2019 SCIENCELINE  
Journal of Life Science and Biomedicine  
J Life Sci Biomed, 9 (2): 45-51, 2019  
License: CC BY 4.0  
ISSN 2251-9939  
Geprotsel, biocompatible implant: comparative  
estimation of its application results for providing  
airstasis and hemostasis in the lung surgery  
Shukhrat Nurmatovich Khudaybergenov, Otabek Djurayevich Eshonkhodjaev, and Mukhabbat  
Kuralbayevna Khalmuratova   
Republican Specialized Research Centre of Surgery named after academician V.Vakhidov, Tashkent, Uzbekistan  
Corresponding author’s Email: sh.u.matkarimov@gmail.com  
ABSTRACT  
Original Article  
PII: S225199391900008-9  
Introduction. In surgery, the prevention of postoperative complications has always been and  
remains relevant. One of the most important components that contribute to reducing the  
number of complications, in addition to effective drainage, restoration of muscle tone and  
Rec.  
Rev.  
Pub.  
27 January 2018  
05 March 2019  
25 March 2019  
adequate breathing, is reliable aerostasis and hemostasis. When performing operations on  
the lungs against the background of the presence in patients of factors affecting the  
incidence of failure in aero- and hemostasis (COPD, emphysema), the risk of developing  
these complications can reach 11.8% after lobectomy, after wedge-shaped resections up to  
9.1% and after decortication up to 33.3%, which is 14.7% for all operations in general  
(violation of aerostasis - 5.9% and hemostasis - 8.8%.  
Aim. The aim of study was to investigate the effectiveness of the proposed domestic implant  
“Geprocel” in the treatment and prevention of disorders of aero- and hemostasis during  
pulmonary operations.  
Keywords  
Aerostasis,  
Hemostasis,  
Collagen,  
Methods. The study included 69 patients operated in the department of surgery of the Lung  
and Mediastinum of the "Republican Specialized Scientific and Practical Medical Center of Oxidized cellulose,  
Surgery named after Academician V. Vakhidov" State Institution for the period from 2015 to  
June 2018. Hemostatic implant in the form of a fine powder was developed at RSRCS named  
after acad. V. Vakhidov”. Geprotsel consists of the following components: the sodium salt of  
carboxymethyl cellulose, oxidized cellulose and nanocellulose associated with calcium ions  
(Patent No. IAP 20160273), in accordance with requirements of ISO 10993-1-2011.  
Biodegradable implant,  
Geprotsel,  
Heprocel,  
Pulmonary operations  
Results. The use of the Heprotsel biological implant reduced the need for additional single  
lung tissue flashing to ensure adequate aero- and hemostasis from 38.2% to 11.4% and  
multiple reinforcement with sutures from 29.4% to 5.7% (χ2 = 7.706; Df = 2; P = 0.021).  
INTRODUCTION  
The issues of postoperative complications still remain actual for the surgery. As it is known, the main  
predetermining moment in the prophylaxis of respiratory disorders and prevention of infectious complications  
at the thoracic surgeries is a quick and a complete spread of lung in the postoperative period. A reliable airstasis  
and hemostasis besides effective drainage, recovery of muscular tonus and adequate respiration are very  
important promoting factors [1-2].  
The absence of persistent airstasis leads to: an incomplete spread of lung, a pneumothorax with a  
formation of residual cavities, the development of empyema and bronchial fistulas. Theses complications  
together with the infection become a main cause of progressing respiratory and cardiac failures leading to the  
lethal outcomes [3-4].  
Unconvincing intraoperative air- and hemostasis and complications force sometimes to increase the scope  
of surgery; seal failure of the pleural cavity in the early postoperative period in some cases serves as indication  
for the rethoracotomy and the extension of surgery scope due to the remained lung lobes [5].  
The problems connected with air- and hemostasis are one the most often occurred in the lung surgery. A  
variety of methods for solving them have been offered, but the majority of them are characterized by the prime  
cost of the used material. So, the development of domestic materials for their use at different surgical  
interventions, particularly in the lung surgery is an actual issue of health care. In our previous researches, we  
To cite this paper: Khudaybergenov ShN, Eshonkhodjaev OD, and Khalmuratova MK (2019). Geprotsel, biocompatible implant: comparative estimation of its  
application results for providing airstasis and hemostasis in the lung surgery. J. Life Sci. Biomed. 9(2): 45-51; www.jlsb.science-line.com  
45  
proved the efficiency of proposed biodegradable polycomposite implant with oxidized cellulose – “Geprotsel”  
with air- and hemostatic aim at lung surgeries. Subject to the positive results of experimental investigations the  
next stage for the biological implant efficiency were clinical trials.  
