Topical hemostatic agents for reconstructive uterine surgery: opportunities and prospects of application

DOI

https://dx.doi.org/10.18565/aig.2025.381

Dzhumamuradova E.Z., Kozachenko A.V.
Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia

The article presents a review of the current data on topical hemostatic agents in surgical practice with a focus on their use in reconstructive uterine surgery. It provides the analysis of scientific literature, historical overview on the evolution of hemostatic agents, the classification of the main groups of topical hemostatic agents (absorbable matrices, active hemostatic agents, combined preparations and innovative biopolymer agents) on the basis of the mechanism of action, efficacy and safety profile. Special attention is paid to the role of these agents in preventing and controlling intra- and postoperative bleeding during pelvic surgeries in women. The correct use of modern topical hemostatic agents as part of complex surgical tactics can minimize intraoperative blood loss, reduce the need for blood transfusion, reduce the risk of postoperative adhesions and improve tissue regeneration, which can be important for maintaining reproductive potential. It has been concluded that further research is needed to optimize protocols for the use of topical hemostatic agents in reconstructive uterine surgery depending on the type and extent of the operation.
Conclusion: Further prospects are associated with conducting targeted randomized controlled trials particularly in the field of reconstructive uterine surgery, studying long-term reproductive outcomes (pregnancy rate, uterine scar condition) and developing new “smart” biopolymer materials that integrate the functions of hemostasis, regeneration and prevention of adhesions.

Authors’ contributions: Kozachenko A.V., Dzhumamuradova E.Z. – developing the concept of the study, selecting the literature, writing the text, editing the text.
Conflicts of interest: Authors declare lack of the possible conflicts of interests.
Funding: The study was conducted without sponsorship.
For citation: Dzhumamuradova E.Z., Kozachenko A.V. Topical hemostatic agents for
reconstructive uterine surgery: opportunities and prospects of application.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (1): 19-26 (in Russian)
https://dx.doi.org/10.18565/aig.2025.381

topical hemostatic agents

adhesions

surgical complications

reconstructive uterine surgery

Full text (in Russian)

