Tissue anastomosis using a KTP laser: An experimental study

Summary

Sutured visceral anastomoses are time-consuming and complex when performed endoscopically. Theoretically, laser-welded visceral anastomoses are possible and are potentially easier and quicker to perform endoscopically than the sutured anastomoses. In this living canine study, we compared the operating time and intraluminal bursting pressure of laser-welded vs sutured anastomoses of (1) common bile duct (CBD), (2) small intestine, (3) colon and (4) ureter. Each organ was joined to itself using both anastomotic techniques. Welded anastomoses were much quicker in each organ system. Watertight anastomoses were achieved in each organ tested with both anastomotic techniques. Intraluminal hydrostatic bursting pressures occurred at lower pressures (approximately 70% of sutured anastomosis bursting pressure) in all organs. Though not qualified, tensile disruption pressure appeared to be significantly lower in the welded anastomoses as compared to the sutured anastomoses. Laser-welded visceral anastomoses are rapid and watertight. Compared to sutured anastomoses, welded anastomoses are less secure to intraluminal bursting pressures and probably less to tensile pressures. Strength enhancing adjunctive measures, such as serosal adhesives or serosal clips, may strengthen welded anastomoses and are worthy of additional studies.

Keywords:

• anastomosis
• KTP laser
• tissue welding