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PubMed2000

[Sutureless phacotrabeculectomy. Interim results].

BACKGROUND: To study the medium-term success rate of a simple surgical technique for combined operation of cataract and glaucoma. MATERIALS AND METHODS: Of 50 patients with cataract and various types of glaucoma, 55 eyes underwent a combined operation for cataract and glaucoma and were followed up for at least 6.5 months. The phacoemulsification war performed through a scleral tunnel. After implantation of a foldable IOL an "inverse T" incision of the tunnel floor was performed to create a valve mechanism closure. RESULTS: In 45 eyes (83%) the intraocular pressure was controlled without medications during the follow-up time. In 10 cases (17%) a new glaucoma medication was introduced postoperatively. Following early postoperative complications were noticed: early intraocular hypertension (20.0%), wound leakage (20.0%), early intraocular hypotension (10.9%), hyphema (19.1%). CONCLUSIONS: No-stitch phacotrabeculectomy appears to be a safe and (medium-term) effective procedure for combined surgery of cataract and glaucoma.

Aged↗
PubMed1987

Microvascular thermic sleeve anastomosis: a sutureless technique.

Microvascular thermic sleeve anastomosis performed with bipolar coagulation was investigated under experimental conditions. Patency rates of 100 percent for arteries (approximately 1.0 mm in external diameter) and 78 percent for veins (approximately 0.7 mm in external diameter) were achieved. The lumen contour was studied with plastic casts done at intervals of three hours, one day, three days, seven days, 15 days, and 30 days postoperative. Histopathologic studies were carried out to determine the changes caused by intussusception and heating spots.

Anastomosis, Surgical↗
PubMed2000

Sutureless coronary artery bypass with biologic glued anastomoses: preliminary in vivo and in vitro results.

OBJECTIVE: As heart surgery becomes increasingly focused on minimally invasive techniques, it has become apparent that conventional techniques of anastomosis will need to be severely altered or abandoned. Toward that end, we developed and tested in vitro and in vivo coronary artery bypass graft anastomoses using a biologic glue formulated from bovine albumin and glutaraldehyde. We used a double-balloon catheter as a temporary internal stent to create and seal the anastomosis during gluing. METHODS: Initially, anastomoses were made between cryopreserved human saphenous vein segments and coronary arteries in vitro on 12 intact bovine hearts. A total of 42 anastomoses were created with the catheter system introduced into the distal end of the graft, exiting the back wall, and entering the anterior wall of the coronary artery. Two balloons (one in the graft and one in the coronary artery) held the anastomosis stable while the biologic glue was applied externally and allowed to set for 2 minutes. The balloon catheter was then removed from the end of the graft simulating a side-to-side internal thoracic artery anastomosis. After the graft had been flushed to assure distal end patency, the open end of the graft was clipped, turning the anastomosis into an end-to-side graft. A pressure transducer was then attached to the graft and saline solution forcefully infused. RESULTS: All grafts easily held a pressure of 300 mm Hg; 10 grafts were tested up to 560 mm Hg without leaks. Distal and proximal coronary artery patency was checked by examining flow out of the coronary ostia and by cutting arteries distal to the grafts. All anastomoses were patent on being opened and no glue was seen intraluminally. Subsequently, 3 anastomoses of the left internal thoracic artery to the left anterior descending artery have been constructed in goats, with autopsies at 24 hours, 10 months, and 1 year revealing patent anastomoses. CONCLUSION: A biologic glue and catheter system has been developed that allows a coronary anastomosis with a high bursting strength to be performed. When the system has been further developed and tested, truly minimally invasive heart surgery may be possible.

Adhesives↗
PubMed2002

Sutureless coronary anastomosis with an anastomotic device and tissue adhesive in off-pump porcine coronary bypass grafting.

OBJECTIVE: In the search for a facilitated coronary artery anastomosis, we assessed the feasibility of a hybrid anastomosis technique that used a prototype anastomotic device with an extraluminal frame (crinoline-like) and octyl-cyanoacrylate adhesive. METHODS: During off-pump coronary artery bypass grafting in pigs (n = 8), a left internal thoracic artery-right coronary artery anastomosis was constructed and evaluated during the operation and at 5 postoperative weeks. The anastomosis was examined by flow measurement, angiography, intraluminal cast geometric analysis, and histologic analysis. RESULTS: Anastomosis construction required 6.2 +/- 1.3 minutes (mean +/- SD). At 5 weeks all anastomoses were fully patent, with minor anastomotic diameter narrowing (median 16%, 15th-85th percentile 16%-26%). After 30-second graft occlusion, median peak hyperemic flow response was 5.0 (15th-85th percentile 4.4-6.5). As a result of complete, streamlining filling of anastomotic wall recesses by neointima formation, more intimal hyperplasia was found in the crinoline-adhesive anastomoses than in sutured control anastomoses. No excessive, lumen-narrowing neointima formation was observed, however. CONCLUSIONS: The hybrid coronary anastomosis technique was feasible without any need for dedicated application tools. If technical improvements can be realized, the hybrid technique may provide an alternative to manual suturing.

Anastomosis, Surgical↗
PubMed2003

Sutureless laparoscopic heminephrectomy using laser tissue soldering.

