Superwetting Injectable Hydrogel with Ultrastrong and Fast Tissue Adhesion for Minimally Invasive Hemostasis

Abstract

Injectable hydrogels have recently emerged as alternatives to sutures for various clinical indications. However, existing injectable hydrogels are unsuitable for hemostasis in minimally invasive surgery because of their weak interfacial adhesion and complex/prolonged processing. Herein, a superwetting injectable hydrogel composed of oppositely charged polysaccharides is developed. The spontaneous spreading of the injectable hydrogel on the surfaces achieves complete wetting and forms tight interfacial contact by absorbing the interfacial water. The superwetting ability and subsequent covalent crosslinking perform fast and ultrastrong wet adhesion (140 kPa) on the tissue surface. Ex vivo porcine and in vivo rat models show that the hydrogel successfully leads to the aggregation of erythrocytes for targeted hemostasis (in less than 12 s) without requiring external adjuncts, and no postsurgical adhesions to the peripheral tissues. This further demonstrates that hydrogel can act as an effective hemostasis agent in laparoscopic surgery in a rabbit model. Overall, the strong wet adhesion, antibacterial properties, and easy operability make this injectable hydrogel a promising candidate for hemostasis applications, as it can successfully combine clinical efficacy and transformation opportunities for minimally invasive surgery.

Bioinspired Multiphase Gels Using Spatial Confinement Strategy

“…In the intraoperative hemostasis area, gels are expected to replace traditional techniques such as ligation or compression to minimize the wound . To enhance tissue adhesion and achieve fast hemostasis, Wei et al developed an injectable gel which can spread on tissue surfaces rapidly . The reported hydrogel is composed of hyaluronic acid functionalized by an aldehyde group, and quaternary amine chitosan functionalized by catechol; both of them display favorable biocompatibility.…”

“…53 To enhance tissue adhesion and achieve fast hemostasis, Wei et al developed an injectable gel which can spread on tissue surfaces rapidly. 54 The reported hydrogel is composed of hyaluronic acid functionalized by an aldehyde group, and quaternary amine chitosan functionalized by catechol; both of them display favorable biocompatibility. Upon mixing the solutions with sodium chloride, the charge interactions between each component are weakened due to the shielding effect generated by the high concentration ions.…”

Short Peptide Nanofiber Biomaterials Ameliorate Local Hemostatic Capacity of Surgical Materials and Intraoperative Hemostatic Applications in Clinics

“…Due to the potential adverse factors in cytotoxicity, immunogenicity, and molecular designability, they cannot provide enough safe hemostatic alternatives for intracorporal use in NCTH in truncal areas and IMB in visceral organs, such as filling complex‐shaped voids, full coverage of large bleeding mucosal surface, and flexible integration with MIS. [ 4b,7 ] So far, although technologically new formulations have enabled the rapid acceleration in hemostatic technique and medical device, such as smart tissue adhesive, [ 31 ] minimally invasive sealing patch, [ 277 ] and injectable ultrastrong bioadhesive, [ 278 ] the research of hemostatic material in surgery has largely lagged behind other medical advances making few clinical translations. In the last 20 years, RADA16 peptide‐related nano‐hemostat is a very appealing option for surgeons to explore optimal hemostatic techniques [ 51 ] and result in intracorporal robust hemostatic efficacy in a wide scope of surgical procedures.…”

Robust aortic media adhesion using hydrophobically modified Alaska pollock gelatin‐based adhesive for aortic dissections

“…[5][6][7] Consequently, other types of adhesives such as cyanoacrylate, 8 fibrin 9 and poly(ethylene glycol) 10 have been used in surgical operations. Several other approaches have been developed to adhere soft tissues using adhesive hydrogels based on bio-inspired polymers, [11][12][13][14][15] genetically engineered polypeptides, 16 polysaccharides, [17][18][19][20] and (meth)acrylate polymers 21,22 ; however, their applications in cardiovascular surgery, especially for type-A aortic dissection, are limited by their poor mechanical properties, adhesion strength, and biocompatibility.…”