In vitro large diameter bowel anastomosis using a temperature controlled laser tissue soldering system and albumin stent.
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.
Spector
David
D
Tel-Aviv Souraky Medical Center, Surgery B, Tel-Aviv 64239, Israel.
Rabi
Yaron
Y
Vasserman
Irena
I
Hardy
Amos
A
Klausner
Joseph
J
Rabau
Micha
M
Katzir
Abraham
A
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
D000418:Albumins