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Kocaaga B, Inan T, Yasar Nİ, Yalcin CE, Sungur FA, Kurkcuoglu O, Demiroz A, Komurcu H, Kizilkilic O, Aydin SY, Aydin Ulgen O, Güner FS, Arslan H. Innovative Use of an Injectable, Self-Healing Drug-Loaded Pectin-Based Hydrogel for Micro- and Supermicro-Vascular Anastomoses. Biomacromolecules 2024; 25:3959-3975. [PMID: 38934558 PMCID: PMC11238333 DOI: 10.1021/acs.biomac.4c00102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Microvascular surgery plays a crucial role in reconnecting micrometer-scale vessel ends. Suturing remains the gold standard technique for small vessels; however, suturing the collapsed lumen of microvessels is challenging and time-consuming, with the risk of misplaced sutures leading to failure. Although multiple solutions have been reported, the emphasis has predominantly been on resolving challenges related to arteries rather than veins, and none has proven superior. In this study, we introduce an innovative solution to address these challenges through the development of an injectable lidocaine-loaded pectin hydrogel by using computational and experimental methods. To understand the extent of interactions between the drug and the pectin chain, molecular dynamics (MD) simulations and quantum mechanics (QM) calculations were conducted in the first step of the research. Then, a series of experimental studies were designed to prepare lidocaine-loaded injectable pectin-based hydrogels, and their characterization was performed by using Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM), and rheological analysis. After all the results were evaluated, the drug-loaded pectin-based hydrogel exhibiting self-healing properties was selected as a potential candidate for in vivo studies to determine its performance during operation. In this context, the hydrogel was injected into the divided vessel ends and perivascular area, allowing for direct suturing through the gel matrix. While our hydrogel effectively prevented vasospasm and facilitated micro- and supermicro-vascular anastomoses, it was noted that it did not cause significant changes in late-stage imaging and histopathological analysis up to 6 months. We strongly believe that pectin-based hydrogel potentially enhanced microlevel arterial, lymphatic, and particularly venous anastomoses.
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Affiliation(s)
- Banu Kocaaga
- Department of Chemical Engineering, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Tugce Inan
- Department of Chemical Engineering, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Nesrin İsil Yasar
- Informatics Institute, Computational Science and Engineering Division, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Can Ege Yalcin
- Cerrahpasa Medical Faculty, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University-Cerrahpasa, Istanbul 34089, Turkey
| | - Fethiye Aylin Sungur
- Informatics Institute, Computational Science and Engineering Division, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Ozge Kurkcuoglu
- Department of Chemical Engineering, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
| | - Anil Demiroz
- Cerrahpasa Medical Faculty, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University-Cerrahpasa, Istanbul 34089, Turkey
| | - Hasan Komurcu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Balat Or-Ahayim Hastanesi, Istanbul 34087, Turkey
| | - Osman Kizilkilic
- Cerrahpasa Medical Faculty, Department of Interventional Radiology, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey
| | - Servet Yekta Aydin
- Cerrahpasa Medical Faculty, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University-Cerrahpasa, Istanbul 34089, Turkey
| | - Ovgu Aydin Ulgen
- Cerrahpasa Medical Faculty, Department of Pathology, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey
| | - Fatma Seniha Güner
- Department of Chemical Engineering, Istanbul Technical University, Maslak, 34469 Istanbul, Turkey
- Sabancı University Nanotechnology Research and Application Center, Istanbul 34956, Turkey
| | - Hakan Arslan
- Cerrahpasa Medical Faculty, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University-Cerrahpasa, Istanbul 34089, Turkey
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Kohli A, Dave A, Dixit P, Katrolia D, Kumar P, Kala PC. Efficacy of novel, three jaw adventitia holding microclamps compared to Acland microclamps in patients undergoing end-to-end microvascular anastomosis: A randomized control trial. J Plast Reconstr Aesthet Surg 2023; 87:69-77. [PMID: 37812846 DOI: 10.1016/j.bjps.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To evaluate the efficacy of three jaw adventitia holding (TADH) microclamps in end-to-end microvascular anastomosis. BACKGROUND Acland clamps, though highly efficacious, require a steep learning curve and are associated with complications such as back walling and incomplete bites. METHODS A single center, parallel group, 30-patient randomized clinical trial was conducted with a 1:1 allocation ratio in Acland and TADH microclamp groups. Primary outcome was time taken for microvascular anastomosis in terms of arterial and venous clamping and suturing time. Secondary outcomes included ease of use, need for clamp flipping and adventitia trimming, and need for assistance and flap survival. RESULTS TADH microclamps were found to be beneficial when compared to Acland microclamps in end-to-end microvascular anastomosis, in terms of artery clamp time (19.07 ± 3.751 min, 95% CI 10.058-17.942, p < 0.001), artery suture time (15.87 ± 3.357 min, 95% CI 10.660-17.206, p < 0.001), vein clamp time (21.50 ± 3.849 min, 95% CI 12.131-19.469, p < 0.001), and vein suture time (16.58 ± 3.147 min, 95% CI 13.232-20.368, p < 0.001). The TADH microclamps did not require flipping to enable suturing of the posterior walls of the vessel. Statistically significant difference was found in surgeon-reported ease of use with TADH microclamps (Chi-square value 9.867, p < 0.001). Statistically significant difference was found in relation to the need for assistance with TADH microclamps (Chi-square value 19.286, p < 0.001). CONCLUSION This study found TADH microclamps to be faster, easier to use, and clinically efficacious in reducing the anastomosis time compared to those of the Acland clamps.
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Affiliation(s)
- Aakash Kohli
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Aniket Dave
- Plastic & Reconstructive Surgery, Apollo CBCC Cancer Care, Ahmedabad, India; Department of Plastic Surgery & Burns, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Dixit
- Department of Plastic Surgery & Burns, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepti Katrolia
- Department of Plastic Surgery & Burns, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pravin Kumar
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prakash Chandra Kala
- Department of Plastic Surgery & Burns, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
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3
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Wu J, Lee J, Jung JY, Hwang JH, Kim KS, Shin M, Lee H, Park SH. Less-Suture Vascular Anastomosis: Development of Alternative Protocols with Multifunctional Self-Wrapping, Transparent, Adhesive, and Elastic Biomaterials. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2301098. [PMID: 37196994 DOI: 10.1002/adma.202301098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/04/2023] [Indexed: 05/19/2023]
Abstract
Blood vessel anastomosis by suture is a life-saving, yet time-consuming and labor-intensive operation. While suture-less alternatives utilizing clips or related devices are developed to address these shortcomings, suture anastomosis is still overwhelmingly used in most cases. In this study, practical "less-suture" strategies are proposed, rather than ideal "suture-less" methods, to reflect real-world clinical situations. In the case of rat artery (d = 0.64 mm) anastomosis, the less-suture anastomosis involves the application of thin, adhesive, transparent, and self-wrapping films to the site. This surprisingly reduces the number of stitches required from ten (without films) to four (with films), saving 27 min of operating time per vessel. Furthermore, the decreased number of stitches largely alleviates fibrosis-mediated wall-thickening. Thus, a less-suture strategy is particularly useful for anastomosis of multiple vessels in emergency conditions and small-diameter vessels.
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Affiliation(s)
- Jingxian Wu
- Department of Chemistry, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Jaemeun Lee
- R&D Center for Advanced Pharmaceuticals & Evaluation, Korea Institute of Toxicology (KIT), Daejeon, 34114, Republic of Korea
| | - Joo Young Jung
- Orthopaedic Department, Seail Hospital, Busan, 48793, Republic of Korea
| | - Jeong Ho Hwang
- Animal Model Research Group, Korea Institute of Toxicology (KIT), Jeongeup, 56212, Republic of Korea
- Human and Environmental Toxicology, Korea University of Science and Technology (UST), Daejeon, 34113, Republic of Korea
| | - Ki-Suk Kim
- R&D Center for Advanced Pharmaceuticals & Evaluation, Korea Institute of Toxicology (KIT), Daejeon, 34114, Republic of Korea
| | - Mikyung Shin
- Department of Biomedical Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Haeshin Lee
- Department of Chemistry, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Sun-Hyun Park
- R&D Center for Advanced Pharmaceuticals & Evaluation, Korea Institute of Toxicology (KIT), Daejeon, 34114, Republic of Korea
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Orădan AV, Dindelegan GC, Vinaşi RC, Muntean MV, Dindelegan MG, Chiriac L, Volovici V. Reduction of Anastomotic Time Through the Use of Cyanoacrylate in Microvascular Procedures. Plast Surg (Oakv) 2022; 30:335-342. [PMID: 36212098 PMCID: PMC9537713 DOI: 10.1177/22925503211019619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/16/2021] [Indexed: 11/03/2023] Open
Abstract
Background: Ever since the description of the first microvascular anastomosis, numerous alternative methods have been described to the classical approach. Tissue adhesive has shown promising result in previous studies and can be a fast and efficient alternative which still requires more studies to allow its clinical implementation. Methods: A randomized comparative experimental study was conducted on rats' femoral arteries and an end-to-end anastomosis was performed in order to compare 2 anastomosis techniques. In one group, a simple interrupted suture was utilized, whereas in the second group a combination between fewer sutures and tissue adhesive was used. The anastomotic time, total operative time, blood flow velocity before, immediately after and 48 hours after the procedure, as well as an independent grading of the anastomosis immediately after the procedure were performed. Magnetic resonance imaging (MRI) was performed in order to assess the degree of stenosis. After euthanasia, histology and scanning electron microscopy (SEM) were performed on the vessels in order to assess possible complications. Results: A total of 24 anastomoses were performed, of which 12 with a classic technique and 12 with an adhesive technique. All the anastomoses were patent with a significant reduction of anastomotic and total operative time. The grading of the anastomoses showed better results in the classic suture group. The blood flow velocities were not statistically significant between the 2 groups. On MRI there was one stenotic anastomosis, whereas histology and SEM showed more complications on the adhesive group. Conclusion: Anastomotic times were significantly lower with a non-significant trend toward more thrombotic complications in the adhesive group. Further improvement of the glue properties and refinement of the technique will likely make it a viable alternative to interrupted suturing in the future.
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Affiliation(s)
- Alex V. Orădan
- Department of Plastic Surgery, Clinical Rehabilitation
Hospital, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
- Center for Surgical Simulation and Training, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
| | - George C. Dindelegan
- Center for Surgical Simulation and Training, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
- First Surgical Clinic, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ramona C. Vinaşi
- Center for Surgical Simulation and Training, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Neuroscience, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maximilian V. Muntean
- Department of Plastic Surgery, “Prof. Dr. I. Chiricuta”
Institute of Oncology, “Iuliu Hatieganu” University of Medicine and
Pharmacy, Cluj-Napoca, Romania
| | - Maximilian G. Dindelegan
- Center for Surgical Simulation and Training, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Otorhinolaryngology, “Iuliu Haţieganu” University of
Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Liviu Chiriac
- National Magnetic Resonance Center, Faculty of Physics,
Babeş-Bolyai University, Cluj Napoca, Romania
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC University Medical Center, Rotterdam, The
Netherlands
- Center for Medical Decision Making, Department of Public
Health, Erasmus MC University Medical Center, Rotterdam, The
Netherlands
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Wu Y, Suo Y, Wang Z, Yu Y, Duan S, Liu H, Qi B, Jian C, Hu X, Zhang D, Yu A, Cheng Z. First clinical applications for the NIR-II imaging with ICG in microsurgery. Front Bioeng Biotechnol 2022; 10:1042546. [PMID: 36329697 PMCID: PMC9623121 DOI: 10.3389/fbioe.2022.1042546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022] Open
Abstract
In microsurgery, it is always difficult to accurately identify the blood supply with ease, such as vascular anastomosis, digit replantation, skin avulsion reconstruction and flap transplantation. Near-infrared window I (NIR-I, 700—900 nm) imaging has many clinical applications, whereas near-infrared window II (NIR-II, 1,000–1700 nm) imaging has emerged as a highly promising novel optical imaging modality and used in a few clinical fields recently, especially its penetration distance and noninvasive characteristics coincide with the needs of microsurgery. Therefore, a portable NIR-II imaging instrument and the Food and Drug Administration (FDA) approved indocyanine green (ICG) were used to improve the operation efficiency in microsurgery of 39 patients in this study. The anastomotic vessels and the salvaged distal limbs were clearly visualized after intravenous injection of ICG. The technique enabled identification of perforator vessels and estimation of perforator areas prior to the flap obtention and made it easier to monitor the prognosis. Overall, this study highlights the use of the portable NIR- II imaging with ICG as an operative evaluation tool can enhance the safety and accuracy of microsurgery.
