title: Ureteral repair with titanium staples: comparison with suture closure.
abstract: OBJECTIVE
  Vascular closure staple (VCS) clips made of titanium were initially developed for microvascular anastomoses with little knowledge of their effectiveness in larger tubular tissue structures. This study compares VCS clips and sutures in the closure of longitudinal ureterotomy incisions.
  
  
  METHODS
  In 9 pigs, 1-cm-long anterior, longitudinal ureterotomy incisions were randomly assigned to closure with either 4-0 interrupted polyglactin sutures or VCS clips.
  
  
  RESULTS
  Clip closure was significantly faster (74+/-28 versus 534+/-182 seconds). All 18 ureters were patent and without signs of leakage, calculus formation, or stenoses after 3 months. Clip closure resulted in slightly but not statistically significantly less narrowing of the duct lumen, but there was no difference in wall thickness at the repair site. At histologic examination, all 18 incisions healed without signs of acute inflammation or marked fibrosis.
  
  
  CONCLUSIONS
  Ureterotomy closure with VCS clips results in wound healing that is as effective as suture closure, with a comparable degree of narrowing. The time required for clip closure is only about 1/7 that required for suture closure.
authors.affiliation: Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
authors.forename: A K
authors.initials: AK
authors.lastname: Leppäniemi
authors.forename: D C
authors.initials: DC
authors.lastname: Wherry
authors.forename: E
authors.initials: E
authors.lastname: Pikoulis
authors.forename: H V
authors.initials: HV
authors.lastname: Hufnagel
authors.forename: N
authors.initials: N
authors.lastname: Fishback
authors.forename: N M
authors.initials: NM
authors.lastname: Rich
mesh_terms: D000818:Animals; D013536:Suture Techniques; D013537:Sutures; D013552:Swine; D014025:Titanium; D014513:Ureter / Q000473:pathology / Q000601:surgery*
chemical_list: D014025:Titanium