Endoscopic Powder: A Game-Changer in Haemostasis for Minimally Invasive Surgery
Effective control of haemostasis is critical to the success of any surgical procedure. 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. But the same factors that make MIS appealing also make bleeding control more difficult. 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.
Surgi-ORC® Powder: An Innovative Haemostatic Solution
Among haemostatic powders, plant-based, absorbable types like Surgi-ORC® have demonstrated both safety and effectiveness. Originally launched as a sheet in 1943, ORC has now been adapted into powder to address the needs of current minimally invasive surgeries.
Advantages of Surgi-ORC® Endoscopic Powder
• Accelerated Clotting: ORC’s mechanism enhances platelet activity and clot formation
• Conformability: The powder’s granular shape adapts to wounds, covering both large and deep surfaces
• 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
• Fully Absorbable: Powder dissolves safely, posing no harm to nerves or vessels
Thanks to these features, Surgi-ORC® powder excels at controlling bleeding from small vessels in restricted surgical fields.
Delivery Devices: Enhancing Precision in MIS
How the powder is delivered greatly influences its effectiveness in surgery. Most MIS procedures rely on bellows-type applicators for controlled and accurate powder delivery.
How Bellows Applicators Function
Bellows applicators, which look like syringes, have various tip lengths for applying powder via laparoscopic ports. Compressing the bellows dispenses a controlled amount of powder right onto the bleed, maintaining clear visibility.
Best Practices for Using Endoscopic Powder
• Orientation: How you hold the device (vertically or horizontally) influences powder distribution more than how hard you squeeze
• Powder Characteristics: Particle size, flow, and how the powder handles moisture will affect performance
• Surgeon Technique: Output depends on the speed and force used when compressing the bellows
Real-World Applications of Endoscopic Powder
In cases where visibility is poor or anatomy is complex, endoscopic powder becomes an essential tool. Because of its conformability, surgeons can treat both broad raw surfaces and deep crevices with ease.
Typical Applications:
• Laparoscopic liver resections
• Cardiothoracic MIS cases
• Gynaecology MIS surgeries
• Endoscopic submucosal dissections (ESD)
• Minimally invasive urology 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
A clinical study of SURGICEL® Powder (an ORC-based agent) on 103 patients revealed:
• 87.4% of patients had bleeding stopped in 5 minutes; 92.2% within 10 minutes
• Strong performance in open and minimally invasive settings
• No product-related complications—no rebleeding, thromboembolism, or adverse reactions
• Surgeons rated it highly effective and easy to use, with precise powder delivery and minimal need for additional intervention [3]
Overall, the data shows SURGICEL® Powder as a safe, effective, and adaptable haemostatic agent—especially when conventional tools aren’t enough.
Conclusion
As MIS continues to evolve, so does the demand for advanced haemostatic tools. Endoscopic powder, particularly ORC-based formulations, stands out as a reliable, fast-acting, and surgeon-friendly solution for bleeding control.
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 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 Endoscopic Powder 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.