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A New Suturing Device For Aortic Surgery: Towards Minimally Invasive Aortic Surgery
Takahiro Matsuoka, Yoshifumi Itoda, Ryoichi Kondo, Ichiro Sakuma, Minoru Ono.
The University of Tokyo, Tokyo, Japan.
OBJECTIVE: In recent years, minimally invasive procedures have been widely accepted for cardiac surgery. However no significant progress has been made in the field of vascular surgery because of difficulty in performing a secure running suture and tying a knot in a limited space. To make the anastomosis easier, various devices have been developed, but nothing has been universally used. We developed a new suturing device that composed of a 4-0 polypropylene suture with an anchoring mechanism at one extremity. This device eliminates knot tying after completion of running suture. The purpose of the study is to evaluate the efficacy and safety of the new suturing device.
METHODS: Fifteen pigs were used in this study. Through a left thoracotomy, the descending aorta was exposed. Cross-clamp was applied and the descending aorta was transected. It was anastomosed in an end-to-end fashion by running suture using the new suturing device (group D) or the conventional 4-0 polypropylene suture (group C). In eight pigs for chronic study, the anastomosis was constructed using group D (n=5) and group C (n=3). In seven other pigs for acute study, two anastomosis per one were performed using group D (n=7) or group C (n=7). The suturing time was recorded and angiographic evaluation was done.
RESULTS: All anastomoses were successfully completed. The mean suturing time was 351±11 sec in group D (n=12) and 450±22 sec in group C (n=10). The significant difference (p=0.0289) was observed between the two groups. All anastomoses had no evidence of leakage. Angiography demonstrated no filling defects of stenosis and thrombosis.
CONCLUSIONS: We confirmed the efficacy and safety of the new suturing device compared to the conventional suture in open aortic anastomosis in a pig model. We believe this new device may provide more advantages in a limited space during minimally invasive vascular aortic surgery. For the evaluation of the long-term results, we will evaluate the histopathological examination of anastomosis site for chronic study.
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