U-clip for airway reconstruction: an experimental study of the feasibility of a robot-assisted endoscopic procedure.
BACKGROUND
The U-clip anastomotic device was developed to facilitate interrupted anastomoses without the need to tie sutures. Recently, this technology has been expanded into various fields of surgery. However, in the field of airway reconstruction, there have been no previous reports of this technology being used. The present study examined the technical feasibility of performing safe and efficient robot-assisted endoscopic airway reconstruction using nitinol U-clips in rabbits.


METHODS
A total of six tracheal anastomoses with S60 U-clips were performed using the da Vinci Surgical System. Anastomosis time and complications were recorded. The effectiveness of anastomoses was evaluated by postoperative observation of rabbits for 8 weeks and measurement of anastomotic strictures and pathological findings.


RESULTS
All procedures were completed safely. Mean procedure time was 14 ± 1.8 min (mean ± SD). There were no perioperative complications; however, all animals died between postoperative days 14-27, and anastomotic stricture was the likely cause of death. All anastomoses had severe strictures; the mean stricture rate was measured as being 51.1 ± 33.3 (%).


CONCLUSIONS
Although the technical feasibility of robot-assisted endoscopic airway reconstruction using U-clips has been demonstrated in rabbits, the safety of this technique has not been evaluated. Our data suggest that U-clips are not a feasible approach for airway reconstruction surgery because of the occurrence of severe postoperative anastomotic stricture.
Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan. wryuichi@med.kanazawa-u.ac.jp
Ryuichi
R
Waseda
Makoto
M
Oda
Isao
I
Matsumoto
Masaya
M
Takizawa
Norihiko
N
Ishikawa
Nobuyoshi
N
Tanaka
Mari
M
Shimada
Yusuke
Y
Tanaka
Go
G
Watanabe
D000714:Anastomosis, Surgical / Q000009:adverse effects; D000818:Animals; D001980:Bronchi / Q000601:surgery*; D001999:Bronchoscopy / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D011475:Prosthesis Failure; D011817:Rabbits; D012371:Robotics / Q000295:instrumentation*; D013525:Surgical Instruments / Q000009:adverse effects; D014132:Trachea / Q000601:surgery*; D014133:Tracheal Diseases / Q000209:etiology*