Endoscopic Powder for Haemostasis: A Breakthrough in Minimally Invasive Surgery

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. These positive factors, however, increase the complexity of haemostasis. 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. Here, topical haemostats such as endoscopic powders become essential, helping to control bleeding and improve surgical efficiency.

 

 

Spotlight on Surgi-ORC®-Based Endoscopic Powder

Among haemostatic powders, plant-based, absorbable types like Surgi-ORC® have demonstrated both safety and effectiveness. Introduced decades ago as a sheet, oxidized regenerated cellulose (ORC) is now available in powder form for today’s MIS challenges.

 

 

Key Benefits of Surgi-ORC® Endoscopic Powder

• Fast Bleeding Control: ORC speeds up clotting by promoting platelet adhesion
• Shape Plasticity: The granular structure of powdered haemostats and their shape plasticity allows them to conform easily to large and deep surface wounds
• Plant-Based Safety: Free from animal or human components, it reduces risks of immune reactions and disease transmission
• Antibacterial Environment: The oxidation process lowers pH, creating an acidic microenvironment that offers bactericidal benefits
• Fully Absorbable: Powder dissolves safely, posing no harm to 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.

 

 

Precision Application: Endoscopic Powder Delivery Devices

The delivery method is a critical yet often overlooked factor in a powder’s haemostatic performance. In MIS, bellows pump-based applicators are widely used to deliver endoscopic powder with accuracy and control.

 

 

Operation of Endoscopic Powder Applicators

These applicators—resembling syringe-like devices—are equipped with short or long applicator tips designed to deliver the powder through laparoscopic ports or trocars. Compressing the bellows dispenses a controlled amount of powder right onto the bleed, maintaining clear visibility.

 

 

Maximizing Effectiveness: Usage Tips

• 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.

Common Uses Include:

• Minimally invasive liver surgeries
• Thoracic surgery procedures
• Laparoscopic gynaecologic interventions
• Endoscopic submucosal dissections (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]

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 Endoscopic Powder 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. 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.