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I noticed you used sutures or clips to manage bleeding at the end of the case. What some surgeons have shared with me is that while these methods can effectively control discrete bleeding points, they may be less efficient or practical when dealing with persistent oozing, particularly from small capillaries or broad raw surfaces where precise placement is challenging or the tissue is friable. I’d like to introduce SURGICEL™ Absorbable hemostat as an effective alternative to nuisance broad surface bleeding that is designed to control continuous oozing bleeding on broad surfaces without the need for heat through its unique dual mechanism of action.3-4 This means you maintain a clear field and preserve the local tissue integrity, especially when you’re working close to lymphatics and nerves”. SURGICEL™ is made from ORC which induces vasoconstriction and works in part with the patient’s endogenous clotting factors to initiate clot formation to achieve hemostasis.3 There are two different formulations that I would suggest as optimal solutions. SURGICEL™ Powder is made of 100% SURGICEL™ material in powder form to efficiently and effectively stop continuous oozing bleeding on broad surfaces.1-3 It requires no prep1† and achieves hemostasis in an average of 30 seconds, even after irrigation, allowing you to address the bleeding and continue operating.*1,4,5 SURGICEL SNoW™ has a unique structured matrix that makes it easy to adjust and move.6 SURGICEL SNoW™ provides 43% faster hemostasis3* and is more effective than 4 layers of SURGICEL™ Original Hemostat.7 It conforms and adheres to the bleeding site, and is designed to retain its shape for better handling, conformability, and easier insertion through trocars.3,6*§ SURGICEL SNoW has been associated with up to 38% lower transfusion costs.*8 You mentioned your patients are unwell and preventing SSIs is important for positive patient outcomes, SURGICEL™ is the first and only hemostat that has proven antibacterial properties in vitro against a broad range of organisms including various antibiotic-resistant bacteria.9-14,¶,|| You also mentioned clinical evidence is an important consideration for your decision making. There is extensive clinical research that demonstrates the use of adjunctive hemostats have been associated with reduced resource utilization, hospital length of stay, OR time, fewer transfusions, and reduced rates of readmission.15-24 Would you be open to having me attend a few of your robotic procedures so you can evaluate the performance of SURGICEL™ versus traditional mechanical methods for managing broad surface bleeding?

References

*Compared to SURGICEL Original.

†Based on preclinical testing in a swine acute liver abrasion model

§17/21 surgeons agree (n=7) or strongly agree (n=10) that SURGICEL SNoW™ conforms better than SURGICEL™ Original. 19/19 surgeons agree (n=13) or strongly agree (n=6) that SURGICEL SNoW™ adheres to tissue better than SURGICEL™ Original.

¶The clinical benefit of these bactericidal claims has not been studied or demonstrated.

||In vitro compared to other TAH available in the US

1. MacDonald M. Pivotal study comparing performance of SURGICEL™ Powder—Absorbable Hemostatic Powder to ARISTA™ Absorbable Hemostatic Particles and PerClot® Polysaccharide Hemostatic System in a swine acute live biopsy model. Study 15-0120, Project 16438. September 2, 2015. Ethicon, Inc.

2. MacDonald M. Pivotal study comparing performance of SURGICEL™ Powder—Absorbable Hemostatic Powder to SURGICEL™ Original Absorbable Hemostat in a swine acute liver abrasion model. Study 15-0061, Project 16438. September 2, 2015. Ethicon, Inc.

3. SURGICEL™ Technical Report. 2018. Ethicon, Inc.

4. MacDonald M. Study comparing performance of SURGICEL™ Powder—Absorbable Hemostatic Powder to marketed competitive powdered topical hemostats in a swine acute liver abrasion model. Study 16-0006, Project 16438. March 8, 2016. Ethicon, Inc.

5. SURGICEL™ POWDER Absorbable Hemostat [Instructions for Use]. Ethicon, Inc.

6. Helms J. ETHICON™ biosurgery SNoW marketing claims
report. July 12, 2010. Ethicon, Inc.

7. Shnoda P. Project SNoW: Comparison of SURGICEL Non-Woven and SURGICEL™ ORIGINAL in the acute swine splenic incision hemostasis model. January 29, 2009. Ethicon, Inc.

8. Martyn D, Kocharian R, Lim S, et al. Reduction in hospital costs
and resource consumption associated with the use of
advanced topical hemostats during inpatient procedures. J
Med Econ. 2015;18(6):474481.

9. SURGICEL® ORIGINAL, SURGICEL® NU-KNIT®, SURGICEL® FIBRILLAR™ Instructions For Use. Ethicon, Inc

10. SURGICEL® SNoW™ Instructions For Use. Ethicon, Inc.

11. SURGICEL® Powder Instructions For Use. Ethicon, Inc.

12. Spangler D, Rothenburger S, Nguyen K, Jampani H, Weiss S, Bhende S, In Vitro Antimicrobial Activity of Oxidized Regenerated Cellulose Against Antibiotic-Resistant Microorganisms. Surgical Infections. 2003;4(3): 255-262.

13. Dineen P. The effect of oxidized regenerated cellulose on experimental infected splenotomies. J Surg Res 1977;23:114-116

14.SURGICEL™ Absorbable Hemostat. Full Prescribing Information, Ethicon, Inc.

CONFIDENTIAL. FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMER OR FOR EXTERNAL DISTRIBUTION.

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