Sutureless Group Research Articles

A comparative study of the effect of suture-less and multiple suture techniques on inflammatory complications following third molar surgery

The aim of this prospective randomized study was to evaluate the effect of not using sutures on postoperative pain, swelling and trismus after lower third molar surgery. 80 patients with impacted lower third molars were referred for surgical extraction (42 males; 38 females; aged 18–38years). The patients were randomly divided into two equal groups (sutures n=40; suture-less n=40). In the experimental group, the flaps were replaced without suturing. The control group was selected using the same criteria and treated under the same surgical protocol as the experimental group, except that the flaps were apposed using multiple sutures. Pain, swelling and trismus were evaluated at 24h, 48h and 1week postoperatively in both groups. The operation time was found to be significantly longer in the multiple sutures group (p<0.05). There was significantly less pain, swelling and trismus at 24h and 48h, respectively, in the suture-less group (p<0.05). There was no significant difference between the two treatment groups in terms of pain, swelling and trismus, at 1week postoperatively (p>0.05). There is less postoperative pain, swelling and trismus with the suture-less technique in third molar surgery.

A Modified Symblepharon Ring for Sutureless Amniotic Membrane Patch to Treat Acute Ocular Surface Burns

The objective of this study is to evaluate a sutureless technique by using a modified symblepharon ring to fix an amniotic membrane (AM) patch on the ocular surface to treat acute ocular burns. Seventy-five patients with acute ocular burns of total 75 eyes graded III to VI were enrolled in this study. They were randomly divided into two groups. Thirty-nine eyes received the sutureless AM patch with a modified symblepharon ring, and the other 36 eyes underwent the conventional sutured AM patch as control. The time and the rate of epithelialization, corneal neovascularization, and complications were recorded. Both the operation time and the time to epithelial closure in the sutureless group were much shorter than that in the suture group (P < .01). The rate of reepithelialization in the sutureless group was higher than in the suture group (P < .05). The rate of the vascularization and symblepharon were lower in the sutureless group than in the suture group (P < .05). The conjunctival sac contraction occurred only in the eyes with grade V and VI in the sutureless group and was later than in the suture group (P < .05). This modified method is simple, minimally invasive, free from trauma, and more effective compared with controls.

Sutureless jejuno-jejunal anastomosis in gastric cancer patients: a comparison with handsewn procedure in a single institute

BackgroundThe biofragmentable anastomotic ring has been used to this day for various types of anastomosis in the gastrointestinal tract, but it has not yet achieved widespread acceptance among surgeons. The purpose of this retrospective study is to compare surgical outcomes of sutureless with suture method of Roux-and-Y jejunojejunostomy in patients with gastric cancer.MethodsTwo groups of patients were obtained based on anastomosis technique (sutureless group versus hand sewn group): perioperative outcomes were recorded for every patient.ResultsThe mean time spent to complete a sutureless anastomosis was 11±4 min, whereas the time spent to perform hand sewn anastomosis was 23±7 min. Estimated intraoperative blood loss was 178±32ml in the sutureless group and 182±23ml in the suture-method group with no significant differences. No complications were registered related to enteroanastomosis. Intraoperative mortality was none for both groups.ConclusionsThe Biofragmentable Anastomotic Ring offers a safe and time-saving method for the jejuno-jejunal anastomosis in gastric cancer surgery, and for this purpose the ring has been approved as a standard method in our clinic. Nevertheless currently there are few studies on upper gastrointestinal sutureless anastomoses and this could be the reason for the low uptake of this device.

Tailored sutureless meatoplasty: A new technique for correcting meatal stenosis

ObjectiveStandard practice for meatoplasty includes the use of sutures to evert the mucosa. We present a novel technique that is equivalent to standard meatoplasty without the need for suturing. Materials and methodsA retrospective chart review was performed of patients who presented with primary meatal stenosis in 2007–2009. One group underwent a tailored, sutureless meatoplasty performed by one surgeon. The second group underwent a standard meatoplasty with mucosal advancement and suturing of the mucosal edges by another surgeon. Data were collected regarding demographics, presenting symptoms, symptom resolution, and postoperative complications. These were then compared between the two groups. Preoperative and postoperative uroflowmetry data were collected for the sutureless group to demonstrate objective improvement. ResultsOf 85 patients, aged 2–17 years, 60 underwent the tailored, sutureless procedure while 25 had a standard meatoplasty. The majority of patients presented with a deviated and/or narrowed stream of urine. There was no statistical difference between the two groups in regard to symptom resolution. Uroflowmetry data analyzed for 20 patients in the sutureless group demonstrated a significant improvement in Qmax and flow pattern; there was no significant change in % post-void residual. No patient had a complication in either group, or presented with recurrence. ConclusionsTailored sutureless meatoplasty is comparable to meatoplasty with mucosal advancement in resolving symptoms, improving uroflowmetry parameters, and complication rate, but is more efficient and cost effective.

