LASER-TISSUE SOLDERING IN URINARY-TRACT RECONSTRUCTION - FIRST HUMAN-EXPERIENCE

Objectives. Laser tissue soldering (LTS) in the urinary tract provides an immediate leak-free seal and may avoid complications seen with con ventional repair (such as fistula and stricture). We have begun a Phas e I clinical trial investigating the use of LTS in performing urologic reconstructive surgery. Methods. Ten patients (aged 3 months to 38 ye ars) underwent urologic reconstruction using LTS with a protein solder composed of human albumin (42%) and indocyanine green dye. In each ca se standard microsuture repair preceded laser-soldered suture line rei nforcement. Anastomotic closure time and immediate leak pressure were measured, Postoperatively, all patients were evaluated for evidence of complications, including stricture, fistula formation, or impaired he aling. Results. Using LTS as an adjunct to suturing added an average o f 7.9 +/- 3.0 minutes (28%) to the overall mean anastomotic time of 28 .3 +/- 9.4 minutes. Intraoperative leak pressure measurements for lase r-soldered anastomoses (greater than or equal to 94.2 +/- 24.2 mm Hg) were significantly higher (P < 0.001) than primarily sutured anastomos es (20 +/- 2.9 mm Hg). Two instances of suture disruption (20%) occurr ed during laser activation, neither of which were repaired with suture s. Average follow-up for all patients was 7.1 +/- 2.2 months. There we re no intraoperative or postoperative complications, including the 2 p atients with suture disruption. Conclusions. These initial clinical re sults indicate that LTS is safe, easy to perform, and, contrary to con ventional suturing, provides an immediate leak-free closure. Follow-up in these and other patients, as well as those undergoing sutureless a nd stent-free procedures, will determine whether our method of LTS ben efits patients undergoing urologic reconstruction.