Sutureless liver repair and hemorrhage control using laser-mediated fusion of human albumin as a solder.
BACKGROUND
Major liver trauma has a high mortality because of immediate exsanguination and a delayed morbidity from septicemia, peritonitis, biliary fistulae, and delayed secondary hemorrhage. We evaluated laser soldering using liquid albumin for welding liver injuries.


METHODS
Fourteen lacerations (6 x 2 cm) and 13 nonanatomic resection injuries (raw surface, 8 x 2 cm) were repaired. An 805-nm laser was used to weld 53% liquid albumin-indocyanine green solder to the liver surface, reinforcing it by welding a free autologous omental scaffold. The animals were heparinized and hepatic inflow occlusion was used for vascular control. For both laceration and resection injuries, 16 soldering repairs were evaluated acutely at 3 hours. Eleven animals were evaluated chronically, two at 2 weeks and nine at 4 weeks.


RESULTS
All 27 laser mediated-liver repairs had minimal blood loss compared with the suture controls. No dehiscence, hemorrhage, or bile leakage was seen in any of the laser repairs after 3 hours. All 11 chronic repairs healed without complication.


CONCLUSIONS
This modality effectively seals the liver surface, joins lacerations with minimal thermal injury, and works independently of the patient's coagulation status.
Wadia
Y
Y
Oregon Medical Laser Center, Providence St. Vincent Medical Center, Portland, Oregon, USA. yasminwadia@yahoo.com
Xie
H
H
Kajitani
M
M
D000818:Animals; D006488:Hemostasis, Surgical; D006498:Hepatectomy; D006801:Humans; D007208:Indocyanine Green; D022125:Lacerations / Q000601:surgery*; D017075:Laser Coagulation; D008099:Liver / Q000293:injuries* / Q000601:surgery; D012709:Serum Albumin; D013536:Suture Techniques; D013552:Swine; D014945:Wound Healing / Q000502:physiology; D014949:Wounds, Nonpenetrating / Q000601:surgery; D014951:Wounds, Stab / Q000601:surgery
D012709:Serum Albumin; D007208:Indocyanine Green