Sutureless total thyroidectomy: a safe and cost‐effective alternative

Advanced vessel sealing devices provide an alternative to conventional ligation techniques for thyroidectomy. To date, most studies have been inadequately powered to explore differences in the infrequent post-operative complications following thyroidectomy. This study is designed to compare the outcomes of sutureless thyroidectomy and conventional thyroidectomy for recurrent laryngeal nerve (RLN) injury, permanent hypoparathyroidism, and haematoma formation. A cohort study of consecutive patients undergoing total thyroidectomy using conventional versus sutureless techniques was performed. Sutureless thyroidectomy was performed using either Ligasure Precise (Covidien) or Harmonic Focus (Johnson and Johnson) devices. The primary outcome measures were post-operative haemorrhage, permanent RLN injury and hypoparathyroidism. Secondary outcome measures were operative time, temporary hypoparathyroidism and vocal cord dysfunction. A cost minimization analysis comparing the two techniques was performed. From January 2006 to July 2009, 1935 consecutive patients underwent total thyroidectomy. Of these, 772 underwent conventional thyroidectomy and 1163 were performed using a sutureless technique. The mean operative time was significantly lower in the sutureless group (71 versus 86 min, P = 0.02). There was no difference in the post-operative complications of haematoma (0.78% conventional versus 1.12% sutureless, P = 0.46), permanent hypoparathyroidism (1.30% conventional versus 0.52% sutureless, P = 0.06) or permanent RLN injury (0.26% conventional versus 0.52% sutureless, P = 0.39). There was an overall cost saving of AUD$14,300 per 100 total thyroidectomy cases performed using the sutureless technique. Sutureless thyroidectomy is a safe and efficient way of performing total thyroidectomy and has the potential to reduce operating room costs.

Primary Sutureless Repair for Infants With Mixed Total Anomalous Pulmonary Venous Drainage

Mixed type total anomalous pulmonary venous drainage (TAPVD) poses technical challenges and high mortality owing to diminutive size and remote location of the pulmonary vein (PV) confluences. We hypothesized that primary application of sutureless repair may better incorporate small and remote confluences, thereby minimizing PV stenosis and improving outcomes. Twenty-two consecutive infants (1985 to 2009; median age 27 days; body weight 3.7 kg) with mixed type TAPVD were retrospectively reviewed. Survival and reintervention were compared between the sutureless group (n = 8) and the conventional group (n = 14). Predictors for death and reintervention were identified by an univariate analysis using a chi(2) test. No differences were noted on preoperative and intraoperative variables between the groups. There were 5 early deaths in the conventional group and no deaths in the sutureless group (p = 0.05). There were trends toward improved survival (100% versus 57% at 1 year, p = 0.07) and freedom from reintervention (100% versus 67% at 1 year, p = 0.09) in the sutureless group. The univariate analysis showed that preoperative PV obstruction (p = 0.05), conventional repair (p = 0.05), palliative surgery (p = 0.001), and residual PV obstruction (p = 0.002) were the risk factors for death. Preoperative PV obstruction, palliative surgery, and residual PV obstruction were the predictors for reintervention (p < 0.05 for all). The primary sutureless repair for the patients with mixed type TAPVD appeared to be safe and effective, resulting in no mortality and reintervention. There were nonsignificant trends toward improving survival and reintervention in the sutureless group. The patients who had sutureless repair and partially unrepaired PV revealed reasonable early and medium-term physiologic tolerance without need for reinterventions.

