Vesicourethral anastomosis with 2-octyl cyanoacrylate adhesive in an in vivo canine model

Comparison of leakage pressures of vesicourethral anastomosis performed with intracorporeal suturing in a simulator and conventional suturing ex vivo in canine cadaveric tissue

OBJECTIVE

To compare conventional and intracorporeal vesicourethral anastomosis (VUA) in canine cadaveric tissue.

STUDY DESIGN

Cadaveric ex vivo study.

STUDY POPULATION

Twenty-eight canine bladders with urethra.

METHODS

Specimens after prostatectomy were randomly divided into intracorporeal (I) group or conventional (C) group. For the I group, VUA was performed in a simulator with laparoscopic needle holders and telescope. For the C group, the anastomosis was performed in vitro with standard instruments. The VUA was performed with 4-0 monofilament absorbable suture and was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and number of suture bites were recorded.

RESULTS

Fourteen samples were entered in each group. The dorsal side of the anastomosis was initially performed, followed by the ventral side. The median suturing time was 30.8 minutes (range, 19.3-39.2) for the I group and 17.3 minutes (range, 9.2-21.3) for the C group (P < .0001). The median leakage pressure was 10.9 mm Hg (range, 4.1-29.7) for the I group and 10.8 mm Hg (range, 6.2-18.5) for the C group (P = .94). The median number of stitches was 20 (range, 14-26) for the I group and 19 (range, 11-28) for the C group (P = .96). The distribution of the site of leakage was similar between groups (P = .381).

CONCLUSION

Vesicourethral anastomosis can be performed with leakage pressures similar to intracorporeal and conventional suturing.

CLINICAL SIGNIFICANCE

This study represents the first step toward laparoscopic radical prostatectomy in dogs.

Preclinical evaluation of a regenerative immiscible bioglue for vesico-vaginal fistula

Currently, there are no clinically available tissue adhesives that work effectively in the fluid-rich and highly dynamic environments of the human body, such as the urinary system. This is especially relevant to the management of vesico-vaginal fistula, and developing a high-performance tissue adhesive for this purpose could vastly expand urologists' surgical repertoire and dramatically reduce patient discomfort. Herein, we developed a water-immiscible mussel protein-based bioadhesive (imWIMBA) with significantly improved properties in all clinical respects, allowing it to achieve rapid and strong underwater adhesion with tunable rheological properties. We evaluated in vivo potential of imWIMBA for sealing thermally injured fistula tracts between the bladder and vagina. Importantly, the use of imWIMBA in the presence of prolonged bladder drainage resulted in perfect closure of the vesico-vaginal fistula in operated pigs. Thus, imWIMBA could be successfully used for many surgical applications and improve treatment efficacy when combined with conventional surgical methods. STATEMENT OF SIGNIFICANCE: Vesico-vaginal fistula (VVF) is an abnormal opening between the bladder and the vagina, which is a stigmatized disease in many developing countries. Leakage of urine into internal organs can induce serious complications and delay wound repair. Conventional VVF treatment requires skillful suturing to provide a tension-free and watertight closure. In addition, there is no clinically approved surgical glue that works in wet and highly dynamic environments such as the urinary system. In this work, for potential clinical VVF closure and regeneration, we developed an advanced immiscible mussel protein-based bioglue with fast, strong, wet adhesion and tunable rheological properties. This regenerative immiscible bioglue could be successfully used for sealing fistulas and further diverse surgical applications as an adjuvant for conventional suture methods.

Non-suture technique for rabbit oviduct anastomosis with 2-octyl cyanoacrylate: a histopathologic and biomechanical analysis

AIM

The aim of this study was to investigate histological and biomechanical properties of oviduct anastomosis with 2-octyl cyanoacrylate (OCA) in the rabbit.

MATERIAL AND METHODS

Sixty female rabbits were randomly divided equally into three groups: A (control), B (traditional catgut suture), and C (non-suture technique using OCA). After suture or OCA anastomosis, gross examination (adhesion formation) and histopathology (hematoxylin-eosin), ultrastructure (transmission electron microscopy), and biomechanics (bursting pressure) on para-anastomotic site were investigated on oviduct taken at 1 (A1, B1, C1) and 4 (A2, B2, C2) weeks, respectively.

RESULTS

Adhesion score in group B was more severe than that in groups A and C at 1 and 4 weeks. Histopathology showed that acute endosalpingitis in group B was the most intense at 1 week, followed by significantly more tissue stimulation induced by catgut and foreign-body giant cells in group B than in group C at 4 weeks. Ultrastructural damage of ciliated cells was reversed partly (B2) and completely (C2) at 4 weeks. Bursting pressure in C1 was weaker than that in B1, followed by no significant difference at 4 weeks.

CONCLUSION

Non-suture using OCA for oviduct anastomosis can be accepted as a new-perspective technique.

