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Fibrin Sealants — Tisseel, Evicel, Artiss

Fibrin sealants are two-component biologic adhesives that reproduce the final common pathway of coagulation at the application site — delivering concentrated fibrinogen and thrombin simultaneously through a dual-syringe applicator. When the two components meet, thrombin immediately cleaves fibrinogen to form a fibrin clot that bonds tissue, seals bleeding surfaces, and reinforces suture lines. The clot resorbs over 10–14 days, leaving no persistent foreign body.[1][2]

Fibrin sealants are the most versatile of all intraoperative adjuncts — bridging hemostatic, sealing, and adhesive roles. In GU reconstruction they are used for anastomotic reinforcement (urinary diversion, pyeloplasty, vesicourethral), Peyronie's grafting (as a carrier beneath collagen fleece), flap adhesion, graft inosculation (BMG ureteroplasty), and pelvic dead-space obliteration.

Available Products​

ProductManufacturerClot formationDistinguishing feature
TisseelBaxter~10 secondsWorkhorse; 500 IU/mL thrombin; supports all sealing/hemostatic/adhesive roles
EvicelEthicon~10 secondsPurified human fibrinogen; no antifibrinolytic (no aprotinin)
ArtissBaxter~60 seconds (slow-cure)Low thrombin concentration (~4 IU/mL); for flap adhesion / graft fixation where longer working time is needed
VistasealEthicon~10 secondsNewer formulation with integrated spray applicator
RaplixaMallinckrodtN/ADry powder formulation (no reconstitution); different workflow

Mechanism​

  1. Component A (fibrinogen + factor XIII ± aprotinin): pooled human fibrinogen at ~80 mg/mL
  2. Component B (thrombin + calcium chloride): human or bovine thrombin at 4–500 IU/mL
  3. When mixed at the tissue surface:
    • Thrombin cleaves fibrinogen → fibrin monomer
    • Factor XIII cross-links fibrin into a stable fibrin clot
    • Calcium supports the reaction
    • Aprotinin (in Tisseel) slows plasmin-mediated fibrinolysis, extending clot durability

Cure time by product​

  • Standard (Tisseel, Evicel): ~10 seconds — near-instant
  • Slow-cure (Artiss): ~60 seconds — intended to allow tissue repositioning / flap adhesion before setting

GU Reconstruction Applications​

1. Urinary-tract anastomosis reinforcement​

  • Pyeloplasty — sprayed over the ureteropelvic anastomosis after closure
  • Ureteroureterostomy / ureteral reimplantation — reinforces suture lines
  • Vesicourethral anastomosis after radical prostatectomy — sprayed after anastomosis completion
  • Ileal conduit / neobladder ureteroenteric anastomosis — sealing any leak-prone interface

2. Peyronie's disease tunical grafting​

  • Used as a thin film beneath collagen fleece (TachoSil) in the Hatzichristodoulou sealing technique and PICS technique
  • Alternative to suture fixation of grafts in selected applications
  • See Peyronie's — plaque incision/grafting

3. Urethroplasty​

  • Anastomosis reinforcement at the urethrourethral junction in excision and primary anastomosis
  • Graft fixation for onlay buccal mucosa urethroplasty — thin fibrin layer beneath the graft promotes inosculation and prevents early shear
  • Staged urethroplasty — fibrin glue can secure the first-stage mucosal graft to the corpus spongiosum

4. Partial nephrectomy​

  • Adjunct to renorrhaphy — sealed over the parenchymal suture line
  • Collecting-system repair reinforcement — over the mucosal closure

5. Pelvic dead-space obliteration​

  • After exenteration / APR — fibrin glue plus omental flap fills the pelvic basin
  • After radical cystectomy — reduces postoperative fluid collections

6. Flap adhesion (Artiss specifically)​

  • Slow-cure Artiss is specifically designed for flap adhesion, allowing the surgeon to position and adjust the flap before the glue sets
  • Body-contouring surgery, skin flap fixation, burn reconstruction
  • Limited direct GU use but relevant in phalloplasty skin flap fixation

7. IPP infection prevention​

  • Fibrin sealant at wound closure — part of the Razdan "zero infection" protocol (ChloraPrep + fibrin sealant + no drains) with reported zero infections in 103 primary IPP cases
  • See Penile implants — infection

Application​

Preparation​

  • Reconstitute from freeze-dried vials (standard) or retrieve from frozen storage
  • ~5–10 minute preparation time depending on product
  • Some products require warming to 37°C before use
  • Assemble the dual-syringe applicator (spray or drip tip depending on application)

Delivery modes​

ModeBest for
DripSmall surfaces, focal application
SprayBroad surfaces (renal bed, flap adhesion, pelvic basin)
EasySpray / gas-assistedLaparoscopic / robotic; propellant-driven even distribution

Application technique​

  1. Dry the field — fibrin sealant does not work well on pooled blood
  2. Apply both components simultaneously through the dual applicator
  3. Do not smear — allow the fibrin to form naturally
  4. Hold 30–60 seconds for standard product; up to 3 minutes for Artiss
  5. Check for adherence; re-apply a second layer if needed

Cost and Practicality​

  • $300–600 per kit (2 mL or 5 mL configurations)
  • Significant reconstitution time in emergencies — preparing a kit during active bleeding is impractical; kits should be opened proactively
  • Most OR pharmacies keep one kit in the room for reconstructive urology cases and urinary diversion
  • Shelf life of reconstituted product is short — use within 4 hours

Contraindications and Cautions​

  • Bovine thrombin-containing products — rare antibody formation and paradoxical coagulopathy (see topical thrombin for the clinical story)
  • Never inject intravascularly — thrombin in a vein causes pulmonary embolism
  • Anaphylaxis — rare; document allergies to any component
  • Aprotinin (in Tisseel) — slight risk of anaphylaxis with repeated exposure (aprotinin was withdrawn from IV use years ago for this reason)
  • Religious objections — human-plasma-derived fibrinogen may conflict with some religious dietary restrictions; document accordingly

Fibrin Sealant vs. Collagen-Fibrinogen Patch vs. Hemostatic Matrix​

AgentRole
Fibrin sealant (this page)Liquid two-component spray — versatile adhesive + sealant + hemostatic
TachoSil / collagen-fibrinogen patchSolid-phase fibrin sealant on a collagen carrier — best for focal sealing of defects
FloSealThrombin + gelatin matrix — best for diffuse surface oozing
CyanoacrylatesSkin-level adhesive only

See Also​

References​

1. Spotnitz WD. Fibrin sealant: the only approved hemostat, sealant, and adhesive — a laboratory and clinical perspective. ISRN Surg. 2014;2014:203943. doi:10.1155/2014/203943

2. Fathollahi A, Razdan S, Razdan S. Zero infection protocol in inflatable penile prosthesis surgery: a prospective cohort study using chlorhexidine-alcohol skin preparation and fibrin sealant hemostasis. Int J Impot Res. 2025. doi:10.1038/s41443-025-01174-8