Sutureless technique to support anastomosis during thoracic aorta replacement

BackgroundIn aortic replacement procedures the aortic wall and Teflon strips form a double layer, with the use of continuous sutures. Surgical glues may or may not be used to enhance the durability of the anastomoses. In this technical report a modification of the aortic stumps preparation is devised.The technique reduces substantially the preparation time of the aortic stumps by the use of ligation clips and a surgical sealant.TechniqueSuturing is the standard method for the aortic-teflon double-layer formation prior to Dacron anastomosis. In this study, instead of suturing, 5-6 ligation clips are primarily applied on the exterior of the double layer to facilitate proper cooptation. Secondarily, in order to fuse the two layers together, a sealant is injected in between the Teflon and aortic wall. Thus each stump is delivered quickly sutureless for the Dacron anastomosis.Between January 2003 and March 2009 this modified operative technique was performed in 14 cases (group A) with a mean age of 50 ± 16 years. This was contrasted against 24 controls (group B), with a mean age of 40 ± 28 years, treated with the conventional method, where only continuous sutures were used during the anastomosis. All patients were cases of ascending aorta replacement and/or aortic hemi-arch replacement, for acute aortic dissection or aortic dilatation.ResultsThe pure anastomosis time (stump preparation and Dacron connection) was shortened by approximately 25 minutes depending on surgeon's experience. The anastomosis blood-loss was also significantly reduced in the sutureless group A, as evident by the dry operative field and the limited use of blood products, post-prosthetic graft anastomosis. This reflected to a faster post-operative recovery, faster extubation and fewer complications. At a mean follow-up of 21 ± 7 days, there were no post-operative deaths being related to acute aortic dissection or rupture of the anastomotic site.ConclusionAortic replacement with the combination of ligation clips and a surgical sealant vs. sutures alone allows easy manipulations of the aorta and adaptation of the diameters, thus optimizing aortic operational timings and hemostasis. Moreover, it prevents blood loss and aortic wall trauma from multiple sutures.

Novel Sutureless Keratoplasty with a Chemically Defined Bioadhesive

The purpose of this study was to evaluate sutureless keratoplasty using a chemically-defined bioadhesive (CDB) made from food or medical additives. Sutureless automated lamellar therapeutic keratoplasty (ALTK) using a CDB was performed on three rabbit eyes. Allogenic lamellar graft was transplanted onto the recipient bed using either suture fixation or a sutureless technique using the CDB. Slit-lamp examination was performed at selected intervals to evaluate the grade of epithelialization and the corneal clarity. The rabbits were killed at 90 days after operation and the eyes processed for histology, electron microscopic examination, and immunohistochemistry for cytokeratins and cell junction-related proteins. Sutureless keratoplasty was successfully performed with appropriate handling time before the CDB gelatinized. All the glued grafts were rapidly epithelialized within 7 days, and thereafter remained clear and attached for 90 days. Histologic and ultrastructural findings on the sutureless group showed the normal feature of stromal and epithelial cells and the grafts to be closely adhered with no inflammatory or scarring changes on the interface. Immunohistochemistry of the epithelial cells on the sutureless group revealed a similar expression pattern to the control group. These results demonstrate that sutureless keratoplasty using the CDB is easy to perform, with reliable attachment and no fear of toxic effects or disease transmissions. The authors expect the CDB to become a major choice for corneal treatment, especially in lamellar keratoplasty, posterior keratoplasty, and amniotic membrane transplantation on corneas.

Sutureless Fixation of Amniotic Membrane Patch as a Therapeutic Contact Lens by Using a Polymethyl Methacrylate Ring and Fibrin Sealant in a Rabbit Model

To introduce and evaluate a sutureless technique by using a polymethyl methacrylate (PMMA) ring and fibrin sealant to fix an amniotic membrane (AM) patch on the ocular surface as a therapeutic contact lens in a rabbit model. PMMA rings were fabricated by duplicating an impression of a rabbit conjunctival fornix. The central cornea of the left eye in 16 rabbits was deepithelialized (diameter = 10 mm). A human AM patch was fixed to the ocular surface by using either a PMMA ring and fibrin sealant or interrupted 10-0 nylon sutures. The fibrin sealant was used to create the PMMA ring-AM complex but not to attach the AM/PMMA ring to the ocular surface. The rabbits were followed up with slit-lamp examination and fluorescein staining for 7 days. Reepithelialization and complications were recorded. The corneal epithelial defect was recovered in each rabbit of both groups after 5 days. In the sutureless group, all membranes remained in place and intact during the follow-up period. One eye was noted to have a partial conjunctival epithelial defect caused by exposure to the PMMA ring. In contrast, >50% of rabbits in the interrupted suture group exhibited complications including conjunctival edema, suture loosening, patch detachment, bleeding, and conjunctival epithelial defects. The sutureless technique that uses a PMMA ring and fibrin sealant for AM patch placement has a lower incidence of complications than the interrupted suture method. This sutureless technique may promote increased clinical use of AM patch by alleviating patients' pain and shortening surgical time.

