Title: Effectiveness of a Thrombin-gelatin Flowable for treating severe liver bleeding: An
experimental study
Version: 3 Date: 29 Nov 2023
Reviewer's report:
Dr. Sanchez del Valle and co-authors present have submitted a revised manuscript based on the
comments of the three reviewers. The submission could be improved by:
1. Clarifying if the surgeons were blinded to the treatment group until after the liver injury was
created. If the surgeons were not blinded through the performance of the injury to the liver, how
was bias in performance of the injury avoided?
2. Further clarification of the time of pressure application would be helpful. The authors state that
the manufacturer’s instructions were followed. This does not seem accurate as the manufacturers
recommend two minutes of pressure application after product application and that reapplication
of product can be repeated followed by pressure as necessary if hemostasis is not achieved after
the initial two minutes of pressure. Did the authors check at two minutes to see if hemostasis was
achieved? How was the 12 minute time for pressure chosen? Please clarify why the extended
pressure application time not suggested by the manufacturer was not added to the application
time for both the flowable and the control agent.
Title: Effectiveness of a Thrombin-gelatin Flowable for treating severe liver bleeding: An
experimental study
Version: 3 Date: 29 Nov 2023
Reviewer's report:
Dr. Sanchez del Valle and co-authors present have submitted a revised manuscript based on the
comments of the three reviewers. The submission could be improved by:
1. Clarifying if the surgeons were blinded to the treatment group until after the liver injury was
created. If the surgeons were not blinded through the performance of the injury to the liver, how
was bias in performance of the injury avoided?
2. Further clarification of the time of pressure application would be helpful. The authors state that
the manufacturer’s instructions were followed. This does not seem accurate as the manufacturers
recommend two minutes of pressure application after product application and that reapplication
of product can be repeated followed by pressure as necessary if hemostasis is not achieved after
the initial two minutes of pressure. Did the authors check at two minutes to see if hemostasis was
achieved? How was the 12 minute time for pressure chosen? Please clarify why the extended
pressure application time not suggested by the manufacturer was not added to the application
time for both the flowable and the control agent.
Please review this paper.
user
Title: Effectiveness of a Thrombin-gelatin Flowable for treating severe liver bleeding: An
experimental study
Version: 3 Date: 29 Nov 2023
Reviewer's report:
Dr. Sanchez del Valle and co-authors present have submitted a revised manuscript based on the
comments of the three reviewers. The submission could be improved by:
1. Clarifying if the surgeons were blinded to the treatment group until after the liver injury was
created. If the surgeons were not blinded through the performance of the injury to the liver, how
was bias in performance of the injury avoided?
2. Further clarification of the time of pressure application would be helpful. The authors state that
the manufacturer’s instructions were followed. This does not seem accurate as the manufacturers
recommend two minutes of pressure application after product application and that reapplication
of product can be repeated followed by pressure as necessary if hemostasis is not achieved after
the initial two minutes of pressure. Did the authors check at two minutes to see if hemostasis was
achieved? How was the 12 minute time for pressure chosen? Please clarify why the extended
pressure application time not suggested by the manufacturer was not added to the application
time for both the flowable and the control agent.
assistant