Use of a Novel Penetrating, Sutureless Anastomotic Device in Arterial Microvascular Anastomoses

Abstract

The advent of microsurgery and microvascular anastomosis has helped to alter the treatment of many traumatic defects as well as revolutionize the reconstructive options after extirpative surgery. These procedures, however, continue to be technically demanding and intensive. In addition, increased ischemia and operative times are known to raise complications in microsurgery, particularly in older patients. The nitinol U-clip (Medtronic, Inc., Minneapolis, MN) is a new penetrating clip applied in an interrupted fashion that eliminates knot tying and decreases operative time. This technology holds the potential for rapid, reproducible sutureless microvascular anastomoses. In addition, the surgical technique is very similar to conventional suture microanastomosis, lending itself to comparatively decreased learning curves and suitability for training programs. We present three consecutive cases of successful microsurgical anastomoses using this technology.

Modern adjuncts and technologies in microsurgery: An historical and evidence‐based review

“…There has been some limited reporting of this clipping system in coronary artery bypass surgery but very little in reconstructive microsurgery. A case report,53 and a series of three cases have reported generally rapid anastomoses with a reduced learning curve over other mechanical anastomotic aides 54…”

Rapid prototyped sutureless anastomosis device from self‐curing silk bio‐ink

“…As an alternative to sutures, nitinol and titanium clips which are crimped in an interrupted pattern to anchor vessel ends have been developed . The average reported time to complete anastomosis for both ends of a vascular graft ranges from 14 to 18 min . Alternatives to anastomosis clips, such as stapling cartridges and ring pin staples, use a minimal number of components to complete anastomosis with a single crimping motion but require an intricate loading process which extend the average procedure from 14 to 30 min …”

“…6,31 The average reported time to complete anastomosis for both ends of a vascular graft ranges from 14 to 18 min. 6,[31][32][33] Alternatives to anastomosis clips, such as stapling cartridges and ring pin staples, use a minimal number of components to complete anastomosis with a single crimping motion but require an intricate loading process which extend the average procedure from 14 to 30 min. 7,30,34 In contrast, the average length to perform a doublesided anastomosis using the silk devices designed here was approximately 1 min.…”

Technology‐assisted and sutureless microvascular anastomoses: Evidence for current techniques

“…It has, however, been compared favorably to other mechanical anastomotic aides in a small series. 51 The results regarding the VCS clip applicator are summarized in Table 2.…”