A Novel Shape-memory Monofilament Suture For Minimally Invasive Cardiac Surgery
Ryuta Seguchi, Norihiko Ishikawa, Takafumi Horikawa, Tatsuya Tarui, Ryuta Kiuchi, Shigeyuki Tomita, Hiroshi Ohtake, Kenji Kawachi, Go Watanabe.
Newheart Watanabe Institute, Tokyo, Japan.
OBJECTIVE: Thoracoscopic knot tying can complicate or prolong minimally invasive surgical procedures. A novel shape-memory monofilament suture with the spiral in its tail has been developed to speed up suture fixation during minimally invasive cardiac surgery. The purpose of this study was to evaluate its usefulness and safety in the minimally invasive cardiac surgery.
METHODS: We installed a needle with 4-0 monofilament suture composed of copolymer of polyvinilidene difuluoride and hexafluoropropylene to an originally invented jig and heated it in an oven. By only passing through the needle into the spiral made at the tail of the suture, Hangmans` knot was easily made. For the fundamental experiment, to evaluate the effectiveness of the novel shape-memory monofilament suture, 2 surgeons with varying thoracoscopic experience tied knots within a simulated minimally invasive setting, using both the novel shape-memory suture and conventional monofilament suture. The time elapsed for knot tying and tensile strength of each knot was measured. For the clinical experiment, we applied the novel suture in robot-assisted cardiac surgery and conducted a follow-up survey of complications which indicates any flaw of the novel suture.
RESULTS: Mean knot-tying time was significantly shorter with the novel suture than the conventional suture (114±33 vs. 173±47 seconds, p<0.05). The ultimate tensile strength of each knot was 17.4N in the novel suture and 16.5 N in conventional suture. In the 121 cases follow up of robot-assisted cardiac surgery, there was no complication related to the novel suture; such as sutura leakage, bleeding, or infection.
CONCLUSIONS: The novel shape-memory monofilament suture has a great potential for speeding up minimally invasive cardiac surgery while retaining strength of the knot, and can be safely used.
Figure legend: The novel shape-memory monofilament suture and the jig.
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