Polymer implants are increasingly used in medicine. Cellulose derivates are non-toxic, have good  
biocompatibility and provide tremendous opportunities for medical application. Oxidized cellulose is a very  
interesting material for biomedical research, due to its degradation in human body, hemostatic and  
antibacterial properties [6]. Collagen-based hemostatic agents have relatively low hemostatic activity in a wet  
environment, in systemic coagulopathies and thromboblastemia, infection risk. Collagen tends to lose the  
hemostatic capacity after autoclaving, which limits the application [7]. Oxidized cellulose is widely used in  
surgery for the treatment of skin lesions, long-term chronic wounds, liver, kidney resection, etc. Oxidized  
cellulose is insoluble in water, has a fibrous structure and high mechanical strength [8-10].  
Therefore, the objective of the clinical study was to evaluate the effectiveness of Geprocel, a new domestic  
implant, in the treatment and prevention of disorders of aero- and hemostasis failures at lung surgeries.  
MATERIAL AND METHODS  
Hemostatic implant in the form of a fine powder was developed at RSRCS named after acad. V. Vakhidov”.  
Geprotsel consists of the following components: the sodium salt of carboxymethyl cellulose, oxidized cellulose  
and nanocellulose associated with calcium ions (Patent No. IAP 20160273), in accordance with requirements of  
ISO 10993-1-2011.  
A total of 69 patients operated at the department of lungs and mediastinum surgery of the Republican  
Specialized Research Centre of Surgery between 20015 and June, 2018 were included into this part of  
investigation.  
All those patients had the risk development connected with air- and hemostasis both in intra-operative  
and in the postoperative periods. There were 35 patients in the main group (2017-2018) after resection phase or  
the lung parenchyma injury at the discharge from commissures. “Geprotsel” film has been applied over the  
defect of lung tissue for providing air- and hemostasis. 34 patients (2015-2017) were included into the group of  
comparison (comparable by age, sex, pathology, type of surgery and other objective criteria of contrastive  
analysis homogeneity).  
Surgical procedure  
The upper-midline laparotomy was performed under inhalation anesthesia (5% isoflurane). During the  
surgery, anesthesia was maintained by inhalation of 2- 2.5% isoflurane. The flat liver wounds of approximately 1  
cm in diameter and 0.1 cm in depth were formed. Thus active parenchymal bleeding was stimulated (Figure 1).  
After suction, the hemostatic powder Heprocel was applied on the bleeding liver surface in Heprocel group. The  
control was treated only with standard gauze.  
Ethical approval  
The review board and ethics committee of RSCS named after acad. V.Vakhidov approved the study  
protocol and informed consents were taken from all the participants.  
Statistical analysis  
The obtained results were subjected to the statistical processing with the using the standard package of  
Microsoft Excel 2010 software by the method of variation statistics with the estimation of indexes’ values  
(M±m).  
RESULTS  
The groups for comparison were representative by all main indices. In all cases during the intervention we  
noted the occurrence of injured part of pulmonary tissue parenchyma the form of which is depended on the resection  
type (organ lobe or its part) and also on the injury level during the discharge from commissures (echinococcectomy,  
decortications). Hemostasis in the area of pulmonary tissue injury (after acute resection at lobectomy or hardware  
wedge-shaped resection) was primary estimated after performing the main stage of surgery. In the comparison  
group we used standard methods for hemostasis achievement (tamponade, diathermo-coagulation, thermal effect).  
To cite this paper: Khudaybergenov ShN, Eshonkhodjaev OD, and Khalmuratova MK (2019). Geprotsel, biocompatible implant: comparative estimation of its  
application results for providing airstasis and hemostasis in the lung surgery. J. Life Sci. Biomed. 9(2): 45-51; www.jlsb.science-line.com  
46  
At the absence of the effect we conducted a sewing of bleeding area. In the main group “Geprotsel” film was initially  
used for this aim – it was glue on the injured area with a fixation and a combined estimation of air- and  
hemostasis efficiency. Then we estimated hermeticity by conducting the test for airstasis. In the comparison group  
at the occurrence of air intake from organ parenchyma we also performed a fixation by additional sewing.  
