用于腹腔镜单层肠切开术闭合的可吸收和不可吸收无结倒刺缝线的体内评估：与无倒刺缝线的临床和生物力学比较

In vivo assessment of an absorbable and nonabsorbable knotless barbed suture for laparoscopic single-layer enterotomy closure: a clinical and biomechanical comparison against nonbarbed suture.

作者信息

Omotosho Philip, Yurcisin Basil, Ceppa Eugene, Miller Jeffrey, Kirsch David, Portenier Dana D

机构信息

Division of Minimally Invasive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.

出版信息

J Laparoendosc Adv Surg Tech A. 2011 Dec;21(10):893-7. doi: 10.1089/lap.2011.0281.

DOI:10.1089/lap.2011.0281

PMID:22129144

Abstract

BACKGROUND

Laparoscopic intracorporeal suturing and knot tying is a complex skill that requires repeated deliberate practice to master. A novel self-anchoring barbed suture material that does not require knot tying can eliminate knot failure and reduce operating time. The goal of this study was to compare the in vivo efficacy of two novel knotless barbed sutures (absorbable and nonabsorbable) for use with the Endo Stitch™ device (Covidien), against conventional suture (Endo Stitch device with Polysorb™ suture; Covidien) for laparoscopic closure of viscerotomies in canine stomach, jejunum, and colon.

METHODS

Following Institutional Animal Care and Use Committee approval, 24 dogs underwent laparoscopic creation of 25-mm viscerotomies, three each in the stomach, jejunum, and colon. All viscerotomies were closed with the Endo Stitch device using the absorbable or nonabsorbable barbed suture or conventional suture. Closure time for each viscerotomy was recorded. Animals were survived for 3, 10, or 21 days, at which point the viscerotomies were burst-pressure tested.

RESULTS

The closure leak rate in this study with 216 total viscerotomy closures was 0%. There was no statistically significant difference in mean burst pressure between viscerotomies closed with barbed suture versus control suture at any of the survival intervals. Barbed suture with the Endo Stitch device was associated with statistically significantly faster closure times than the control suture with the Endo Stitch device (P<.05), resulting in a reduction in closure time between 35% and 42%.

CONCLUSION

This study reports the first use of barbed suture for the Endo Stitch device in laparoscopic gastrointestinal closure. The barbed suture for the Endo Stitch device is effective for laparoscopic single-layer gastrointestinal closure and is associated with a significantly reduced closure time.

摘要

背景

腹腔镜体内缝合和打结是一项复杂的技能，需要反复刻意练习才能掌握。一种新型的无需打结的自锚定倒刺缝线材料可消除打结失败并减少手术时间。本研究的目的是比较两种新型无结倒刺缝线（可吸收和不可吸收）与Endo Stitch™装置（柯惠公司）联合使用时，与传统缝线（Endo Stitch装置搭配Polysorb™缝线；柯惠公司）在犬类胃、空肠和结肠的腹腔镜内脏切口闭合中的体内效果。

方法

经机构动物护理和使用委员会批准后，24只犬接受腹腔镜下制作25毫米的内脏切口，胃、空肠和结肠各制作三个。所有内脏切口均使用Endo Stitch装置，采用可吸收或不可吸收的倒刺缝线或传统缝线进行闭合。记录每个内脏切口的闭合时间。动物存活3、10或21天，此时对内脏切口进行破裂压力测试。

结果

本研究中，总共216次内脏切口闭合的闭合漏率为0%。在任何存活间隔期，使用倒刺缝线闭合的内脏切口与对照缝线闭合的内脏切口之间的平均破裂压力均无统计学显著差异。与使用Endo Stitch装置的对照缝线相比，Endo Stitch装置搭配倒刺缝线的闭合时间在统计学上显著更快（P<0.05），闭合时间减少了35%至42%。