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Affiliation(s)
- Yifan Wu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yongkuan Suo
- Joint Laboratory for Molecular Medicine, Institute of Molecular Medicine, Northeastern University, Shenyang, Liaoning, China
| | - Zheng Wang
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yifeng Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shuang Duan
- Joint Laboratory for Molecular Medicine, Institute of Molecular Medicine, Northeastern University, Shenyang, Liaoning, China
| | - Hongguang Liu
- Joint Laboratory for Molecular Medicine, Institute of Molecular Medicine, Northeastern University, Shenyang, Liaoning, China
| | - Baiwen Qi
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chao Jian
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiang Hu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Dong Zhang
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Aixi Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- *Correspondence: Aixi Yu, ; Zhen Cheng,
| | - Zhen Cheng
- State Key Laboratory of Drug Research, Molecular Imaging Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
- Shandong Laboratory of Yantai Drug Discovery, Bohai Rim Advanced Research Institute for Drug Discovery, Yantai, Shandong, China
- *Correspondence: Aixi Yu, ; Zhen Cheng,
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6
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Scott BB, Randolph MA, Guastaldi FPS, Wu RC, Redmond RW. Light-Activated Vascular Anastomosis. Surg Innov 2022:15533506221104382. [DOI: 10.1177/15533506221104382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. There have been few advances in technique since vascular anastomosis was performed with silk suture on a curved needle in 1902. This technique results in disruption of the endothelium with exposed intraluminal suture, both of which may lead to thrombocyte aggregation, intimal hyperplasia, and vascular stenosis. A variety of alternative techniques have been explored, with limited success. Photochemical tissue bonding (PTB) is a light-activated methodology of rapidly cross-linking tissue interfaces at the molecular level. Herein, we describe a new technique for anastomosis of venous interposition graft in an ovine model of femoral artery bypass utilizing PTB. Methods. Polypay specific pathogen free sheep (n = 5; 40-45 kg) underwent femoral artery bypass utilizing saphenous vein. The femoral artery was transected and reversed saphenous vein was implanted as an interposition graft. The proximal anastomosis was created as a vein-over-artery cuff utilizing PTB, and the distal anastomosis was created with standard interrupted 8-0 polypropylene suture. Four weeks post-index operation, femoral angiogram was performed to evaluate patency, tortuosity, and luminal diameter. All bypass grafts were harvested and longitudinal and transverse histological sections from the proximal anastomosis were analyzed. Results. The PTB anastomoses (n = 5) were immediately watertight and patent. All animals survived the 28-day study duration. Angiography revealed patent grafts with no aneurysm or stenosis (n = 5). Histologic examination revealed integration of the venous endothelium with the arterial adventitia. Conclusion. Photochemical tissue bonding creates an immediate strong, watertight vascular anastomosis that can withstand physiologic arterial pressure and remains patent at 28 days without the need for intraluminal suture.
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Affiliation(s)
- Benjamin B. Scott
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Plastic Surgery Research Laboratory, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Mark A. Randolph
- Plastic Surgery Research Laboratory, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Fernando P. S. Guastaldi
- Skeletal Biology Research Center, Department of Oral and Maxillofacial Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Ruby C. Wu
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Robert W. Redmond
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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7
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Chiesa-Estomba CM, Mayo-Yanez M, Palacios-García JM, Lechien JR, Viljoen G, Karkos PD, Barillari MR, González-García JA, Sistiaga-Suarez JA, González-Botas JH, Ayad T, Ferlito A. Stapler-Assisted Pharyngeal Closure After Total Laryngectomy: A Systematic Review and Meta-Analysis. Oncol Ther 2022; 10:241-252. [PMID: 35357676 PMCID: PMC9098751 DOI: 10.1007/s40487-022-00193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Pharyngocutaneous fistula (PCF) remains the most frequent complication following total laryngectomy (TL). Pharyngeal closure with a surgical stapler (SAPC) has been proposed as an effective closure technique that decreases the rate of PCF, reduces surgical time, decreases the length of hospital stay, and shortens the time required before safely initiating oral feeding. Methods This study involved a systematic review and meta-analysis of patients with laryngeal cancer who underwent TL and with subsequent stapler pharyngeal closure, in order to analyse the current literature regarding the role of SAPC after TL. Results The incidence of PCF in the stapler-assisted suture group (SASG) was 9.5% (95% CI 8.2–15.9%), with a mean absolute deviation of 1.12, while in the hand-suture group (HSG) group the incidence was 23.4% (95% CI 23–26.1%), with a mean absolute deviation of 5.71 (p = 0.01). Conclusions SAPC may decrease the risk of PCF in patients following TL. Based on the current data, SAPC appears to shorten the surgical time and the length of hospital stay. Nevertheless, prospective randomized trials are required to validate these findings.
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Affiliation(s)
- Carlos M Chiesa-Estomba
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia-Biodonostia Health Research Institute, Calle Doctor Begiristain, #1. CP. 20014, Donostia-San Sebastian, Gipuzkoa-Basque Country, Spain. .,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.
| | - Miguel Mayo-Yanez
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006, A Coruña, Galicia, Spain.,Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Santiago de Compostela, Spain.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
| | - Jose M Palacios-García
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Virgen Macarena, Seville, Spain.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
| | - Jerome R Lechien
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
| | - Gerrit Viljoen
- Division of Otolaryngology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
| | - Petros D Karkos
- Department of Otolaryngology-Head and Neck Surgery, AHEPA University Hospital, Thessaloniki, Greece
| | - Maria R Barillari
- Department of Mental and Physical Health and Preventive Medicine, "L. Vanvitelli" University, Naples, Italy.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de L'Université de Montréal, Montreal, Canada
| | - Jose A González-García
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia-Biodonostia Health Research Institute, Calle Doctor Begiristain, #1. CP. 20014, Donostia-San Sebastian, Gipuzkoa-Basque Country, Spain
| | - Jon A Sistiaga-Suarez
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia-Biodonostia Health Research Institute, Calle Doctor Begiristain, #1. CP. 20014, Donostia-San Sebastian, Gipuzkoa-Basque Country, Spain
| | - Jesus Herranz González-Botas
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006, A Coruña, Galicia, Spain.,Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Santiago de Compostela, Spain
| | - Tareck Ayad
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de L'Université de Montréal, Montreal, Canada.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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8
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Schulten L, Spillner J, Kanzler S, Teubner A, Jockenhoevel S, Apel C. A polyurethane-based surgical adhesive for sealing blood vessel anastomoses-A feasibility study in pigs. J Biomed Mater Res B Appl Biomater 2022; 110:1922-1931. [PMID: 35293688 DOI: 10.1002/jbm.b.35049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/24/2022] [Accepted: 03/03/2022] [Indexed: 12/14/2022]
Abstract
Peri- and postoperative anastomotic leakage from blood vessel anastomosis is a common and potentially life-threatening complication. As an adjunctive therapy providing an additional layer of safety, a new biodegradable, polyurethane-based adhesive was developed. It consists of two components: an isocyanate-functionalized prepolymer and an amino-based curing agent. The adhesive was investigated in a porcine animal model to seal sutured blood vessel anastomoses of arteries, veins, aortas and prosthetic aortic graft replacements. The material-determined properties of the adhesive like viscosity, processing and polymerization time as well as bonding strength were well suited for this application. The adhesive stopped perioperative suture-line bleedings and stayed on all anastomoses until sacrifice. Hematological and serological inflammation marker assessments were unobtrusive. The histological evaluation showed a mild to moderate local tissue reaction to the adhesive constituting a physiological, non-adverse tissue-biomaterial interaction. The adhesive did not interfere with vascular wound healing. The adhesive demonstrated to be suitable to improve the outcome of cardiovascular surgeries by securing the classical sutured anastomoses in a fast, easy and safe manner. However, further studies are required to quantitatively evaluate efficacy in terms of anastomotic leakage prevention as well as long-term tissue compatibility and degradation.
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Affiliation(s)
- Lisanne Schulten
- Department of Biohybrid & Medical Textiles, Institute of Applied Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Jan Spillner
- Clinic for Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | | | - Andreas Teubner
- Central Animal Facility, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Stefan Jockenhoevel
- Department of Biohybrid & Medical Textiles, Institute of Applied Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Christian Apel
- Department of Biohybrid & Medical Textiles, Institute of Applied Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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9
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Moritz WR, Raman S, Pessin S, Martin C, Li X, Westman A, Sacks JM. The History and Innovations of Blood Vessel Anastomosis. Bioengineering (Basel) 2022; 9:bioengineering9020075. [PMID: 35200428 PMCID: PMC8869402 DOI: 10.3390/bioengineering9020075] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
Surgical technique and technology frequently coevolve. The brief history of blood vessel anastomosis is full of famous names. While the techniques pioneered by these surgeons have been well described, the technology that facilitated their advancements and their inventors deserve recognition. The mass production of laboratory microscopes in the mid-1800s allowed for an explosion of interest in tissue histology. This improved understanding of vascular physiology and thrombosis laid the groundwork for Carrel and Guthrie to report some of the first successful vascular anastomoses. In 1916, McLean discovered heparin. Twenty-four years later, Gordon Murray found that it could prevent thrombosis when performing end-to-end anastomosis. These discoveries paved the way for the first-in-human kidney transplantations. Otolaryngologists Nylen and Holmgren were the first to bring the laboratory microscope into the operating room, but Jacobson was the first to apply these techniques to microvascular anastomosis. His first successful attempt in 1960 and the subsequent development of microsurgical tools allowed for an explosion of interest in microsurgery, and several decades of innovation followed. Today, new advancements promise to make microvascular and vascular surgery faster, cheaper, and safer for patients. The future of surgery will always be inextricably tied to the creativity and vision of its innovators.
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Affiliation(s)
- William R. Moritz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (W.R.M.); (S.P.); (C.M.); (X.L.); (A.W.)
| | - Shreya Raman
- School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - Sydney Pessin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (W.R.M.); (S.P.); (C.M.); (X.L.); (A.W.)
| | - Cameron Martin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (W.R.M.); (S.P.); (C.M.); (X.L.); (A.W.)
| | - Xiaowei Li
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (W.R.M.); (S.P.); (C.M.); (X.L.); (A.W.)
| | - Amanda Westman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (W.R.M.); (S.P.); (C.M.); (X.L.); (A.W.)
| | - Justin M. Sacks
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (W.R.M.); (S.P.); (C.M.); (X.L.); (A.W.)
