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PubMedDate not supplied

Sutureless microvascular anastomosis using a neodymium-yag laser.

A technique is described in which a Neodymium-YAG laser is used to anastomose arteries 0.8 to 1.0 mm in diameter. Heat generated by the laser causes fusion of the collagen of the media, making direct handling of the vessel wall unnecessary. Four variations of the technique were performed in 120 rat carotid arteries. Angiographic and scanning electron microscopic studies were carried out immediately after surgery and at intervals of 1 day to 6 months after anastomosis. Patency rates as high as 92.5% were recorded. The technique that produced the most secure anastomosis was considered to be one in which a vascular strut was used as an aid in apposition, followed by the application of a piece of vein wall to the anastomosis with tissue adhesive. The main advantages of the laser technique are speed and consistency. Complications such as disruption and aneurysm formation are considered to be rare.

Animals↗
PubMed1989

Sutureless microvascular anastomosis using the THC:YAG laser: a preliminary report.

Laser anastomosis of the rat carotid artery was performed using a new mid-infrared laser, the pulsed thulium-holmium-chromium: YAG (THC:YAG) laser (2.15 microns). Solid silicone stents made stay sutures unnecessary for coaptation of vessel edges during laser bonding. Grossly, the laser anastomoses displayed minimal thermal distortion of the vessel contour and no tissue carbonization. Of the 30 anastomoses performed, 27 were patent and 3 had separation of the weld shortly after the approximator clamp was released. Mean anastomotic time was 4 min 48 sec. Mean bursting pressure for the 9 vessels tested was 400 mm Hg. Thrombosis did not occur at any time during our examination of these anastomoses. Fusion of collagen fibers in the media was confirmed histologically. Unlike the CO2 laser, the THC:YAG is transmissible through flexible silica fibers, which greatly facilitates delivery of the laser in a microsurgical operative field. The THC:YAG provides shallower absorption depth than Nd:YAG and argon lasers but somewhat deeper tissue penetration than CO2. For microvessels, this intermediate absorption results in full-thickness fusion of the media, with minimal thermal damage to vascular tissue adjacent to the anastomosis.

Anastomosis, Surgical↗
PubMed1995

Sutureless anastomosis using a biofragmentable anastomosis ring.

The biofragmentable anastomosis ring (BAR) is composed of polyglycolic acid and barium sulfate. When used for intestinal anastomosis, the BAR fragments after the anastomosis is established. We used this device in 43 patients. In three patients, the anastomosis with BAR was abandoned due to technical difficulties. A total of 43 anastomoses with BAR were performed in 40 patients. The operations in which BAR was used included right hemicolectomy in 12 patients, transverse colectomy in 7, sigmoidectomy in 11, small bowel resection in 5 and other bowel resections in 8. The time spent for the BAR anastomsis ranged from 7 to 30 min with a mean of 15.2 min, which was significantly shorter than that of conventional hand-sutured anastomosis in 23 cases. The fragmentation and excretion of the BAR occurred from 14 to 49 days later with a mean of 21.8 days. There was only one instance of anastomotic leakage (1/40, 2.5%), which occurred in a patient with a cytomegaloviral infection of the intestine. A postoperative barium enema study in 28 patients showed no passage disturbance through the anastomosis. In conclusion, the anastomosis using BAR is considered to be a simple, safe, and fast method for performing either colonic or small intestinal anastomosis.

Adult↗
PubMed1993

Laparoscopic endocorporeal mobilization followed by extracorporeal sutureless anastomosis for the treatment of carcinoma of the left colon.

Surgery has become progressively more reliant on technology. The technique of colonic anastomosis utilizing the biofragmentable anastomotic ring (BAR) is one such example. The benefits of therapeutic laparoscopy have been applied to the arena of colorectal surgery. A case is presented that combines these two modalities in a patient with colon cancer, laparoscopic mobilization of the large bowel, exteriorized resection, and BAR anastomosis.

Adenocarcinoma↗
PubMed1991

First sutureless closure of a colotomy: short-term results of experimental laser anastomosis of the colon.

To assess the possibility of laser anastomosis of the colon, experimental laser closure of colotomies was performed. Transverse colotomies (average 20.7 mm) in New Zealand white rabbits (n = 20) were closed with a 1,064-nm Nd:YAG laser at a pulsating 0.5-W wave of power, using guy sutures to approximate the tissue edges. The laser energy was applied through a specially designed hand piece and hand-held 600-microns gas-cooled noncontact quartz fiber to produce a satisfactory tissue welding. Similar colotomies were closed using a single layer of interrupted sutures of 5-0 Maxon (Davis & Geck, Pearl River, NY) in a control group (n = 20). Bursting pressure and index of narrowing were recorded immediately after anastomosis and at 1, 4, and 7 days following surgery. Bursting pressure of the laser-welded closure at 1 day was significantly lower than that of the sutured controls (P less than 0.01); however, all rabbits recovered uneventfully. There was a marked decrease in adhesion formation following laser anastomosis (P less than 0.05). Conversely, one control rabbit showed functional stenosis at 4 days. Histologic study revealed an accelerated healing in the laser group. The index of narrowing was significantly higher in the laser group than in the control group (P less than 0.05). The completely water-sealed laser anastomosis reduces adhesions and is comparable to conventional suture anastomosis of the colon.

