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PubMed2000

Microvascular anastomosis using 2-octyl cyanoacrylate in the rat femoral artery.

Patency of the microvascular anastomosis is the most important requirement for tissue survival in free tissue transfer and in replantation. In efforts to improve on the standard suture method of microvascular anastomosis, new techniques such as limited-suture sleeve anastomoses and histoacryl glue anastomoses have been employed experimentally. However, as a result of factors such as tissue toxicity and suboptimal outcome, cyanoacrylates have not enjoyed clinical use. In addition, sleeve anastomoses continue to utilize suture, increasing the risks of intimal damage, platelet adhesion, and thrombosis. In an attempt to surmount these problems, the authors investigated the use of a new 2-octyl cyanoacrylate glue and a sutureless sleeve anastomosis. Anastomosis of 20 rat femoral arteries with a sutureless sleeve technique bonded with glue resulted in an 80% patency rate at 1 day to 3 weeks. Failures occurred in the first few attempts as the technique was evolving. These encouraging results suggest that 2-octyl cyanoacrylate may have applicability in quick, sutureless microvascular anastomoses.

Anastomosis, Surgical↗

PubMed2006

A phacovitrectomy with a clear corneal incision for a full-thickness macular hole.

PURPOSE: To describe the results of a pars plana vitrectomy, combined with phacoemulsification, using a sutureless, superotemporal, clear corneal incision for patients with a macular hole. METHODS: This study reviewed the records of 22 patients (22 eyes) who underwent a phacoemulsification with the insertion of an acrylic intraocular lens, using a 3.2 mm superotemporal clear corneal incision and a pars plana vitrectomy with an internal limiting membrane peeling in one session, for the treatment of a macular hole. RESULTS: All 22 patients had their macular holes closed using the combined surgical procedures. The mean preoperative visual acuity was 0.086, and the mean postoperative visual acuity was 0.173. This improvement was statistically significant (paired Student's t-test, p < 0.05). No patients developed posterior capsular opacity, retinal detachment, or a cystoid macular edema. The surgically induced astigmatism (SIA) was 0.808 diopters (0.808 +/- 0.761) two months after surgery. CONCLUSIONS: Combining cataract surgery with vitrectomy can achieve visual rehabilitation in the early postoperative period without requiring post-vitrectomy cataract surgery. A sutureless clear corneal incision, used in this procedure, can minimize the SIA and promote postoperative wound healing. If sutureless, transconjunctival, pars plana vitrectomy can be used more widely in the future, then the simplified, combined cataract surgery using a small clear corneal incision will also become more common, hence decreasing operation time, and hastening postoperative recovery.

Adult↗

PubMed2001

[Bioadhesives in ocular surgery].

PURPOSE: To evaluate the histological inflammatory activity that bioadhesives such as fibrin, cyanoacrylate, unsutured valved closure and suturing, generate when applied on scleral tissue. METHODS: We used a total of 80 eyes of 80 white rabbits which we divided into 8 groups of ten eyes each and distributed according to the two periods of time (1 week and 30 days) and four technique used for closure: 10/0 nylon suture, sutureless self-sealing, cyanoacrylate glue (Histoacryl), and fibrin glue (Tissucol). ANOVA was used for the statistical study of histological inflammation. Descriptive statistical analysis was used for the study of the degree of healing. RESULTS: After 7 days, the fibrin bioadhesive led to greater inflammatory response than did the other techniques (p<0.001). The cyanoacrylate adhesive caused less inflammatory activity than did suturing material (p<0.005). On day 30, the inflammatory reaction generated by the fibrin and cyanoacrylate adhesives was greater than of the suturing and self valved closure technique (p<0.005). After 7 days, the degree of healing with the suture, sutureless technique and cyanoacrylate adhesive was incomplete, while healing was moderate with the fibrin glue. After 30 days the degree of healing with cyanoacrylate glue was incomplete. At this time the degree of healing, with the suture, sutureless technique and fibrin adhesive was complete. CONCLUSIONS: Fibrin causes greater inflammatory reaction than do the other techniques. The cyanoacrylate adhesive shows a biological tolerance identical to the suture technique. This shows that cyanoacrylate bioadhesives are a viable alternative to suturing in scleral surgery.

Adhesives↗

PubMed2005

Long-term intraocular pressure change after clear corneal phacoemulsification in Thai glaucoma patients.