Mikashima Y., Imamura H., Shirakawa Y., Takagi H., Okazaki K. Hypersensitive reaction of oxidized regenerated cellulose powder in total knee arthroplasty. Cureus. 2024; 16(4): e59097. https://dx.doi.org/10.7759/cureus.59097
Zhou H., Ge J., Bai Y., Liang C., Yang L. Translation of bone wax and its substitutes: history, clinical status and future directions. J. Orthop. Translat. 2019; 17: 64-72. https://dx.doi.org/10.1016/j.jot.2019.03.005
Sutton L. History of the hemostat. JAMA Dermatol. 2017; 153(9): 914. https://dx.doi.org/10.1001/jamadermatol.2017.2656
Baird E.O., McAnany S.J., Lu Y., Overley S.C., Qureshi S.A. Hemostatic agents in spine surgery: a critical analysis review. JBJS Rev. 2015; 3(1): e2. https://dx.doi.org/10.2106/JBJS.RVW.N.00027
Колесов С.В., Васильев А.Н., Шахин А.В., Рассовский С.В., Казьмин А.И., Швец В.В., Переверзев В.С., Баранов С.А., Абдулин Т.В., Багиров С.Б., Морозова Н.С., Бибикова Е.Е. Местные кровоостанавливающие препараты в хирургии позвоночника. Обзор литературы. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2025; 32(1): 293-304. [Kolesov S.V., Vasilev A.N., Shakhin A.V., Rassovskiy S.V., Kazmin A.I., Shvets V.V., Pereverzev V.S., Baranov S.A., Abdulin T.V., Bagirov S.B., Morozova N.S., Bibikova E.E. The use of topical hemostatic agents in spinal surgery. N.N. Priorov Journal of Traumatology and Opthopedics. 2025; 32(1): 293-304 (in Russian)]. https://dx.doi.org/10.17816/vto322763
Tompeck A.J., Gajdhar A.U.R., Dowling M., Johnson S.B., Barie P.S., Winchell R.J. et al. A comprehensive review of topical hemostatic agents: the good, the bad, and the novel. J. Trauma Acute Care Surg. 2020; 88(1): e1-e21. https://dx.doi.org/10.1097/TA.0000000000002508
MacDonald M.H., Wang A.Y., Clymer J.W., Hutchinson R.W., Kocharian R. An in vivo comparison of the efficacy of hemostatic powders, using two porcine bleeding models. Med. Devices (Auckl). 2017; 10: 273-9. https://dx.doi.org/10.2147/MDER.S140663
Ishikura H., Nishiwaki T., Fujita S., Masuyama Y., Hatano M., Tanaka T. et al. Oxidized regenerated cellulose powder reduces perioperative bleeding and thigh swelling in total hip arthroplasty: a prospective interventional study. J. Orthop. Surg. Res. 2025; 20(1): 505. https://dx.doi.org/10.1186/s13018-025-05913-x
Yoon P.W., Kim H.J., Yoon J.Y., Moon J.K., Lee S. The efficacy of oxidised regenerated cellulose powder in reducing blood loss during primary total hip arthroplasty: a retrospective cohort study. J. Orthop. Surg. Res. 2025; 20(1): 368. https://dx.doi.org/10.1186/s13018-025-05782-4
Wakasa J., Iwakiri K., Ohta Y., Minoda Y., Kobayashi A., Nakamura H. Perioperative bleeding control in total hip arthroplasty: hemostatic powder vs. tranexamic acid-a prospective randomized controlled trial. Arch. Orthop. Trauma Surg. 2024; 144(8): 3797-805. https://dx.doi.org/10.1007/s00402-024-05475-3
Kaneko T., Hayakawa K., Miyazaki T. Clinical efficacy of oxidized regenerated cellulose powder in perioperative blood management in direct anterior total hip arthroplasty. SICOT J. 2025; 11: 36. https://dx.doi.org/10.1051/sicotj/2025036
Fagotti A., Costantini B., Fanfani F., Vizzielli G., Rossitto C., Lecca A. et al. Risk of postoperative pelvic abscess in major gynecologic oncology surgery: one-year single-institution experience. Ann. Surg. Oncol. 2010; 17(9): 2452-8. https://dx.doi.org/10.1245/s10434-010-1059-3
Behbehani S., Tulandi T. Oxidized regenerated cellulose imitating pelvic abscess. Obstet. Gynecol. 2013; 121(2 Pt 2 Suppl 1): 447-9. https://dx.doi.org/10.1097/aog.0b013e318276ce3f