Anastomosis, Surgical↗
PubMed1992

Sutureless laparoscopic rectopexy for procidentia. Technique and implications.

Procedures for treating rectal prolapse may constitute some of the best applications for colorectal laparoscopic techniques. Although the condition is benign, rectal prolapse is often debilitating and frequently progressive in terms of functional limitations. Moreover, many patients are elderly, medically unfit, or both. A technique that afforded relief of prolapse and of incontinence by laparoscopic rectal sacropexy, performed without sutures, using a newly designed laparoscopic sacral tacker and laparoscopic staples, is described. Indications, contraindications, technical details, and surgical implications are discussed. Laparoscopic pelvic suspension procedures are presented as realistic and appropriate objectives for colon and rectal surgeons.

Colorectal Surgery↗
PubMed1996

First experimental sutureless laser anastomosis of the large bowel: long-term study.

UNLABELLED: Large bowel anastomoses were successfully performed without sutures on New Zealand white rabbits using 1,064 nm, 0.4-W power pulsating Nd:YAG laser to create tissue welding. PURPOSE: The aim of this study was to assess long-term results of our experimental data and summarize our experimental work on laser colon anastomosis. METHODS: This experimental study investigated long-term integrity, degree of narrowing, animal body weight change, visual findings, microscopic appearance, and collagen concentration of laser colon anastomoses, compared with those of conventional sutured anastomoses at thirty and ninety postoperative days. RESULTS: Two animals in the laser group died without leakage. Postsurgical course in all remaining rabbits studied was uneventful. Bursting pressures in the two groups were equivalent, but the laser group exhibited a consistent narrowing tendency. However, laser anastomoses demonstrated fewer and milder adhesions, and animals showed a better recovery of body weight. Histologically, laser anastomoses showed better layer-to-layer reconstitution without foreign body response and with less fibrosis. Difference in collagen (hydroxyproline) concentration did not reach statistical significance. CONCLUSION: The nature of tissue welding via laser remains undefined, but there is definitely a future for laser bowel anastomosis.

Anastomosis, Surgical↗
PubMed1988

Sutureless colon anastomosis with fibrin glue in the rat.

The only technique available for creating an intestinal anastomosis without tissue strangulation is gluing. Theoretically, this could lead to a higher hydroxyproline content and greater mechanical strength than in a sutured anastomosis. To test the hypothesis, 83 rats underwent left colon resection and inverted primary anastomosis with either one layer of sutures (NG group) or fibrin glue (FG group). Seven-day FG anastomoses showed less adhesions (P = .02) but one subclinical leakage and a further radiologic one, compared with a greater amount of adhesions but no leakages in the NG group. The mean bursting pressures (mmHg) in the FG and NG groups, respectively, were 25 +/- 20 (SD) and 63 +/- 23 (N.S.) 30 minutes after surgery, 107 +/- 33 and 115 +/- 30 after one day, 81 +/- 31 and 133 +/- 26 (P less than .001) after four days, and 161 +/- 36 and 175 +/- 24 after seven days. The somewhat earlier rise in hydroxyproline content in the glued anastomoses did not lead to significant intergroup differences. The glued anastomoses were thus weak during the critical lag period of healing. Also, by preventing adhesion formation, the glue may reduce the extra blood supply from perianastomotic vessels. The outcomes might have differed more under demanding experimental or clinical situations.

Anastomosis, Surgical↗
PubMed1999

[Sutureless corneal cataract surgery. Limbal release incisions for correcting astigmatism].

BACKGROUND: To prevent surgically induced astigmatism following clear corneal cataract surgery. PATIENTS AND METHODS: Limbal relaxing incisions of 6 or 8 mm length respectively and 0.5 mm depth were performed in 52 patients with spheric cornea or astigmatism with the rule of 0.8 +/- 0.3 dpt after temporal corneal cataract incision. The same amount of patients, operated on with the same surgical procedure except keratotomies, served as control. RESULTS: After 6 months the with-the-wound-change (WTW) in the LRI axis using the Hollady method was -0.08 +/- 0.5 dpt in the spheric cases with limbal keratotomy and +0.5 +/- 0.7 dpt in the control cases. The patients with preoperative astigmatism with the rule showed a WTW in the LRI axis of -0.09 +/- 0.5 dpt in the keratotomy cases and +0.39 +/- 0.7 dpt in the corresponding control patients. CONCLUSION: Limbal relaxing incision is a reliable and safe procedure to reduce postoperative astigmatism after cataract surgery.

