Spector David, Rabi Yaron, Vasserman Irena, Hardy Amos, Klausner Joseph, Rabau Micha, Katzir Abraham
Tel-Aviv Souraky Medical Center, Surgery B, Tel-Aviv 64239, Israel.
Lasers Surg Med. 2009 Sep;41(7):504-8. doi: 10.1002/lsm.20799.
In today's age of advancing surgical technology, there is a need for better and simpler methods of tissue bonding. The use of lasers for tissue welding or soldering is one of these sutureless methods. In 30 years of laser tissue bonding (LTB) research, published reports of cylindrical organ anastomosis were limited to small diameters. The tension resisted by the anastomosis, which is caused by the intraluminal pressure, is also proportional to the organ diameter. Therefore the anastomosis of large diameter organs requires significantly stronger mechanical strength. The aim of this study is to demonstrate such an anastomosis.
In vitro anastomosis of porcine small bowel was performed by either LTB or sutures. Anastomosis in the laser group (number of samples, n = 15) included two main stages of soldering. The bowel edges were approximated over a solid albumin stent and heated with a temperature controlled GaAs laser system to 75 degrees C. This was followed by spreading liquid albumin on the anastomotic line and heating by the same system again to 75 degrees C. The control group (n = 5) was sutured anastomosis. All anastomoses were assessed by burst pressure measurement.
The burst pressure of the laser group attained 170+/-40 mmHg which was significantly higher than that of the sutured group 83+/-37 mmHg (P < 0.001).
This report describes the in vitro LTB anastomosis of a large diameter cylindrical organ. The immediate bond strength, as estimated by burst pressure measurements, was double compared to sutured anastomosis.
在当今手术技术不断进步的时代，需要更好、更简便的组织黏合方法。使用激光进行组织焊接或钎焊就是其中一种无需缝合的方法。在30年的激光组织黏合（LTB）研究中，已发表的关于圆柱形器官吻合术的报告仅限于小直径情况。由腔内压力引起的吻合口所承受的张力也与器官直径成正比。因此，大直径器官的吻合需要显著更强的机械强度。本研究的目的是展示这样一种吻合术。
采用LTB或缝合方法对猪小肠进行体外吻合术。激光组（样本数量，n = 15）的吻合术包括两个主要的钎焊阶段。将肠边缘在固体白蛋白支架上对合，并用温度控制的砷化镓激光系统加热至75摄氏度。随后在吻合线上涂抹液体白蛋白，再用同一系统加热至75摄氏度。对照组（n = 5）采用缝合吻合术。所有吻合口均通过爆破压力测量进行评估。
激光组的爆破压力达到170±40 mmHg，显著高于缝合组的83±37 mmHg（P < 0.001）。
本报告描述了大直径圆柱形器官的体外LTB吻合术。通过爆破压力测量估计，即时黏合强度是缝合吻合术的两倍。
