Efficacy of a Novel Medical Adhesive for Sealing Lung Parenchyma: An in vitro Study in Rabbit Lungs

Abstract

<b><i>Introduction:</i></b> During thoracic resection procedures, complete hemostasis and aerostasis are priorities. A persistent alveolar air leak is associated with increased morbidity and mortality rates. This study aimed to evaluate whether the novel medical adhesive VIVO (Adhesys Medical GmbH Aachen, Germany) is a reliable alternative sealing technique to routine surgical procedures. <b><i>Methods:</i></b> We conducted an in vitro animal study by analyzing 21 lungs of New Zealand (<i>n</i> = 19) and Chinchilla Bastard (<i>n</i> = 2) rabbits (age, 11–18 weeks; weight, 2,400–3,600 g). Three groups, each comprising 7 animals, were evaluated. VIVO (VIVO-group) was compared with standard surgical lung parenchymal lesion closure with a polypropylene suture (Suture-group) and TachoSil® (TachoSil-group). We adopted a stable, pressure-controlled ventilation protocol. After explantation, a surgical incision 0.5-cm deep and 1.5-cm wide was made in the lungs using a customized template. Air leak was measured quantitatively (mL/min) using a respirator and visualized qualitatively by 2 observers who made independent judgments. Next, the leak was closed using VIVO, suture, or TachoSil® as specified by the manufacturer. Subsequently, positive end-expiratory pressure (PEEP) and inspiratory pressure were gradually increased until a maximum of 15 and 30 mbar were attained, respectively. <b><i>Results:</i></b> At PEEPs of 8, 10, and 15 mbar, VIVO achieved complete sealing of the profound parenchymal defect in all (<i>n</i> = 7) lungs. After closure of the incision, we observed an air leak variation of 127 ± 114 mL/min (Suture-group), 31 ± 49 mL/min (VIVO-group), and 114 ± 134 mL/min (TachoSil-group). VIVO showed a significantly lower air leak than surgical sutures (<i>p</i> = 0.031) and TachoSil® (<i>p</i> = 0.046). <b><i>Conclusion:</i></b> VIVO offers sufficient closure of the lung parenchymal lesions. The novel adhesive enabled significantly better sealing with lower persistent air leakage than TachoSil® or surgical sutures. Further investigation using in vivo models is strongly encouraged to confirm our findings.

Long-Term Degradation Assessment of a Polyurethane-Based Surgical Adhesive—Assessment and Critical Consideration of Preclinical In Vitro and In Vivo Testing

“…On the other hand, for research on PU-based tissue adhesive in general, the presented results complete an integral step of the preclinical development of the described PUAS. It has already been demonstrated to be able to overcome material-based shortcomings of other adhesives for different indications as investigated and published in previous research [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. In the present study, the complete degradation of PUAS was documented for the first time.…”

“…The adhesive can be stored at room temperature and can be easily administered to the target location using the sterile, ready-to-use dual-chamber syringe. It already demonstrated its easy handling and efficacy in different studies ranging from ex vivo studies to in vivo studies [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

A polyurethane‐based surgical adhesive for sealing blood vessel anastomoses—A feasibility study in pigs

“…For example, anastomoses created during gastrointestinal surgeries could benefit from reinforcement with adhesive as well. Moreover, air leakages of sutured lung incisions could be prevented 32 …”

“…Moreover, air leakages of sutured lung incisions could be prevented. 32 The PU-based adhesive used in this study fulfills the requirements for suture line reinforcement presented in the beginning. 13,15 Especially the fast and easy preparation and application together with the quick polymerization in wet environments enabled by the addition of an amino-based curing agent are advantageous compared to other materials.…”