Endoscopic Powder for Haemostasis: A Breakthrough in Minimally Invasive Surgery
Effective control of haemostasis is critical to the success of any surgical procedure. 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. Reduced access, poor visualisation, and no sense of touch make handling bleeding in MIS more difficult.
Conventional techniques like suturing, tying off vessels, or cauterization can be difficult to use during MIS. That’s where topical haemostatic agents, especially endoscopic powder, come into play as vital adjuncts to improve visibility, control oozing, and speed up procedures.
Understanding Surgi-ORC® Endoscopic Powder
Surgi-ORC® endoscopic powder is a standout, plant-derived, absorbable haemostat with robust clinical backing. 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
• Conformability: The powder’s granular shape adapts to wounds, covering both large and deep surfaces
• No Animal Content: Plant origin means reduced risk of allergic or infectious complications
• Bactericidal Properties: Acidic environment inhibits bacterial growth
• Biodegradable and Safe: Powder is absorbed with no toxicity, even near sensitive structures
With these properties, Surgi-ORC® endoscopic powder is perfect for mild-to-moderate bleeding, particularly from capillaries, veins, or small arteries in hard-to-reach areas.
Delivery Devices: Enhancing Precision in MIS
The choice of delivery device plays a major role in the powder’s performance during MIS. Bellows pump applicators are commonly used for precise powder placement in minimally invasive settings.
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
• Device Orientation: The angle of application (vertical/horizontal) affects how the powder spreads—often more than compression speed
• 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. Its adaptability allows direct application to large, raw surfaces or narrow anatomical crevices.
Typical Applications:
• Minimally invasive liver surgeries
• Cardiothoracic MIS cases
• Gynaecologic laparoscopic procedures
• Endoscopic submucosal dissections (ESD)
• Urologic procedures
Endoscopic powders boost surgical efficiency by speeding up haemostasis, cutting transfusion needs, and improving results.
Clinical Evidence: Proven Performance of ORC Powder
A postmarket clinical study evaluating SURGICEL® Powder (ORC-based haemostatic agent) in 103 patients undergoing various surgical procedures reported:
• 87.4% of patients had bleeding stopped in 5 minutes; 92.2% within 10 minutes
• Effective in both open and MIS procedures
• No complications such as rebleeding, thromboembolism, or side effects reported
• Surgeons found it easy to use, highly effective, and praised the precise delivery with little extra intervention needed
These findings confirm that SURGICEL® Powder is safe, efficient, and versatile, particularly for managing mild-to-moderate bleeding where traditional methods may fall short.
Summary
The future of MIS depends on effective, next-generation haemostatic agents. 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. Endoscopic Powder 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. 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.