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PubMed1998

Sutureless repair of major intracranial vessels with the Sundt clip-graft: technical note.

Major intracranial vessels can be damaged during tumor resection. With the availability of refined microvascular techniques, direct repair or by-pass of the damaged segment is possible. These methods, however, often require temporary occlusion of the offending vessel, can result in a less than optimal angiographic result, and are difficult to perform in a deep field. Additionally, in some patients direct repair or by-pass is not feasible because of the friability of the vessel or as a result of the large size of the tear. In these cases the Sundt clip-graft represents a valid adjunct to the armamentarium of the surgeon. Over the years, it has been used by the senior author in five patients where vascular injury occurred during the removal of brain tumors (3 meningiomas, one pituitary adenoma, and one low-grade glioma). In this report we illustrate our most recent experience with this ingenious tool. A 22-year-old man underwent resection of a recurrent left temporal lobe low-grade glioma. During resection of the tumor, a tear occurred in a branch of the middle cerebral artery. The tear was repaired using a Sundt clip-graft. A post-operative angiogram, performed five days later, showed patency of the vessel with no evidence of wall irregularities. Described 30 years age to be used primarily in aneurysm surgery, the Sundt clip-graft provides an excellent, too often forgotten, sutureless method of repairing intracranial vessels damaged during tumor removal.

Adult↗
PubMed2003

Sutureless Lichtenstein: first results of a prospective randomised clinical trial.

Inguinal hernia repair, according to Lichtenstein, is very popular due to its minimal invasiveness (local anaesthesia), easy and reproducible technique, low recurrence rate, and low morbidity. However, recent publications demonstrate an elevated rate of chronic irritations and pain, probably due to tension or nerve compression by the fixing sutures. We, therefore, established a concept to avoid these sutures by attaching the prosthesis with glue. After a pilot study, a randomised prospective trial was started. The aim of our study was to compare the results of the classical Lichtenstein repair (group 1) vs the "Sutureless Lichtenstein" (group 2) in terms of postoperative complications and recurrences. Operative access and management of the hernial sac was equal to Lichtenstein for both groups. In group 1, we sutured the mesh with PDS 2/0; in group 2, the mesh was glued with n-butyl-cyanoacrylate. In both groups, the operation was then completed according to Lichtenstein, and unrestricted activity was allowed after 2 weeks. A total of 46 patients have been operated on. The follow-up results at 3 weeks and [3 months] were: group 1 ( n=24) vs group 2 ( n=22): recurrences 0 [0] vs 0 [0], minor pain 8 [4] vs 4 [1], local numbness 14 [10] vs 10 [6]. No adhesive-related complications were seen. Patients will be followed for 2 years. The results in group 2 were excellent, and there was no difference vs group 1. Furthermore, there was a tendency for better results in group 2. These results are very promising and justify a continuation of the study.

Adult↗
PubMed2005

Development of sutureless vascular connecting system for easy implantation of small-caliber artificial grafts.

A novel sutureless vascular connecting system, an assembly with a delivery rod, an introducing sheath, and a connecting device, was developed for easy implantation of small-caliber vascular grafts less than 2 mm in internal diameter. A microporous stainless tube (length 2 mm, external diameter 1.6 mm, wall thickness 65 microm, pore diameter 400 microm, pore-to-pore distance 500 microm) was designed to serve as a connecting device. The feasibility of the system was tested using two types of preliminary animal experiments. One animal model consisted of graft implantation into the rat abdominal aorta (1.5 mm in diameter). The connecting device was inserted into the proximal and distal ends of the aorta through the introducing sheath by pushing the delivery rod with the connecting device placed over it. Subsequently, the aortic segments were inserted into both ends of model grafts made of segmented polyurethane (1.8 mm in internal diameter) and were fixed with banding silk threads from the exterior. The procedure was completed within 20 min without requiring specialized microsurgery techniques. Blood leakage and obstruction did not occur. The second model consisted of an end-to-end anastomosis between rabbit common carotid arteries (2 mm in diameter), which was performed within several minutes of blood flow interruption. Scanning electron microscopy demonstrated that the luminal surface of the device was fully covered with endothelial cells (ECs) after 1 week as a result of transluminal ingrowth of native ECs through the micropores in the device. This endothelialization may prevent early thrombus-induced occlusion. This simple and "easy-to-learn" technique will promote the development of small-caliber arterial grafts, and furthermore, it may have potential for clinical application.