- Correspondence: ; Tel.: +1-314-362-7388
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10
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Li M, Pan G, Zhang H, Guo B. Hydrogel adhesives for generalized wound treatment: Design and applications. JOURNAL OF POLYMER SCIENCE 2022. [DOI: 10.1002/pol.20210916] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Meng Li
- State Key Laboratory for Mechanical Behavior of Materials, and Frontier Institute of Science and Technology Xi'an Jiaotong University Xi'an China
| | - Guoying Pan
- State Key Laboratory for Mechanical Behavior of Materials, and Frontier Institute of Science and Technology Xi'an Jiaotong University Xi'an China
| | - Hualei Zhang
- State Key Laboratory for Mechanical Behavior of Materials, and Frontier Institute of Science and Technology Xi'an Jiaotong University Xi'an China
| | - Baolin Guo
- State Key Laboratory for Mechanical Behavior of Materials, and Frontier Institute of Science and Technology Xi'an Jiaotong University Xi'an China
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research College of Stomatology, Xi'an Jiaotong University Xi'an China
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11
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Mallela DP, Bose S, Shallal CC, Goldsborough E, Xun H, Chen J, Stonko DP, Brandacher G, Sacks J, Kang SH, Hicks CW. A systematic review of sutureless vascular anastomosis technologies. Semin Vasc Surg 2021; 34:247-259. [PMID: 34911631 DOI: 10.1053/j.semvascsurg.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/11/2022]
Abstract
Vascular anastomoses typically involve a handsewn technique requiring significant surgical training, expertise, and time. The aim of our systematic review was to identify and describe sutureless vascular anastomosis techniques. We performed a systematic review of all sutureless vascular anastomosis technologies published in MEDLINE, PubMed, Embase, CINAHL, Cochrane, Web of Science, and Scopus Library databases and a patent review using US Patent and Trade Office Application, US Patent and Trademark Office Patent, Google Patents, Lens, Patent Quality Through Artificial Intelligence, SureChEMBL, and E-Space Net. Data from inclusion studies and patents published between January 1, 1980 and July 15, 2021 were abstracted to describe their category, anastomosis type and configuration, study types, and advantages and disadvantages encountered with each technology. Two hundred eleven original studies and 475 patents describing sutureless vascular anastomosis technologies were identified. In the literature, stents/stent-grafts/grafts (n = 61), lasers (n = 53), and couplers (n = 27) were the predominant device categories. In the patent review, adhesive technologies (n = 103), stents/stent-grafts/grafts (n = 68), and mechanical connectors (n = 61) predominated. The majority of studies involved in vivo animal studies (n = 193); 32.2% (n = 68) of investigations involved human trials; and 17.9% (n = 85) of patent technologies were approved by the US Food and Drug Administration. The main advantages described for sutureless anastomosis technologies included faster procedure time and greater patency rates compared with handsewn anastomoses. The main disadvantages included reduced vessel compliance, stenosis, leakage, and device costs. The appeal of sutureless technology is substantiated by numerous animal trials, but their use in humans remains limited. This may be a reflection of strict regulatory criteria and/or vascular complications associated with currently available technologies.
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Affiliation(s)
- Deepthi P Mallela
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Halsted 668, Baltimore, MD, 21287
| | - Sanuja Bose
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christopher C Shallal
- Department of Biomedical Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD
| | | | - Helen Xun
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center Boston, MA
| | - Jonlin Chen
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - David P Stonko
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Justin Sacks
- Division of Plastic and Reconstructive Surgery, Washington University Medical Center, St Louis, MO
| | - Sung H Kang
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Halsted 668, Baltimore, MD, 21287.
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12
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Zhang Z, Li Y, Zhang T, Yang X, Fan K, Wang D, Li S, Hu Y, Fu W. Titanium implants modified by laser microtexturing enhance the bioactivity of gastric epithelial cells and fibroblast cells. J Appl Biomater Funct Mater 2021; 19:22808000211064951. [PMID: 34905988 DOI: 10.1177/22808000211064951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The clinical application of anastomotic instruments improves the efficiency of the digestive tract surgery. However, the stapler with titanium nails implanted is still controversial in terms of anastomotic complications, and further improvement and optimization are needed. The purpose of this study was to explore the optimal microtextured parameters that could enhance the bioactivity of titanium implants in vitro. Laser microtexturing technology was used to construct the groove-type microstructural surfaces with different parameters, and human gastric mucosal epithelial cells (GES-1 cells) and mouse fibroblasts (3T3 cells) were cultured on the surface of the titanium plates in vitro. The data of cell adhesion, cell proliferation and cell activity were obtained and statistically analyzed. The textured titanium plates meet the expected design. GES-1 and 3T3 cell adhesion were better in the surface of titanium plates in microstructural group than that in the polished group. GES-1 and 3T3 cells also showed higher proliferative activity in the microstructural group compared with the polished group. The laser textured titanium plates have good groove-type microstructure, which increase the surface roughness, change the surface wettability, promote the adhesion, proliferating and orderly growth of GES-1 and 3T3 cells, and show good biological properties.
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Affiliation(s)
- Zhaoxiong Zhang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Yuanchun Li
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Ting Zhang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Xiaoyang Yang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education (Tianjin University of Technology), Tianjin, People's Republic of China
| | - Kaihu Fan
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Daohan Wang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Shuliang Li
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.,Department of Gastrointestinal Surgery, The Second People's Hospital of Liaocheng, Linqing, Shandong, People's Republic of China.,Department of Gastrointestinal Surgery, The Second Hospital of Liaocheng Affiliated to Shandong First Medical University, Linqing, Shandong, People's Republic of China
| | - Yahui Hu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education (Tianjin University of Technology), Tianjin, People's Republic of China
| | - Weihua Fu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
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Alnajar A, Reul RM, Hirji S. Commentary: Paving the way for less-invasive lung transplantation: Time to ditch the stich? JTCVS Tech 2021; 9:188-189. [PMID: 34647097 PMCID: PMC8501249 DOI: 10.1016/j.xjtc.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Ahmed Alnajar
- Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Fla
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14
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Compression of the vascular wall to create a friction fit in a vascular anastomotic coupler. J Mech Behav Biomed Mater 2021; 123:104681. [PMID: 34362677 DOI: 10.1016/j.jmbbm.2021.104681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/22/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022]
Abstract
A previously reported microvascular coupler was shown to effectively create vascular anastomoses, but was too large for practical clinical use. To safely reduce coupler size, certain failure modes needed to be better understood. The coupler functions, in part, by compressing the vessel wall between two concentric rings, creating a friction fit that anchors the device to the vessel. This work investigates the relationship between vessel wall compression and resulting friction fit strength to ensure reducing coupler size will not unduly increase the risk that this friction fit might fail. Vascular walls were compressed to a specified strain and the tensile force required to overcome the resulting friction was measured. Experiments were conducted with various vessel types (Porcine common carotid artery, splenic artery, and jugular vein), across a range of compressive strains (55-95%), and by using either PEEK or HDPE to compress the vessel. Tensile force was increased at a rate of 5 g/min or held constant for 24 h. For experiments with incrementally increasing force, the force at failure varied with compressive strain via a power function. At 70% compression, PEEK produced 4.6 times stronger friction fits than HDPE, and common carotid arteries and splenic arteries produced 1.8 and 1.3 times stronger fits than jugular veins respectively. For experiments where tensile force was applied for 24 h, much lower forces were required to overcome friction. These results were compared to friction fit failure in a coupler prototype and it was found that the prototypes failed at just 30% of the force required to cause vessel slip under the other test conditions. These results were used to develop a model that predicts the probability of device failure via vessel slipping (one design, smaller than previously reported, was estimated to fail at maximum in vivo axial stress once in 500 anastomoses, a potentially safe level of risk).
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15
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Qassemyar Q, Michel G, Gianfermi M, Atlan M, Havet E, Luca-Pozner V. Sutureless venous microanastomosis using thermosensitive poloxamer and cyanoacrylate: experimental study on a rat model. J Plast Reconstr Aesthet Surg 2021; 75:433-438. [PMID: 34247962 DOI: 10.1016/j.bjps.2021.05.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 05/08/2021] [Accepted: 05/28/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Sutureless microvascular anastomoses could simplify the microvascular field, shortening operative time and improving the final outcome. The use of thermosensitive poloxamers (TP407) together with the application of cyanoacrylate as an alternative method for conventional sutures was well-documented for arteries, but not for veins. The purpose of our study was to prove the feasibility of this technique for venous anastomoses and compare it with the traditional hand-sewn technique on a rat model. MATERIALS AND METHODS Twenty male Sprague-Dawley rats that weighed between 265 and 310 g were used. In the sutureless group (SG), 20 left external jugular veins (LEJV) end-to-end anastomoses were performed using a T704 and cyanoacrylate glue. They were compared to 20 right external jugular veins (REJV) anastomoses sutured with conventional 10-0 stitches (control group - CG). Diameters of veins, anastomosis time, and patency rate at 15 days were reported. Foreign body reaction was assessed histologically. RESULTS The mean diameter of the LEJV was 0.94 ± 0.1 mm and 0.95 ± 0.09 mm for the REJV. The mean anastomosis time was 11.9 ± 1.37 min for the SG and 27.75 ± 3.31 min for the CG. In the latter group, the immediate patency rate was 95% and 90% at 15 days. For the SG group, 90% of the anastomoses were patent immediately and 85% at 15 days. CONCLUSION TP407 and cyanoacrylate could offer a fast and reliable technique for sutureless venous anastomoses. Before human application, effectiveness of this method remains to be confirmed in larger animals in a long-term follow-up.
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Affiliation(s)
- Q Qassemyar
- Department of Plastic and Reconstructive Surgery, University Hospital Armand-Trousseau, 26 avenue du Dr Arnold Netter, 75012 Paris, France; Faculty of Medicine, Sorbonne University, 91 boulevard de l'hôpital, 75013 Paris, France; Anatomy Department, University of Picardie, Rue des Louvels, 80000 Amiens, France
| | - G Michel
- Anatomy Department, University of Picardie, Rue des Louvels, 80000 Amiens, France
| | - M Gianfermi
- Anatomy Department, University of Picardie, Rue des Louvels, 80000 Amiens, France
| | - M Atlan
- Faculty of Medicine, Sorbonne University, 91 boulevard de l'hôpital, 75013 Paris, France; Department of Plastic Surgery, Tenon Hospital, 4 Rue de la Chine, 75020 Paris, France
| | - E Havet
- Anatomy Department, University of Picardie, Rue des Louvels, 80000 Amiens, France
| | - V Luca-Pozner
- Department of Plastic and Reconstructive Surgery, University Hospital Armand-Trousseau, 26 avenue du Dr Arnold Netter, 75012 Paris, France; Faculty of Medicine, Sorbonne University, 91 boulevard de l'hôpital, 75013 Paris, France.
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16
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Hossay C, Donnez J, Dolmans MM. Whole Ovary Cryopreservation and Transplantation: A Systematic Review of Challenges and Research Developments in Animal Experiments and Humans. J Clin Med 2020; 9:jcm9103196. [PMID: 33023111 PMCID: PMC7601276 DOI: 10.3390/jcm9103196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 12/13/2022] Open
Abstract
Ovarian tissue cryopreservation and transplantation is the only fertility preservation option that enables both restoration of fertility and resumption of ovarian endocrine function, avoiding the morbidity associated with premature menopause. It is also the only technique available to prepubertal patients and those whose treatment cannot be delayed for life-threatening reasons. Ovarian tissue cryopreservation can be carried out in two different ways, either as ovarian cortical fragments or as a whole organ with its vascular pedicle. Although use of cortical strips is the only procedure that has been approved by the American Society for Reproductive Medicine, it is fraught with drawbacks, the major one being serious follicle loss occurring after avascular transplantation due to prolonged warm ischemia. Whole ovary cryopreservation involves vascular transplantation, which could theoretically counteract the latter phenomenon and markedly improve follicle survival. In theory, this technique should maintain endocrine and reproductive functions much longer than grafting of ovarian cortical fragments. However, this procedure includes a number of critical steps related to (A) the level of surgical expertise required to accomplish retrieval of a whole ovary with its vascular pedicle, (B) the choice of cryopreservation technique for freezing of the intact organ, and (C) successful execution of functional vascular reanastomosis upon thawing. The aim of this systematic review is to shed light on these challenges and summarize solutions that have been proposed so far in animal experiments and humans in the field of whole ovary cryopreservation and transplantation.
