Microvascular Anastomoses: An Evaluation of Laser-Assisted Technique

Fried, Marvin P.; Moll, Erik R. S.

doi:10.1001/archotol.1987.01860090066021

Cited by 15 publications

(8 citation statements)

References 14 publications

(1 reference statement)

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“…However, in most LAVA studies, stay sutures were still employed to support vessel approximation and anastomotic strength ( Figure 4) [2,7,[12][13][14][15][21][22][23]27,31,34,35,38,42,43,46,47,[68][69][70][71]81]. Several studies in which stay sutures were entirely omitted and the vessel segments were adjoined using microforceps, a balloon catheter, or a polyvinyl alcohol splint reported lower patency rates and were not applicable to all vessel sizes [16,17,23].…”

Section: Summary Of Experimental Resultsmentioning

confidence: 99%

“…The superficial absorption of the CO2 laser (λ = 10,600 nm) was more suitable for microvascular anastomoses (Ø ≤ 1 mm). However, when operated in continuous-wave mode, CO2 LAVW was often associated with full-thickness thermal damage and a high rate of aneurysm formation ( Figure 5A) [1,7,12,26,43,70,72,80,81]. LAVW with a pulsed thulium-holmium-chromiumdoped (THC):yttrium-aluminum-garnet (YAG) laser (λ = 2,150 nm, targets water as chromophore), which has an OPD between that of the CO2 and neodymium (Nd):YAG laser (λ = 1,064 nm, also targets water as chromophore), produced sutureless microvascular anastomoses with bursting pressures of 400 ± 55 mmHg, while thermal damage was limited to the adventitia [39].…”

Section: Summary Of Experimental Resultsmentioning

confidence: 99%

“…First, the relatively low welding strengths produced with LAVW often require additional sutures to reinforce the anastomosis, ultimately defeating the purpose of the modality. [3,[5][6][7][8]10,[12][13][14]18,20,22,24,26,28,30,32,[34][35][36]40,67,69,70] Second, extensive thermal damage may extend to the basal membrane of the intima ( Figure 1) and cause intimal hyperplasia [7,20], thrombosis [7,26], and aneurysm formation [13,15,21,34,38,71,72]. To overcome these disadvantages, several more refined welding techniques have been developed, including sLAVW, scaffold-and solder-enhanced LAVW (ssLAVW) (Figure 2), and photochemical laser-assisted tissue bonding.…”

Section: Introductionmentioning

confidence: 99%

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Laser-assisted vessel welding: state of the art and future outlook

Pabittei

Boon

Heger

et al. 2015

JCTRes

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Laser-assisted vascular welding (LAVW) is an experimental technique being developed as an alternative to suture anastomosis. In comparison to mechanical anastomosis, LAVW is less traumatic, non-immunogenic, provides immediate water tight sealant, and possibly a faster and easier procedure for minimally invasive surgery. This review focuses on technical advances to improve welding strength and to reduce thermal damage in LAVW. In terms of welding strength, LAVW has evolved from the photothermally-induced microvascular anastomosis, requiring stay sutures to support welding strength, to sutureless anastomoses of medium-sized vessels, withstanding physiological and supraphysiological pressure. Further improvements in anastomotic strength could be achieved by the use of chromophore-containing albumin solder and the employment of (biocompatible) polymeric scaffolds. The anastomotic strength and the stability of welds achieved with such a modality, referred to as scaffold-and solder-enhanced LAVW (ssLAVW), are dependent on the intermolecular bonding of solder molecules (cohesive bonding) and the bonding between solder and tissue collagen (adhesive bonding). Presently, the challenges of ssLAVW include (1) obtaining an optimal balance between cohesive and adhesive bonding and (2) minimizing thermal damage. The modulation of thermodynamics during welding, the application of semi-solid solder, and the use of a scaffold that supports both cohesive and adhesive strength are essential to improve welding strength and to limit thermal damage.

