Safety and Performance Evaluation of Su2ura Approximation, a New Suturing Device, in Pigs

One of the challenging aspects of minimal invasive surgery (MIS) is intracorporal suturing, which can be significantly time-consuming. Therefore, there is a rising need for devices that can facilitate the suturing procedure in MIS. Su2ura Approximation Device (Su2ura Approximation) is a novel device developed to utilize the insertion of anchors threaded with stitches to allow a single action placement of a suture. The objective of this study was to evaluate the long-term safety and tissue approximation of Su2ura Approximation in comparison to Endo Stitch + Surgidac sutures in female domestic pigs. All incision sites were successfully closed by both methods. Firm consolidation within and around the incision site was noted in several animals in both treatment groups, which corresponded histopathologically to islands of ectopic cartilage or bone spicules within the fibrotic scar. These changes reflect heterotopic ossification that is commonly seen in the healing of abdominal operation sites in pigs. No other abnormal findings were observed throughout the study period. In conclusion, the use of Su2ura Approximation under the present experimental conditions revealed no safety concerns.

O46 SUTURABLE MESH IMPROVES OUTCOMES FOR LAPAROTOMY CLOSURE IN COMPARISON TO POLYPROPYLENE SUTURE IN A REALISTIC PORCINE MODEL

Aim Laparotomy closures fail due to suture pull-through. We hypothesize that a novel suturable mesh device may limit pull-through via mechanisms of force distribution at the suture-tissue interface and fibrous encapsulation of the device filaments. This new tissue approximation device may lead to improved outcomes for laparotomy closure. Material and Methods Fifteen domestic swine 74 kg in size were randomly allocated to three groups for epigastric laparotomy closure with either size 0 suturable mesh, number 1 suturable mesh, or number 1 polypropylene. All three devices were placed in running fashion with 1 cm bites and 1 cm travels. Primary endpoints were hernia formation at 13 weeks and a semiquantitative analysis of the histological tissue response. Secondary endpoints included adhesions, surgical site occurrence (SSO), and documentation of “loose sutures”. Results There were numerically fewer hernias in the number 1 suturable mesh group. Nine of the 10 suturable mesh devices were well encapsulated within the tissues and could not be pulled away, while 4 of the 5 polypropylene sutures were loose. Adhesions were least for number 1 suturable mesh. Histologically, the suturable mesh implanted devices showed good fibrovascular ingrowth and were judged to be “non-irritants”. The soft tissue response was statistically greater (p = .006) for the number 1 suturable mesh than for the number 1 polypropylene. Conclusions The mechanism of how meshes support closure sites is clearly demonstrated with this model. Suturable mesh has the potential to change surgical algorithms for abdominal wall closure.

Stretchable, Bio-Compatible, Antioxidant and Self-Powering Adhesives from Soluble Silk Fibroin and Vegetal Polyphenols Exfoliated Graphite

The development of bio-glues is still a challenging task, regarding adhesion on wet surfaces; often, high performance and adaption to complex geometries need to be combined in one material. Here, we report biocompatible adhesives obtained by blending regenerated silk (RS) with a soluble plant-derived polyphenol (i.e., chestnut tannin) that was also used to exfoliate graphite to obtain graphene-based RS/tannin (G-RS/T) composites. The resultant G-RS/T hybrid material exhibited outstanding stretchability (i.e., 400%) and high shear strength (i.e., 180 kPa), superior to that of commercial bio-glues, and showed sealant properties for tissue approximation. Moreover, we showed how such nanocomposites exhibit electromechanical properties that could potentially be used for the realization of green and eco-friendly piezoelectric devices. Finally, we demonstrate the in vitro glue’s biocompatibility and anti-oxidant properties that enable their utilization in clinical applications.

Mesh abdominoplasty for rectus diastasis in women and men

Purpose Meshes clearly have improved outcomes for tissue approximation over suture repairs for incisional hernias. A knowledge gap exists as to the surgical complication rate and post-operative outcomes of a mesh rectus diastasis repair with a narrow well-fixed mesh that simultaneously narrows the rectus muscles and closes the widened linea alba. Methods Inclusion criteria for mesh abdominoplasty were patients who (1) underwent a retrorectus planar mesh for repair of rectus diastasis (2) did not have a concurrent incisional hernia and (3) underwent skin tailoring as part of a cosmetic aspect of their care. The primary endpoint was surgical site occurrence (SSO) at any time after surgery as determined with review of their office and hospital medical records. Secondary endpoints included the length and complexity of the return to the operating room for any reason, non-surgical complications, readmission, post-operative recovery, surgical site infection, recurrence/persistence of abdominal wall laxity, and soft tissue revision rates. Results SSO rate was 0% for the 56 patients who underwent this procedure. There were 40 women and 16 men. Superficial infections requiring oral antibiotics were required in three patients. One was a drain site erythema, one was for a superficial stitch abscess, and the third was for a mesh strip knot infection 6 months after the procedure. One patient underwent further tightening of the abdominal wall. Rates of soft tissue revision in the office for improved cosmesis were 23% in women and 6% in men. Conclusion Repair of rectus diastasis with a narrow well-fixed mesh and concurrent skin abdominoplasty is a well-tolerated and reliable procedure with low recurrence and low SSO in the manner described. It is a procedure that works for both female and male pattern rectus diastasis, and has become our procedure of choice for moderate and severe rectus diastasis.

Plasticised Regenerated Silk/Gold Nanorods Hybrids as Sealant and Bio-Piezoelectric Materials

Manual and mechanical suturing are currently the gold standard for bowel anastomosis. If tissue approximation fails, anastomotic leaks occur. Anastomotic leaks may have catastrophic consequences. The development of a fully absorbable, biocompatible sealant material based on a bio-ink silk fibroin can reduce the chance of anastomotic leaks. We have produced a Ca-modified plasticised regenerated silk (RS) with gold nanorods sealant. This sealant was applied to anastomosed porcine intestine. Water absorption from wet tissue substrate applied compressive strains on hybrid RS films. This compression results in a sealant effect on anastomosis. The increased toughness of the hybrid plasticised RS resulted in the designing of a bio-film with superior elongation at break (i.e., ≈200%) and bursting pressure. We have also reported structure-dependent piezoelectricity of the RS film that shows a piezoelectric effect out of the plane. We hope that in the future, bowel anastomosis can be simplified by providing a multifunctional bio-film that makes feasible the mechanical tissue joint without the need for specific tools and could be used in piezoelectric sealant heads.

Upper Gastrointestinal Endoscopy: Basic Upper Endoscopy

Since the beginning of the 1970s, flexible endoscopy of the gastrointestinal tract has been the dominant modality for the diagnosis of gastrointestinal disease. Over the same period, developments in technology and methodology have made possible the use of endos-copy to treat a host of conditions that once were considered to be manageable only by means of surgical intervention. The concept of performing endoscopic surgery has become a reality with the advancement of endoscopic therapies to control hemorrhage and perform mucosal ablations, resections, and tissue approximation. In addition, investigation into intra-abdominal interventions has begun with the progression of natural orifice transluminal endoscopic surgery (NOTES). The tools created for both intraluminal and transluminal procedures will allow the endoscopist to continue to supplant surgical therapies for numerous gastrointestinal diseases. The integration of flexible endoscopic techniques into the armamentarium of the gastrointestinal surgeon permits a more multidi-mensional approach to the treatment of digestive system disorders. The modern surgeon must continue to stay abreast of these en-doscopic advances to provide appropriate patient care. This review contains 12 figures, 2 tables, and 21 references. Key words: optical biopsy, chromoendoscopy, over the scope clips, endoscopic suturing techniques