Progress in cardiovascular anastomoses: will the vascular join replace Carrel's technique?

Vascular reconstructions are becoming challenging due to the comorbidity of the aging population and since the introduction of minimally invasive approaches. Many sutureless anastomosis devices have been designed to facilitate the cardiovascular surgeon's work and the vascular join (VJ) is one of these. We designed an animal study to assess its reliability and long-term efficacy. VJ allows the construction of end-to-end and end-to-side anastomoses. It consists of two metallic crowns fixed to the extremity of the two conduits so that vessel edges are joined layer by layer. There is no foreign material exposed to blood. In adult sheep both carotid arteries were prepared and severed. End-to-end anastomoses were performed using the VJ device on one side and the classical running suture technique on the other side. Animals were followed-up with Duplex-scan every 3 months and sacrificed after 12 months. Histopathological analysis was carried out. In 20 animals all 22 sutureless anastomoses were successfully completed in less than 2 min versus 6 +/- 3 min for running suture. Duplex showed the occlusion of three controls and one sutureless anastomosis. Two controls and one sutureless had stenosis >50%. Histology showed very thin layer of myointimal hyperplasia (50 +/- 10 microm) in the sutureless group versus 300 +/- 27 microm in the control. No significant inflammatory reaction was detected. VJ provides edge-to-edge vascular repair that can be considered the most physiological way to restore vessel continuity. For the first time, in healthy sheep, an anastomotic device provided better results than suture technique.

Ultrasound biomicroscopy of conventional and sutureless pars plana sclerotomies: a comparative and longitudinal study

PURPOSE: To report the rate of ultrasonically visible vitreous incarceration and longitudinal changes of incarcerated vitreous in pars plana sclerotomies after conventional suturing or sutureless technique using ultrasound biomicroscopy. METHODS: Twenty-five consecutive eyes (25 patients) undergoing primary three-port pars plana vitrectomy participated. The first 16 pars plana vitrectomies were performed with standard conventional sutured sclerotomies, and the following nine pars plana vitrectomies were performed with modified sutureless sclerotomies. Patient demographics, diagnoses, procedures, and complications were recorded. Each patient had ultrasound biomicroscopy performed 1 week before surgery, and also after surgery at 1 week, 2 weeks, 3 weeks, 4 weeks, 2 months, 3 months, and 6 months. Visible vitreous incarceration was graded as 0 to 3. RESULTS: Vitreous incarceration was seen in 41 of 48 sclerotomies (85.4%) in the conventionally sutured group, and in 23 of 27 sclerotomies (85.2%) in the sutureless group, with no significant difference in severity among sclerotomies within each group and between the two groups. There was a significant difference in the rate of vitreous incarceration between diabetic patients with proliferative retinopathy and others ( P = .002). No progressive change of visible vitreous incarceration was noted in any eye during the 6-month postoperative period. No sclerotomy-related complications occurred during the study period. CONCLUSIONS: Ultrasound biomicroscopy showed no difference in the amount of visible vitreous incarceration in conventionally sutured or sutureless sclerotomies. There was no visible longitudinal change in the incarcerated vitreous during the 6 months of follow-up in uncomplicated cases.

Two year follow-up of astigmatism after phacoemulsification with adjusted and unadjusted sutured versus sutureless 5.2 mm superior scleral incisions

Purpose: To evaluate changes in astigmatism 6 months to 2 years after 5.2 mm superior scleral incision phacoemulsification using 3 closures.Setting: Department of Ophthalmology, Vejle Hospital, Vejle, Denmark.Methods: This long-term follow-up study included 75 consecutive phacoemulsification patients who were randomly allocated to 1 of 3 incision closures: 1 intraoperatively adjusted cross suture, 1 unadjusted cross suture, no suture. Postoperative astigmatism after 1 and 2 years was evaluated by keratometric cylinder, induced astigmatism (Naeser's polar values), induced cylinder (Jaffe's vector analysis), and vector decomposition (Olsen). The data were compared with 1 week values.Results: In the previous study, median astigmatism after 6 months was similar in all 3 groups, but only the sutureless group showed early stability. Significant againstthe-rule (ATR) changes were seen in the sutured cases (P < .01). The 1 and 2 year follow-up showed continued stability in the sutureless cases. The adjusted-suture group exhibited stability after 6 months, while the unadjusted-suture group showed a further tendency to change ATR. At 2 years, median ranges of astigmatism were -0.49 to -0.90 diopter (D) (Naeser), 0.77 to 1.02 D (Jaffe), and 96% to 98% ATR (Olsen). The intergroup differences were not statistically significant.Conclusion: Two year follow-up confirmed that sutureless closure led to early astigmatism stability. Using a suture prolonged the postoperative period of astigmatism instability, and if used without intraoperative adjustment, a tendency toward a less predictable outcome persisted after 2 years.