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Section: Summary Of Experimental Resultsmentioning

confidence: 99%

Section: Summary Of Experimental Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Laser-assisted vessel welding: state of the art and future outlook

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Boon

Heger

et al. 2015

JCTRes

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“…Studies nique [1,2,10,15,16]. However, the mechanism(s) have shown that coz laser welding of m~croves-underlying this effect are still not fully under-sels can be achieved at temperatures above 60°C, stood.…”

Section: Discussionmentioning

confidence: 99%

“…weld may simply be due to the heat produced by Tissue welding has been demonstrated to be the laser energy-However, the temperatures at an effective alternative to standard suture tech-which the weld is achieved have varied. Studies nique [1,2,10,15,16]. However, the mechanism(s) have shown that coz laser welding of m~crovesunderlying this effect are still not fully under-sels can be achieved at temperatures above 60°C, stood.…”

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confidence: 99%

Laser‐assisted microvascular anastomosis using CO₂ and KTP/532 lasers

Samonte

Fried

1991

Lasers Surg Med

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The milliwatt carbon dioxide (CO2) laser has been shown to be an effective device for performing laser-assisted microvascular anastomosis (LAMA) with consistently high patency rates, minimal tissue disruption, and rapid surgical time as well as the potential for reduced inflammation due to fewer foreign bodies (sutures) in the wound. The purpose of this investigation was to determine the feasibility of using the potassium titanyl phosphate (KTP) laser to perform LAMA and to compare it to CO2 LAMA in both arteries and veins. Patency rates, inflammatory response, and course of healing were evaluated through histological analysis. Twenty-eight rats were divided into two groups, which underwent either CO2 or KTP LAMA and then were sacrificed at 3 days, and 1, 2, 4, 8, and 12 weeks postoperatively. Patency rates for arteries and veins were comparable for both wavelengths (CO2: 100% for arteries, 93% for veins; KTP: 93% for arteries, 93% for veins). Histological grading of inflammation and fibrosis showed no significant difference between the two groups. This study demonstrated the efficacy of using the KTP/532 laser in performing LAMA. We found the KTP and CO2 LAMA to have comparable patterns of tissue damage and course of healing. Although this experiment did not investigate the mechanism(s) of tissue welding, our results suggest that successful LAMA may be independent of wavelength.

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The Efficacy of Absorbable Suture for Microvascular Anastomoses

Fried

Caminear

Sloman-Moll

1990

Archives of Otolaryngology - Head and Neck Surgery

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Although microvascular anastomoses are routinely performed with nonabsorbable sutures, a foreign body reaction can be stimulated that acts as a nidus for inflammation, infection, and possible thrombosis. Absorbable sutures should be able to diminish this reaction. There are sparse data describing the use of absorbable sutures for both arterial and venous anastomoses. This investigation compares standard microvascular anastomotic technique using nonabsorbable 10-0 sutures (nylon) with absorbable 10-0 sutures (polyglactin 910), using a previously reported tubed superficial epigastric flap model in rats. Patency rates and histologic responses are compared at intervals of 3 days and 1, 2, 8 and 12 weeks postoperatively. Arterial and venous patency rates were similar for both materials (overall nonabsorbable, 85.9%; overall absorbable, 84.4%). A somewhat increased inflammatory response was noted in the arterial absorbable group at 1 week and in both the venous and arterial nonabsorbable groups at 8 and 12 weeks postoperatively. The later finding most probably represents the continued presence of the nylon sutures. The incidence of intraluminal thrombosis was greater for nonabsorbable suture, occurring in two arterial and four venous anastomoses, compared with only one absorbable suture venous anastomosis. We conclude that nonabsorbable suture is as efficacious as standard absorbable material in both arterial and venous microanastomoses with the potential benefit of diminished foreign body reaction.

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Microvascular Anastomoses: An Evaluation of Laser-Assisted Technique

Cited by 15 publications

References 14 publications

Laser-assisted vessel welding: state of the art and future outlook

Laser-assisted vessel welding: state of the art and future outlook

Laser‐assisted microvascular anastomosis using CO₂ and KTP/532 lasers

The Efficacy of Absorbable Suture for Microvascular Anastomoses

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Microvascular Anastomoses: An Evaluation of Laser-Assisted Technique

Cited by 15 publications

References 14 publications

Laser-assisted vessel welding: state of the art and future outlook

Laser-assisted vessel welding: state of the art and future outlook

Laser‐assisted microvascular anastomosis using CO2 and KTP/532 lasers

The Efficacy of Absorbable Suture for Microvascular Anastomoses

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Laser‐assisted microvascular anastomosis using CO₂ and KTP/532 lasers