OBJECTIVES: To evaluate long-term intraocular pressure (IOP) changes after sutureless clear corneal phacoemulsification in eyes with preoperatively controlled glaucoma. DESIGN: Retrospective study. SETTING: Eye Clinic, Ramathibodi Hospital, Faculty of Medicine, Mahidol University. MATERIAL AND METHOD: The medical records of 218 patients who had uneventful sutureless clear corneal phacoemulsification with acrylic foldable lens (IOL) implantation were retrospectively reviewed. Included were 58 patients with medically controlled open-angle glaucoma and 160 normal controls. Follow-up was 12 to 18 months. Outcome measures were postoperative IOP and number of glaucoma medications. RESULTS: Postoperatively, there was an insignificant decrease in IOP in the glaucoma group; the mean decrease was 1.4 mm Hg +/- 3.8 (SD) at 12 months and 1.6 +/- 4.2 mm Hg at 18 months. The mean number of medications decreased significantly at 12 months (0.51 +/- 0.75) and at 18 months (0.41 +/- 0.83) (P = .04). The control group also had a significant decrease in IOP, with a mean decrease of 0.83 +/- 2.8 mm Hg at 12 months (P = .01) and 1.26 +/- 2.9 mm Hg at 18 months (P < .0001). The decrease in IOP was more pronounced in eyes with a higher preoperative IOP in both the glaucoma and control groups. CONCLUSION: These findings suggest that sutureless clear corneal phacoemulsification with foldable acrylic IOL implantation is a relatively safe and simple surgical option in patients with cataract and well-controlled glaucoma. The approach provided favorable long-term IOP change and led to rapid visual rehabilitation in both the glaucoma and control group.

Aged↗

PubMedDate not supplied

Experimental prosthetic vein valve.

Medical and surgical management of venous insufficiency syndrome (VIS) has produced disappointing results despite the recent introduction of new surgical techniques. This has prompted the investigation of a sutureless prosthetic vein valve. Ten prosthetic sutureless vein valves have been tested to date. The valves are of two types, one constructed of platinum, the other of titanium. Fourteen to eighteen months post-insertion into the femoral vein or vena cava of mongrel dogs, five valves remain patent as shown be venography. The sutureless prosthetic vein valve is a promising development in the treatment of venous insufficiency.

Animals↗

PubMed1987

[Use of myocardial electric stimulation for the treatment of cardiac rhythm disorders].

Under study were 3 kinds of national sutureless myocardial electrodes compared with sutured electrodes. Sutureless electrodes were simply and reliably implanted into the ventricles and right auricle of the heart, they had better biophysical properties than sutured electrodes. The application of sutureless electrodes and special elevator of the breast bone allows to decrease the duration and traumatism of operations of myocardial electrocardiostimulation, lethality can be reduced to 1%, the amount of hospital complications to 5%.

Adult↗

PubMed1994

[Refractive changes following cataract extraction with intraocular lens implantation].

Refractive changes after six cataract surgery procedures with intraocular lens implantation were assessed; namely, (1) 11 mm incision with running suture closure (n = 25 eyes), (2) 6.5 mm incision with running suture closure (n = 23). (3) 6.5 mm incision with horizontal suture closure (n = 21), (4) 6.5 mm incision without suture closure (n = 40), (5) 5.5 mm incision without suture closure (n = 46), and (6) 3.2 mm incision without suture closure (n = 46). The axis-based keratometric cylinder, absolute value of the induced cylinder vector, and spherical equivalent of the refractive power were analyzed up to 6 months after surgery. Refractive changes did not reach a stable state at 3 months postoperatively for the 11 mm and 6.5 mm running suture closure groups, but they stabilized at 3 months postoperatively for the 6.5 mm horizontal suture and sutureless closure groups, at 1 month postoperatively for the 5.5 mm sutureless closure group, and at 2 weeks postoperatively for the 3.2 mm sutureless closure group. It is concluded that the timing of refractive stabilization differs significantly among procedures, and smaller incisions with wound closure methods which do not exert a vertical force cause fewer postoperative refractive changes.

Aged↗

PubMed1993

Postoperative astigmatism following phacoemulsification with sutured vs. unsutured wounds.