After performing the main stage of the surgery in 13 (37.1%) cases of the main group and in 12 (35,3%) cases  
of the comparison group there was noted non- intensive capillary bleeding from the injured part of pulmonary  
tissue. In the comparison group after using standard hemostatic procedures and estimation of airstasis  
efficiency in 13 (38.2%) cases we conducted the sewing of parenchyma defect and in 6 (17.6%) and in 4 (11.8%)  
patients the problem with air- and hemostasis was kept respectively. That is why they were undergone a  
recurrent sewing (10 – 29.4% cases). Hemorrhagic discharge through the drainage was determined in 3(8,8%)  
patients in the postoperative period and they were required additional hemostatic procedures. In other 2 (5.9%)  
patients we observed airstasis failure after surgery. We achieved positive clinical effect in the problem cases  
with both hemostasis and airstasis, but it influenced on the duration of pleural cavity drainage and then in 2  
(5.9%) cases led to the development of the acute pleural empyema (Table 1).  
Table 1. The frequency of intraoperative hemostasis and airstasis failures after anatomical or atypical resection  
of lung and additional sewing  
Main group  
Comparison group  
Index  
abs.  
%
abs.  
17  
12  
5
%
Intra-operative failures after resection  
Hemostasis failure  
18  
13  
5
51.4%  
37.1%  
14.3%  
11.4%  
2.9%  
2.9%  
5.7%  
5.7%  
0.0%  
0.0%  
0.0%  
50.0%  
35.3%  
14.7%  
38.2%  
17.6%  
11.8%  
29.4%  
29.4%  
8.8%  
Airstasis failure  
Additional sutures on the lung tissue  
Hemostasis failure  
4
1
13  
6
Airstasis failure  
1
4
Total  
2
10  
10  
3
Recurrent sewing of the lung tissue  
Hemostasis failure (after surgery)  
Airstasis failure (after surgery)  
Total  
2
0
0
0
2
5.9%  
5
14.7%  
Additional sutures on the lung tissue were required only in 4 (11.4%) cases in the main group after which they  
were kept only in 2 patients and then they were eliminated by recurrent fixation of sutures. There were no such  
complications in the postoperative period. It should be mentioned that after using the “Geprotsel” film we achieved  
an absolute air-and hemostasis in majority of cases and only in 4 (11.4%) patients we performed a recurrent sewing  
of the area with bleeding or affected airstasis. The problem with hemostasis or airstasis with the help of proposed  
biologic method, by our view, was connected with uneven surface of the injured area after lobectomy (2 cases),  
hardware sewing for wedge-shaped resection of peripheral benign tumor (neurofibroma - 1 case) and decortications  
(1 case). The applied film in those cases was not able to provide a complete hermiticity due to the tuberous surface of  
the defect – this area was additionally sewed and absolute hemostasis was achieved. The positive side of those cases  
is the fact that a biological material used for producing the “Geprotsel” film was used for getting another form of  
the implant – in the form of powder with analogous high adhesive properties providing an effective air- and  
hemostasis at application on small (up to 2-3 cm) uneven defect of pulmonary tissue parenchyma.  
After singular application of fixing sutures on the pulmonary tissue the problems with airstasis were kept in 4  
(11.8%) patients of the comparison group and only in1 (2.9%) patient of the main group. The problems with  
hemostasis were kept in 17.6% (6) and 2.9% (1) cases respectively (criterion χ2=8.522; Df=3; P=0.047). In spite of  
the fact that additional fixing sutures had solved those problems, we noted airstasis failure in 2 (5.9%) cases and  
hemostasis failure in 3 (8.8%) patients of the comparison group in the postoperative period and in the whole it  
led to the development of these complications in 5 (14.7%) cases. The use of the “Geprotsel” film allowed to level  
completely the development risk of these complications in the postoperative period (criterion χ2=9.107; Df=3;  
P=0.036). Subject to all intra- and postoperative failures of air- and hemostasis we reduced these complications  
indices in the main group from 44.1% (15 – comparison group; hemostasis - 9 (26.5%); airstasis - 6 (17.6%)) to 5.7%  
(2 – main group; 1 (2.9%) air-and hemostasis failures) (criterion χ2=14.727; Df=3; P=0.003).  
To cite this paper: Khudaybergenov ShN, Eshonkhodjaev OD, and Khalmuratova MK (2019). Geprotsel, biocompatible implant: comparative estimation of its  
application results for providing airstasis and hemostasis in the lung surgery. J. Life Sci. Biomed. 9(2): 45-51; www.jlsb.science-line.com  
47  
The necessity of achieving absolute air-and hemostasis was effected on the both duration of this stage and of  
surgery in the whole. The use of the “Geprotsel” film after surgery’s main stage for leveling the complications  
development allowed to reduce the period for achieving air- and hemostasis from 32.8±2.5 minutes in the  
comparison group up to 12.5±1.2 minutes in the main group (Т-criterion – 7.32; P<0.001). General duration of the  
surgery was reduced from 135.6±6.1 minutes т (comparison group) up to 107.2±4.7 minutes (Т-criterion – 3.69;  
P<0.001) (Figure 1).  
