Resorbable Self-Locking Implant for Lung Lobectomy Through Video-Assisted Thoracoscopic Surgery: First Live Animal Application

Abstract

The aim of this pilot test was to test a new self-locking resorbable implant for hilum occlusion during a video-assisted thoracoscopic lung lobectomy in a surviving pig model. Once the thoracic cavity was assessed and structures identified, the right middle lobe and its respective hilum were exposed. The implant was introduced with a semiclosed loop through a working channel and positioned around the pulmonary lobe. Occlusion was performed with a conventional Crile forceps and a laparoscopic Kelly forceps. Lobe section was done with laparoscopic Metzenbaum scissors and tissue removal through the dorsal access. No signs of pneumothorax or bleeding were observed during a 60-day follow-up. Necropsy findings showed minimal pleuritis in caudal access and in the lobar stump. A granulomatous formation was found around a dense, amorphous material, which was identified as remains of a small part of the implant. Histopathological findings showed signs of a chronic healing process without other alterations. The resorbable implant LigaTie appears to exhibit similar handling and application characteristics during surgery as nonsurgical tie wraps. The resorbable implant avoids the uncontrolled substances not suitable for implants of conventional ties. The results of this pilot test suggested the resorbable implant's mechanical properties provided effective tissue support to complete the healing of the pulmonary hilum.

Evaluation of a resorbable self‐locking ligation device for performing peripheral lung biopsies in a caprine cadaveric model

“…This device may therefore be attractive for lung lobectomy at the pulmonary hilus as well as thoracoscopy‐assisted lobectomies in small‐breed dogs and cats. Successful hilar lung lobectomies with LigaTie were recently reported in 3 dogs and 1 pig . The results of our study provide evidence sufficient to justify further evaluation of the device for complete lung lobectomies and thoracoscopy‐assisted surgery.…”

“…Successful hilar lung lobectomies with LigaTie were recently reported in 3 dogs and 1 pig. 20,21 The results of our study provide evidence sufficient to justify further evaluation of the device for complete lung lobectomies and thoracoscopy-assisted surgery.…”

“…The current version of LigaTie (made of poly[GA‐co‐TMC]) has been efficacious for ligation of ovarian pedicles, spermatic cords, renal arteries, pulmonary hilus, and cystic ducts . Ultrasonographic visualization of the device was no longer possible an average of 3.6 months after ligation of the spermatic cord in dogs, which is consistent with complete resorption during this period .…”

“…The current version of LigaTie (made of poly[GA-co-TMC]) has been efficacious for ligation of ovarian pedicles, spermatic cords, renal arteries, pulmonary hilus, and cystic ducts. [14][15][16][17][18][19][20][21] Ultrasonographic visualization of the device was no longer possible an average of 3.6 months after ligation of the spermatic cord in dogs, which is consistent with complete resorption during this period. 17 During biomechanical testing, the device could withstand a load of 23 N at a strain of 25% both before and 1 week after degradation; these results provide evidence to suggest that sufficient strength is maintained throughout the healing time of blood vessels.…”

“…13 A self-locking resorbable ligation device has recently been found efficacious for ligation of ovarian pedicles, spermatic cords, renal arteries, pulmonary hilus, and cystic ducts in animals. [14][15][16][17][18][19][20][21] This device design was based on that of a cable tie modified to create a relatively inert, resorbable device that can reliably achieve complete hemostasis in soft tissue surgery. The device has been confirmed as resorbable, and preliminary reports reported no evidence of short-or long-term tissue reactions.…”