A total of 293 cases of phacoemulsification cataract surgery with a 5.0- or 6.0-mm frown incision were analysed retrospectively to compare postoperative astigmatism between cases with sutured wounds and those with unsutured wounds. Astigmatic analysis was done with a simplified method (keratometric readings with steep meridians between 46 degrees and 134 degrees were considered "with-the-rule" [WTR], and those with steep meridians less than 46 degrees and greater than 134 degrees, "against-the-rule" [ATR]). Among patients with WTR astigmatism preoperatively, the mean keratometric cylinder in the sutureless group (n = 53) was significantly lower at 1 day and at 4 to 6 months postoperatively than before surgery (p < or = 0.001); in the suture group (n = 120) the mean cylinder was significantly higher at 1 day and significantly lower at 4 to 6 months than before surgery (p < 0.05). Among patients with ATR astigmatism preoperatively, the mean keratometric cylinder in the sutureless group (n = 22) was significantly higher at 1 day than before surgery (p < 0.01); in the suture group (n = 98) the mean cylinder was significantly lower at 1 day than before surgery (p < 0.001), and the difference at 4 to 6 months almost reached statistical significance (p = 0.052). Vector analysis showed that surgically induced cylinders in the suture and sutureless groups were similar. Our findings suggest that in the short term patients with preoperative WTR astigmatism may benefit from unsutured wounds, and those with preoperative ATR astigmatism may benefit from sutured wounds if the incision is placed in the vertical meridian.

Astigmatism↗

PubMed1998

Application of cyanoacrylate adhesive (Krazy Glue) in critical cardiac injuries.

BACKGROUND AND AIMS OF THE STUDY: Although small lacerations of the myocardium may be repaired easily using conventional methods, larger tears or ruptures, especially if they occur in infarcted myocardial tissue, may create formidable technical challenges. Described is a method for applying sutureless pericardial patches for control of hemorrhage. METHODS: A sutureless pericardial patch was glued to the myocardium with commercially available household cyanoacrylate (Krazy Glue) in seven patients. RESULTS: No patient in this series developed any evidence of mediastinal infection as a result of this technique. Six patients were discharged home without any long-term sequelae noted. One patient developed reinfarction and died of arrhythmia two weeks following surgery. Autopsy revealed that the laceration had healed and that the patch was closely adherent. Bacteriology studies revealed that different brands of cyanoacrylate are not only bacterium-free but also exhibit a bactericidal effect. CONCLUSIONS: Sutureless pericardial patches fastened to the myocardium with cyanoacrylate glue to control hemorrhage under critical situations were easy to apply, safe and effective in this series of patients.

Adhesives↗

PubMed2006

Modified microkeratome-assisted posterior lamellar keratoplasty using a tissue adhesive.

OBJECTIVE: To compare graft stability and astigmatic change using suture vs tissue adhesive in an experimental model of microkeratome-assisted posterior lamellar keratoplasty. METHODS: A 300-microm-thick partial flap keratectomy was performed in human donor corneoscleral rims using an artificial anterior chamber and a manual microkeratome. The flap stopped at the left central opening border, providing a wide hinge to add stability. After flap reflection, a 6.25-mm trephination was performed to obtain a disc of posterior stroma, Descemet membrane, and endothelium. The disc was positioned in a sutureless fashion, and the flap secured with either 5 interrupted sutures or a chondroitin-sulfate-aldehyde-based adhesive. Increasing intrachamber pressures were created to detect graft stability. Videokeratographic data were recorded to evaluate astigmatic change. RESULTS: The mean (SD) astigmatic change was 3.08 (0.84) diopters (D) in the sutured group and 1.13 (0.55) D in the glued group (P = .008). Mean (SD) resisted pressures were 95.68 (27.38) mm Hg and 82.45 (18.40) mm Hg in the sutured and glued groups, respectively (P = .97). CONCLUSION: This modified technique of microkeratome-assisted posterior lamellar keratoplasty showed excellent graft stability in both groups. Flaps sealed with the novel tissue adhesive had reduced astigmatic changes in our experimental model. CLINICAL RELEVANCE: Sutureless microkeratome-assisted posterior lamellar keratoplasty using tissue adhesive may become a new alternative in the surgical treatment of corneal endothelial disorders.

Aged↗

PubMed1982

Ten-year experience of 359 epicardial pacemaker systems: complications and results.