The complications development connected with air- and hemostasis failure in the postoperative period  
influenced on the duration of pleural cavity drainage. After 2-3 days the drain was removed in 97.1% (34  
patients) in the main group and in 88.2% (31 patients) in the comparison group. After 4 days in 1 patient with  
airstasis failure of the main group the drain was also removed after its relief.  
In 4 (11.8%) patients of the comparison group it was required a long term drainage with the drain removal  
after 5 days in 1 (2.9%) case, after 6-10 days in 2 (5.9%) cases and in 1 (2,9%) case the patient was discharged due  
to the development of acute empyema with further removal of the drain only at the achieving the complication  
regress after 33 days (Table 2).  
Т-criterion – 3.69;  
180  
150  
120  
90  
core group comparison group  
P<0.001  
135.6  
107.2  
Т-criterion – 7.32;  
P<0.001  
60  
32.8  
12.5  
30  
0
The period of achievement of aero- and hemostasis The duration of the operation  
Figure 1. Average duration (minutes) of air- and hemostasis achieving period and the whole operative  
intervention  
Table 2. The period of drain removal  
Main group  
Comparison group  
Total  
Complication  
abs.  
%
abs.  
29  
1
%
abs.  
62  
2
%
After 2 days  
33  
1
94.3%  
2.9%  
2.9%  
0.0%  
0.0%  
100%  
85.3%  
2.9%  
2.9%  
5.9%  
2.9%  
100%  
89.9%  
2.9%  
2.9%  
2.9%  
1.4%  
After 3 days  
After 4-5 days  
After 6-10 days  
Discharged with drain  
Total  
1
1
2
0
2
2
0
1
1
35  
34  
69  
100%  
At the mean data comparison of the pleural cavity drainage duration we noted a significant reduce of this  
index from 3.38±0.31 days in the comparison group up to 2.09±0.06 days in the main group (T-criterion – 4.09;  
P<0.001). The duration of the postoperative period on the background of intra-operative use of biological  
implant for air- and hemostasis reduced from 9.8±0.4 days up to 8.2±0.2 days (T-criterion – 3.58; P<0.01). The  
whole hospital stay was also significantly reduced from 12.1±0.4 days up to 10.7±0.2 days (T-criterion – 3.13;  
P<0.01). Summarizing the course of the postoperative period the following can be mentioned: intra-operative  
use of the domestic biological implant at the lung surgeries allowed to completely level the risk of air- and  
hemostasis failures in the postoperative period. In 3 (8.8%) cases of the comparison group we registered  
hemostasis failure and 2 (5.9%) cases of airstasis failure. The necessity in the additional fixing of sutures lines or  
defect zone of lung parenchyma after lobectomy in 1 case and in 1 case of decortications led to the significant  
deformation of adjacent organ tissue and in its turn it led to the development of the syndrome of the lung low volume  
- 5.9% (Table 3).  
To cite this paper: Khudaybergenov ShN, Eshonkhodjaev OD, and Khalmuratova MK (2019). Geprotsel, biocompatible implant: comparative estimation of its  
application results for providing airstasis and hemostasis in the lung surgery. J. Life Sci. Biomed. 9(2): 45-51; www.jlsb.science-line.com  
48  
This complication was noted only in 1 (2.9%) case of the main group. In other 2 (5.9%) cases of the  
comparison group on the background of long term drainage with airstasis failure and in 1 patient with low  
volume of the lung the acute pleural empyema was developed which was solved conservatively. The general  
frequency of complications in both groups reduced from 14.7% (5 patients in the comparison group) up to 2.9% (1  
patient in the main group) (significance of differences by χ2: 8.737; Df=5; P=0.043). There rate of complications  
frequency affected on the hospital stay duration. In proper time, 7-9 days after the surgery 88.6% (31 patients) of  
the main group and 67.6% (23 patients) of the comparison group were discharged. A prolonged hospital stay was  
required to 4 (11.4%) and 11 (32.4%) patients respectively (Table 4). Hereby, the implementation of domestic  
biological implant into the clinical practice at performing lung surgeries allowed to completely level the risk of  
postoperative failures of air- and hemostasis development, to reduce the general frequency of complications from  
14.7% up to 2.9% (χ2= 8.737; P=0.043) and the necessity of prolonged hospital stay from 32.4% up to 11.4%.  
Table 3. Complications frequency in the postoperative period  
Main group  
Comparison group  
Complication  
abs.  
%
abs.  
