GATT-Patch Versus SURGICEL® Original in Minimally Invasive Liver and Gallbladder Surgery

Liver Diseases Clinical Trial

Official title:

A Prospective, Multicenter, Randomized Clinical Investigation Evaluating GATT-Patch for Hemostasis During Minimally Invasive Liver and Gallbladder Surgery

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05900037
• Other study ID #: DHF-01-SP-065
• Status: Recruiting
• Phase: N/A
• Start date: October 6, 2023
• Est. completion date: December 2024

Study information

• Verified date: April 2024
• Source: GATT Technologies BV
• Contact: Stuart Head, MD PhD
• Phone: +31645306042
• Email: s.head[@]gatt-tech.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a pre-market, prospective, randomized (1:1), multicenter, pivotal clinical investigation. The purpose of this investigation is to determine the clinical performance of GATT-Patch as compared with SURGICEL® Original for the management of minimal, mild, or moderate bleeding during minimally invasive liver and gallbladder surgery.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 50
• Est. completion date: December 2024
• Est. primary completion date: June 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 22 Years and older

Eligibility

Inclusion Criteria:

• Subject is scheduled to undergo elective minimally invasive (robotic or laparoscopic) surgery on the liver, including cholecystectomy
• Subject is willing and able to give written informed consent for the clinical investigation participation
• Subjects is 22 years of age or older at the time of enrollment; and
• Subject has been informed of the nature of the clinical investigation. A subject must meet all of the following intra-operative inclusion criteria to be enrolled

into the clinical investigation:

• Subject undergoes a fully minimally invasive surgical approach without the use of a hand port at the time of randomization and application of the patch;
• Subject in whom the Investigator is able to identify a target bleeding site at the liver resection plane for which any applicable conventional means for hemostasis (e.g. suture, ligature or cautery) are ineffective or impractical, and the choice is made to use a hemostatic agent to stop the bleeding
• Pressure on the surface of the hemostatic agent can be applied with the minimally invasive instruments to achieve hemostasis
• Subject has a target bleeding site with a SBSS of 1, 2, or 3 (e.g. reflecting minimal, mild or moderate bleeding severities)

Exclusion Criteria:

• The target bleeding site is from a large defect in an artery or vein that requires vascular reconstruction with maintenance of vessel patency
• Subject is scheduled to undergo surgery on organs other than the liver and its associated biliary and vascular system
• Subject is scheduled to undergo a staged liver surgery procedure (e.g., Associating Liver Partition and Portal vein ligation for Staged hepatectomy [ALPPS])
• Subject is taking multiple antithrombotic therapies in therapeutic dosage up to the time of surgery, but allowing exclusive use of acetylsalicylic acid
• Subject has platelet count <100 x 109/L, an activated partial thrombin time of >100s, or international normalized ratio >2.5
• Subject has a total bilirubin level of =2.5 mg/dl
• Subject is pregnant, planning on becoming pregnant or actively breastfeeding during the 3-month follow-up period
• Subject has a known hypersensitivity to brilliant blue (FD&C Blue #1), porcine gelatin
• Subject who has religious objections to receiving products containing porcine
• Subject has an active or suspected infection at the bleeding site
• Subject in whom the investigational device will be used at the site of a synthetic graft or patch implant
• Subject has a life expectancy of less than 3 months
• Subject has a documented severe congenital or acquired immunodeficiency
• Subject has had or has planned to receive any organ transplantation
• Subject undergoes surgery with the indication of being a living liver donor
• Subject is currently participating or has participated in another clinical investigation within the past 30 days that may affect the endpoints of the study, such as trials related to the surgical procedure and anti-coagulation
• Subject is not appropriate for inclusion in the clinical investigation, per the medical opinion of the Investigator
• Subject has any incidental (pre- and peri-operative) findings deemed by the Investigator to potentially jeopardize the safety or welfare of the subject

Related Conditions & MeSH terms

• Blood Loss, Surgical
• Gallbladder Diseases
• Hemorrhage
• Hemorrhage, Surgical
• Intraoperative Bleeding
• Liver Diseases

Intervention

Device:
• GATT-Patch
GATT-Patch is a sterile, flexible and resorbable hemostatic sealing patch. It presents as a blue, soft, flexible, porcine gelatin fiber-based carrier impregnated with an NHS-POx / NU-POx granulate. GATT-Patch measures 10 cm long by 5 cm wide. GATT-Patch is active and can be applied on both sides. Blue color is an aid to visualize GATT-Patch when applied onto a bleeding location. GATT-Patch is indicated for use as an adjunct to hemostasis in surgery for minimal, mild or moderate bleeding sites when control of bleeding by standard surgical techniques (such as suture, ligature or cautery) is ineffective or impractical. GATT-Patch is intended to be used for management of hemorrhage during surgeries on the liver.
• SURGICEL® Original
SURGICEL® Absorbable Hemostat (oxidized regenerated cellulose) is indicated for use in surgical procedures to assist in the control of capillary, venous and small arterial hemorrhage when ligation or other conventional methods of control are impractical or ineffective.