Anastomosis, Surgical↗
PubMed2002

Sutureless colonic anastomosis in the rat: a randomized controlled study.

The aim of the present study was to evaluate the effect of glue tissue on the healing of colonic anastomosis in rats. Two groups of 20 Wistar rats each were used. Following laparotomy, a segment of 1 cm of the colon was resected, 10 cm from the ileocecal valve. In the control group, the anastomosis was sutured in a single layer with 6-0 polypropylene interrupted extramucosal sutures. In the glue group, the anastomosis was performed by using 2-octyl cyanoacrylate (Dermabond, Ethicon). Rats were sacrificed on day 7 following operation. Integrity of the anastomoses, existence of perianastomotic abscess or peritonitis, and adhesion formation were recorded. Anastomoses were resected including a 2.5-cm of bowel on either side. Bursting pressures were measured and the specimens were sent for histological examination. Anastomotic dehiscence occured in 20% of the animals in each group. Adhesion formation was more extensive in the glue group compared to the control group, but this difference was not statistically significant (p=0.074). Bursting pressures of the anastomoses between the two groups were not statistically significant (p=0.897). The wound healing process, as assessed by inflammatory cell infiltration, blood vessel neodevelopment, collagen deposition and fibroblast activity, did not differ statistically between the two groups (p>0.05). In conclusion, 2-octyl cyanoacrylate provides, under experimental conditions, a sutureless anastomosis equal in healing to the conventionally sutured one. The outcome may differ under demanding clinical situations.

Anastomosis, Surgical↗
PubMed2004

Sutureless patch repair for small blowout rupture of the left ventricle after myocardial infarction.

Rupture of the left ventricular free wall is one of the most serious complications of myocardial infarction. A 73-year-old man with severe chest pain visited our hospital. Coronary angiography revealed acute myocardial infarction in the territory of the diagonal branch. About six hours after successful percutaneous coronary intervention, the patient fell into cardiogenic shock with chest pain. Echocardiography showed moderate pericardial effusion with a subepicardial hematoma, and percardioentesis led to the diagnosis of free wall rupture. Emergency surgery was performed with the use of intra-aortic balloon pumping. The rupture was a blowout type in a small tear at the anterolateral wall of the left ventricle. We repaired the tear with an off-pump sutureless patch using collagen fleece with fibrinogen-based impregnation (TachoComb) and equinous pericardium with fibrin spray. The patient was free of both re-rupture and pseudoaneurysm postoperatively, and was discharged 20 days after the operation. Considering previously reported various procedures for surgical repair, this technique may be useful if the tear is small.

Aged↗
PubMed1989

Twenty-five-year review of the Magovern-Cromie sutureless aortic valve.

We reviewed 25 years (4,798 patient-years) of aortic valve replacement with the Magovern-Cromie sutureless valve. Operative mortality was 11% for isolated aortic valve replacement and 15% for aortic valve replacement with concomitant cardiac procedures. Since 1981, operative mortality has declined to 4.9%. Valve-related morbidity was in the lower expected ranges for prosthetic aortic valves: ball variance, 0.3%/patient-year; paraprosthetic leak, 0.41%/patient-year; valve endocarditis, 0.43%/patient-year; valve thrombosis, 0.04%/patient-year; and embolic events, 3.95%/patient-year. The incidence of aortic valve reoperation was 0.76%/patient-year. The 5-year, 10-year, and 20-year probability of survival corrected for normal mortality was 77%, 64%, and 52% for all discharged patients. This review confirms the Magovern-Cromie valve to be a safe, durable, and efficient prosthetic valve.

Adolescent↗
PubMed2005

Corneal topographic changes after transconjunctival (25-gauge) sutureless vitrectomy.

