Experimental evaluation and clinical use in the head and neck of a 3M/Precise microvascular anastomotic device

Vessel Remodeling after Intima-to-Intima Contact Anastomosis

BACKGROUND

Intima-to-intima microanastomotic vascular remodeling was explored, utilizing a polylactide-caprolactone absorbable vein coupler model (PAVCM), which was designed to simulate a non-absorbable counterpart system with the sole exception of being absorbable.

METHODS

Six New Zealand white rabbits were used. After transection of the jugular vein, 2 PAVCMs were placed, 1 at each transected end. The stumps were slipped through the PAVCMs, and the venous wall was everted 90° to achieve intima-to-intima contact. Reanastomosis of the transected jugular vein was performed bilaterally in 3 rabbits. In the other 3 rabbits, the jugular vein (20 mm) harvested from one side was interpositionally grafted to the jugular vein on the opposite side to ease the anastomotic tension. Patency testing, ultrasonography, and histologic assessments were conducted postoperatively at weeks 2, 4, 12, 16, 22, and 26.

RESULTS

All anastomotic sites were patent, without stenosis, occlusion, or dilatation. In the histologic sections, immature endothelial regeneration was observed at week 2, which was completed by week 4. Regeneration of the tunica media was noted at week 12. Between week 22 and week 26, the tunica media fully regenerated and the coupler dissipated entirely.

CONCLUSIONS

Despite the absence of a coupler to act as an anastomotic buttress, the structure and function of all the vessels appeared normal, even histologically. These outcomes are true milestones in the development of an absorbable vein coupler.

Vascular anastomosis using a biodegradable device with a heat-shrinking sleeve: a preliminary report

PURPOSE

The objective of this study is to present a simple mechanical anastomosis system capable of uniting vessels of differing diameters and to evaluate its applicability.

MATERIALS AND METHODS

A new mechanical system for anastomosis of small vessels was used in 30 rabbits to join 100 sectioned carotid arteries and jugular veins. The system is resorbable and consists of a cuff and a shrinkable sleeve. To carry out the anastomosis, one vessel end is pulled through the cuff and everted over it. The second vessel end is then slipped over the everted vessel end and the cuff. A heat-shrinking sleeve is positioned over the site and shrunk to produce permanent fixation.

RESULTS

The overall patency rate of the anastomoses was 96.6% in the arteries and 93.3% in veins. Microscopically, the intima-to-intima contact sites were bridged by an endothelial layer in the first postoperative weeks.

CONCLUSION

Advantages of the system include a short insertion time, simple instrumentation, a high patency rate, and resorbability. However, the method requires additional vessel length for eversion, and it cannot be used for end-to-side anastomoses.

Abdominal radical trachelectomy: a new surgical technique for the conservative management of cervical carcinoma

Traditionally radical hysterectomy has formed the mainstay of treatment for early stage cervical carcinoma. More recently radical trachelectomy and laparoscopic lymphadenectomy have been introduced to allow preservation of fertility. We present a new approach to fertility-sparing surgery, namely abdominal radical trachelectomy. The technique is similar to a standard radical hysterectomy and lymphadenectomy. In our technique the ovarian vessels are not ligated and, following lymphadenectomy and skeletonisation of the uterine arteries, the cervix, parametrium and vaginal cuff are excised. The residuum of the cervix is then sutured to the vagina and the uterine ateries re-anastomosed.