Kirsch A J, Dean G E, Oz M C, Libutti S K, Treat M R, Nowygrod R, Hensle T W
Department of Urology, Squier Urological Clinic, New York, New York.
J Urol. 1994 Feb;151(2):514-7. doi: 10.1016/s0022-5347(17)35004-8.
One exciting potential use of laparoscopic technology is the extravesical reimplantation of the ureters. We have assessed the efficacy of laser-activated fibrinogen solder to close vesical muscle flaps over submucosal ureters (Lich-Gregoir technique) in a canine model. Four dogs were subjected to unilateral flap closures via a protein solder (indocyanine green and fibrinogen) applied to the bladder serosa and exposed to 808 nm. continuous wave diode laser energy. Contralateral reimplantation was performed using 4-zero vicryl muscle flap closures (controls). At 7, 14 and 28 days postoperatively, intravenous pyelograms confirmed bilateral ureteral patency. At intravesical pressures above 100 cm. H2O, there was no evidence of wound disruption in either group. Nondisrupted wound closures were sectioned and strained until ultimate breakage to determine tensile strength. At each study interval the laser-welded closures withstood greater stress than the controls. Although these data represent single tissue samples and are not amenable to statistical analysis, laser-welded closures appeared to be stronger at each study interval. In conclusion, laser-welded vesical wound closures appear at least as strong as suture closures in the canine model.
腹腔镜技术一种令人兴奋的潜在用途是输尿管膀胱外再植术。我们在犬模型中评估了激光激活纤维蛋白原焊料封闭黏膜下输尿管上方膀胱肌瓣（利奇 - 格雷戈尔技术）的效果。对四只犬通过将蛋白质焊料（吲哚菁绿和纤维蛋白原）应用于膀胱浆膜并暴露于808纳米连续波二极管激光能量进行单侧瓣封闭。对侧再植术采用4 - 0可吸收缝线进行肌瓣封闭（对照组）。术后7天、14天和28天，静脉肾盂造影证实双侧输尿管通畅。膀胱内压力高于100厘米水柱时，两组均无伤口破裂的迹象。将未破裂的伤口封闭处切片并拉伸直至最终断裂以确定抗张强度。在每个研究间隔，激光焊接的封闭处比对照组承受更大的应力。尽管这些数据代表单个组织样本且不适合进行统计分析，但在每个研究间隔激光焊接的封闭处似乎更强。总之，在犬模型中，激光焊接的膀胱伤口封闭至少与缝合封闭一样牢固。
