oxidized regenerated cellulose gauze: A breakthrough in hemostasis

Oxidized regenerated cellulose gauze (Surgi-ORC® Original) is highly effective in managing excessive bleeding, a common complication in procedures like myomectomy. Designed to control capillary, venous, and small arterial bleeding, it is especially useful when conventional methods such as suturing or electrical coagulation are inadequate [6]. Made from oxidized regenerated cellulose, Surgi-ORC® promotes hemostasis by activating the body’s natural coagulation pathways. Upon contact with blood, it forms a gelatinous mass that acts as a matrix for platelet adherence, rapidly facilitating clot formation. Additionally, the low pH environment it creates induces vasoconstriction, further reducing bleeding, while also offering antimicrobial properties.

This dual mechanism—mechanical blockage of the bleeding site and promotion of natural clotting—makes Surgi-ORC® an invaluable tool in controlling bleeding during complex surgical procedures.

Case Study: Efficacy of Surgi-ORC®in Myomectomy

A recent case study evaluated the efficacy and safety of Surgi-ORC® (Surgi-ORC® Original/ORCG and Surgi-ORC® Non-Woven/SNOW variants) during a myomectomy in a 36-year-old female with uterine fibroids. During the surgery, the patient experienced mild bleeding, which was effectively managed using Surgi-ORC®. Hemostasis was achieved within an average of 1 minute and 6 seconds without the need for additional interventions, such as electrocoagulation or pharmacological agents​.

Variants of Surgi-ORC®Fig. 2: Variants of Surgi-ORC® (Surgi-ORC® Original/ORCG and Surgi-ORC®
Non-Woven/SNOW)

The surgeon rated the handling characteristics of Surgi-ORC® highly, emphasizing its ease of application, conformance to tissue surfaces, and efficient preparation. Additionally, the radiological assessments confirmed the rapid liquefaction of Surgi-ORC® by Day 2 post-surgery, with no visible traces of the material, indicating complete absorption as shown in Fig. 3.

Post-surgery X-ray shows no visible traces of Surgi-ORC® on Day 2Fig. 3: Post-surgery X-ray shows no visible traces of Surgi-ORC® on Day 2.

The patient showed no complications during the 60-day follow-up period, highlighting Surgi-ORC®’s safety and effectiveness​ [7].

Benefits of Surgi-ORC® in Myomectomy

  1. Rapid Hemostasis: achieves hemostasis typically within 2 minutes, reducing the time required to control bleeding and allowing for smoother surgical flow.
  2. Biocompatibility and Absorption: fully absorbed by the body within days, eliminating the need for surgical removal and minimizing the risk of foreign body reactions or infections.
  3. Ease of Use: Surgi-ORC® is highly regarded for its easy handling, ability to conform to irregular surfaces, and precise cutability, seamlessly integrating into both open and laparoscopic procedures.
  4. Reduced postoperative complications: The use of Surgi-ORC® has been associated with a lower rate of postoperative complications, such as rebleeding, leading to smoother recoveries.

Conclusion

In conclusion, oxidized regenerated cellulose gauze (ORCG) provides a robust and reliable solution for managing intraoperative bleeding during myomectomy, offering significant benefits such as rapid hemostasis, biocompatibility, and ease of use. The efficacy of ORCG in reducing blood loss, improving surgical outcomes, and minimizing postoperative complications makes it an invaluable tool in gynecological surgeries. Looking forward, the role of ORCG may expand beyond gynecology, supported by ongoing research exploring its potential use in cardiovascular, orthopaedic, and trauma surgeries.As surgical technologies continue to advance, ORCG and similar hemostatic agents will play an increasingly vital role in improving patient outcomes and enhancing the safety of complex surgical procedures.

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