Prospective, randomized vector analysis of astigmatism after three-, one-, and no-suture phacoemulsification

Purpose: To compare surgically induced astigmatism and visual outcomes after three-, one-, and no-suture phacoemulsification.Setting: Johns Hopkins Hospital, Baltimore, Maryland, and Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA.Methods: This prospective, randomized study followed 131 patients treated with phacoemulsification with a 5.5 mm self-sealing scleral tunnel and implantation of a 5.5 mm poly(methyl methacrylate) posterior chamber lens. Radial 10-0 nylon sutures were used in the three- and one-suture groups.Results: Mean astigmatism was greatest in the first postoperative week in all groups and stabilized after 8 weeks. The percentage of patients with with-the-rule (WTR) astigmatism increased from baseline in the one- and three-suture groups and decreased in the sutureless group. Mean uncorrected Snellen acuity was significantly better in the no- and one-suture groups than in the three-suture group at 1 week. There were no significant differences in uncorrected acuity at other times. No statistically significant differences in the surgically induced spherical equivalent were noted among the three groups during the 1 year follow-up. There was significantly less surgically induced keratometric astigmatism in the one-suture group at 4 (P = .03) and 8 (P = .007) weeks postoperatively. At all follow-ups, the sutureless group had the greatest proportion of patients with significant ATR astigmatic shift (1 week, 17%; 4 weeks, 32%), and the lowest proportion of patients with significant WTR astigmatic shift (10% after 1 week). At 4 weeks, the percentage of patients with significant WTR shift in the one-suture group dropped to that in the sutureless group (10%); however, those in the one-suture group had less ATR astigmatic shift (16%).Conclusion: Sutureless and one-suture surgery resulted in a low percentage of WTR induced astigmatism 4 weeks postoperatively. Compared with sutureless surgery, the one-suture surgery resulted in less ATR shift.

Astigmatism after phacoemulsification with adjusted and unadjusted sutured versus sutureless 5.2 mm superior scleral incisions

Purpose: To evaluate changes in astigmatism in the first 6 months after 5.2 mm superior scleral incision phacoemulsification using three different closures.Setting: Department of Ophthalmology, Vejle Hospital, Denmark.Methods: This study comprised 75 consecutive patients who had 5.2 mm superior scleral incision phacoemulsification. Patients were randomly assigned to one of three groups based on type of incision closure: Group 1, one intraoperatively adjusted cross suture; Group 2, one unadjusted cross suture; Group 3, no suture. Inclusion criteria were preoperative astigmatism of 2.00 diopters (D) or less (range of median 0.74 to 0.81 D) and no eye disease except cataract. Postoperative astigmatism was evaluated by keratometric cylinder, induced astigmatism (Naeser), and induced cylinder (Jaffe) on the first day and after 1 week and 1, 3, and 6 months. Time before stability was estimated.Results: All groups had the same level of postoperative keratometric cylinder with no significant change between 1 week and 6 months (range of median 0.81 to 1.06 D). The groups reached the same level of induced astigmatism (Naeser) 3 to 6 months after surgery (range of median −0.44 to −0.64 D). Group 3 (sutureless) reached that value after 1 week, and induced astigmatism was stable thereafter. Both sutured groups (Groups 1 and 2) had a highly significant change between the first week and third month (P < .01). There were no significant intergroup differences in induced cylinder (Jaffe), which stabilized after 1 week in Groups 1 and 2 and after 1 month in Group 3 (range of median 0.61 to 0.87 D). During the early postoperative period, variation was highest in Group 2.Conclusions: Keratometric cylinder, induced astigmatism, and induced cylinder 3 to 6 months postoperatively were similar among the three groups, but early stability was only seen in the sutureless group. If a suture is used, intraoperative adjustment seems to result in lower variations in the early postoperative period.

