Laser activation of tissue sealant in hand-sewn canine esophageal closure
| Autor: | Valluvan Jeevanandam, Reemtsma K, Juan Sanchez, Michael R. Treat, Joseph S. Auteri, Craig R. Smith, Mehmet C. Oz |
|---|---|
| Rok vydání: | 1992 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Esophageal disease business.industry Sealant medicine.medical_treatment Dehiscence Anastomosis medicine.disease Laser Surgery law.invention chemistry.chemical_compound medicine.anatomical_structure chemistry law medicine Thoracotomy Esophagus Cardiology and Cardiovascular Medicine business Indocyanine green |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 103:781-783 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/s0022-5223(19)34962-1 |
| Popis: | Dehiscence rates of esophageal anastomoses are between 5% and 20%. Because small leaks between sutures might promote microabscess formation and lead to dehiscence, we postulated that a better initial physical seal might be beneficial. Reinforcement with laser activation of tissue sealant (LATS) is a new technique that has been shown to increase the bursting strength of anastomoses in other tissues. The tissue sealant is composed of 0.4 ml of hyaluronic acid and 0.2 ml of albumin, to which 3 drops of indocyanine green dye are added to give the sealant a peak absorbance of 805 nm, matching the wavelength (808 nm) of a small, hand-held diode laser. Since tissues do not absorb at this wavelength, laser energy is focused in the sealant, minimizing collateral thermal damage. To extend this concept, we assessed LATS in a canine model of esophageal closure. The esophagus was exposed via a right thoracotomy in 20 dogs, and two transverse incisions, 2 cm in length, were made in each esophagus (n = 40 closures). Both sites were closed with a single layer of interrupted 4-0 polyglycolic acid suture. Either the proximal or distal incision was randomly chosen to receive laser activation of tissue sealant. Tissue sealant was applied to the reapproximated edges of the hand-sewn closure, which was then exposed to diode laser energy. The end point was visible shrinking and desiccation of the sealant, which required about 2 minutes. Each esophagus was recovered at 0, 2, or 7 days postoperatively (n = 10, 5, and 5 dogs, respectively), bursting pressure was measured, and the closures were examined histologically. At all three time points LATS closures had significantly higher bursting pressures than control closures (time 0: 251 ± 87 versus 105 ± 46, p horac C ardiovasc S urg 1992;103:781-3) |
| Databáze: | OpenAIRE |
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