ASSESSMENT OF ALTERNATIVE TISSUE APPROXIMATION TECHNIQUES FOR LAPAROSCOPY

Objective To investigate the feasibility and results of applying alter native techniques of tissue approximation for experimental urothelial re-anastomosis in an open and laparoscopic setting. Materials and meth ods The study was carried out in two phases; in phase 1, an open porci ne ureteric re-anastomosis was performed using gelatin/resorcin/formal dehyde (GRF) glue, fibrin glue or potassium-titanyl-phosphate laser ti ssue-welding with a fluorescein-doped human albumin solder. The anasto moses were assessed both immediately, by leak pressure, and by the ope rating time, upper tract urodynamic studies and light and scanning ele ctron microscopy, 6 weeks after surgery. In phase 2, the best techniqu e from phase 1 was compared with sutured controls for porcine retroper itoneoscopic dismembered pyeloplasty, using the same assessment criter ia. Results In phase 1, GRF glue produced adhesion which was insuffici ently flexible to withstand rotation of the anastomosis and this techn ique was therefore abandoned. Fibrin-glued anastomoses withstood leak pressures equal to those from laser-welding (P=0.91) and gave similar changes in maximum pressure with a Whitaker test at 6 weeks (P=0.30), but were superior in requiring a shorter operating time (P=0.02) and i n their electron and light microscopic appearances. In phase 2, fibrin glue gave similar changes in maximum pressure with a Whitaker test to those from polyglactin 910 sutures (P=0.51) but withstood higher leak pressures (P=0.01), had a shorter operating time (P=0.01) and had sup erior electron and light microscopic appearances. Conclusion Fibrin gl ue produced effective experimental laparoscopic pelvi-ureteric anastom oses within less operating time than did sutured controls. Such anasto moses withstood supra-physiological pressures, with no evidence of fun ctional obstruction and with a more favourable histological result aft er 6 weeks. Laparoscopic evaluation of this modality in a clinical set ting is now justified.