title: In vitro large diameter bowel anastomosis using a temperature controlled laser tissue soldering system and albumin stent.
abstract: OBJECTIVE
  In today's age of advancing surgical technology, there is a need for better and simpler methods of tissue bonding. The use of lasers for tissue welding or soldering is one of these sutureless methods. In 30 years of laser tissue bonding (LTB) research, published reports of cylindrical organ anastomosis were limited to small diameters. The tension resisted by the anastomosis, which is caused by the intraluminal pressure, is also proportional to the organ diameter. Therefore the anastomosis of large diameter organs requires significantly stronger mechanical strength. The aim of this study is to demonstrate such an anastomosis.
  
  
  METHODS
  In vitro anastomosis of porcine small bowel was performed by either LTB or sutures. Anastomosis in the laser group (number of samples, n = 15) included two main stages of soldering. The bowel edges were approximated over a solid albumin stent and heated with a temperature controlled GaAs laser system to 75 degrees C. This was followed by spreading liquid albumin on the anastomotic line and heating by the same system again to 75 degrees C. The control group (n = 5) was sutured anastomosis. All anastomoses were assessed by burst pressure measurement.
  
  
  RESULTS
  The burst pressure of the laser group attained 170+/-40 mmHg which was significantly higher than that of the sutured group 83+/-37 mmHg (P < 0.001).
  
  
  CONCLUSIONS
  This report describes the in vitro LTB anastomosis of a large diameter cylindrical organ. The immediate bond strength, as estimated by burst pressure measurements, was double compared to sutured anastomosis.
authors: Tel-Aviv Souraky Medical Center, Surgery B, Tel-Aviv 64239, Israel.
authors: David
authors: D
authors: Spector
authors: Yaron
authors: Y
authors: Rabi
authors: Irena
authors: I
authors: Vasserman
authors: Amos
authors: A
authors: Hardy
authors: Joseph
authors: J
authors: Klausner
authors: Micha
authors: M
authors: Rabau
authors: Abraham
authors: A
authors: Katzir
mesh_terms: D000418:Albumins / Q000627:therapeutic use; D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D004195:Disease Models, Animal; D007421:Intestine, Small / Q000601:surgery*; D017075:Laser Coagulation / Q000379:methods*; D011336:Probability; D011897:Random Allocation; D015607:Stents; D013536:Suture Techniques; D013552:Swine; D013696:Temperature; D013718:Tensile Strength
chemical_list: D000418:Albumins