Tam T., Harkins G., Dykes T., Gockley A., Davies M. Oxidized regenerated cellulose resembling vaginal cuff abscess. JSLS. 2014; 18(2): 353-6. https://dx.doi.org/10.4293/108680813X13693422518597
Ng E.P., Tung K.L., Yip S.L., Tse M.S., Kwok T.K., Wong K.K. A prospective randomised controlled trial evaluating prophylactic Floseal, a gelatin and thrombin-based haemostatic matrix, in postoperative drain output and blood transfusion in transforaminal lumbar interbody fusion surgery. Eur. Spine J. 2023; 32(7): 2282-7. https://dx.doi.org/10.1007/s00586-023-07748-8
Luo P., Lai Q., Xu L., Chen Z., Guo R., Xie B. et al. Efficacy and safety evaluation of a novel hemostatic gelatin matrix for intraoperative hemostasis: a prospective, randomized controlled trial. Sci. Rep. 2024; 14(1): 27324. https://dx.doi.org/10.1038/s41598-024-77487-3
Ponce J., García-Tejedor A., Barahona M., Cappuccio S., Costantini B., Fedele C. et al. Effectiveness and safety of an absorbable modified polymer starch powder hemostat versus usual care in gynecology procedures: a prospective, multi-center, and randomized study. PLoS One. 2025; 20(9): e0331376. https://dx.doi.org/10.1371/journal.pone.0331376
Chen Y., Wu L., Li P., Hao X., Yang X., Xi G. et al. Polysaccharide based hemostatic strategy for ultrarapid hemostasis. Macromol. Biosci. 2020; 20(4): e1900370. https://dx.doi.org/10.1002/mabi.201900370
Kenny S., Gabra H., Hall N.J., Flageole H., Illie B., Barnett E. et al. A study of safety and effectiveness of Evicel fibrin sealant as an adjunctive hemostat in pediatric surgery. Eur. J. Pediatr. Surg. 2024; 34(6): 512-21. https://dx.doi.org/10.1055/s-0044-1785443
Ибрагимова У.Д., Козаченко И.Ф., Адамян Л.В. Овариальный резерв и методы хирургического гемостаза при доброкачественных опухолях яичников. Акушерство и гинекология. 2025; 8: 150-8. [ Ibragimova U.D., Kozachenko I.F., Adamyan L.V. Ovarian reserve and surgical hemostasis methods for benign ovarian tumors. Obstetrics and Gynecology. 2025; (8): 150-8 (in Russian)]. https://dx.doi.org/10.18565/aig.2025.175
Montera R., Ficarola F., Plotti F., Terranova C., De Cicco Nardone C., Guzzo F. et al. The use of sealing hemostat patch (HEMOPATCH®) in laparotomic myomectomy: a prospective case-control study. Arch. Gynecol. Obstet. 2023; 307(5): 1521-8. https://dx.doi.org/10.1007/s00404-023-06957-2
Zou C.Y., Han C., Xing F., Jiang Y.L., Xiong M., Li-Ling J. et al. Smart design in biopolymer-based hemostatic sponges: from hemostasis to multiple functions. Bioact. Mater. 2024; 45: 459-78. https://dx.doi.org/10.1016/j.bioactmat.2024.11.034
Липатов В.А., Бордунова М.А., Панов А.А., Денисов А.А. К вопросу классификации местных кровоостанавливающих средств. Innova. 2022; 4(29): 38-41. [Lipatov V.A., Bordunova M.A., Panov A.A., Denisov A.A. On the issue of classification of local hemostatic agents. Innova. 2022; 4(29): 38-41 (in Russian)].
Zou C.Y., Li Q.J., Hu J.J., Song Y.T., Zhang Q.Y., Nie R. et al. Design of biopolymer-based hemostatic material: Starting from molecular structures and forms. Mater. Today Bio. 2022; 17: 100468. https://dx.doi.org/10.1016/j.mtbio.2022.100468
Stark M., Wang A.Y., Corrigan B., Woldu H.G., Azizighannad S., Cipolla G. et al. Comparative analyses of the hemostatic efficacy and surgical device performance of powdered oxidized regenerated cellulose and starch-based powder formulations. Res. Pract. Thromb. Haemost. 2024; 9(1): 102668. https://dx.doi.org/10.1016/j.rpth.2024.102668
Raimondo D., Raffone A., Saccone G., Travaglino A., Degli Esposti E., Mastronardi M. et al. Cellulose absorbable barrier for prevention of de-novo adhesion formation at the time of laparoscopic myomectomy: a systematic review and meta-analysis of randomized controlled trials. Eur. J. Obstet. Gynecol. Reprod. Biol. 2020; 245: 107-13. https://dx.doi.org/10.1016/j.ejogrb.2019.12.033
