Revolutionizing Bleeding Control: The Impact of Endoscopic Powder in MIS
Securing haemostasis effectively is essential for positive surgical outcomes. Beyond minimizing intraoperative blood loss, it significantly reduces the risks associated with transfusions and postoperative complications. However, in minimally invasive surgeries (MIS)—such as laparoscopic and endoscopic procedures—haemostasis presents unique challenges due to restricted access, limited visibility, and anatomical complexity.
With the rise of less invasive surgery, adaptable and efficient haemostatic agents are more vital than ever, especially where standard techniques fail.
Why Bleeding Control in MIS is Difficult
While MIS offers benefits such as shorter recovery and less scarring compared to open surgery, it brings new challenges. But the same factors that make MIS appealing also make bleeding control more difficult. The lack of space, restricted visibility, and absence of tactile cues make diffuse or irregular bleeding especially tough to address.
Traditional methods—sutures, ligation, or electrocautery—are often impractical in these settings. That’s where topical haemostatic agents, especially endoscopic powder, come into play as vital adjuncts to improve visibility, control oozing, and speed up procedures.
Spotlight on Surgi-ORC®-Based Endoscopic Powder
Among haemostatic powders, plant-based, absorbable types like Surgi-ORC® have demonstrated both safety and effectiveness. ORC was first introduced in 1943 in sheet form and has since evolved to meet the demands of modern MIS through powder formulations.
Why Surgi-ORC®-Based Endoscopic Powder Stands Out
• Effective Haemostasis: ORC facilitates platelet adhesion and aggregation to accelerate clotting
• Shape Plasticity: The granular structure of powdered haemostats and their shape plasticity allows them to conform easily to large and deep surface wounds
• No Animal Content: Plant origin means reduced risk of allergic or infectious complications
• Antibacterial Environment: The oxidation process lowers pH, creating an acidic microenvironment that offers bactericidal benefits
• Biocompatible and Absorbable: Completely resorbed by the body with no cytotoxic effects, even near nerves or vessels
These characteristics make Surgi-ORC® endoscopic powder an ideal choice for managing mild to moderate bleeding—especially capillary, venous, or small arterial oozing in confined spaces.
Optimizing Application with Delivery Devices in MIS
How the powder is delivered greatly influences its effectiveness in surgery. In MIS, bellows pump-based applicators are widely used to deliver endoscopic powder with accuracy and control.
How Bellows Applicators Function
Bellows applicators, which look like syringes, have various tip lengths for applying powder via laparoscopic ports. The bellows mechanism lets surgeons deposit powder accurately without blocking the field of view.
Key Considerations for Optimal Use
• Orientation: How you hold the device (vertically or horizontally) influences powder distribution more than how hard you squeeze
• Powder Properties: The grain size and flowability, plus moisture sensitivity, impact delivery
• Operator Technique: Delivery efficiency varies based on how quickly and forcefully the bellows are compressed [5]
Real-World Applications of Endoscopic Powder
In surgical settings where access is limited or structures are delicate, endoscopic powder proves invaluable. Because of its conformability, surgeons can treat both broad raw surfaces and deep crevices with ease.
Common Uses Include:
• Laparoscopic liver resections
• Thoracic surgery procedures
• Laparoscopic gynaecologic interventions
• Endoscopic procedures like ESD
• Urological surgeries
By enhancing visibility and enabling faster bleeding control, endoscopic haemostats can shorten operative time, reduce the need for blood products, and contribute to better surgical outcomes [6].
ORC Powder: Efficacy and Safety in Studies
A clinical study of SURGICEL® Powder (an ORC-based agent) on 103 patients revealed:
• 87.4% haemostasis at 5 minutes, rising to 92.2% at 10 minutes
• Strong performance in open and minimally invasive settings
• No complications linked to the product: no rebleeding, clots, or negative reactions
• Surgeons rated it highly effective and easy to use, with precise powder delivery and minimal need for additional intervention [3]
This evidence supports the safety, efficiency, and flexibility of SURGICEL® Powder for difficult bleeding scenarios.
Conclusion
With minimally invasive surgery on the rise, there’s a growing need for innovative bleeding control solutions. Endoscopic powder, particularly ORC-based formulations, stands out as a reliable, fast-acting, and surgeon-friendly solution for bleeding control.
No matter the complexity—be it confined spaces, delicate organs, or irregular wounds—ORC endoscopic powder ensures safe, effective bleeding control for today’s surgical demands.
References
1. Zhang Y, Song D, Huang H, Liang Z, Liu H, Huang Y, Zhong C, Ye G. Minimally invasive hemostatic materials: tackling a dilemma of fluidity and adhesion by photopolymerization in situ. Scientific Reports. 2017 Nov 10;7(1):15250.
2. De la Torre RA, Bachman SL, Wheeler AA, Bartow KN, Scott JS. Hemostasis and hemostatic agents in minimally invasive surgery. Surgery. 2007 Oct 1;142(4):S39-45.
3. 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. Clinical and Applied Thrombosis/Hemostasis. 2023 Jul;29:10760296231190376.
4. Xiao X, Wu Z. Endoscopic Powder A narrative review of different hemostatic materials in emergency treatment of trauma. Emerg Med Int. 2022;2022: 6023261
5. Stark M, Wang AY, Corrigan B, Woldu HG, Azizighannad S, Cipolla G, Kocharian R, De Leon H. Comparative analyses of the hemostatic efficacy and surgical device performance of powdered oxidized regenerated cellulose and starch-based powder formulations. Research and Practice in Thrombosis and Haemostasis. 2025 Jan 1;9(1):102668.
6. Bustamante-Balén M, Plumé G. Role of hemostatic powders in the endoscopic management of gastrointestinal bleeding. World Journal of Gastrointestinal Pathophysiology. 2014 Aug 15;5(3):284.