1.9 mum diode laser assisted anastomoses (LAMA) in reconstructive microsurgery: results of the preliminary clinical study

摘要

The authors report an original 1.9 mum diode laser asissted microvascular anastomosis (LAMA) in human. This technique has been applied in 20 patients during reconstructive surgery for digital replantations (n=6), for digital revascularizations (n=4) and for free flap transfers (n=10). LAMA were always performed on vessel (16 arteries and 6 veins) which did not impede the chance of success of the surgical procedure in case of thrombosis. LAMA was performed with a 1.9mum-diode laser after placement of 2 equidistant stitches at 180 degrees. The diode spot was obtained by mean of a 300mum optic fiber transmitted to the vessel wall via a pencil size hand piece. The following parameters were used: spot size = 500mum, power = 70 to 220 mW, pulse duration = 0.7 to 3 seconds. Ten to 15 spots were applied on each face. The mechanism involved is a theraml effect on the collagen of the adventitia and media leading to a phenomenon which the authors have termed "heliofusion". Immediate assessment consisted in evaluating the permeability by patency test (O'Brien) and water-tightness. Secondary assessment consisted in evaluating the clinical success, confirmed by Doppler at one month. Using LAMA, the average time for completing an anastomosis was 7 minutes compared to 18 minutes when sutures were used. The patency test demonstrated that all anastomosis were positive. This was confirmed at one month using clinical evaluation and Doppler. This preliminary trial has permitted to define the modalities fo LAMA in human. The technique is simple, rapid and easily learned. The laser source has a size similar to that a diathermy. The handpiece is very rergonomic and can be sterilized. LAMA does not replace sutures but is complementary, thanks to a reduction in the number of stitches used and to an access to surgical areas which are not easily accessible. This study must be completed by a larger scale study to confirm this technique and its reliability. Others uses could be performed on different tissues such as biliary and urinary track, especially under laparoscopic conditions.