PURPOSE: To evaluate the topographic changes in the cornea after pars plana vitrectomy (PPV) with 25-gauge transconjunctival sutureless vitrectomy (TSV) system. DESIGN: Prospective, interventional case series. METHODS: In this prospective study, we evaluated the topographic changes of the cornea in 32 eyes of 32 patients who underwent PPV with the 25-gauge TSV system. The topographic parameters that were analyzed statistically were the average corneal power, corneal surface cylinder, surface asymmetry index, and surface regularity index. Mean induced astigmatism was estimated by vector analysis software. Wilcoxon test was used for statistical analysis. RESULTS: There was no significant change in average corneal power, corneal surface cylinder, surface asymmetry index, and surface regularity index parameters at first day, first week, and first month after the operation. Mean induced astigmatism was 0.38 diopters at 15 degrees. CONCLUSIONS: Corneal surface and astigmatic changes were observed to be insignificant in the early postoperative period after PPV with the 25-gauge TSV system.

Aged↗
PubMed2006

A prospective randomized clinical trial of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery in Nepal.

PURPOSE: To compare the efficacy and visual results of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery (SICS) for the treatment of cataracts in Nepal. DESIGN: Prospective, randomized comparison of 108 consecutive patients with visually significant cataracts. METHODS: settings: Outreach microsurgical eye clinic. patients: One hundred eight consecutive patients with cataracts were assigned randomly to receive either phacoemulsification or SICS. intervention Cataract surgery with implantation of intraocular lens. main outcome measures: Operative time, surgical complications, uncorrected and best-corrected visual acuity (BCVA), astigmatism, and central corneal thickness (CCT). RESULTS: Both surgical techniques achieved excellent surgical outcomes with low complication rates. On postoperative day 1, the groups had comparable uncorrected visual acuity (UCVA) (P = 0.185) and the SICS group had less corneal edema (P = 0.0039). At six months, 89% of the SICS patients had UCVA of 20/60 or better and 98% had a best-corrected visual acuity (BCVA) of 20/60 or better vs 85% of patients with UCVA of 20/60 or better and 98% of patients with BCVA of 20/60 or better at six months in the phaco group (P = 0.30). Surgical time for SICS was much shorter than that for phacoemulsification (P < .0001). CONCLUSION: Both phacoemulsification and SICS achieved excellent visual outcomes with low complication rates. SICS is significantly faster, less expensive, and less technology dependent than phacoemulsification. SICS may be the more appropriate surgical procedure for the treatment of advanced cataracts in the developing world.

Aged↗
PubMed2004

Multivessel distal sutureless off-pump coronary artery bypass grafting procedure using magnetic connectors.

Proximal anastomotic devices for beating heart coronary artery bypass grafting (CABG) have been developed to avoid ascending aortic manipulation. Distal anastomotic devices may become an extremely useful tool to assist in enabling minimally invasive (robotic) multivessel CABG. As a transition phase toward this ultimate goal we have been using a distal anastomotic device for the left internal mammary artery-left anterior descending artery (LIMA-LAD) anastomosis. In addition we recently performed two off-pump coronary artery bypass procedures that were distally completely sutureless.

Aged↗
PubMed2005

Sutureless repair with TachoComb sheets for oozing type postinfarction cardiac rupture.

Left ventricular free-wall rupture is a well recognized complication of myocardial infarction and a frequent cause of death. The appropriate surgical management varies significantly depending on the condition of the tear and the presence of concomitant lesions. We present a case of oozing type postinfarction cardiac rupture that was treated successfully by a sutureless patch technique using a fibrin tissue-adhesive collagen fleece (TachoComb [Torii Pharmaceutical, Tokyo, Japan]). This represents a quick, effective, and safe option for dealing with oozing type myocardial rupture due to myocardial infarction.

Aged↗
PubMed2006

Endoscopic off-pump aortic valve replacement: does the pericardial cuff improve the sutureless closure of left ventricular access?