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Affiliation(s)
- Camille Hossay
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Jacques Donnez
- Society for Research into Infertility, 1150 Brussels, Belgium;
| | - Marie-Madeleine Dolmans
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium;
- Gynecology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
- Correspondence: ; Tel.: +32-(0)2-764-5237; Fax: +32-(0)2-764-9507
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17
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Lu Q, Liu K, Zhang W, Li T, Shi AH, Ding HF, Yan XP, Zhang XF, Wu RQ, Lv Y, Wang SP. End-to-end vascular anastomosis using a novel magnetic compression device in rabbits: a preliminary study. Sci Rep 2020; 10:5981. [PMID: 32249793 PMCID: PMC7136200 DOI: 10.1038/s41598-020-62936-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/10/2020] [Indexed: 11/08/2022] Open
Abstract
Magnetic compression anastomosis (MCA) has been appreciated as an innovative alternative to manual suturing in vascular reconstruction. However, magnetic devices have limitations in their applications. The present study aimed to introduce a newly developed magnetic device for end-to-end vascular anastomosis. Twenty male New Zealand rabbits were randomly assigned to receive end-to-end postcaval vein anastomosis using either a newly designed MCA device (Group MCA) or continuous-interrupted suturing (Group CIS). The anastomotic patency was evaluated by Doppler or venography immediately, 1 week, and 12 weeks after surgery. Anastomotic quality was evaluated gross and microscopic histological study 12 weeks after surgery. The procedure was successfully performed and all animals survived until sacrifice. The duration of surgery and anastomosis time in Group MCA were significantly shorter compared to Group CIS (all p < 0.001), and the incidence of anastomotic patency and postoperative morbidity were comparable between the two groups (all p > 0.05). Hematoxylin-eosin staining showed that anastomotic intima from Group MCA was much smoother with more regularly arranged endothelial cells than from compared to the Group CIS. A novel MCA device was successfully applied in rabbit vascular anastomosis. We demonstrated the reliability and effectiveness of this newly developed MCA in this study.
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Affiliation(s)
- Qiang Lu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Kang Liu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Wei Zhang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Tao Li
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Ai-Hua Shi
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Hong-Fan Ding
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Xiao-Peng Yan
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Xu-Feng Zhang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Rong-Qian Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
| | - Shan-Pei Wang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
- Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
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Redmond RW, Kochevar IE. Medical Applications of Rose Bengal‐ and Riboflavin‐Photosensitized Protein Crosslinking. Photochem Photobiol 2019; 95:1097-1115. [DOI: 10.1111/php.13126] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/27/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Robert W. Redmond
- Wellman Center for Photomedicine Massachusetts General Hospital Harvard Medical School Boston MA
| | - Irene E. Kochevar
- Wellman Center for Photomedicine Massachusetts General Hospital Harvard Medical School Boston MA
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20
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Farzin A, Miri AK, Sharifi F, Faramarzi N, Jaberi A, Mostafavi A, Solorzano R, Zhang YS, Annabi N, Khademhosseini A, Tamayol A. 3D-Printed Sugar-Based Stents Facilitating Vascular Anastomosis. Adv Healthc Mater 2018; 7:e1800702. [PMID: 30375196 DOI: 10.1002/adhm.201800702] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/10/2018] [Indexed: 12/18/2022]
Abstract
Microvascular anastomosis is a common part of many reconstructive and transplant surgical procedures. While venous anastomosis can be achieved using microvascular anastomotic coupling devices, surgical suturing is the main method for arterial anastomosis. Suture-based microanastomosis is time-consuming and challenging. Here, dissolvable sugar-based stents are fabricated as an assistive tool for facilitating surgical anastomosis. The nonbrittle sugar-based stent holds the vessels together during the procedure and are dissolved upon the restoration of the blood flow. The incorporation of sodium citrate minimizes the chance of thrombosis. The dissolution rate and the mechanical properties of the sugar-based stent can be tailored between 4 and 8 min. To enable the fabrication of stents with desirable geometries and dimensions, 3D printing is utilized to fabricate the stents. The effectiveness of the printed sugar-based stent is assessed ex vivo. The fabrication procedure is fast and can be performed in the operating room.
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Affiliation(s)
- Ali Farzin
- Division of Engineering in Medicine; Department of Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA 02139 USA
| | - Amir K. Miri
- Division of Engineering in Medicine; Department of Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA 02139 USA
| | - Fatemeh Sharifi
- Division of Engineering in Medicine; Department of Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA 02139 USA
- School of Mechanical Engineering; Sharif University of Technology; Tehran 14588-89694 Iran
| | - Negar Faramarzi
- Division of Engineering in Medicine; Department of Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA 02139 USA
| | - Arian Jaberi
- School of Mechanical Engineering; Shiraz University; Shiraz 71936-16548 Iran
| | - Azadeh Mostafavi
- Department of Mechanical and Materials Engineering; University of Nebraska; Lincoln NE 68588 USA
| | | | - Yu Shrike Zhang
- Division of Engineering in Medicine; Department of Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA 02139 USA
| | - Nasim Annabi
- Division of Engineering in Medicine; Department of Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA 02139 USA
| | - Ali Khademhosseini
- Division of Engineering in Medicine; Department of Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA 02139 USA
- Center of Nanotechnology; Department of Physics; King Abdulaziz University; Jeddah 21569 Saudi Arabia
- Center for Minimally Invasive Therapeutics (CMIT); Department of Bioengineering; Department of Chemical and Biomolecular Engineering; Department of Radiology; California NanoSystems Institute (CNSI); University of California; Los Angeles CA 90095 USA
| | - Ali Tamayol
- Division of Engineering in Medicine; Department of Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA 02139 USA
- Department of Mechanical and Materials Engineering; University of Nebraska; Lincoln NE 68588 USA
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21
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Hiebl B, Ascher L, Luetzow K, Kratz K, Gruber C, Mrowietz C, Nehring ME, Lendlein A, Franke RP, Jung F. Albumin solder covalently bound to a polymer membrane: New approach to improve binding strength in laser tissue soldering in-vitro. Clin Hemorheol Microcirc 2018; 69:317-326. [PMID: 29630534 DOI: 10.3233/ch-189108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laser tissue soldering (LTS) based on indocyanine green (ICG)-mediated heat-denaturation of proteins might be a promising alternative technique for micro-suturing, but up to now the problem of too weak shear strength of the solder welds in comparison to sutures is not solved. Earlier reports gave promising results showing that solder supported by carrier materials can enhance the cohesive strength of the liquid solder. In these studies, the solder was applied to the carriers by dip coating. Higher reliability of the connection between the solder and the carrier material is expected when the solder is bound covalently to the carrier material. In the present study a poly(ether imide) (PEI) membrane served as carrier material and ICG-supplemented albumin as solder substrate. The latter was covalently coupled to the carrier membrane under physiological conditions to prevent structural protein changes. As laser source a diode continuous-wave laser emitting at 808 nm with intensities between 250 mW and 1500 mW was utilized. The albumin functionalized carrier membrane was placed onto the tunica media of explanted pig thoracic aortae forming an overlapping area of approximately 0.5×0.5 cm2. All tests were performed in a dry state to prevent laser light absorption by water. Infrared spectroscopy, spectro-photometrical determination of the secondary and primary amine groups after acid orange II staining, contact angle measurements, and atomic force microscopy proved the successful functionalization of the PEI membrane with albumin. A laser power of 450 mW LTS could generate a membrane-blood vessel connection which was characterized by a shear strength of 0.08±0.002 MPa, corresponding to 15% of the tensile strength of the native blood vessel. Theoretically, an overlapping zone of 4.1 mm around the entire circumference of the blood vessel could have provided shear strength of the PEI membrane-blood vessel compound identical to the tensile strength of the native blood vessel. These in-vitro results confirmed the beneficial effects of solder reinforcement by carrier membranes, and suggest LTS with covalently bound solders on PEI substrates for further studies in animal models.
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Affiliation(s)
- B Hiebl
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behaviour and Virtual Center for Replacement - Complementary Methods to Animal Testing, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany.,Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany
| | - L Ascher
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany.,BAM Federal Institute for Materials Research and Testing, Berlin, Germany
| | - K Luetzow
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany
| | - K Kratz
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany
| | - C Gruber
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behaviour and Virtual Center for Replacement - Complementary Methods to Animal Testing, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - C Mrowietz
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany.,Institute for Clinical Hemostaseology and Transfusion Medicine, University of Saarland, Homburg/Saar, Germany
| | - M E Nehring
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behaviour and Virtual Center for Replacement - Complementary Methods to Animal Testing, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - A Lendlein
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany
| | - R-P Franke
- Central Institute for Biotechnology, University of Ulm, Ulm, Germany
| | - F Jung
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany
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22
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Fonouni H, Kashfi A, Majlesara A, Stahlheber O, Konstantinidis L, Kraus TW, Mehrabi A, Oweira H. Analysis of the hemostatic potential of modern topical sealants on arterial and venous anastomoses: an experimental porcine study. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:134. [PMID: 28755096 DOI: 10.1007/s10856-017-5932-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/20/2017] [Indexed: 06/07/2023]
Abstract
One of the widely accepted adjunctive agents in the variety of surgical modalities are sealants. Our study aim was to compare four commonly used modern sealants in a standardized experimental setting to assess their feasibility, and hemostatic efficacy in vascular anastomosis. Forty landrace pigs (weight: 24.7 ± 3.8 kg) were randomized into the control (n = 8) and four sealant groups; TachoSil® (n = 8), Tissucol Duo® (n = 8), Coseal® (n = 8), and FloSeal® (n = 8). After doing a portal vein end-to-end anastomosis as well as stitches of aortic incision, the sealants were applied on anastomotic site. The control group was left intact. In portal vein anastomosis, the sealants led to a complete hemostasis significantly better than control group. The mean of blood loss was also significantly reduced. In successful subgroups, there was a difference in the mean-time to reach complete hemostasis ranging from 15 s in Coseal® to 76 s in FloSeal® group (p < 0.05). In aortotomy experiments, except Tissucol Due®, which had insufficient hemostasis, other sealants led to a complete hemostasis. The mean blood loss was significantly reduced in sealants groups as well. The four sealants are effective in reducing the suture-hole bleeding in portal vein anastomosis. However, the hemostatic potential is heterogeneous among sealants. This means that "one-size-fits-all" approach is not appropriate for application of sealants in diversity of vascular surgery and it should be based on the type and the severity of injury and the structure of tissue. Comparison of hemostasis efficacy of four modern sealants (TachoSil®, Tissucol Duo®, Coseal®, and FloSeal®) in vascular anastomosis in porcine model. The figures below show the total blood loss (g) in the control and sealant groups after aortotomy (left) and portal vein anastomosis (right). The mean of blood loss decreased significantly by the usage of sealants in both experiment groups as compared to control group (*: p < 0.05; sealant groups vs. control group). 1. The right column shows the mean of blood loss (g) in all experiments in each group. 2. The middle column presents the subgroup with unsuccessful hemostasis at the end of observation time (Tmax = 20 sec. for aortotmy and 300 sec. for portal vein anastomosis). 3. The left column shows mean of total blood loss in subgroups with successful hemostasis during observation time (20 sec for aortotomy and 300 sec for portal vein).
