Publication
During the last 40 years a focus in research was put on sutureless tissue fusion, to handle the limits of conventional suturing such as vascular wall damage due to the enetrating needle, intraluminal foreign body reactions caused by non-absorbable suture material and thrombocyte aggregation, impaired endothelial function, intimal hyperplasia and hence stenosis. Sutured wounds have greater and longer duration inflammatory response than laser soldered wounds. Furthermore suturing does not create a watertight connection, which can, for example, in visceral surgery lead to an entry for pathogens resulting in severe complications such as infections or death. The trend in modern surgery towards endoscopic and minimally invasive approaches requires adaptation of the surgical instruments and techniques. The method of tissue adaptation is therefore limited by free moving space thus revealing conventional suturing unsuitable. Fibrin based adhesives or glues achieve insufficient tensile strength for suture replacement and are further limited by early resorption. These products can be used as temporary sealants or hemostatic agents. Cyanoacrylate based adhesives offer sufficient tensile strength, but are limited by toxicity, allergic reaction, anaphylaxis and immediate polymerization properties, precluding a precise surgical application. An excellent review on different laser soldering and welding techniques has been published by McNally.
Jacques Fellay, Flavia Aurelia Shoko Hodel