In the last ten years (1970-1980) 457 patients underwent permanent pacemaker insertion in the Brompton Hospital. Our practice has been somewhat atypical in that the majority of these patients had epicardial leads, initially using a Cordis intramural sutured electrode (85 patients), and subsequently a Medtronic sutureless electrode (274 patients). Our initial experience with these electrodes was satisfactory, but more recently it has become apparent that the long-term morbidity and complication rate is high. The respective complication rates being 25% and 18% for sutured and sutureless epicardial electrodes. In this study, lead complications were defined as those requiring lead replacement, and problems most commonly encountered were high voltage threshold, infection, and lead fracture. Unless there are specific indications for epicardial pacing it is now our policy to treat patients requiring permanent pacing with endocardial systems. Our complication rate with this technique (90 patients) is significantly lower (9%).

Adolescent↗

PubMed1994

Different techniques of extracapsular cataract extraction: bacterial contamination during surgery. Prospective study on 230 consecutive patients.

This study was performed to investigate the correlation between the contamination of the anterior chamber and the technique of extracapsular cataract extraction (ECCE). Three different methods were used: uncomplicated planned ECCE, phacoemulsification involving suturing method, and sutureless technique. All patients had posterior chamber intraocular lenses implanted. Two hundred and thirty consecutive patients were included in this prospective study, and preoperative smears of the conjunctiva and intraoperative aspirates of the anterior chamber were investigated. Samples of the aqueous humor were taken at the beginning and at the end of the operation. Cultures were incubated and held for 14 days. More than 71% of the preoperative smears were contaminated by coagulase-negative staphylococci, the most commonly isolated bacteria. However, 27% of the patients had culture-positive anterior chamber aspirates intraoperatively, also with coagulase-negative staphylococci as the most frequent organisms. In no case did postoperative endophthalmitis develop. Preliminary results in a small population show that the contamination of the aqueous humor is statistically significantly less frequent if the cataract extraction is performed by phacoemulsification than if it is done without phacoemulsification. Another interesting finding is that anterior chamber contamination is not significantly more frequent, if a sutureless technique is used for cataract surgery.

Adult↗

PubMed1998

Intestinal anastomosis by use of the biofragmentable anastomotic ring: is it safe and efficacious in emergency operations as well?

PURPOSE: Although sutureless anastomosis by use of the biofragmentable anastomotic ring is now accepted as an alternative to conventional manual sutured or stapled methods in elective enterocolic surgery, its applicability to emergency enterocolic surgery has not yet been established. The aim of this prospective study was to determine whether the biofragmentable anastomotic ring anastomosis in emergency enterocolic surgery could be performed as safely as in elective surgery or as emergency handsewn anastomosis. METHODS: To evaluate the safety and efficacy of sutureless bowel anastomosis by use of the biofragmentable anastomotic ring in emergency enterocolic surgery, a prospective, randomized study was undertaken to compare the biofragmentable anastomotic ring with conventional handsewn anastomotic technique. One hundred nineteen patients who required emergency laparotomy were randomly assigned to two groups: 56 patients (47 percent) underwent 58 biofragmentable anastomotic ring anastomoses, and 63 patients (53 percent) underwent 65 sutured anastomoses. In addition, the safety and efficacy of the biofragmentable anastomotic ring in emergency surgery were compared with those of the biofragmentable anastomotic ring in 86 elective biofragmentable anastomotic ring anastomoses performed in 84 patients during the same period of time. RESULTS: Specific intraoperative complications related to use of biofragmentable anastomotic rings occurred in six patients (10.7 percent), and another new biofragmentable anastomotic ring anastomosis was constructed in one patient. These reflected learning-curve errors, but they did not adversely affect the outcome. No statistical differences were observed among the groups with respect to wound complications, postoperative bleeding, intra-abdominal abscess, intestinal obstruction, or postoperative death. As for anastomotic leakage, six patients, two in each group, had complications of anastomotic failure, wherein four colonic fistulas required a diversion and two enteric fistulas closed spontaneously. Although there were no statistically significant differences in incidence of leaks among groups (P = 0.4522), two fistulas in colocolic anastomoses, one in the suture group and the other in the biofragmentable anastomotic ring group, manifested the risk of primary anastomosis in emergency colon resection. Seven patients, three in the elective biofragmentable anastomotic ring group and two each in the emergency suture and biofragmentable anastomotic ring groups, died after the operation, but no deaths were directly attributed to the anastomotic technique used. CONCLUSION: The data suggest that the biofragmentable anastomotic ring is a safe and reliable alternative to conventional handsewn anastomosis in emergency enterocolic surgery, where the rapidity and security of anastomosis may be critical. Consideration, however, should be given to emergency primary colocolic or colorectal anastomosis, because of a high risk of anastomotic failure, although there are too few cases for a definite conclusion.

