Laser-assisted tissue closure with a unique solder-film patch.

摘要

A technique for improving laser-assisted tissue closure methods has been developed and evaluated with a series of in vitro and in vivo tests. This technique has the potential for clinical application. Future work to refine the technique and target a specific surgical application could possibly introduce laser-assisted tissue welding into the clinic as a sutureless method of wound closure.; Laser-assisted tissue welding is a possible alternative to suturing with the potential to allow many conventional surgical procedures to be performed in a minimally invasive fashion. The advantages of laser-tissue welding over sutures include reduced inflammation and foreign body response, liquid-tight seals, faster healing, and the potential for simpler methods of minimally invasive wound closure. However, despite a substantial amount of research in the field, laser-based methods of wound closure have yet to gain widespread clinical acceptance. Some of the obstacles to the acceptance of laser-tissue welding technology are poor strength and reproducibility of the welds, thermal damage to the tissue, and ambiguous and arbitrary end-points in the welding process. Improvements to tissue welding procedures and a better understanding of the mechanisms involved in the tissue welding process are required before this technique of tissue closure can be applied clinically.; One particular problem associated with tissue welding is poor acute wound closure strength that is sometimes followed by an additional short-term loss of strength after hydration of the closure site. In this study, a factor that contributes to poor acute strength in a particular welding technique has been identified, and a method with clinical potential to improve the acute strength has been developed. Applying a biodegradable polymer film patch over the solder adhesive improved the acute wound strengths. Using the patch to reinforce the cohesive strength of the solder reduces the problem of further increasing the weld strength to improving the adhesion of the solder to the tissue. Also demonstrated is the technique's ability to reduce the loss of strength that accompanies hydration of the closure site. A preliminary investigation to identify possible problems that could arise if the technique is applied clinically is discussed.