BACKGROUND AND PURPOSE: Widespread application of laparoscopic partial nephrectomy has been limited by the lack of a reliable means of attaining hemostasis. We describe laser tissue welding using human albumin as a solder to control bleeding and seal the collecting system during laparoscopic heminephrectomy in a porcine model. MATERIALS AND METHODS: Laparoscopic left lower-pole heminephrectomy was performed in five female domestic pigs after occluding the hilar vessels. Using an 810-nm pulsed diode laser (20 W), a 50% liquid albumin-indocyanine green solder was welded to the cut edge of the renal parenchyma to seal the collecting system and achieve hemostasis. Two weeks later, an identical procedure was performed on the right kidney, after which, the animals were sacrificed and both kidneys were harvested for ex vivo retrograde pyelograms and histopathologic analysis. RESULTS: All 10 heminephrectomies were performed without complication. The mean operative time was 82 minutes, with an average blood loss of 43.5 mL per procedure. The mean warm ischemia time was 11.7 minutes. For each heminephrectomy, a mean of 4.2 mL of solder was welded to the cut parenchymal surface. In three of the five acute kidneys and all five 2-week kidneys, ex vivo retrograde pyelograms demonstrated no extravasation. In addition, no animal had clinical evidence of urinoma or delayed hemorrhage. Histopathologic analysis showed preservation of the renal parenchyma immediately beneath the solder. DISCUSSION: Laser tissue welding provided reliable hemostasis and closure of the collecting system while protecting the underlying parenchyma from the deleterious effect of the laser during porcine laparoscopic heminephrectomy.

Albumins↗
PubMed1999

Diffuse nodular eyelid lipogranuloma following sutureless transconjunctival blepharoplasty dressed with topical ointment.

PURPOSE: Transconjunctival blepharoplasty is becoming the approach of choice for many cosmetic surgeons. The authors describe a case of a diffuse, multinodular eyelid lipogranuloma following transconjunctival blepharoplasty, after which the unsutured wound was dressed with a topical ointment. METHODS: Report of clinical course and histopathologic findings. RESULTS: A patient developed multiple firm, nontender masses of the left lower eyelid that enlarged despite topical and systemic medical therapy. Prior to referral, the progressive lesions had recurred despite three successive attempts at surgical eradication. Histopathologic examination of excised tissue demonstrated a multifocal lipogranulomatous inflammation consistent with reaction to retained ointment. CONCLUSIONS: Sclerosing lipogranulomas are a known complication of intradermal lipid injection, as well as a late complication of sinus surgery after postoperative nasal packing with ointment-saturated gauze. The application of a topical ointment should be avoided until after transconjunctival lower blepharoplasty unless wound closure is secure or until conjunctival epithelialization is complete.

Administration, Topical↗
PubMed2002

A laboratory model for microkeratome-assisted posterior lamellar keratoplasty utilizing a running graft suture and a sutureless hinged flap.

PURPOSE: To evaluate changes in anterior corneal curvature and graft stability with different sized donor buttons in a laboratory model of posterior lamellar keratoplasty. METHODS: Thirty-six human eye bank corneas (18 donors and 18 recipients) were mounted on an artificial anterior chamber. A manual microkeratome was used to create a hinged anterior lamellar keratectomy. A 7.0-mm diameter posterior lamellar disk (posterior stroma, Descemet's membrane, and endothelium) was then trephinated from the recipient cornea. Three different sizes (7.0, 7.25, and 7.5 mm) of donor buttons were compared. They were sutured into the recipient bed with a running 10-0 nylon suture and covered by the host corneal flap. The flap was replaced without sutures. The resulting endokeratoplasty was analyzed by computerized videokeratography and tonometry. RESULTS: Regular postoperative astigmatism was present in all cases. There was an average increase in astigmatism of 1.47 +/- 1.49 diopters (D) postoperatively. The mean change in the average keratometry readings was -5.12 +/- 6.12 D. The grafts and flaps maintained watertight seals with average leak pressures of 66.9 +/- 46.4 mm Hg. Although donor buttons oversized by 0.5 mm had the least change in average keratometry reading, those oversized by 0.25 mm had the best stability at high pressure. All groups had little change in astigmatism. CONCLUSION: The optimal sized button of those tested would be either oversized by 0.25 or 0.5 mm. This new surgical technique may result in lower risk of high and irregular astigmatism in the management of corneal endothelial disorders.

Adult↗
PubMed2001

Sutureless liver repair and hemorrhage control using laser-mediated fusion of human albumin as a solder.

BACKGROUND: Major liver trauma has a high mortality because of immediate exsanguination and a delayed morbidity from septicemia, peritonitis, biliary fistulae, and delayed secondary hemorrhage. We evaluated laser soldering using liquid albumin for welding liver injuries. METHODS: Fourteen lacerations (6 x 2 cm) and 13 nonanatomic resection injuries (raw surface, 8 x 2 cm) were repaired. An 805-nm laser was used to weld 53% liquid albumin-indocyanine green solder to the liver surface, reinforcing it by welding a free autologous omental scaffold. The animals were heparinized and hepatic inflow occlusion was used for vascular control. For both laceration and resection injuries, 16 soldering repairs were evaluated acutely at 3 hours. Eleven animals were evaluated chronically, two at 2 weeks and nine at 4 weeks. RESULTS: All 27 laser mediated-liver repairs had minimal blood loss compared with the suture controls. No dehiscence, hemorrhage, or bile leakage was seen in any of the laser repairs after 3 hours. All 11 chronic repairs healed without complication. CONCLUSION: This modality effectively seals the liver surface, joins lacerations with minimal thermal injury, and works independently of the patient's coagulation status.

Animals↗
PubMed1988

Sutureless scleral buckle for retinal detachment with thin sclera.

Retinal detachment surgery can be hazardous in the presence of thin sclera, with increased risk of inadvertent perforation. We designed polymethylmethacrylate belt loops that can be fixed to the sclera with cyanoacrylate tissue adhesive, allowing 360 degrees scleral buckling to be performed without sutures. We report the successful use of this technique in a three-year-old girl with a rhegmatogenous retinal detachment and blue sclerae.

Child, Preschool↗