OBJECTIVE: Off-pump trans left ventricular approach provides more precise deployment of stented aortic valve of any size with respect to the endovascular replacement. One of the key steps of this procedure is the ventricle repair after catheter withdrawing. We designed an animal study to compare the consistency of a sutureless repair of the left ventricle access using nitinol occluder with and without pericardial cuff on the ventricular side. METHODS: Material description: The Amplatz-nitinol occluder consists of two square heads squeezing ventricle wall in between them, sealing the defect. To improve its sealing property, a pericardial patch was sutured to the ventricular head of the occluder. Animal study setup: In adult pigs, a 30F sheath was inserted into the epigastric area through the cardiac apex, up to the left ventricle, simulating the approach for off-pump aortic valve replacement. The sheath was then removed and the ventricle closed with standard occluder in half of the animals, and cuffed occluder in the other half. Animals were followed-up for 3h, collecting haemodynamics data and pericardial bleeding. RESULTS: Device was successfully deployed in 12 animals in less than 1min. In the group where the standard occluder was used, bleeding during the deployment was 80+/-20ml and after the deployment was 800+/-20ml over 3h. In the group where the cuffed occluder was used, bleeding during the deployment was 85+/-20ml and after the deployment was 100+/-5ml over 3h. In the cuffed group, bleeding was significantly lower than the standard group, p-value being <0.001. CONCLUSIONS: The occluder is easy to use and the pericardial cuff dramatically increases its efficacy as demonstrated by a significant reduction of blood loss. The cuffed occluder opens the way for endoscopic, off-pump, transventricular aortic valve replacement.

Animals↗
PubMed2006

Combined phacoemulsification, foldable intraocular lens implantation, and 25-gauge transconjunctival sutureless vitrectomy.

We describe a technique for combined cataract and vitreoretinal surgery using a 25-gauge transconjunctival sutureless vitrectomy system. This technique was successfully performed in 20 consecutive cases. Outcomes were assessed in terms of visual acuity, intraocular pressure, postoperative refractive error, and incidence of complications. The technical feasibility, rationale, and advantages and disadvantages of this technique are discussed.

Adult↗
PubMed2004

A "plastic" sutureless abdominal wall closure in gastroschisis.

BACKGROUND/PURPOSE: Several techniques are described for closure of the gastroschisis abdominal wall defect. The authors describe a technique that allows for spontaneous closure that is simple, cosmetically appealing, and minimizes intraabdominal pressure after bowel reduction. METHODS: Under either general anesthetic or analgesia with sedation, the gastroschisis bowel is decompressed, and the bowel is primarily reduced. The gastroschisis defect is covered with the umbilical cord tailored to fit the opening, and 2 Tegaderm (3M Healthcare, MN) dressings reinforce the defect ("plastic closure"). Intragastric pressure is monitored during and after the procedure. If primary reduction is not possible, the bowel is reduced daily via a spring-loaded silo (Bentec Medical, CA). After reduction of the bowel, the defect is allowed to close spontaneously using the "plastic closure" technique. The authors prospectively treated a cohort of patients with gastroschisis that included simple to complex cases using this technique. RESULTS: Ten children with gastroschisis were treated; 6 of these children had a primary reduction and simple closure of their defect using the "plastic closure." In the remaining 4 children, the plastic closure was used either primarily or secondarily to silo placement, despite the need for repair of complex intestinal anomalies. The average times to first feeding and discharge were 12.5 and 28.3 days, respectively. Six of the 10 children (60%) had small umbilical hernias, and only 1 underwent operative repair at 13 months of age. CONCLUSIONS: The plastic closure of gastroschisis is simple, safe, and cosmetically appealing. Intraabdominal pressures are well controlled, and the umbilical position remains centrally located in this sutureless technique. Umbilical defects can occur but are observed for spontaneous closure like most primary umbilical hernias.

Gastroschisis↗
PubMed2004

Side-to-side sutureless vascular anastomosis with magnets.