Locations

Country	Name	City	State
United States	Atrium Health	Charlotte	North Carolina
United States	University of Southern California	Los Angeles	California
United States	Intermountain Healthcare	Murray	Utah
United States	Weill-Cornell	New York	New York
United States	Capital Health	Pennington	New Jersey
United States	Washington University	Saint Louis	Missouri

Sponsors (1)

Lead Sponsor	Collaborator
GATT Technologies BV

Country where clinical trial is conducted

United States, 

References & Publications (2)

Boerman MA, Roozen E, Sanchez-Fernandez MJ, Keereweer AR, Felix Lanao RP, Bender JCME, Hoogenboom R, Leeuwenburgh SC, Jansen JA, Van Goor H, Van Hest JCM. Next Generation Hemostatic Materials Based on NHS-Ester Functionalized Poly(2-oxazoline)s. Biomacromolecules. 2017 Aug 14;18(8):2529-2538. doi: 10.1021/acs.biomac.7b00683. Epub 2017 Jul 25. — View Citation

Roozen EA, Warle MC, Lomme RMLM, Felix Lanao RP, van Goor H. New polyoxazoline loaded patches for hemostasis in experimental liver resection. J Biomed Mater Res B Appl Biomater. 2022 Mar;110(3):597-605. doi: 10.1002/jbm.b.34938. Epub 2021 Sep 18. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Conversion from minimally invasive to open surgery, and reasons for conversion	SBSS 1-5	During surgical procedure
Other	Procedure duration	Time in minutes	During surgical procedure
Other	Duration of hepatic blood inflow reduction	Time in minutes	During surgical procedure
Other	Estimated blood loss during surgery	mL	During surgical procedure
Other	Number and type of blood transfusions during hospitalization	Platelets, Erythrocytes, Plasma	During surgical procedure
Other	Duration of Intensive Care Unit (ICU) stay	Time in Days	During hospitalization up to hospital discharge after the surgical procedure, estimated up to 30 days
Other	Total hospitalization time	Time in Hours	From surgery to discharge from the ICU, estimated up to 30 days
Other	Postoperative drainage volume, characteristics, and duration	Serous, sanguineous, serosanguineous, other Sanguineous Serosanguinous Serous, Sanguineous, Serosanguineous, Purulent, Other	During hospitalization up to hospital discharge after the surgical procedure, estimated up to 30 days
Other	Rate of subjects requiring reoperation	Occurrence yes/no	During postoperative 3-months follow-up
Other	Rate of subjects with liver resection surface complications on ultrasound	Fluid collection, biloma, hematoma, patch encapsulation, patch rolling up on the surface	At 6 week follow-up visit
Other	Amount of hemostatic material needed versus bleeding surface	cm2 patch per cm2 bleeding	During surgical procedure
Other	GATT-Patch device-specific user satisfaction questionnaire	Likert scale (strongly disagree, disagree, neutral, agree, strongly agree) with (strongly) agreeing meaning a better outcome	At completion of the surgical procedure, at day 0
Primary	Rate of hemostasis within 7 minutes from introduction of the first (piece of) patch through the trocar without rebleeding at the 10-minute time point from initiating pressure on the entire surface of the hemostatic agent	SBSS 0	During surgical procedure
Secondary	Median time in seconds from introducing the hemostatic agent through the trocar and achieving hemostasis	SBSS 0	During surgical procedure
Secondary	Median time in seconds from introducing the hemostatic agent through the trocar to initiating pressure on the entire surface of the agent	SBSS 0	During surgical procedure
Secondary	Median time in seconds to hemostasis from initiating pressure on the entire surface of the agent	SBSS 0	During surgical procedure
Secondary	Percentage of hemostasis from initiating pressure on the entire surface of the agent at 30, 60, 120, 180, 240, 300, 360, 420, 480, 540 and 600 seconds	SBSS 0-5	During surgical procedure
Secondary	Kaplan-Meier estimated distribution of time to hemostasis from initiating pressure on the entire surface of the agent	SBSS 0	During surgical procedure
Secondary	Treatment failure, defined as no hemostasis with the agent at 10 minutes from initiating pressure on the entire surface of the agent	SBSS 1-5 at the 10 minute timepoint	During surgical procedure
Secondary	Rebleeding after the 10-minute time point from initiating pressure on the entire surface of the agent but before subject wound closure	SBSS 1-5 after initially SBSS 0	During surgical procedure
Secondary	Number of times an additional (piece of) hemostatic agent needs to be used to achieve hemostasis	SBSS 1-5	During surgical procedure

External Links

•   GATT Technologies B.V. website