Astigmatic and Refractive Stabilization After Cataract Surgery

We assessed the timing of astigmatic and refractive stabilization following six cataract surgery procedures with intraocular lens implantation in 229 eyes divided into six groups in the following incision sizes and methods of wound closure: 11-mm incision with running suture closure (26 eyes) 6.5-mm incision with running suture closure (29 eyes) 6.5-mm incision with single horizontal suture closure (25 eyes) 6.5-mm incision without suture closure (46 eyes) 5.5-mm incision without suture closure (51 eyes) 3.2-mm incision without suture closure (52 eyes) Analyzed up to 6 months postoperatively were: the mean and standard deviation of axis-based keratometric cylinders the absolute value of the induced-cylinder vector the spherical equivalent of the refractive power. In the 11- and 6.5-mm incision running suture groups, these parameters did not stabilize during the study period. In the 6.5-mm incision horizontal suture and sutureless groups, the values stabilized at 3 months postoperatively; in the 5.5-mm incision group, at 1 month; and in the 3.2-mm incision group, at 2 weeks. These results indicate that the appropriate point at which to prescribe postoperative correction spectacles differs significantly depending on the procedure, and that smaller incisions with wound-closure methods that do not exert vertical force are associated with fewer postoperative refractive changes.

Experimental carcinogenesis at sutured and sutureless colonic anastomoses.

This study explores the role of sutures and the healing colonic wound in experimental carcinogenesis. One hundred sixty rats underwent surgery with colotomy and repair using silk, steel, or Vicryl (Ethicon, Somerville, NJ) sutures or a sutureless technique. Forty rats had a sham procedure. All animals received azoxymethane for 12 weeks at a dose of 10 mg/kg/week. Half the rats commenced carcinogen before surgery, and half commenced it eight weeks after surgery. Animals with anastomotic tumors were found in 46 percent of the sham group (P less than 0.05 cf. sutured), 41 percent of the sutureless group (P less than 0.02 cf. sutured), and 68 percent of the sutured group. The corresponding figures for anastomotic carcinoma were 9 percent (P less than 0.001 cf. sutured), 22 percent, and 38 percent. No significant differences in tumor yield were noted among the different sutures. However, several differences were noted between the two carcinogen models. In those animals that received surgery first, there was a higher incidence of anastomotic tumors (P less than 0.002) and cancers (P less than 0.0001) in the sutured and sutureless groups, and those tumors that occurred in the sutured group were considerably larger than in those that had carcinogen first (15.9 mm cf. 4.9 mm; P less than 0.0001). Overall, all sutures seem to enhance anastomotic tumor formation, and we would suggest that a sutureless anastomosis may diminish this risk.

Sutureless anastomosis of blood vessels using cyanoacrylate adhesives.

On the assumption that the remaining suture threads of the anastomotic line play an important role in the progression of anastomotic neointimal hyperplasia, we performed an experimental study on the sutureless anastomosis of blood vessels. An expanded polytetrafluoroethylene graft, 5 mm in diameter and 2 cm in length, was implanted on the abdominal aorta of mongrel adult using one of three methods of anastomosis, namely; a continuous suture, a stay suture, or sutureless anastomosis. Overall patency rates were 83.3 per cent, 91.7 per cent and 75.0 per cent respectively. The thickness of the pannus in the distal anastomotic line after 12 months was 107 microns in one graft in the continuous suture group, 106 microns and 222 microns in 2 grafts each in the stay suture group, and 41 microns and 117 microns in 2 grafts each in the sutureless group. Because there were cases of patency even after 12 months with a very small pannus thickness, sutureless anastomosis is considered to be a useful method of preventing anastomotic neointimal hyperplasia.

Carbon Dioxide Laser-Assisted Microscopic Vasovasostomy

Microsurgical vasovasostomy has become an increasingly important part of the urologist's armamentarium. We have combined the C02 laser at milliwatt powers to achieve welding with microsurgical techniques. We divided 30 adult male Sprague-Dawley rats into six groups: sham surgery, vasectomy, control microsurgical anastomoses, laser-assisted anastomoses with sutures left in, laser-assisted anastomoses with sutures removed, and sutureless anastomoses. Laser-assisted anastomoses were achieved using a Bioquantum C02 laser coupled to a Wild operating microscope. Power densities ranging from 5.1 to 8.5 watts/mm2 were utilized. All animals were sacrificed after 6 weeks; light and scanning microscopy was performed. Our results show the feasibility of laser-assisted anastomoses, although some animals in the sutureless group had sperm granulomas and anastomotic strictures. Laserassisted anastomosis using sutures for alignment, whether sutures were left in or removed following laser treatment, appeared equal to control microsurgical techniques. However, it is noted that the muscle wall thickness in the area of the vasovasostomy was significantly reduced in the laser-assisted groups; this result may imply vas wall weakness.