3
%
Hemostasis failure  
0
0
1
0.0%  
0.0%  
2.9%  
0.0%  
2.9%  
8.8%  
5.9%  
5.9%  
5.9%  
14.7%  
Airstasis failure  
2
Low volume of the lung  
Acute pleural empyema  
Total  
2
0
1
2
5
Significance of differences ( χ2 criterion)  
8.737; Df=5; P=0.043  
Table 6. The frequency of prolonged hospital stays in the postoperative period  
Main group  
Comparison group  
Complication  
abs.  
31  
%
abs.  
23  
%
Discharged in standard period (after 7-9 days)  
88.6%  
11.4%  
100%  
67.6%  
32.4%  
100%  
Prolonged hospital stay  
Total  
4
11  
35  
34  
DISCUSSION  
In surgery, the prevention of postoperative complications has always been and remains relevant. In thoracic  
operations, it is known that the leading determining factor in the prevention of respiratory disorders and the  
prevention of infectious complications is the fastest and most complete smoothing of the lung in the  
postoperative period. One of the most important components contributing to this, in addition to effective  
drainage, restoration of muscle tone and adequate breathing, is reliable aerostasis and hemostasis.  
In a study by Wain et al. [11] showed that a violation of the tightness of the lung suture intraoperatively  
occurs in 70% of cases. According to the European Society of Thoracic Surgeons (ESTS), the incidence of long-  
term aerostasis failure after marginal resection of the lung and lobectomy is 3.5% and 8.3%, respectively [12].  
Long-term failure of aerostasis is always associated with the need for prolonged drainage of the pleural cavity,  
an increase in the duration of inpatient treatment, and an increased risk of developing infectious complications.  
The European Society of Thoracic Surgeons defines the failure of aerostasis as prolonged with air discharge for  
5 days or more after surgery. Brunelli et al. [13, 14] in studies on the risk factors for leakage of the seam of the  
lung, they also determine long-term failure of aerostasis for a period of 7 days or more.  
Modern approaches in the prevention of postoperative complications associated with lack of aero- and  
hemostasis in the literature are based on the use of new technologies to strengthen the bronchial suture.  
Nevertheless, the literature data on the effectiveness of the use of various patches are contradictory in many  
respects. Along with the use of traditional materials, there is an active search and development of materials  
based on bio-base.  
The most promising means of biological hemostasis are fibrin polymers. Their main advantage is that they  
completely consist of biological blood components and, when applied to the damaged area, imitate the  
physiological mechanism of hemostasis. However, fibrin compositions are usually two-component and are  
To cite this paper: Khudaybergenov ShN, Eshonkhodjaev OD, and Khalmuratova MK (2019). Geprotsel, biocompatible implant: comparative estimation of its  
application results for providing airstasis and hemostasis in the lung surgery. J. Life Sci. Biomed. 9(2): 45-51; www.jlsb.science-line.com  
49  
applied to tissues with the help of injection needles, nebulizers, catheters. Moreover, two-spray applicators are  
used, which creates certain difficulties in their use in thoracic surgery.  
Long-term use of cellulose in the form of a dressing material is experiencing a new period of using its  
derivatives, which, depending on the type and degree of polymerization, can be widely used in surgery as an  
independent active principle as a bioinert non-toxic biodegradable implant with certain physical and chemical  
properties as well as medical properties.  
CONCLUSION  
The issues of prevention and treatment of air- and hemostasis failure still remain actual in the modern lung  
surgery. It is especially actual for those patients who have chronic obstructive lung disease, emphysematous  
injuries and other concomitant diseases of respiratory system. During the lung surgeries in patients with  
chronic obstructive lung disease, emphysema the risk of these complications development can reach up to 11.8%  
after lobectomy, after wedge-shaped resections – up to 9.1% and after decortications – up to 33.3%. In whole by  
all surgeries it makes up 14.7% (airstasis failure – 5.9% and hemostasis failure - 8,8%). The use of the “Geprotsel”  
biological implant allowed to reduce a necessity of the additional single sewing of the pulmonary tissue for  
providing air- and hemostasis from 38.2% up to 11.4% and multiple fixing by sutures from 29.4% up to 5.7% (χ2=  
7.706; Df=2; P=0.021).  
DECLARATIONS  
Acknowledgements  
This work was supported by “Republican Specialized Scientific and Practical Medical Center of Surgery  
named after Academician V.Vakhidov”, Uzbekistan.  
Authors’ contributions  
All authors contributed equally to this work.  
Competing interests  
The authors declare that they have no competing interests.  
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application results for providing airstasis and hemostasis in the lung surgery. J. Life Sci. Biomed. 9(2): 45-51; www.jlsb.science-line.com  
51