Suture‐Free Technique for Canine Ureteral Resection‐Anastomosis Using a Microvascular Anastomotic System: A Cadaveric Study

Abstract

This study demonstrated the feasibility of a suture-free technique of canine ureteral resection-anastomosis using a commercially available MAS. The MAS anastomosis was faster and had higher burst strength compared with the HS anastomosis.

Suture‐Free Ureterovesical Anastomosis Using a Microvascular Anastomosis System: Canine Cadaveric Study

“…The GEM microvascular anastomotic devices (2 mm internal diameter) were applied to the ureter as described by Wavreille et al Each cut ureter end was passed through 1 ring, which was mounted in the anastomotic device. For mounting, placement was made in a triangular fashion.…”

“…Some surgeons have adopted a modified Lich‐Gregoir technique, which allows an extravesical anastomosis that is covered by closure of the mucosal anastomosis in a seromuscular tunnel . The successful use of a commercially available microanastomotic system (MAS) for ureteral anastomosis in the dog using an ex vivo model was recently reported . This device, known as the GEM Microvascular Anastomotic COUPLER™ (GEM, Birmingham, AL), has been used in people for microvascular anastomosis and is recommended for vessels having an outside diameter >0.8 and <4.3 mm, and a wall thickness of ≤0.5 mm .…”

“…The 2 rings are then compressed and interlocked using a microanastomotic device. This previous study showed the device was adaptable for use in canine ureters and that the MAS technique had advantages of reduced surgical time, avoidance of intraluminal foreign material, and resistance to bursting pressures comparable to sutured anastomoses . However, it was found that the technique for ureteral impalement needed to be modified to include only the mucosa/submucosa as impalement of the entire ureteral wall led to incomplete closure of the MAS.…”

“…17,18 The successful use of a commercially available microanastomotic system (MAS) for ureteral anastomosis in the dog using an ex vivo model was recently reported. 20 This device, known as the GEM Microvascular Anastomotic COUPLER TM (GEM, Birmingham, AL), has been used in people for microvascular anastomosis and is recommended for vessels having an outside diameter >0.8 and <4.3 mm, and a wall thickness of 0.5 mm. [21][22][23][24][25][26] The GEM system utilizes surgical grade steel pins that allow each end of a vessel to be everted and impaled on a microanastomotic ring composed of polypropylene.…”