Abstract
Conventional anastomoses with interrupted sutures are challenging and inevitably associated with trauma to the vessel walls. The goal of this study was to evaluate a novel alternative adhesive-based suture-free anastomosis technique that uses an intraluminal stent. Overall, 120 porcine coronary vessels were analyzed in an ex vivo model and were examined for their mechanical (n = 20 per cohort) and hydrostatic strength (n = 20 per cohort). Anastomoses were made using the novel VIVO adhesive with an additional intraluminal nitinol stent and was compared to interrupted suture anastomosis and to native vessels. Sutureless anastomoses withstood pressures 299 ± 4.47 [mmHg] comparable to native vessels. They were performed significantly faster 553.8 ± 82.44 [sec] (p ≤ 0.001) and withstood significantly higher pressures (p ≤ 0.001) than sutured anastomoses. We demonstrate that the adhesive-based anastomosis can also resist unphysiologically high longitudinal tensile forces with a mean of 1.33 [N]. Within the limitations of an in vitro study adhesive-based suture-free anastomosis technique has the biomechanical potential to offer a seamless alternative to sutured anastomosis because of its stability, and faster handling. In vivo animal studies are needed to validate outcomes and confirm safety.
Highlights
Sutured anastomoses have been the gold standard in microsurgical interventions, they require lengthy operating times and high surgical skills
Compared to other non-sutured microvascular anastomosis techniques, such as coupling devices, the use of fibrin glue in combination with sutures for anastomosis with a leakage rate of 6.3% is inferior to these m ethods[7]
The failure of an anastomosis at 20 ml/min occurred within the VIVO group in two anastomoses at high pressures
Summary
Sutured anastomoses have been the gold standard in microsurgical interventions, they require lengthy operating times and high surgical skills. Compared to other non-sutured microvascular anastomosis techniques, such as coupling devices, the use of fibrin glue in combination with sutures for anastomosis with a leakage rate of 6.3% is inferior to these m ethods[7]. Intermolecular forces such as hydrogen bonds, electrostatic interactions, and van der Waals interactions are beneficial for adherence in dry tissues[8,9]. VIVO has shown significant hemostatic results in mass bleeding porcine liver resection models[18] and long-term rabbit mass bleeding liver resection m odels[19] Both investigations were conducted in liver tissue that was bleeding heavily and moist. Experimental analysis of the mechanical force by traction tests[21] as well as the burst pressure tests[2] are established in vitro methods for the evaluation of new anastomosis procedures
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