Astigmatism↗
PubMed2004

Sutureless circumcision: a prospective randomised controlled study.

Our aim was to study the advantages of glue versus sutures for circumcision in children. A randomised prospective controlled study was conducted with 152 boys; glue was used on 80 and sutures on 72. The procedures were quicker and the duration and severity of postoperative pain were significantly less (p < 0.001) in the cases in which glue was used. The tissue glue is a perfectly feasible alternative to sutures for circumcision in children and has potentially significant advantages.

Case-Control Studies↗
PubMed2006

Sutureless and stapleless laparoscopic splenectomy using radiofrequency: LigaSure device.

BACKGROUND: Bleeding is the main complication and cause of conversion during laparoscopic splenectomy (LS). We present the advantages of the LigaSure vessel sealing system added to the lateral approach for achieving safe vascular control. METHODS: We performed 63 consecutive LS in a 3-year period using LigaSure in two affiliated university hospitals. We employed a right semilateral position technique with dissection of the spleen and vessel sealing using LigaSure. Forty-two patients had benign hematological disease, 19 had malignant disease, and two had splenic cysts. RESULTS: A total of 58 LS were completed with five conversions due to hilar bleeding (three cases), difficult dissection (one), and massive splenomegaly (one). In all but five patients, blood loss was less than 100 ml. No transfusions were needed. There were five postoperative complications: portal thrombosis (one case), hemoperitoneum (two), surgical wound infection (one), and pleural effusion (one). CONCLUSIONS: The use of LigaSure, and the semilateral position, results in a gain of time and safety. Furthermore, average intraoperative bleeding is very low.

Adolescent↗
PubMed2003

Clinical experience of sutureless closed hemorrhoidectomy with LigaSure.

PURPOSE: The purpose of this study was to evaluate the LigaSure vessel sealing system as an alternative to closed hemorrhoidectomy. METHODS: Sixty-one patients with Grade 3 or 4 symptomatic hemorrhoids were prospectively randomly assigned to undergo hemorrhoidectomy with the LigaSure vessel sealing system or hemorrhoidectomy using the conventional Ferguson procedure. We determined the operation time, postoperative pain, amount of time taken off from work, and complications associated with both techniques. RESULTS: Mean operative time for the LigaSure hemorrhoidectomy was 15 +/- 5.4 minutes and for the Ferguson operation, 21.2 +/- 8.2 minutes. The difference was significant (P < 0.01). There was also a significant decrease in pain measurements reported on postoperative Days 1 and 2 (P < 0.05) in the LigaSure group. The incidence of postoperative wound swelling and complications were similar between two groups. There was no difference in the period of time off from work between patient groups. CONCLUSION: This study confirms that LigaSure system can achieve a radical ablation of hemorrhoids, reduce operative time, and result in less postoperative pain on postoperative Days 1 and 2.

Adult↗
PubMed2005

Sutureless intestinal anastomosis with the biofragmentable anastomosis ring: experience of 632 anastomoses in a single institute.

PURPOSE: Uncertainty with the safety of the biofragmentable anastomosis ring makes surgeons hesitate in its widespread use in intestinal surgery. This study was designed to evaluate the validity of the biofragmentable anastomosis ring as a routine anastomotic device in enterocolic surgery. METHODS: The study analyzed the nine-year experience of 632 biofragmentable anastomosis ring anastomoses performed in 617 patients: 525 (83 percent) as elective procedures and 107 (17 percent) as emergency. Three classic types of anastomosis, end-to-end (n=354), end-to-side (n=263), and side-to-side (n=15), were performed with a standard technique. RESULTS: Anastomotic sites included ileocolic/ileorectal in 283 patients (45 percent), colorectal in 148 (23 percent), enteroenteric in 101 (16 percent), and colocolic in 100 patients (16 percent). Anastomotic leakage with clinical relevance was observed in five patients (0.8 percent): three elective cases, and two emergency (2 colorectal anastomoses and 1 ileorectal required diversions). Among 13 instances (2.1 percent) with postoperative intestinal obstruction, only 1 required relaparotomy for closed-loop obstruction. Seven patients (1.1 percent; 4 elective cases, and 3 emergency) died postoperatively; no deaths were directly related to the biofragmentable anastomosis ring technique. CONCLUSIONS: Our data suggest that the anastomosis using the biofragmentable anastomosis ring is a uniform and highly reliable technique even in high-risk emergency surgery. Along with its clinical validities, clinical application of the biofragmentable anastomosis ring in different types of anastomoses in enterocolic surgery is expected to be expanded with a high level of technical safety.

Adolescent↗