Title: Effectiveness of a Thrombin-gelatin Flowable for treating severe liver bleeding: An
experimental study
Version: 2 Date: 27 Oct 2023
Reviewer's report:
The authors have conducted an experimental study on hemostasis in liver injury comparing
hepa=c packing as standard procedure versus Floseal applica=on as the hemosta=c method. A
swine model with 20 animals was used. Twelve animals were in the standard group and 8 in
the Floseal group.
The manuscript is easily understandable and the criteria of the trial are clearly described. The
contents and the goal of the study are important and the methods used and the results achieved
are worthwhile of being published.
Nevertheless, there are several points that need the aIen=on of the authors to improve the quality
of the manuscript.
- In the introduc=on sec=on of the paper the authors start with a descrip=on of the possible
difficul=es of hemostasis in elec=ve liver surgery and compare this to hemostasis in liver trauma.
Hemostasis in both elec=ve liver surgery and severe liver trauma are significantly different. In
severe liver trauma the pa=ents are cold, acido=c and have impaired coagula=on - they need
prompt aIen=on and effec=ve hemostasis that will be mostly established by adequate packing
within a damage control concept. This important factor is not the case in an elec=ve seQng. The
authors’ seQng in this trial is equivalent to elec=ve liver surgery. Although the lessons of this
trial can be perfectly adapted to the situa=on of severely injured pa=ents with ac=vely bleeding
liver lacera=on, the trial itself is a unique mixture of an elec=ve surgical seQng and a therapeu=c
approach to “packing” that will predominantly be used in trauma. In the introduc=on of the
manuscript, these circumstances should be clearly outlined.
- The only exclusion criteria: “Animals in which one of the suprahepatic veins had not been
selectively injured were excluded from the study” is not clearly understandable. The authors
should re-write this sentence and clarify the probable reasons why an animal did not qualify.
How many animals were used to perform the trial in 20 animals? Were there some that
unexpectedly died before, during or after intubation or during the surgery?
- The randomiza=on process is not clearly described. The authors do not state at which =mepoint
the randomiza=on was made - before or during surgery- and if during the surgery, at which stage?
- The descrip=on of the experimental model should also include the age, weight and gender of
the animals.
- During the follow-up at 12, 60 and 120 minutes were only one or two packs removed from
over the injuries or all 10 pads? The authors should clarify if there were differences at different
=mepoints, which pads were removed first and why, if all pads were removed at each =mepoint.
Title: Effectiveness of a Thrombin-gelatin Flowable for treating severe liver bleeding: An
experimental study
Version: 2 Date: 27 Oct 2023
Reviewer's report:
The authors have conducted an experimental study on hemostasis in liver injury comparing
hepa=c packing as standard procedure versus Floseal applica=on as the hemosta=c method. A
swine model with 20 animals was used. Twelve animals were in the standard group and 8 in
the Floseal group.
The manuscript is easily understandable and the criteria of the trial are clearly described. The
contents and the goal of the study are important and the methods used and the results achieved
are worthwhile of being published.
Nevertheless, there are several points that need the aIen=on of the authors to improve the quality
of the manuscript.
- In the introduc=on sec=on of the paper the authors start with a descrip=on of the possible
difficul=es of hemostasis in elec=ve liver surgery and compare this to hemostasis in liver trauma.
Hemostasis in both elec=ve liver surgery and severe liver trauma are significantly different. In
severe liver trauma the pa=ents are cold, acido=c and have impaired coagula=on - they need
prompt aIen=on and effec=ve hemostasis that will be mostly established by adequate packing
within a damage control concept. This important factor is not the case in an elec=ve seQng. The
authors’ seQng in this trial is equivalent to elec=ve liver surgery. Although the lessons of this
trial can be perfectly adapted to the situa=on of severely injured pa=ents with ac=vely bleeding
liver lacera=on, the trial itself is a unique mixture of an elec=ve surgical seQng and a therapeu=c
approach to “packing” that will predominantly be used in trauma. In the introduc=on of the
manuscript, these circumstances should be clearly outlined.
- The only exclusion criteria: “Animals in which one of the suprahepatic veins had not been
selectively injured were excluded from the study” is not clearly understandable. The authors
should re-write this sentence and clarify the probable reasons why an animal did not qualify.
How many animals were used to perform the trial in 20 animals? Were there some that
unexpectedly died before, during or after intubation or during the surgery?
- The randomiza=on process is not clearly described. The authors do not state at which =mepoint
the randomiza=on was made - before or during surgery- and if during the surgery, at which stage?
- The descrip=on of the experimental model should also include the age, weight and gender of
the animals.
- During the follow-up at 12, 60 and 120 minutes were only one or two packs removed from
over the injuries or all 10 pads? The authors should clarify if there were differences at different
=mepoints, which pads were removed first and why, if all pads were removed at each =mepoint.
Please review this paper.
user
Title: Effectiveness of a Thrombin-gelatin Flowable for treating severe liver bleeding: An
experimental study
Version: 2 Date: 27 Oct 2023
Reviewer's report:
The authors have conducted an experimental study on hemostasis in liver injury comparing
hepa=c packing as standard procedure versus Floseal applica=on as the hemosta=c method. A
swine model with 20 animals was used. Twelve animals were in the standard group and 8 in
the Floseal group.
The manuscript is easily understandable and the criteria of the trial are clearly described. The
contents and the goal of the study are important and the methods used and the results achieved
are worthwhile of being published.
Nevertheless, there are several points that need the aIen=on of the authors to improve the quality
of the manuscript.
- In the introduc=on sec=on of the paper the authors start with a descrip=on of the possible
difficul=es of hemostasis in elec=ve liver surgery and compare this to hemostasis in liver trauma.
Hemostasis in both elec=ve liver surgery and severe liver trauma are significantly different. In
severe liver trauma the pa=ents are cold, acido=c and have impaired coagula=on - they need
prompt aIen=on and effec=ve hemostasis that will be mostly established by adequate packing
within a damage control concept. This important factor is not the case in an elec=ve seQng. The
authors’ seQng in this trial is equivalent to elec=ve liver surgery. Although the lessons of this
trial can be perfectly adapted to the situa=on of severely injured pa=ents with ac=vely bleeding
liver lacera=on, the trial itself is a unique mixture of an elec=ve surgical seQng and a therapeu=c
approach to “packing” that will predominantly be used in trauma. In the introduc=on of the
manuscript, these circumstances should be clearly outlined.
- The only exclusion criteria: “Animals in which one of the suprahepatic veins had not been
selectively injured were excluded from the study” is not clearly understandable. The authors
should re-write this sentence and clarify the probable reasons why an animal did not qualify.
How many animals were used to perform the trial in 20 animals? Were there some that
unexpectedly died before, during or after intubation or during the surgery?
- The randomiza=on process is not clearly described. The authors do not state at which =mepoint
the randomiza=on was made - before or during surgery- and if during the surgery, at which stage?
- The descrip=on of the experimental model should also include the age, weight and gender of
the animals.
- During the follow-up at 12, 60 and 120 minutes were only one or two packs removed from
over the injuries or all 10 pads? The authors should clarify if there were differences at different
=mepoints, which pads were removed first and why, if all pads were removed at each =mepoint.
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