Adolescent↗

PubMed1991

Fibrin sealant improves surgical results of type A acute aortic dissections.

From January 1984 to July 1990, 63 patients were operated on for type A acute aortic dissection. Forty-two patients (aged 22 to 80 years) had isolated replacement of the ascending aorta with the following techniques: group 1 (n = 10) had replacement of the ascending aorta with an intraluminal sutureless graft, group 2 (n = 14) had a Dacron prosthesis sutured to the aorta, and in group 3 (n = 18) the proximal and distal aortic stumps were glued together and reinforced at the suture sites with fibrin sealant before implantation of the Dacron prosthesis. There were no significant differences between the three groups with respect to age, sex, or preoperative clinical and anatomical data. Three (30%) intraoperative deaths occurred in group 1, 4 (29%) in group 2, and none in group 3. Cross-clamp and extracorporeal circulation time were significantly lower in group 1 when compared with groups 2 and 3. Perioperative blood loss during the first 24 hours was significantly lower in group 3 (372 +/- 155 mL) when compared with group 1 (755 +/- 210 mL; p less than 0.05) or group 2 (1,055 +/- 370 mL; p less than 0.01). Total hospital mortality was 7 (70%) in group 1, 6 (43%) in group 2, and 1 (5.5%) in group 3. All patients were reviewed: one late death occurred in group 2 and none in the other groups. All survivors were in good clinical condition. In conclusion, intraluminal sutureless grafts allowed shorter cross-clamp and extracorporeal circulation time but did not improve surgical results for treatment of type A acute aortic dissections.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMed2004

PermaVision intracorneal lens for the correction of hyperopia.

PURPOSE: To evaluate the safety, predictability, and efficacy of sutureless synthetic keratophakia (SSK) with PermaVision intracorneal lens (Anamed) implantation. SETTING: Ophthalmic Hospital, Rome, Italy. METHODS: This retrospective study analyzed the refractive outcomes in 10 eyes of 6 patients who had SSK with PermaVision lens implantation for spherical hyperopia (cylinder less than 1.0 diopter [D]). Preoperatively, the mean spherical equivalent (SE) refraction was +4.33 D +/- 1.52 (SD) (range +3.00 to +6.37 D). All procedures were performed using the Hansatome microkeratome (Bausch & Lomb) with a superior hinge except in 1 eye in which the flap was cut using the Amadeus microkeratome (Allergan) with a nasal hinge. RESULTS: Six months after PermaVision lens insertion, the mean SE refraction was +0.03 +/- 0.36 D (range -0.50 to +0.38 D), the mean uncorrected visual acuity was 0.85 +/- 0.13 (range 0.63 to 1.00), and the mean best corrected visual acuity was 0.99 +/- 0.19 (range 0.63 to 1.25). No eye lost lines of visual acuity. In 1 eye, the lens was acutely decentered and had to be explanted. CONCLUSIONS: Sutureless synthetic keratophakia with the PermaVision intracorneal lens is a new technique for the correction of hyperopia. It is easy to perform as well as reversible, and the learning curve of the experienced laser in situ keratomileusis surgeon is short. The technique was safe and effective for spherical hyperopia, but longer follow-up and additional cases are needed to draw conclusions about the efficacy of the technique.

Adult↗

PubMed2001

Surgical strategy for left ventricular free wall rupture after acute myocardial infarction.

BACKGROUND: Left ventricular free wall rupture is usually fatal without surgical intervention. However, the most appropriate surgical procedure remains controversial. METHODS: Seventeen patients (14 men, 3 women) who developed left ventricular free wall rupture after acute myocardial infarction were treated surgically. Their mean age was 65.4 years (range, 55 to 79 years). The following surgical procedures were performed: infarctectomy and patch reconstruction in 1 patient, direct closure with or without patch covering in 4 patients, simple patch covering anchored by running suture in 4 patients, and a sutureless technique in 7 patients. Endventricular patch closure was performed in 1 patient with ventricular septal perforation. RESULTS: One of 3 patients with a blow-out type rupture and 1 of 13 patients with an oozing type rupture died shortly after operation. The overall surgical mortality rate was 11.8%. CONCLUSIONS: Selection of the optimal procedure for each cardiac condition is important for obtaining good results. For patients with ongoing squirting bleeding, patch covering is the technique of choice. For oozing, the sutureless technique is preferable.

