Endoscopic Powder: A Game-Changer in Haemostasis for Minimally Invasive Surgery
The ability to achieve reliable haemostasis is vital in every surgical setting. It not only limits blood loss during surgery but also lowers risks of transfusion and complications after the procedure. 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.
As more procedures move toward minimally invasive methods, there’s a greater demand for flexible, effective bleeding control solutions when traditional methods aren’t enough.
Challenges of Haemostasis in Minimally Invasive Surgery
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. 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
• 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. Its adaptability allows direct application to large, raw surfaces or narrow anatomical crevices.
Common Uses Include:
• Minimally invasive liver surgeries
• Cardiothoracic MIS cases
• 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].
Clinical Evidence: Proven Performance of ORC Powder
Research on SURGICEL® Powder in 103 surgical patients found:
• Hemostasis was achieved in 87.4% of cases at 5 minutes, and 92.2% at 10 minutes
• Effective in both open and MIS procedures
• No product-related complications—no rebleeding, thromboembolism, or adverse reactions
• Surgeons noted its ease of use, accuracy, and minimal need for extra measures
Overall, the data shows SURGICEL® Powder as a safe, effective, and adaptable haemostatic agent—especially when conventional tools aren’t enough.
Final Thoughts
As MIS continues to evolve, so does the demand for advanced haemostatic tools. ORC-based endoscopic powders offer surgeons rapid, flexible, and reliable bleeding control options.
Whether you're managing bleeding in a deep pelvic space, a raw liver surface, or a narrow endoscopic field, ORC endoscopic powder delivers the performance and flexibility modern surgery requires—safely and effectively.
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 Endoscopic Powder 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.