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Affiliation(s)
- Hamidreza Fonouni
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arash Kashfi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ali Majlesara
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Oliver Stahlheber
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lukas Konstantinidis
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas W Kraus
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
| | - Hani Oweira
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Saegusa N, Sarukawa S, Ohta K, Takamatsu K, Watanabe M, Sugino T, Nakagawa M, Akiyama Y, Kusuhara M, Kishi K, Inoue K. Sutureless microvascular anastomosis assisted by an expandable shape-memory alloy stent. PLoS One 2017; 12:e0181520. [PMID: 28742116 PMCID: PMC5524395 DOI: 10.1371/journal.pone.0181520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 07/03/2017] [Indexed: 12/04/2022] Open
Abstract
Vascular anastomosis is the highlight of cardiovascular, transplant, and reconstructive surgery, which has long been performed by hand using a needle and suture. However, anastomotic thrombosis occurs in approximately 0.5-10% of cases, which can cause serious complications. To improve the surgical outcomes, attempts to develop devices for vascular anastomosis have been made, but they have had limitations in handling, cost, patency rate, and strength at the anastomotic site. Recently, indwelling metal stents have been greatly improved with precise laser metalwork through programming technology. In the present study, we designed a bare metal stent, Microstent, that was constructed by laser machining of a shape-memory alloy, NiTi. An end-to-end microvascular anastomosis was performed in SD rats by placing the Microstent at the anastomotic site and gluing the junction. The operation time for the anastomosis was significantly shortened using Microstent. Thrombus formation, patency rate, and blood vessel strength in the Microstent anastomosis were superior or comparable to hand-sewn anastomosis. The results demonstrated the safety and effectiveness, as well as the operability, of the new method, suggesting its great benefit for surgeons by simplifying the technique for microvascular anastomosis.
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Affiliation(s)
- Noriko Saegusa
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Shizuoka, Japan
- Department of Plastic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Shunji Sarukawa
- Department of Plastic and Reconstructive Surgery, School of Medicine, Jichi Medical University, Tochigi, Japan
| | | | | | | | - Takashi Sugino
- Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masahiro Nakagawa
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yasuto Akiyama
- Research Institute, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Kazuo Kishi
- Department of Plastic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Keita Inoue
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Shizuoka, Japan
- Department of Plastic and Reconstructive Surgery, School of Medicine, Jichi Medical University, Tochigi, Japan
- Avenue Cell Clinic, Tokyo, Japan
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24
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An intraluminal stent facilitates light-activated vascular anastomosis. J Trauma Acute Care Surg 2017; 83:S43-S49. [DOI: 10.1097/ta.0000000000001487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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25
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Mbaidjol Z, Kiermeir D, Schönfeld A, Arnoldi J, Frenz M, Constantinescu MA. Endoluminal laser-assisted vascular anastomosis-an in vivo study in a pig model. Lasers Med Sci 2017; 32:1343-1348. [PMID: 28608190 DOI: 10.1007/s10103-017-2250-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/04/2017] [Indexed: 10/19/2022]
Abstract
Microvascular surgery is time consuming and requires high expertise. Laser-assisted vascular anastomosis (LAVA) is a promising sutureless technique that has the potential to facilitate this procedure. In this study, we evaluate the handling of our soldering material and the 1-week patency rate in a porcine model. Six pigs were subjected to LAVA. For each pig, the saphenous artery on one side was transected while the contralateral side was used as control. A porous polycaprolactone scaffold soaked in 40% (w/w) bovine serum albumin solution in combination with 0.1% (w/w) indocyanine green was wrapped at the anastomosis site and at the control site. Both sides were then soldered with a diode laser coupled into a light diffuser fiber emitting radiation with a wavelength of 808 nm and a power of 2-2.2 W. Vessels were successfully soldered with a 100% immediate patency rate. The 1-week patency rate was 83% for the anastomoses versus 67% for the control side. Vessels irradiated for 80 to 90 s tended to maintain the highest patency rate. Macroscopically, there was no difference between the two sides. The patch was easy to handle provided that the environment could be kept dry. This study shows the potential and the limitations of endoluminal LAVA as a one-step procedure without the use of stay sutures. Further studies are needed to improve the soldering material, the long-term patency rate, and standardized irradiation parameters. The long-term effects of laser soldering on the vessel wall remain to be determined.
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Affiliation(s)
- Zacharia Mbaidjol
- Department of Plastic and Reconstructive Surgery, Inselspital Bern, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
| | - David Kiermeir
- Department of Plastic and Reconstructive Surgery, Inselspital Bern, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Annemarie Schönfeld
- Institute of Applied Physics, University of Bern, Sidlerstrasse 5, 3012, Bern, Switzerland
| | - Jörg Arnoldi
- Department of Plastic and Reconstructive Surgery, Inselspital Bern, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Martin Frenz
- Institute of Applied Physics, University of Bern, Sidlerstrasse 5, 3012, Bern, Switzerland
| | - Mihai A Constantinescu
- Department of Plastic and Reconstructive Surgery, Inselspital Bern, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
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26
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Zhang B, Montgomery M, Chamberlain MD, Ogawa S, Korolj A, Pahnke A, Wells LA, Massé S, Kim J, Reis L, Momen A, Nunes SS, Wheeler A, Nanthakumar K, Keller G, Sefton MV, Radisic M. Biodegradable scaffold with built-in vasculature for organ-on-a-chip engineering and direct surgical anastomosis. NATURE MATERIALS 2016; 15:669-78. [PMID: 26950595 PMCID: PMC4879054 DOI: 10.1038/nmat4570] [Citation(s) in RCA: 373] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 01/19/2016] [Indexed: 05/12/2023]
Abstract
We report the fabrication of a scaffold (hereafter referred to as AngioChip) that supports the assembly of parenchymal cells on a mechanically tunable matrix surrounding a perfusable, branched, three-dimensional microchannel network coated with endothelial cells. The design of AngioChip decouples the material choices for the engineered vessel network and for cell seeding in the parenchyma, enabling extensive remodelling while maintaining an open-vessel lumen. The incorporation of nanopores and micro-holes in the vessel walls enhances permeability, and permits intercellular crosstalk and extravasation of monocytes and endothelial cells on biomolecular stimulation. We also show that vascularized hepatic tissues and cardiac tissues engineered by using AngioChips process clinically relevant drugs delivered through the vasculature, and that millimetre-thick cardiac tissues can be engineered in a scalable manner. Moreover, we demonstrate that AngioChip cardiac tissues implanted with direct surgical anastomosis to the femoral vessels of rat hindlimbs establish immediate blood perfusion.
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Affiliation(s)
- Boyang Zhang
- Department of Chemical Engineering, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Miles Montgomery
- Department of Chemical Engineering, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - M. Dean Chamberlain
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Shinichiro Ogawa
- McEwen Center for Regenerative Medicine, Toronto, Ontario, Canada
| | - Anastasia Korolj
- Department of Chemical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Aric Pahnke
- Department of Chemical Engineering, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Laura A. Wells
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Stéphane Massé
- The Toby Hull Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jihye Kim
- Department of Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Lewis Reis
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Abdulah Momen
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Sara S. Nunes
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Aaron Wheeler
- Department of Chemical Engineering, University of Toronto, Toronto, Ontario, Canada
- Department of Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- The Toby Hull Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Gordon Keller
- McEwen Center for Regenerative Medicine, Toronto, Ontario, Canada
| | - Michael V. Sefton
- Department of Chemical Engineering, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Milica Radisic
- Department of Chemical Engineering, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- The Heart and Stroke/Richard Lewar Centre of Excellence, Toronto, Ontario, Canada
- Correspondence should be addressed to M.R. ()
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27
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Zhu P, Esckilsen S, Atkinson C, Chen XP, Nadig SN. A simplified cuff technique for abdominal aortic transplantation in mice. J Surg Res 2015; 200:707-13. [PMID: 26375503 DOI: 10.1016/j.jss.2015.08.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 08/06/2015] [Accepted: 08/21/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Allograft arteriopathy is still a leading cause of late organ failure. The aortic allograft model in mice has been used to study chronic rejection and has given useful information in the development of graft arteriosclerosis. However, the technical difficulties of small vessel anastomoses still continue to limit its widespread use. We introduce a new simple method for aortic transplantation in mice. METHODS The descending aorta or infrarenal aorta from the donor mouse was anastomosed to the infrarenal aorta using a cuff technique. Aortic transplantation was performed in 30 mice, 10 isografts and 20 allografts. No immunosuppression was administered, and the recipients were sacrificed at day 28. The grafts were histologically analyzed. RESULTS Implantation of grafts could be completed in an average of 23 min. There was no technical failure in all 60 anastomoses. The overall survival rate was 93.3%. Histology of aortas revealed typical aspects of chronic rejection in the allografts at day 28. No significant lesion was observed in isografts. CONCLUSIONS We have developed an innovative, stable, and simple aortic transplantation model in mice, which is useful for vascular research in transplantation and beyond.
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MESH Headings
- Allografts/pathology
- Allografts/transplantation
- Anastomosis, Surgical
- Animals
- Aorta, Abdominal/pathology
- Aorta, Abdominal/transplantation
- Aorta, Thoracic/pathology
- Aorta, Thoracic/transplantation
- Graft Rejection/pathology
- Isografts/pathology
- Isografts/transplantation
- Male
- Mice
- Mice, Inbred BALB C/surgery
- Mice, Inbred C57BL/surgery
- Models, Animal
- Transplantation, Homologous/methods
- Transplantation, Isogeneic/methods
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Affiliation(s)
- Peng Zhu
- Division of Transplantation, Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Scott Esckilsen
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Carl Atkinson
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina; Division of Transplantation, Department of Surgery, Members of the South Carolina Investigators in Transplantation (SCIT), Charleston, SC
| | - Xiao-Ping Chen
- Division of Transplantation, Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Satish N Nadig
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina; Division of Transplantation, Department of Surgery, Members of the South Carolina Investigators in Transplantation (SCIT), Charleston, SC.
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Instrumento de grapado quirúrgico vascular para realizar una sutura mecánica entre un vaso sanguíneo y una prótesis sintética. ANGIOLOGIA 2015. [DOI: 10.1016/j.angio.2014.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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29
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Abstract
BACKGROUND The resection and reconstruction of large vessels, including the portal vein, are frequently needed in tumor resection. Warm ischemia before reconstruction might have deleterious effects on the function of some vital organs and therefore, how to reconstruct the vessels quickly after resection is extremely important. The present study was to introduce a new type of magnetic compression anastomosis (MCA) device to establish a quick non-suture anastomosis of the portal vein after resection in canines. METHODS The new MCA device consists of a pair of titanium alloy and neodymium-ferrum-boron magnet (Ti-NdFeB) composite rings. The NdFeB magnetic ring as a core of the device was hermetically sealed inside the biomedical titanium alloy case. Twelve canines were divided into two groups: a MCA group in which the end-to-end anastomoses was made with a new device after resection in the portal vein and a traditional manual suture (TMS) group consisted of 6 canines. The anastomosis time, anastomotic patency and quality were investigated at week 24 postoperatively. RESULTS The portal vein was reconstructed successfully in all of the animals and they all survived. The duration of portal vein anastomosis was significantly shorter in the MCA group than in the TMS group (8.16+/-1.25 vs 36.24+/-2.17 min, P<0.05). Portography and ultrasound showed that the blood flow was normal without angiostenosis or thrombosis in all of the canines. Hematoxylin-eosin staining and electron microscope scanning showed in contrast to the TMS group, MCA anastomotic intimal was much smoother with more regularly arranged endothelial cells at week 24 postoperatively. CONCLUSIONS The Ti-NdFeB composite MCA device was applicable in reconstruction of large vessels after resection. This device was easy to use and the anastomosis was functionally better than the traditional sutured anastomosis.
