Local and systemic effects of fibrin and cyanoacrylate adhesives on lung lesions in rabbits

Effect of Saline Sealing After CT-Guided Lung Biopsy on Pneumothorax and Hemoptysis

OBJECTIVE

To confirm that saline sealing of the needle trace after computed tomography (CT)-guided lung biopsy reduces the incidence of pneumothorax and chest tube insertion, and to observe its effects on pulmonary hemorrhage and hemoptysis.

MATERIALS AND METHODS

Patients who underwent CT-guided lung biopsy at our hospital between January 2018 and January 2024 were included in the study. Patients were divided into 2 groups according to whether the needle trace was sealed with saline after tissue sampling. Patient baseline characteristics, lung lesion factors, procedural factors, pneumothorax rates, chest tube insertion rates, pulmonary hemorrhage rates, and hemoptysis rates were recorded.

RESULTS

The incidence of pneumothorax was 28.9% (38/132) and 15.8% (15/95) in groups A (control) and B (with sealed traces), respectively (P=0.002). The incidence of pneumothorax requiring chest tube insertion was significantly lower in group B than in group A (1.1% vs. 6.8%; P=0.048). The incidence of pulmonary hemorrhage was similar between the 2 groups (38.6% vs. 42.1%; P=0.599). No significant difference was observed in the hemoptysis of patients in groups A and B (6.8% vs. 10.5%; P=0.320). In the binary logistic regression analysis, significant risk factors for pneumothorax included lack of saline sealing, smaller lesion size, multiple passes through the pleura, and the lateral decubitus position. Smaller lesions and longer biopsy trace lengths were independent risk factors for hemoptysis.

CONCLUSIONS

Sealing the needle trace with saline significantly reduced the incidences of pneumothorax and chest tube insertion due to pneumothorax. Moreover, it did not significantly increase the incidence of pulmonary hemorrhage or hemoptysis. This technique is recommended for use in CT-guided lung biopsies.

In vivo comparative assessments on pleural adhesive effects of three commercially available sealants

Objective

Surgical sealant, which is used for the reinforcement of suture lines, has been widely used in lung-resection surgeries with the aim of reducing postoperative morbidity; however, it may exacerbate surgical-site adhesion, creating the risks of restrictive thoracic movement and a difficult entrance for redo operation. We aimed to assess the pleural adhesive effects of 3 frequently used surgical sealants, (1) fibrin glue (fibrin), (2) a composite of polyethylene glycol and human serum albumin (PEG/HSA), and (3) bioabsorbable polyglycolic acid felt (PGA), in an in vivo setting.

Methods

Eighty-one rats were randomly assigned to 3 experimental groups-fibrin, PEG/HSA, and PGA. After intrapleural application of the sealants, the extent and severity of adhesion and inflammation were quantitatively compared among the 3 groups at 2, 4, and 8 weeks.

Results

The scores for both the extent and severity of adhesion were significantly greater in the PGA group than the other 2 groups throughout postoperative period (P < .001 for all). Although both scores in the PES/HSA and fibrin groups were 0 at 2 weeks, the fibrin group showed significantly greater scores than the PES/HSA group thereafter (P < .001 for all). Trends in inflammation scores were similar of those of adhesion scores, favoring the PES/HSA group followed by the fibrin group (P < .001 for all).

Conclusions

Among 3 commonly used sealants, PEA/HSA showed least degree of adhesion/inflammation compared with fibrin and PGA, whereas PGA demonstrated greatest degrees of adhesion/inflammation throughout a postoperative course of 8 weeks in an in vivo model.

Comparison of Different Pneumorrhaphy Methods after Partial Pulmonary Lobectomy in Dogs

Pulmonary loborraphy can be performed using manual sutures and staples, although other methods, such as tissue adhesives, are also cited in the veterinary literature. Although the surgery is well tolerated in the canine species, failure in pulmonary aerostasis is still a reality since all the methods described so far eventually lead to air leakage after the use of the partial lobectomy technique in the lungs. Within this context, the aim of this research was to compare the effectiveness of different hermetic sealing methods after partial lobectomy of the right caudal lung lobe (RCLL) in dogs. 30 cadavers models were divided in 6 groups: G1-cobbler suture associated with simple continuous; G2-overlapping continuous suture associated with simple continuous suture; G3-Ford interlocking suture; G4-Stapling device; G5-Tissue glue (cyanoacrylate). After performing the sealing techniques, the lungs were submerged in water and inflated with oxygen at positive ventilatory pressures at physiological (up to 14.7 mmHg, which is equivalent to up to 20 cmH2O) and supraphysiological levels (above 14.7 mmHg) to evaluate the performance of the sealing methods. At physiological ventilatory pressure levels, there was no difference between groups. Sealing with surgical glue was superior to interlocking sutures and stapling devices at supraphysiological levels of ventilatory pressure.

Bio-macromolecular design roadmap towards tough bioadhesives

Emerging sutureless wound-closure techniques have led to paradigm shifts in wound management. State-of-the-art biomaterials offer biocompatible and biodegradable platforms enabling high cohesion (toughness) and adhesion for rapid bleeding control as well as robust attachment of implantable devices. Tough bioadhesion stems from the synergistic contributions of cohesive and adhesive interactions. This Review provides a biomacromolecular design roadmap for the development of tough adhesive surgical sealants. We discuss a library of materials and methods to introduce toughness and adhesion to biomaterials. Intrinsically tough and elastic polymers are leveraged primarily by introducing strong but dynamic inter- and intramolecular interactions either through polymer chain design or using crosslink regulating additives. In addition, many efforts have been made to promote underwater adhesion via covalent/noncovalent bonds, or through micro/macro-interlock mechanisms at the tissue interfaces. The materials settings and functional additives for this purpose and the related characterization methods are reviewed. Measurements and reporting needs for fair comparisons of different materials and their properties are discussed. Finally, future directions and further research opportunities for developing tough bioadhesive surgical sealants are highlighted.