Smart sealants for prevention and monitoring of gastrointestinal anastomotic leaks using portable smartphone-controlled ultrasound transducers

Abstract

Millions of patients every year undergo gastrointestinal surgery. While often lifesaving, sutured and stapled reconnections leak in around 10% of the cases. Penetration of digestive fluids into the peritoneal cavity may lead to dreadful complications, including sepsis and premature death. Modern suture supports and tissue adhesives only insufficiently address the issue. Due to the scarcity of alternatives, surgeons rely on monitoring surrogate markers and clinical symptoms, which oftentimes lack sensitivity and specificity, hence only offering late-stage detection of already fully developed leaks. Here, a first-of-its-kind, modular, intelligent suture support patch capable of sealing and monitoring leaks under harsh gastrointestinal conditions is presented. The smart adhesive layered hydrogel patch provides, in addition to unprecedented tissue sealing under most demanding conditions, unique leak-detection capabilities based on pH and/or enzyme-responsive sensing elements, which can be read out by non-invasive point-of-need ultrasound imaging. Reliable detection of the breaching of sutures in as little as 3 hours in intestinal leak and 15 minutes in gastric leak conditions, and before an actual leak develops, is demonstrated. This technology paves the way for next-generation suture support materials that offer disambiguation in cases of anastomotic leaks based on point-of-need monitoring, without reliance on complex electronics or bulky (bio)electronic implantables.

Nanothermometry-enabled intelligent laser tissue soldering

“…(5) The invasiveness of sutures and staples resulting in foreign body reaction with local inflammation has increased the need to develop adequate alternatives, either as replacements or as suture support materials. Surgical adhesives and glues seem appealing choices (3,6,7) but also present challenges, including low adhesion (e.g., fibrin-based glues and poly(ethylene glycol), or PEGs), toxicity (e.g., cyanoacrylates (8)), low chemical stability (fibrin glues are prone to digestion in gastrointestinal fluids (6,9)), foreign body reactions, and immunogenicity. (10) Laser welding and soldering were proposed decades ago as potential wound-closing methods.…”