Aged↗

PubMed2002

Two generations of the St. Jude Medical ATG coronary connector systems for coronary artery anastomoses in coronary artery bypass grafting.

BACKGROUND: In the past, coronary anastomoses have been performed using running and, occasionally, interrupted non-resorbable sutures. Recently, special interest has developed in mechanical anastomotic devices to facilitate minimal invasive techniques or limited access surgery. The experience with two series of patients undergoing coronary artery bypass grafting (CABG) using the St. Jude Medical ATG coronary connector systems (investigational stainless steel device, not yet commercially available) for vein-to-coronary artery anastomoses is reported here. METHODS: Between November 2000 and April 2002, we evaluated two generations of distal coronary connector systems in 19 patients who were scheduled for multivessel CABG. One vein graft-to-coronary artery anastomosis per patient was performed with a stainless steel mechanical connector, in an ongoing investigational study. Although these two generations of the St. Jude Medical ATG coronary connectors have the same underlying construction, somewhat cumbersome loading of the first-generation system led to simplification of the second-generation system, which is currently evaluated. RESULTS: With the first generation of distal connector, hemostasis was instantaneous in all cases, and all anastomoses were patent at the end of the procedure. However, retrograde flow to the native coronary artery was restricted in 1 patient. The connector was removed, and the anastomosis was performed with a running suture at the same site. Three-month angiography or magnetic resonance imaging angiography was available in 11 patients with 10 patent connector grafts. With the second-generation connectors one of five had to be removed because of leakage, and the anastomosis could be sutured at the same site. The other four connector anastomoses were patent and hemostatic at the end of the procedure. CONCLUSIONS: The St. Jude Medical ATG coronary connector system is an effective device for sutureless vein graft to coronary artery anastomoses in CABG. The second-generation system presents a further development eliminating some drawbacks of the first generation such as cumbersome, time-consuming loading as well as suitability for smaller coronary arteries. These connectors allow construction of geometrically round anastomoses and theoretically may also be suitable for sequential anastomoses. After tremendous research and development efforts, an optimized mechanical connection system for small vessel anastomoses has been introduced into clinical investigation. This represents a major step in the era of sutureless vascular connections in cardiac surgery.

Aged↗

PubMed2003

Initial experience with proximal anastomoses performed with a mechanical connector.

BACKGROUND: The Symmetry Bypass System Aortic Connector (St Jude Medical, Inc) is a novel device for the construction of sutureless proximal anastomoses. The connector allows attachment of saphenous vein grafts to the aorta without requiring aortic clamping. We report our initial clinical experience with this device. METHODS: In a 2-month period from May to July 2001, a total of 139 consecutive proximal anastomoses were performed in 67 patients using the connector. All procedures were performed on a beating heart without cardiopulmonary bypass or any aortic clamping. Intraoperative variables and postoperative results were prospectively collected and retrospectively analyzed. RESULTS: Of 139 consecutive proximal anastomoses 138 (99.3%) were successfully completed with the device. One anastomosis required suture revision because of misdeployment. Six anastomoses (4.3%) required an additional suture for leak. Predeployment problems included connector loading/preparation malfunction in 10 grafts (7.2%), five because of human error and five technical failure. There was no operative mortality, perioperative myocardial infarction, or stroke. Vessels bypassed included the circumflex system (n = 59), right coronary artery and branches (n = 48), diagonal branch (n = 26), and left anterior descending coronary artery (n = 6). At a mean follow-up of 7 months, survival was 94.1% and survival free of major adverse cardiac and cerebrovascular events (MACCE) was 88.1%. CONCLUSIONS: Initial clinical experience with a sutureless proximal saphenous vein graft to aorta anastomosis performed with a mechanical connector demonstrates safety, reliability, and ease of use. Surmounting a brief learning curve improves the subtleties of device loading and deployment. Further benefits will be determined in an ongoing randomized study.

Adult↗