PRELIMINARY-RESULTS OF LASER-TISSUE WELDING IN EXTRAVESICAL REIMPLANTATION OF THE URETERS

One exciting potential use of laparoscopic technology is the extravesi cal reimplantation of the ureters. We have assessed the efficacy of la ser-activated fibrinogen solder to close vesical muscle flaps over sub mucosal ureters (Lich-Gregoir technique) in a canine model. Four dogs were subjected to unilateral flap closures via a protein solder (indoc yanine green and fibrinogen) applied to the bladder serosa and exposed to 808 nm. continuous wave diode laser energy. Contralateral reimplan tation was performed using 4-zero vicryl muscle flap closures (control s). At 7, 14 and 28 days postoperatively, intravenous pyelograms confi rmed bilateral ureteral patency. At intravesical pressures above 100 c m. H2O, there was no evidence of wound disruption in either group. Non disrupted wound closures were sectioned and strained until ultimate br eakage to determine tensile strength. At each study interval the laser -welded closures withstood greater stress than the controls. Although these data represent single tissue samples and are not amenable to sta tistical analysis, laser-welded closures appeared to be stronger at ea ch study interval. In conclusion, laser-welded vesical wound closures appear at least as strong as suture closures in the canine model.