943 A NEW DISSOLVABLE MECHANICAL KNOT MAKING NATURAL ORIFICE TRANSLUMENAL ENDOSCOPIC SURGERY A REALITY IN THE URINARY SYSTEM

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy1 Apr 2011943 A NEW DISSOLVABLE MECHANICAL KNOT MAKING NATURAL ORIFICE TRANSLUMENAL ENDOSCOPIC SURGERY A REALITY IN THE URINARY SYSTEM Jude Sauer, Heather Leigh, Idris Ocal, Erik Castle, Paul Andrews, and Mitchell Humphreys Jude SauerJude Sauer Victor, NY More articles by this author , Heather LeighHeather Leigh Victor, NY More articles by this author , Idris OcalIdris Ocal Phoenix, AZ More articles by this author , Erik CastleErik Castle Phoenix, AZ More articles by this author , Paul AndrewsPaul Andrews Phoenix, AZ More articles by this author , and Mitchell HumphreysMitchell Humphreys Phoenix, AZ More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.861AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The next frontier of minimally invasive surgery is natural orifice translumenal endoscopic surgery (NOTES). NOTES techniques involving the urinary system are uniquely limited as any permanent materials will serve as a nidus for encrustation, stone, or even fistula formation. The purpose of this research is to characterize a novel alloy that allows sutures to be mechanically tied while slowly dissolving in the urinary system though a NOTES platform. METHODS Three mature female survival pigs were used and sacrificed at 1, 2, and 3 weeks. The TK–5 (LSI SOLUTIONS Inc, Victor NY) device was used to place either titanium (Ti) or magnesium (Mg) knots on several different tissues though an open incision. Twenty two control Ti and 41 Mg knots were placed on the peritoneal surface of the stomach, left fallopian tube, bladder, inside the bladder, and used to close a cystotomy. The animals were observed for urine leak, stone formation, or complication and at sacrifice tissue was harvested for histopathological examination. RESULTS All animals survived with no adverse events or infections. All cystotomies were hermetic with no urine leaks. The tissue was collected showing similar phases of healing in response to both the Mg and Ti knots. Figures below indicate the Mg (embeded in tissue) vs the Ti knot with scanning electron microscopy. The magnesium knots began to dissolve by the first week, but maintained there holding strength and configuration through the third week. No encrustation of stones formed on any of the knots. CONCLUSIONS The use and safety of titanium has been widely exploited in the peritoneal space for many years, but when used in the urinary system stone formation results. The development of novel magnesium knots allows utilization in the urinary system without the risk of stone formation while providing equivalent holding strength and tissue healing. While more study is needed, this opens the urinary portal to NOTES applications through a reliable and safe method of closure. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e378-e379 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jude Sauer Victor, NY More articles by this author Heather Leigh Victor, NY More articles by this author Idris Ocal Phoenix, AZ More articles by this author Erik Castle Phoenix, AZ More articles by this author Paul Andrews Phoenix, AZ More articles by this author Mitchell Humphreys Phoenix, AZ More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...