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30
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Qassemyar Q, Michel G. A new method of sutureless microvascular anastomoses using a thermosensitive poloxamer and cyanoacrylate: An experimental study. Microsurgery 2015; 35:315-9. [DOI: 10.1002/micr.22381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 12/28/2014] [Accepted: 12/31/2014] [Indexed: 01/06/2023]
Affiliation(s)
- Q. Qassemyar
- Division of Plastic and Reconstructive Surgery; Gustave Roussy Cancer Campus; Grand Paris, 114 Rue Edouard Vaillant Villejuif France
- Department of Anatomy; University of Picardie; Rue Des Louvels Amiens France
| | - G. Michel
- Department of Anatomy; University of Picardie; Rue Des Louvels Amiens France
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Bauer F, Fichter AM, Loeffelbein DJ, Wolff KD, Schütz K, Mücke T. Microvascular anastomosis using modified micro-stents: a pilot in vivo study. J Craniomaxillofac Surg 2014; 43:204-7. [PMID: 25510825 DOI: 10.1016/j.jcms.2014.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/07/2014] [Accepted: 11/07/2014] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Microvascular sutured anastomosis remains the gold standard in microvascular flap surgery but is technically challenging, time-consuming, and sometimes unreliable. The goal of our study has been to develop a microvascular stenting system that can be used for microvascular anastomosis, even without the use of a microscope. MATERIALS AND METHODS Custom-made stainless-steel stents were used to re-establish vessel continuity after the severance of the abdominal aortic vessel in nine rats. At 30 min after re-opening the blood flow, Doppler flowmetry and indocyanine green (ICG) angiography were used to assess vessel patency, and vessels were inspected microscopically for signs of thrombosis. RESULTS Eight of the nine animals survived the procedure. In one case, the abdominal aorta was torn during balloon dilation of the stent. Four out of the nine stent anastomoses showed an excellent fit. In the remaining four cases, a collagen membrane and fibrin glue were successfully used to stop vascular leakage. However, these additional steps might have had a negative impact on vessel patency, and thrombus formation impaired blood flow completely in one case. CONCLUSION Microvascular stent anastomosis is feasible and might in some cases be superior to standard sutured anastomosis. However, a number of technical difficulties remain to be addressed, and long-term results are not yet available.
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Affiliation(s)
- Florian Bauer
- Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Andreas M Fichter
- Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Denys J Loeffelbein
- Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Thomas Mücke
- Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Hackl C, Popp FC, Ehehalt K, Dendl LM, Benseler V, Renner P, Loss M, Dolderer J, Prantl L, Kühnel T, Schlitt HJ, Dahlke MH. Retrograde stapling of a free cervical jejunal interposition graft: a technical innovation and case report. BMC Surg 2014; 14:78. [PMID: 25319372 PMCID: PMC4202252 DOI: 10.1186/1471-2482-14-78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 10/08/2014] [Indexed: 12/18/2022] Open
Abstract
Background Free jejunal interposition is a useful technique for reconstruction of the cervical esophagus. However, the distal anastomosis between the graft and the remaining thoracic esophagus or a gastric conduit can be technically challenging when located very low in the thoracic aperture. We here describe a modified technique for retrograde stapling of a jejunal graft to a failed gastric conduit using a circular stapler on a delivery system. Case presentation A 56 year-old patient had been referred for esophageal squamous cell carcinoma at 20 cm from the incisors. On day 8 after thoracoabdominal esophagectomy with gastric pull-up, an anastomotic leakage was diagnosed. A proximal-release stent was successfully placed by gastroscopy and the patient was discharged. Two weeks later, an esophagotracheal fistula occurred proximal to the esophageal stent. Cervical esophagostomy was performed with cranial closure of the gastric conduit, which was left in situ within the right hemithorax. Three months later, reconstruction was performed using a free jejunal interposition. The anvil of a circular stapler (Orvil®, Covidien) was placed transabdominally through an endoscopic rendez-vous procedure into the gastric conduit. A free jejunal graft was retrogradely stapled to the proximal end of the conduit. Microvascular anastomoses were performed subsequently. The proximal anastomosis of the conduit was completed manually after reperfusion. Conclusions This modified technique allows stapling of a jejunal interposition graft located deep in the thoracic aperture and is therefore a useful method that may help to avoid reconstruction by colonic pull-up and thoracotomy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Marc H Dahlke
- Department of Surgery, University Medical Center Regensburg, Regensburg 93042, Germany.
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Comparison of hand-sewn and stapled anastomoses in surgeries of gastrointestinal tumors based on clinical practice of China. World J Surg Oncol 2014; 12:292. [PMID: 25240386 PMCID: PMC4194420 DOI: 10.1186/1477-7819-12-292] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 08/16/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There is a lack of studies comparing stapled suturing and hand-sewn suturing in the surgeries of gastrointestinal tumors based on the clinical practice of Chinese surgeons. METHODS Data were retrospectively collected from 499 patients who underwent surgery to remove gastrointestinal tumors from January 2008 to December 2009. The patients were divided into two groups according to the method of digestive tract reconstruction: 296 patients received stapled suturing and 203 patients received hand-sewn suturing. The operation time, postoperative hospital stay, postoperative recovery and complications of the patients were evaluated and compared between the two groups. RESULTS The stapling procedure took shorter operative time compared to the hand-sewn procedure for gastric carcinoma, colorectal cancer and esophageal carcinoma (P < 0.05). There was no significant difference between the two groups in postoperative hospital stay (P > 0.05). Patients receiving stapled suturing also showed shorter recovery for gastric cancer, colorectal cancer, and shorter time to recovery of normal gastrocolorectal motility compared with patients in the hand-sewn group (P < 0.05). However, there was no difference between the two groups in terms of normal time to commencing liquid diet for esophageal cancer patients (P > 0.05). We also found that the stapled procedure showed a lower incidence of anastomotic leakage, anastomotic hemorrhage and stump leakage in treating colorectal cancer or gastric carcinoma compared with the hand-sewn procedure (P < 0.05). CONCLUSIONS Application of the stapler in treating gastrointestinal tumors demonstrated better effects on patients in terms of surgical operation time, recovery time to normal functions, and occurrence of complications compared to hand-sewn anastomosis, especially in gastric carcinoma and colorectal cancer.
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Mattei TA, Rehman AA. "Extremely minimally invasive": recent advances in nanotechnology research and future applications in neurosurgery. Neurosurg Rev 2014; 38:27-37; discussion 37. [PMID: 25173621 DOI: 10.1007/s10143-014-0566-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 05/20/2014] [Accepted: 06/22/2014] [Indexed: 12/25/2022]
Abstract
The term "nanotechnology" refers to the development of materials and devices that have been designed with specific properties at the nanometer scale (10(-9) m), usually being less than 100 nm in size. Recent advances in nanotechnology have promised to enable visualization and intervention at the subcellular level, and its incorporation to future medical therapeutics is expected to bring new avenues for molecular imaging, targeted drug delivery, and personalized interventions. Although the central nervous system presents unique challenges to the implementation of new therapeutic strategies involving nanotechnology (such as the heterogeneous molecular environment of different CNS regions, the existence of multiple processing centers with different cytoarchitecture, and the presence of the blood-brain barrier), numerous studies have demonstrated that the incorporation of nanotechnology resources into the armamentarium of neurosurgery may lead to breakthrough advances in the near future. In this article, the authors present a critical review on the current 'state-of-the-art' of basic research in nanotechnology with special attention to those issues which present the greatest potential to generate major therapeutic progresses in the neurosurgical field, including nanoelectromechanical systems, nano-scaffolds for neural regeneration, sutureless anastomosis, molecular imaging, targeted drug delivery, and theranostic strategies.
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Affiliation(s)
- Tobias A Mattei
- Department of Neurosurgery, Brain & Spine Center-InvisionHealth/Buffalo-NY, 400 International Dr., Buffalo, NY, ZIP 14221, USA,
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Shi Y, Zhang W, Deng YL, Zhang YM, Zhang QS, Zhang WY, Zheng H, Pan C, Shen ZY. Magnetic ring anastomosis of suprahepatic vena cava: novel technique for liver transplantation in rat. Transpl Int 2014; 28:89-94. [PMID: 25132515 DOI: 10.1111/tri.12418] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 04/28/2014] [Accepted: 07/27/2014] [Indexed: 11/28/2022]
Abstract
To improve the technique of suprahepatic vena cava (SHVC) reconstruction in rat OLT, novel magnetic rings were designed and manufactured to facilitate reconstruction of SHVC and shorten the anhepatic time. One-hundred and twenty adult male Wistar rats were randomly divided into two groups: rings group (n = 30), using magnetic rings for SHVC reconstruction; suture group (n = 30), 7/0 prolene suture was used for SHVC running anastomosis as control. Cuff techniques were used for portal vein and infrahepatic vena cava reconstruction as Kamada and Calne described. The bile duct was reconnected with a stent. The hepatic re-arterialization was omitted. In the rings group, the SHVC reconstruction took 0.91 ± 0.24 (mean ± SD) min; the anhepatic phase and the recipient operation time were 5.63 ± 0.65 min and 36.02 ± 8.02 min, respectively. In suture group, the anastomotic time of SHVC was 10.40 ± 2.11 min; the anhepatic phase and the recipient operation time were 17.76 ± 2.51 and 49.38 ± 12.06 min, respectively, and there was statistically significant difference between the two groups. The ALT levels reached peak at 24 h post-OLT (186.2 ± 32.5 IU/l) and restored to normal level at 96 h gradually. In the rings group, 29 of 30 rats survived at day 7 and 28 of 30 rats survived at day 30. In contrast, only 25 of 30 recipients in suture group remained alive at day 7 and 22 of 30 remained alive at day 30 (P < 0.05). Better anastomotic healing was founded in rings group by pathology and scanning electron microscope. The magnetic rings technique provides a novel, simple method for SHVC reconstruction of OLT in rat. It significantly shortens anhepatic phase, while the success rate of the operation is satisfactory.
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Affiliation(s)
- Yuan Shi
- Department of Hepatopancreatobiliary Surgery, Organ Transplantation Center, Tianjin First Center Hospital, Nankai District, Tianjin, China
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Pecoraro F, Bajardi G, Dinoto E, Vitale G, Bellisi M, Bracale UM. Endograft connector technique to treat popliteal artery aneurysm in a morbid obese patient. Vascular 2014; 23:165-9. [DOI: 10.1177/1708538114533961] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgical repair of popliteal artery aneurysm in morbid obese patients poses additional challenges. We report a morbid obese patient who had a 59 mm right popliteal artery aneurysm which was successfully treated with the endograft connector technique. This technique was used to perform the distal anastomosis of the below-knee femoro-popliteal bypass. A 10 mm Dacron graft was used as a main graft bypass and an 11 mm/10 cm stentgraft as endograft connector. Following the respective tunnel of the Dacron graft, an end-to-side proximal anastomosis was performed at distal femoral artery. The aneurysm exclusion was obtained through a proximal and a distal ligation. Postoperative duplex showed adequate bypass patency. Knee x-rays demonstrated no signs of stent kinking/fractures. The postoperative course was uneventful and the patient was discharged home on fourth day post operative. The six-month computed tomography scan and the 12-month duplex control showed a patent bypass with no signs of stenosis.
