Abstract
Background: Hand-sewn anastomosis is a crucial part of aortic reconstruction surgery and significantly affects its outcome. The present study presents a novel, bidirectional surgical needle aimed to improve aortic anastomosis in terms of speed and ease of use. Our objective was to assess the efficacy of the new design in comparison with the conventional needle. Methods: A series of simulations were conducted with COMSOL software in order to perform a fatigue comparative analysis between the new and the conventional needle design. Ease of penetration into a piece of polydimethylsiloxane was evaluated. Lastly, the prototype was tested under in-vitro conditions in comparison with the conventional needle. Results: Based on fatigue analysis, the new needle design improves durability, provided the two tips are equally used. The polytetrafluoroethylene coating improves penetration into the tissue by 7% to 17%, while electropolishing improves penetration up to 19%. When using the novel needle design, the average anastomotic task completion time was significantly reduced by 22% and the overall distance of hand movements was significantly reduced by 20%. Conclusions: The proposed design exhibited a shorter anastomotic time and seems promising in relation to ease of use and simplicity of the anastomotic technique it introduces.
Highlights
Aortic aneurysms, the second most common disease of the aorta after atherosclerosis [1], may affect any part of the vessel; abdominal aortic aneurysms are the most frequent, with a prevalence of 1.3% (United Kingdom) to 5% (United States) [2,3]
Despite the widespread use of the endovascular approach, open reconstruction of the diseased aortic segment remains an integral part of aortic aneurysm treatment, especially for patients anatomically unfit for endovascular repair [4] or younger ones with a long life expectancy and lower perioperative risk (4916 procedures in 2013, as documented in United States Medicare datasets [5])
Extended anastomotic time translates to extensive aortic cross-clamping time, which is defined as greater than 30 min for thoracoabdominal aneurysm repair [9] and greater than 50 min for abdominal aneurysms [10], can provoke severe hemodynamic changes in various organs [11], and is related to worse clinical outcomes [12,13]
Summary
The second most common disease of the aorta after atherosclerosis [1], may affect any part of the vessel; abdominal aortic aneurysms are the most frequent, with a prevalence of 1.3% (United Kingdom) to 5% (United States) [2,3]. Anastomosis, the surgical restoration of the continuity of the vessel, is a crucial part of the procedure and significantly affects its outcome. Hand-sewn anastomosis is a crucial part of aortic reconstruction surgery and significantly affects its outcome. The present study presents a novel, bidirectional surgical needle aimed to improve aortic anastomosis in terms of speed and ease of use. Our objective was to assess the efficacy of the new design in comparison with the conventional needle. Methods: A series of simulations were conducted with COMSOL software in order to perform a fatigue comparative analysis between the new and the conventional needle design. When using the novel needle design, the average anastomotic task completion time was significantly reduced by 22% and the overall distance of hand movements was significantly reduced by 20%. Conclusions: The proposed design exhibited a shorter anastomotic time and seems promising in relation to ease of use and simplicity of the anastomotic technique it introduces
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