Martines G., Digennaro R., De Fazio M., Capuano P. Cyanoacrylate sealant compared to fibrin glue in staple line reinforcement during laparoscopic sleeve gastrectomy. Pilot prospective observational study. G. Chir. 2017; 38(1): 50-2. https://dx.doi.org/10.11138/gchir/2017.38.1.050
Chen Y.S., Loh E.W., Shen S.C., Su Y.H., Tam K.W. Efficacy of fibrin sealant in reducing complication risk after bariatric surgery: a systematic review and meta-analysis. Obes. Surg. 2021; 31(3): 1158-67. https://dx.doi.org/10.1007/s11695-020-05098-8
Uccelli M., Targa S., Cesana G.C., Oldani A., Ciccarese F., Giorgi R. et al. Use of fibrin glue in bariatric surgery: analysis of complications after laparoscopic sleeve gastrectomy on 450 consecutive patients. Updates Surg. 2021; 73(1): 305-11. https://dx.doi.org/10.1007/s13304-020-00865-9
Coskun H., Yardimci E. Effects and results of fibrin sealant use in 1000 laparoscopic sleeve gastrectomy cases. Surg. Endosc. 2017; 31(5): 2174-9. https://dx.doi.org/10.1007/s00464-016-5215-0
O'Hanlan K.A., Bassett P. Exploring adverse events and utilization of topical hemostatic agents in surgery. JSLS. 2022; 26(3): e2022.00033. https://dx.doi.org/10.4293/JSLS.2022.00033
Harris J.A., Uppal S., Kamdar N., Swenson C.W., Campbell D., Morgan D.M. A retrospective cohort study of hemostatic agent use during hysterectomy and risk of post-operative complications. Int. J. Gynaecol. Obstet. 2017; 136(2): 232-7. https://dx.doi.org/10.1002/ijgo.12037
Im D. Postoperative pelvic abscess risk in gynecologic surgery: a four-year single institution experience. Cureus. 2025; 17(10): e94383. https://dx.doi.org/10.7759/cureus.94383
Dolcetti V., Lori E., Fresilli D., Del Gaudio G., Di Bella C., Pacini P. et al. US evaluation of topical hemostatic agents in post-thyroidectomy. Cancers (Basel). 2023; 15(9): 2644. https://dx.doi.org/10.3390/cancers15092644
Rudy H.L., Shamamian P., Grande J., Wang F., Lu Y.H., Ricci J.A. Hemostatic agents do not significantly affect seroma formation in abdominal body contouring. Aesthetic Plast. Surg. 2024; 48(7): 1395-402. https://dx.doi.org/10.1007/s00266-023-03748-7
Al-Attar N., de Jonge E., Kocharian R., Ilie B., Barnett E., Berrevoet F. Safety and hemostatic effectiveness of SURGICEL® powder in mild and moderate intraoperative bleeding. Clin. Appl. Thromb. Hemost. 2023; 29: 10760296231190376. https://dx.doi.org/10.1177/10760296231190376
Howard M., Staples J.N., Nelamangala S., Kling C., Duska L.R. Evaluating the risk of post-operative abscess formation following use of hemostatic agents at time of hysterectomy. Gynecol. Oncol. Rep. 2022; 44: 101085. https://dx.doi.org/10.1016/j.gore.2022.101085

Received 23.12.2025

Accepted 26.12.2025

Elina Z. Dzhumamuradova, PhD student, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health
of Russia, 4, Ac. Oparin str., Moscow, 117997, Russia, +7(967)469-06-16, latfullinaelina@mail.ru, https://orcid.org/0009-0004-6586-7788
Andrey V. Kozachenko, Dr. Med. Sci., Senior Researcher at the Gynecological Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4, Ac. Oparin str., Moscow, 117997, Russia, +7(495)438-77-83, a_kozachenko@oparina4.ru,
https://orcid.org/0000-0002-5573-6694
Corresponding author: Andrey V. Kozachenko, a_kozachenko@oparina4.ru

Topical hemostatic agents for reconstructive uterine surgery: opportunities and prospects of application

Dzhumamuradova E.Z., Kozachenko A.V.

Keywords

References

About the Authors

Similar Articles