The use of cyanoacrylate in surgical anastomosis: an alternative to microsurgery

To present anastomosis with cyanoacrylate as a cheap, simple, fast, and available technique for anastomosis in urological, vascular, gynecological, and general surgical procedures. This method may in the future be a good alternative to microsurgery, particularly in centers where facilities are unavailable and the financial implication is unbearable for the patient. Cyanoacrylate is an adhesive or glue that is available in different chemical forms ranging from ethylcyanoacrylate (superglue) to Isobutylcyanoacrylate and octylcyanoacrylate (dermerbond), which is in clinical use. Anastomosis with cyanoacrylate requires the application of stay sutures, a luminal stent and the subsequent application of the adhesive. The adhesives with lower molecular weights produce a rigid and patent region of anastomosis, while the higher molecular compounds produce a consistency close to the normal tissue. This technique presents a surgical method that is socially, culturally, and ethically acceptable, which is affordable to a larger majority of patients in our subregion. Cyanoacrylate anastomosis may in the future present a fast, convenient, simple, and affordable option in the treatment of patients requiring anastomosis. In our subregion where the socio-cultural, psychological, and economic burden of failed anastomosis is high, associated with the low per capital income, this may be a novel option for the management of urogynecological, vascular, neurosurgical, and general surgical procedures requiring either microscopic or macroscopic anastomosis.

Effect of cyanoacrylic glue on penile fracture: an experimental study

PURPOSE

We investigated the effect of Glubran(R)2 cyanoacrylic glue on rat cavernous tissue after forming penile fractures experimentally as well as the histopathological effect. We also investigated its clinical use.

MATERIALS AND METHODS

Experimental penile fracture was formed by incising from the proximal dorsal side of the penis in 32 Wistar Albino rats. The rats were randomly assigned to 4 main groups of 8 each. In the control group the incision was not repaired and it was left to secondary healing. In the glue group cyanoacrylic glue was only applied to the incision region. In the primary repair group the incision was primarily repaired and in the final group cyanoacrylic glue was applied to the incision region following primary repair. Three weeks later penectomy materials were examined histopathologically.

RESULTS

When the control group was compared with the other groups, the differences in cavernous tissue healing with fibrosis and hyperemia-bleeding were statistically significant (p = 0.043 and 0.003, respectively). In the glue group fibrosis was observed in 2 rats. This group was the best according to cavernous healing. Although there was no significant difference between the control group and the other groups according to inflammation (p = 0.057), the glue group was better than the primary repair group (p = 0.026). No significant inflammation or hyperemia-bleeding was observed in the glue group. When the experimental groups were evaluated for histopathological parameters, it was observed that the best results were obtained in the glue group.

CONCLUSIONS

Cyanoacrylic glue can be used in cavernous surgery due to its hemostatic, adhesive and anti-inflammatory properties.

Methods for laparoscopic training using animal models

To reduce the learning curves in humans, several training models have been developed for teaching laparoscopic surgery. The aim of various in vitro or in vivo training models is to help surgeons acquire basic laparoscopic skills such as hand-eye coordination, depth perception, and knot-tying, which should always be acquired prior to organ- or procedure-specific skills. Inexpensive video box trainers are best suited for this purpose. However, advanced laparoscopic skills, such as dissection, cutting, coagulation, and stitching, require more sophisticated animal or human cadaver models. The perfect training model should teach the skills required and should be inexpensive, universally available, and anatomically and physiologically identical to an anesthetized patient. In this paper, we review the different animal models for acquiring advanced laparoscopic skills and try to define their advantages and disadvantages.

The Effect of Cyanoacrylic Glue on Rat Testis, Urethra and Spongiosal Tissue: An Experimental Study

PURPOSE

We examined the effect of Glubran2 on the rat urethra and spongiosal tissue as well as the histopathological effect. We also investigated its clinical use.

MATERIALS AND METHODS

Eight control and 12 study group male Wistar rats were used in our study. The corpus spongiosum tissues, including the urethra and the tunica albuginea of the testis, were cut 0.5 and 0.2 cm long, respectively. Incision areas in the control group were sutured. In the study group Glubran2 was dripped on the area. Three weeks later all rats were sacrificed. The penile and testicular tissues were histopathologically investigated. One-way ANOVA and the t test were applied for statistical analysis.

RESULTS

When the study group was compared with the control group, the difference in urethral healing (p = 0.001), urethral lumen irregularity (p = 0.036), spongiosal tissue healing (p = 0.001), inflammation (p = 0.000), hyperemia-bleeding (p = 0.036) and total healing (p = 0.001) were statistically significant. When the study and control groups were compared, the difference in inflammation (p = 0.000), necrotic areas (p = 0.002), tunica albuginea irregularity (p = 0.005), Sertoli's and Leydig cell destruction (p = 0.005), and testicular spermatogenesis (p = 0.005) were statistically significant.

CONCLUSIONS

While perfect healing in the urethral and spongiosal tissues supports the clinical application, damage to the seminiferous tubules, decreased spermatogenesis at the operated site, tunica albuginea irregularity in a fourth of the testes and calcification in 1 testis were observed.