Preliminary results of laser-assisted sealing of hand-sewn canine esophageal anastomoses

摘要

Abstract: Dehiscence rates of esophageal anastomoses rangebetween 5 and 20%. Causative factors include ischemia,tension, foreign body reaction, microabscesses, and thenegative pressure within the thoracic cavity. Laserassisted tissue sealing (LATS) has been shown todecrease anastomotic leakage rates in other tissues.Using a canine model the efficacy of LATS in enhancingsingle layer hand swen intrathoracic esophagealanastomoses was assessed. Via a left thoracotomy,paired two centimeter transverse incisions (one lasersealed, one control) were made in the proximal anddistal esophagus in nine dogs. Both were sewn using asingle layer of 4-0 polyglycolic acid. A combination ofalbumin (0.2 cc), sodium hyaluronate (0.4 cc), andindocyanine green (1 gtt) was applied to one of therandomly chosen hand sewn repairs. Thealbumin/hyaluronate combination is used to provide aprotein matrix across the anastomosis for ingrowth offibroblasts. Indocyanine green dye selectively absorbsat approximately @805 nm which matches the output ofthe diode laser (808 $POM 1 nm), thus improving uptakeof laser energy by the targeted tissues. Theanastomosis was then exposed to continuous wave diodelaser energy for approximately @2 minutes at a powerdensity of 9.6 W/cm$+2$/. The esophagus was recoveredeither at the time of sealing or two dayspostoperatively and infused with saline under pressure.Bursting pressures were considered the point of initialsaline leakage. At time 0 there was no significantdifference in bursting pressures between the LATS groupand controls. However, at two days postoperativelycontrols burst at 121 $POM 14 mmHg while the laserassisted anastomoses burst at 295 $POM 35 mmHg (p $LS.005). HPS staining of uninjured portions of the lasersealed anastomoses revealed minimal thermal injury tothe mucosal surface initially, with some regenerationof mucosal lining at two days postoperatively. Noforeign body reaction to the solder was noted. Laserreinforcement of single layer hand sewn esophagealanastomoses appears to increase bursting pressure andmay result in reduced incidence of anastomotic leakage.!