OBJECTIVE: Abbe and Payr introduced vascular techniques and devices to facilitate vessel anastomosis over a century ago. Obora published the idea of a sutureless vascular anastomosis with use of magnetic rings in 1978. The purpose of this study was to assess the performance of a new magnetic device to perform a side-to-side arteriovenous anastomosis in a dog model. MATERIAL AND METHODS: Male fox hounds (25 kg) were treated preoperatively and daily postoperatively with clopidogrel bisulfate (Plavix) and aspirin. The femoral artery and vein were exposed unilaterally in 3 dogs and bilaterally in 4 dogs (n = 11 anastomoses). A 4-mm arteriotomy was performed, and 1 oval magnet 0.5 mm thick was inserted into the lumen of the artery and a second magnet was applied external to the artery, compressing and stabilizing the arterial wall to create a magnetic port. An identical venous magnetic port was created with another pair of oval magnets. When the 2 ports were allowed to approach each other, they self-aligned and magnetically coupled to complete the arteriovenous anastomosis. Patency was assessed for the first hour with direct observation, again after 9 weeks with duplex ultrasound scanning, and at 10 weeks under direct open observation. The anastomoses were explanted after 10 weeks. Hydrodynamic resistance was measured ex vivo on the final 8 anastomoses by measuring the pressure drop across an anastomosis with a known flow rate. RESULTS: After implantation, very high flow created visible turbulence and palpable vibration. All 11 anastomoses were patent under direct observation and palpation. Ten of 11 anastomoses were clearly patent on duplex scans, and patency of 1 anastomosis was questionable. Hydrodynamic resistance averaged 0.73 +/- 0.33 mm Hg min/mL (mean +/- SEM). CONCLUSIONS: Vascular anastomoses performed with magnets demonstrated feasibility; exhibited 100% patency after 10 weeks in a dog arteriovenous shunt model; lacked apparent aneurysm or other potentially catastrophic failure; demonstrated remodeling of the vessel wall after several weeks to incorporate the magnets, making the magnetic force unnecessary; and warrants further study in vessels with different sizes, flow rates, and locations. CLINICAL RELEVANCE: We present a magnet-based device used to perform side-to-side peripheral vascular anastomoses. Its advantages include the ability to anastomose vessels without requiring circumferential surgical exposure. Vascular anastomosis performed with these magnets demonstrated 100% patency in the dog, lacked apparent aneurysm or other potentially catastrophic failure, and demonstrated remodeling of the vessel wall after several weeks, to incorporate the magnets, making indefinite retention of field strength unnecessary. This technique could enable minimally invasive procedures, such as complex reconstructive and revascularizing surgery, and warrants further study in vessels with different sizes, flow rates, and locations.

Animals↗
PubMed2006

Sutureless nephron-sparing surgery: use of albumin glutaraldehyde tissue adhesive (BioGlue).

OBJECTIVES: To determine the feasibility of using serum albumin glutaraldehyde tissue adhesive (BioGlue) to achieve hemostasis and prevent urine leakage during nephron-sparing surgery (NSS). METHODS: From February 1993 to April 2005, 174 NSS operations were performed for renal cell carcinoma at our institute. A total of 143 patients underwent NSS with the traditional suturing technique (suture group) and 31 patients underwent a sutureless BioGlue sealing-only procedure (BioGlue group). We compared the two groups for clinical and tumor characteristics and surgical outcome. RESULTS: The patient and tumor characteristics were similar in both groups. The average maximal tumor diameter was 4.21 cm (range 2.2 to 7) for the suture group and 3.67 cm (range 2 to 6.8) for the BioGlue group. The use of BioGlue reduced the mean warm ischemic time by 8.8 minutes (17.2 versus 26 minutes, P = 0.002). The mean estimated blood loss was 45.1 mL in the BioGlue group and 111.7 mL in the suture group (P = 0.001). Blood transfusion was required in 1 patient (3.2%) of the BioGlue group and 24 (17%) in the suture group (P = 0.014). None of the patients treated with BioGlue developed urinary fistula compared with three (2%) in the suture group. CONCLUSIONS: Albumin glutaraldehyde tissue adhesive (BioGlue) alone provided adequate hemostasis during NSS, significantly decreasing the blood loss and transfusion rate, as well as the renal ischemic and operative times. BioGlue was easy to use and safe for sealing the kidney during partial nephrectomy. Future prospective clinical trials are necessary to validate its role during renal surgery.

Adult↗
PubMed1980

Tarsal buckling after sutureless Fasanella-Servat procedures.

A patient who underwent bilateral, sutureless Fasanella-Servat procedures experienced wound dehiscence that resulted in a distorted eyelid contour which rquired substantial wound and eyelid revision. Other methods of handling the problem of suture abrasion exist that may prevent tarsal buckling after a Fasanella-Servat procedure.

Blepharoptosis↗