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Affiliation(s)
- Felice Pecoraro
- Vascular Surgery Unit, University Hospital ‘P. Giaccone’, Palermo, Italy
| | - Guido Bajardi
- Vascular Surgery Unit, University Hospital ‘P. Giaccone’, Palermo, Italy
| | - Ettore Dinoto
- Vascular Surgery Unit, University Hospital ‘P. Giaccone’, Palermo, Italy
| | - Gaetano Vitale
- Vascular Surgery Unit, University Hospital ‘P. Giaccone’, Palermo, Italy
| | - Mario Bellisi
- Vascular Surgery Unit, University Hospital ‘P. Giaccone’, Palermo, Italy
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Ex vivo proof-of-concept of end-to-end scaffold-enhanced laser-assisted vascular anastomosis of porcine arteries. J Vasc Surg 2014; 62:200-9. [PMID: 24613189 DOI: 10.1016/j.jvs.2014.01.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 01/21/2014] [Accepted: 01/25/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The low welding strength of laser-assisted vascular anastomosis (LAVA) has hampered the clinical application of LAVA as an alternative to suture anastomosis. To improve welding strength, LAVA in combination with solder and polymeric scaffolds (ssLAVA) has been optimized in vitro. Currently, ssLAVA requires proof-of-concept in a physiologically representative ex vivo model before advancing to in vivo studies. This study therefore investigated the feasibility of ex vivo ssLAVA in medium-sized porcine arteries. METHODS Scaffolds composed of poly(ε-caprolactone) (PCL) or poly(lactic-co-glycolic acid) (PLGA) were impregnated with semisolid solder and placed over coapted aortic segments. ssLAVA was performed with a 670-nm diode laser. In the first substudy, the optimum number of laser spots was determined by bursting pressure analysis. The second substudy investigated the resilience of the welds in a Langendorf-type pulsatile pressure setup, monitoring the number of failed vessels. The type of failure (cohesive vs adhesive) was confirmed by electron microscopy, and thermal damage was assessed histologically. The third substudy compared breaking strength of aortic repairs made with PLGA and semisolid genipin solder (ssLAVR) to repairs made with BioGlue. RESULTS ssLAVA with 11 lasing spots and PLGA scaffold yielded the highest bursting pressure (923 ± 56 mm Hg vs 703 ± 96 mm Hg with PCL ssLAVA; P = .0002) and exhibited the fewest failures (20% vs 70% for PCL ssLAVA; P = .0218). The two failed PLGA ssLAVA arteries leaked at 19 and 22 hours, whereas the seven failed PCL ssLAVA arteries burst between 12 and 23 hours. PLGA anastomoses broke adhesively, whereas PCL welds failed cohesively. Both modalities exhibited full-thickness thermal damage. Repairs with PLGA scaffold yielded higher breaking strength than BioGlue repairs (323 ± 28 N/cm(2) vs 25 ± 4 N/cm(2), respectively; P = .0003). CONCLUSIONS PLGA ssLAVA yields greater anastomotic strength and fewer anastomotic failures than PCL ssLAVA. Aortic repairs with BioGlue were inferior to those produced with PLGA ssLAVR. The results demonstrate the feasibility of ssLAVA/R as an alternative method to suture anastomosis or tissue sealant. Further studies should focus on reducing thermal damage.
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Yan X, Fan C, Ma J, Li J, Dong D, Wang H, Ma F, Zheng X, Lv Y. Portacaval shunt established in six dogs using magnetic compression technique. PLoS One 2013. [PMID: 24098809 DOI: 10.1371/journal.pone.0076873pone-d-13-21426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS Installing the transjugular intrahepatic portosystemic shunt for portal hypertension is relatively safe, but complications are still high. To explore a new method of portacaval shunt, the magnetic compression technique was introduced into the shunting procedure. METHODS A portal-inferior vena cava shunt was performed on 6 male mongrel dogs by two hemocompatible Nd-Fe-B permanent magnets, parent and daughter. The parent magnet was applied to the inferior vena cava guided by a catheter through the femoral vein. The daughter magnet was moved to the anastomosis position on the portal vein with a balloon catheter through the splenic vein. After the daughter magnet reached the target position, the two magnets acted to compress the vessel wall and hold it in place. Five to 7 days later, under X-ray guidance, the magnets were detached from the vessel wall with a rosch-uchida transjugular liver access set. One month later, histological analysis and portal venography were performed. RESULTS 5-7 days after the first surgery, a mild intimal hyperplasia in the portal vein and the inferior vena cava, and continuity of the vascular adventitia from the portal vein to the inferior vena cava as observed. During the second surgery, the contrast media could be observed flowing from the portal vein into the inferior vena cava. Portal venography revealed that the portosystemic shunt was still present one month after the second surgery. CONCLUSIONS Magnamosis via a device of novel design was successfully used to establish a portacaval shunt in dogs.
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Affiliation(s)
- Xiaopeng Yan
- Department of Hepatobiliary Surgery, First Affiliated Hospital, College of Medicine, Xi'an Jiaotong University, Xi'an Shaanxi Province, China ; XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an Shaanxi Province, China
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Yan X, Fan C, Ma J, Li J, Dong D, Wang H, Ma F, Zheng X, Lv Y. Portacaval shunt established in six dogs using magnetic compression technique. PLoS One 2013; 8:e76873. [PMID: 24098809 PMCID: PMC3786958 DOI: 10.1371/journal.pone.0076873] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/28/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND AIMS Installing the transjugular intrahepatic portosystemic shunt for portal hypertension is relatively safe, but complications are still high. To explore a new method of portacaval shunt, the magnetic compression technique was introduced into the shunting procedure. METHODS A portal-inferior vena cava shunt was performed on 6 male mongrel dogs by two hemocompatible Nd-Fe-B permanent magnets, parent and daughter. The parent magnet was applied to the inferior vena cava guided by a catheter through the femoral vein. The daughter magnet was moved to the anastomosis position on the portal vein with a balloon catheter through the splenic vein. After the daughter magnet reached the target position, the two magnets acted to compress the vessel wall and hold it in place. Five to 7 days later, under X-ray guidance, the magnets were detached from the vessel wall with a rosch-uchida transjugular liver access set. One month later, histological analysis and portal venography were performed. RESULTS 5-7 days after the first surgery, a mild intimal hyperplasia in the portal vein and the inferior vena cava, and continuity of the vascular adventitia from the portal vein to the inferior vena cava as observed. During the second surgery, the contrast media could be observed flowing from the portal vein into the inferior vena cava. Portal venography revealed that the portosystemic shunt was still present one month after the second surgery. CONCLUSIONS Magnamosis via a device of novel design was successfully used to establish a portacaval shunt in dogs.
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Affiliation(s)
- Xiaopeng Yan
- Department of Hepatobiliary Surgery, First Affiliated Hospital, College of Medicine, Xi’an Jiaotong University, Xi’an Shaanxi Province, China
- XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an Shaanxi Province, China
| | - Chao Fan
- Department of Hepatobiliary Surgery, First Affiliated Hospital, College of Medicine, Xi’an Jiaotong University, Xi’an Shaanxi Province, China
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi’an Shaanxi Province, China
| | - Jia Ma
- Department of Hepatobiliary Surgery, First Affiliated Hospital, College of Medicine, Xi’an Jiaotong University, Xi’an Shaanxi Province, China
- XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an Shaanxi Province, China
| | - Jianhui Li
- Department of Surgical Oncology, Third Affiliated Hospital, College of Medicine, Xi’an Jiaotong University (Shaanxi Provincial People’s Hospital), Xi’an Shaanxi Province, China
- XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an Shaanxi Province, China
| | - Dinghui Dong
- Department of Hepatobiliary Surgery, First Affiliated Hospital, College of Medicine, Xi’an Jiaotong University, Xi’an Shaanxi Province, China
- XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an Shaanxi Province, China
| | - Haohua Wang
- XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an Shaanxi Province, China
| | - Feng Ma
- XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an Shaanxi Province, China
| | - Xinglong Zheng
- Department of Hepatobiliary Surgery, First Affiliated Hospital, College of Medicine, Xi’an Jiaotong University, Xi’an Shaanxi Province, China
- XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an Shaanxi Province, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, First Affiliated Hospital, College of Medicine, Xi’an Jiaotong University, Xi’an Shaanxi Province, China
- XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an Shaanxi Province, China
- * E-mail:
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Liang X, Sun G, Hu B, Li J. Microvascular sutureless adhesive bonding anastomosis with a new soluble hollow stent. J Craniofac Surg 2013; 24:1823-7. [PMID: 24036788 DOI: 10.1097/scs.0b013e318285d36f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to assess a new soluble hollow stent used in an experimental sutureless adhesive bonding technique for microvascular anastomosis. Twenty-four New Zealand white rabbits were randomized into 2 groups. Twelve end-to-end anastomoses of carotid arteries were performed with glue and stent in group A. In control group B, 12 anastomoses were performed by manual suturing. Anastomoses were timed; immediate and late patency at 1 day, 7 days, and 3 weeks after surgery were evaluated by ultrasonography. Specimens were then analyzed histologically. This adhesive bonding technique took 7.02 ± 1.26 minutes to perform while the hand-sewn technique took 15.48 ± 2.10 minutes. Immediate and late patencies of the 2 groups were not statistically different. The new technique using glue and stent appeared to be timesaving, feasible, and efficient.
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Affiliation(s)
- Xiangdang Liang
- From the *Orthopedics Department, Chinese PLA General Hospital, Beijing; †Orthopedics Department, Chinese No. 252 Hospital of PLA, Hebei Province; and ‡The Clinic of No. 61646 Military Unit, Beijing, China
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Akbulut S, Wojcicki M, Kayaalp C, Yilmaz S. Liver transplantation with piggyback anastomosis using a linear stapler: a case report. Transplant Proc 2013; 45:1031-3. [PMID: 23622617 DOI: 10.1016/j.transproceed.2013.02.098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The so-called piggyback technique of liver transplantation (PB-LT) preserves the recipient's caval vein, shortening the warm ischemic time. It can be reduced even further by using a linear stapler for the cavocaval anastomosis. Herein, we have presented a case of a patient undergoing a side-to-side, whole-organ PB-LT for cryptogenic cirrhosis. Upper and lower orifices of the donor caval vein were closed at the back table using a running 5-0 polypropylene suture. Three stay sutures were then placed on caudal parts of both the recipient and donor caval with a 5-mm venotomies. The endoscopic linear stapler was placed upward through the orifices and fired. A second stapler was placed more cranially and fired resulting in a 8-9 cm long cavocavostomy. Some loose clips were flushed away from the caval lumen. The caval anastomosis was performed within 4 minutes; the time needed to close the caval vein stapler insertion orifices (4-0 polypropylene running suture) before reperfusion was 1 minute. All other anastomoses were performed as typically sutured. The presented technique enables one to reduce the warm ischemic time, which can be of particular importance with marginal grafts.
