Innovation in the operating room:
gel – instead of sutures – used to obstruct blood flow

Already featured on shelves for food, hygiene and beauty care products, a novel gel is now poised to conquer the operating room arena. For the first time in Israel, doctors at Rambam Health Care Campus (RHCC) have used the gel to stop blood flow during bypass surgery. The gel hardens within seconds, and then melts into the bloodstream after exactly ten minutes.

Recently, the first operation of its kind was performed in Israel, at RHCC: a resident of the north, aged 91, underwent surgery without the use of a heart-lung machine. During the operation surgeons used the innovative gel, LeGoo, which stopped the patient’s blood flow.

During bypass surgery, doctors commonly stop blood flow from the artery upon which they are working to mechanically create a blood-free work area. They generally make this blockage by placing sutures on the heart muscle, before and beyond the bypass site, or by inserting a small tube into the blood vessel. In contrast, the gel blocks by an active process. During the operation, doctors open the bleeding arteries and inject the gel into them. Within two seconds, the gel hardens, and assumes the shape of the blood vessels that it obstructs. This reaction occurs when the gel goes from room to body temperature.

After ten minutes, while doctors perform the bypass, the gel melts. If the surgeon completes the graft in less than 10 minutes, melting can be accelerated by using ice. The gel then leaves the body naturally. The novel gel was developed by the US company, Pluromed, and is marketed in Israel by Neopharm.

According to Rambam’s chief of cardiac surgery, Dr Gil Bolotin, who performed the operation, the gel simplifies surgery and minimizes damage that can result from currently used methods. “With older patients, this surgery is done without a heart-lung machine. The operation is a little more difficult technically for the surgeon, but it has the advantage for the patient of reducing potential complications. The new development further minimizes damage and is easier to perform. This operation was done with great success. It represents how surgery today provides an answer to patients of all ages,” said Dr Bolotin.

 The number of elderly patients undergoing heart surgery has tripled during the last ten years. During 2008, one tenth of patients who underwent heart surgery at Rambam were aged 80 or older. These numbers continue to rise, due to the novel technology, sophisticated devices and expertise gained by the hospital’s cardiac surgery team in recent years. Since the first operation using LeGoo gel in Israel, two such operations were conducted at Rambam during the last two weeks. According to Dr Ziv Beckerman, a senior physician in the Department of Cardiac Surgery who participated in the operation, operations without heart-lung machines are suitable for roughly 20% of patients. “On average, we operate on two such patients every week,” he said. “Medicine is developing, and with it, this entire branch of surgery. The cardiac surgery department at Rambam is not only advancing toward the future, but is participating in its creation.