Laser tissue soldering in urinary tract reconstruction: first human experience.
OBJECTIVE
Laser tissue soldering (LTS) in the urinary tract provides an immediate leak-free seal and may avoid complications seen with conventional repair (such as fistula and stricture). We have begun a Phase I clinical trial investigating the use of LTS in performing urologic reconstructive surgery.


METHODS
Ten patients (aged 3 months to 38 years) underwent urologic reconstruction using LTS with a protein solder composed of human albumin (42%) and indocyanine green dye. In each case standard microsuture repair preceded laser-soldered suture line reinforcement. Anastomotic closure time and immediate leak pressure were measured. Postoperatively, all patients were evaluated for evidence of complications, including stricture, fistula formation, or impaired healing.


RESULTS
Using LTS as an adjunct to suturing added an average of 7.9 +/- 3.0 minutes (28%) to the overall mean anastomotic time of 28.3 +/- 9.4 minutes. Intraoperative leak pressure measurements for laser-soldered anastomoses (> or = 94.2 +/- 24.2 mm Hg) were significantly higher (P < 0.001) than primarily sutured anastomoses (20 +/- 2.9 mm Hg). Two instances of suture disruption (20%) occurred during laser activation, neither of which were repaired with sutures. Average follow-up for all patients was 7.1 + - 2.2 months. There were no intraoperative or postoperative complications, including the 2 patients with suture disruption.


CONCLUSIONS
These initial clinical results indicate that LTS is safe, easy to perform, and, contrary to conventional suturing, provides an immediate leak-free closure. Follow-up in these and other patients, as well as those undergoing sutureless and stent-free procedures, will determine whether our method of LTS benefits patients undergoing urologic reconstruction.
Kirsch
A J
AJ
Department of Urology, Squier Urological Clinic, Columbia University College of Physicians & Surgeons, New York, New York, USA.
Miller
M I
MI
Hensle
T W
TW
Chang
D T
DT
Shabsigh
R
R
Olsson
C A
CA
Connor
J P
JP
D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D005260:Female; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007208:Indocyanine Green; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D012709:Serum Albumin; D013536:Suture Techniques; D013997:Time Factors; D014014:Tissue Adhesives; D014517:Ureteral Obstruction / Q000601:surgery; D014522:Urethral Diseases / Q000601:surgery*
D012709:Serum Albumin; D014014:Tissue Adhesives; D007208:Indocyanine Green