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Affiliation(s)
- S Akbulut
- Department of Surgery, Liver Transplantation Institute, Inonu University Faculty of Medicine, Malatya, Turkey. Elect
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Nonsuture anastomosis of arteries and veins using the magnetic pinned-ring device: a histologic and scanning electron microscopic study. Ann Vasc Surg 2012; 26:985-95. [PMID: 22835565 DOI: 10.1016/j.avsg.2012.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 03/21/2012] [Accepted: 04/23/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND The goal of this study was to evaluate the performance of the magnetic pinned-ring device for nonsuture vascular anastomosis. METHODS The magnetic pinned-ring device consists of paired magnetic rings that are coated with titanium nitride and embedded in a polypropylene shell; the rings are equipped with alternately spaced holes and titanium pins. The vascular anastomosis procedure using the novel magnetic pinned-ring device was performed on 14 mongrel dogs, and the traditional hand-sewing technique was used on 14 additional dogs. In situ end-to-end anastomoses were performed in the femoral artery and the inferior vena cava. Patency was confirmed through ultrasonographic scans at different time points as late as 24 weeks after surgery. Gross observation, histological staining, and scanning electron microscopy were used to evaluate the results at 24 weeks postoperatively. RESULTS The time required to perform the vascular anastomosis was significantly shorter for the magnetic device than for hand sewing. A continuity of re-endothelialization was confirmed in all anastomotic stomas after 24 weeks, and neither formation of aneurysms nor thickening of the vascular wall was noted. The re-endothelialization was smooth at the anastomotic site of the magnetic device, whereas hand sewing resulted in rough and uneven re-endothelialization and the presence of visible sutures. Moreover, the endothelial cells were regularly arranged at the anastomotic site of the magnetic device, whereas different-sized and irregularly aligned endothelial cells were present at the hand-sewn anastomotic site. Use of the magnetic device was associated with significantly decreased deposition of fibrotic collagen and depressed infiltration of inflammatory cells compared with use of the hand-sewing technique. CONCLUSIONS The magnetic pinned-ring device offers a simple, fast, reliable, and efficacious technique for nonsuture vascular anastomosis. Use of this device shortens operation time, maintains a high patency rate, and improves the healing of vascular tissue.
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Bogni S, Schöni D, Constantinescu M, Wirth A, Vajtai I, Bregy A, Raabe A, Pieles U, Frenz M, Reinert M. Tissue fusion, a new opportunity for sutureless bypass surgery. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 112:45-53. [PMID: 21691987 DOI: 10.1007/978-3-7091-0661-7_9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Microsurgical suturing is the standard for cerebral bypass surgery, a technique where temporary occlusion is usually necessary. Non-occlusive techniques such as excimer laser-assisted non-occlusive anastomosis (ELANA) have certainly widened the spectrum of treatment of complex cerebrovascular situations, such as giant cerebral aneurysms, that were otherwise non-treatable. Nevertheless, the reduction of surgical risks while widening the spectrum of indications, such as a prophylactic cerebral bypass, is still a main aim, that we would like to pursue with our sutureless tissue fusion research. The primary concern in sutureless tissue fusion- and especially in tissue fusion of cerebral vessels- is the lack of reproducibility, often caused by variations in the thermal damage of the vessel. This has prevented this novel fusion technique from being applicable in daily surgical use. In this overview, we present three ways to further improve the laser tissue soldering technique.In the first section entitled "Laser Tissue Soldering Using a Biodegradable Polymer," a porous polymer scaffold doped with albumin (BSA) and indocyanine green (ICG) is presented, leading to strong and reproducible tensile strengths in tissue soldering. Histologies and future developments are discussed.In the section "Numerical Simulation for Improvement of Laser Tissue Soldering," a powerful theoretical simulation model is used to calculate temperature distribution during soldering. The goal of this research is to have a tool in hand that allows us to determine laser irradiation parameters that guarantee strong vessel fusion without thermally damaging the inner structures such as the intima and endothelium.In a third section, "Nanoparticles in Laser Tissue Soldering," we demonstrate that nanoparticles can be used to produce a stable and well-defined spatial absorption profile in the scaffold, which is an important step towards increasing the reproducibility. The risks of implanting nanoparticles into a biodegradable scaffold are discussed.Step by step, these developments in sutureless tissue fusion have improved the tensile strength and the reproducibility, and are constantly evolving towards a clinically applicable anastomosis technique.
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Affiliation(s)
- Serge Bogni
- Institute of Applied Physics, University of Bern, Bern, Switzerland
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Polymers for the rapid and effective activation and aggregation of platelets. Biomaterials 2011; 32:7034-41. [DOI: 10.1016/j.biomaterials.2011.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 06/02/2011] [Indexed: 11/20/2022]
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Pabittei DR, Heger M, Balm R, Meijer HEH, de Mol B, Beek JF. Electrospun Poly(ɛ-Caprolactone) Scaffold for Suture-Free Solder-Mediated Laser-Assisted Vessel Repair. Photomed Laser Surg 2011; 29:19-25. [DOI: 10.1089/pho.2010.2779] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dara R. Pabittei
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
- Department of Cardio-thoracic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Michal Heger
- Department of Experimental Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Ron Balm
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Han E. H. Meijer
- Department of Mechanical Engineering, Polymer Technology Group, Technical University of Eindhoven, Eindhoven, the Netherlands
| | - Bas de Mol
- Department of Cardio-thoracic Surgery, Academic Medical Center, Amsterdam, the Netherlands
- Department of Biomedical Engineering, Cardiovascular Biomechanics Group, Technical University of Eindhoven, Eindhoven, the Netherlands
| | - Johan F. Beek
- Department of Biomedical Engineering, Academic Medical Center, Amsterdam, the Netherlands
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Schwaiger N, Wu J, Wright B, Morrissey L, Harris M, Rohanizadeh R. BioWeld® Tube and surgical glue for experimental sutureless venous microanastomosis. Br J Surg 2010; 97:1825-30. [DOI: 10.1002/bjs.7257] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2010] [Indexed: 11/06/2022]
Abstract
Abstract
Background
The medial wall of mammalian veins is generally thin and fragile compared with the thick muscle seen in arteries. This makes venous microanastomoses time consuming and challenging. This study aimed to determine the feasibility and effectiveness of using the BioWeld® Tube in conjunction with a surgical glue (butyl-2-cyanoacrylate) in performing sutureless venous microanastomoses.
Methods
The feasibility and effectiveness of microvascular anastomoses in a rabbit jugular vein model were investigated in six animals, using the BioWeld® Tube in conjunction with butyl-2-cyanoacrylate surgical glue. Patency and tissue repair mechanisms at the anastomotic site were assessed 1 week after the procedure.
Results
All anastomoses remained patent at 1 week. Muscle necrosis occurred only in areas where the tissue was subject to the fold-and-bond procedure.
Conclusion
The study showed the feasibility and short-term effectiveness of the BioWeld® Tube in facilitating venous anastomoses.
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Affiliation(s)
- N Schwaiger
- Clinic for Hand-, Plastic- and Microsurgery Friederikenstift, Hanover, Germany
| | - J Wu
- Victor Chang Cardiac Research Institute, University of Wollongong, Sydney, New South Wales, Australia
| | - B Wright
- Eddyline, University of Wollongong, Sydney, New South Wales, Australia
| | - L Morrissey
- Graduate School of Medicine, University of Wollongong, Sydney, New South Wales, Australia
| | - M Harris
- TM Ventures, University of Sydney, Sydney, New South Wales, Australia
| | - R Rohanizadeh
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
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Liu Y, Wang S, Hu SJ. Multi-objective optimization of end-to-end sutured anastomosis for robot-assisted surgery. Int J Med Robot 2010; 6:368-75. [PMID: 20652861 DOI: 10.1002/rcs.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Due to differences in surgical operations between free-hand and robot-assisted vessel anastomosis, there exist new challenges in applying the manipulation criteria of free-hand surgery to robot-assisted surgery in order to guarantee successful completion of the surgical procedure. METHODS A mathematical model is established to optimize the process variables in vessel anastomosis. The distance between entry point and cross-section, suture tension and the number of individual sutures are selected as design variables. The allowable range of suture tension and the difference between longitudinal stresses of vessel tissue on transverse sections are used as the objective functions. Simulation experiments are carried out to obtain the allowable range of suture tension and tissue stress distribution, based on numerical analysis. RESULTS For a vessel in anastomosis with 4 mm diameter, a larger distance between the entry point and the cross-section and/or more sutures can result in less tissue deformation and a tighter joint between the two vessel ends. The allowable range of suture tension is a function of the number of individual sutures and increases with the decrease of the distance between entry point and cross-section. The optimal designs providing the suture configuration of distance between entry point and cross-section and the number of individual sutures are presented in the case that the performance of robot-assisted anastomosis can be guaranteed without strong control of suture tension. CONCLUSIONS The work provides meaningful results for the optimal design of the suturing procedure in robot-assisted vascular anastomosis when the robotic system does not allow tactile feedback.
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Affiliation(s)
- Ying Liu
- School of Mechanical Engineering, Tianjin University, Tianjin 300072, People's Republic of China
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Bogni S, Stumpp O, Reinert M, Frenz M. Thermal model for optimization of vascular laser tissue soldering. JOURNAL OF BIOPHOTONICS 2010; 3:284-295. [PMID: 20196032 DOI: 10.1002/jbio.201000009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Laser tissue soldering (LTS) is a promising technique for tissue fusion based on a heat-denaturation process of proteins. Thermal damage of the fused tissue during the laser procedure has always been an important and challenging problem. Particularly in LTS of arterial blood vessels strong heating of the endothelium should be avoided to minimize the risk of thrombosis. A precise knowledge of the temperature distribution within the vessel wall during laser irradiation is inevitable. The authors developed a finite element model (FEM) to simulate the temperature distribution within blood vessels during LTS. Temperature measurements were used to verify and calibrate the model. Different parameters such as laser power, solder absorption coefficient, thickness of the solder layer, cooling of the vessel and continuous vs. pulsed energy deposition were tested to elucidate their impact on the temperature distribution within the soldering joint in order to reduce the amount of further animal experiments. A pulsed irradiation with high laser power and high absorbing solder yields the best results.
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Affiliation(s)
- Serge Bogni
- Institute of Applied Physics, Department of Biomedical Photonics, University of Bern, Bern, Switzerland
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Outcomes after 1.9-microm diode laser-assisted anastomosis in reconstructive microsurgery: results in 27 patients. Plast Reconstr Surg 2010; 125:1167-1175. [PMID: 20072082 DOI: 10.1097/prs.0b013e3181d18173] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Microvascular surgery has become an important method for reconstructing surgical defects resulting from trauma, tumors, or burns. The most important factor for successful free flap transfer is a well-executed anastomosis. This study was performed to review the authors' experience with a 1.9-microm diode laser in microsurgery, with special attention to outcomes and performance of the technique. METHODS Between January of 2005 and December of 2007, 27 patients underwent microsurgery with a 1.9-microm diode laser at the authors' institute. The patients had a mean age of 31 years (range, 2 to 59 years); 14 patients were women and 13 patients were men. This technique was used for digital replantations (n = 2) and for free flap transfer (n = 27). Causes of the defects were trauma (n = 14), tumor (n = 9), congenital (n = 2), burn (n = 1), infection (n = 1), arthritis (n = 1), and dog bite (n = 1). Laser-assisted microvascular anastomosis was performed with a 1.9-microm diode laser after placement of equidistant stitches. The following parameters were used: spot size, 400 microm; power, 125 mW; time depending on vessel size (0.8 to 1.8 mm); and fluence varying from 70 to 200 J/cm. RESULTS Three surgical revisions following hematoma and one rupture of the arterial anastomosis leading to a free deep inferior epigastric perforator flap necrosis resulting from high-dose radiotherapy before surgery occurred after laser-assisted microvascular anastomosis, accounting for an overall success rate of 96.6 percent. CONCLUSION This study reports the numerous benefits of the technique: easier performance of vascular anastomosis with difficult access, decrease of reperfusion bleeding and complications, and a short learning curve.
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Ueda K, Mukai T, Ichinose S, Koyama Y, Takakuda K. Bioabsorbable device for small-caliber vessel anastomosis. Microsurgery 2010; 30:494-501. [DOI: 10.1002/micr.20764] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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