MICROARTERIAL ANASTOMOSIS USING A NONCONTACT DIODE-LASER VERSUS A CONTROL STUDY

A series of direct carotid end-to-end laser anastomosis vs. direct man ual suture was carried out on a series of 70 Wistar rats (mean weight 260 g). Both common carotids (0.8-1.2 mm) were sectioned and repaired. The left side (n = 70) was submitted to laser-assisted microvascular anastomosis (LAMA) performed by means of a diode laser device (wavelen gth 830 nm and power output 3 W in continuous wave) without chromophor e. The right side (n = 70) underwent a control manual suture (CMA). Th e diode laser energy was delivered into a micromanipulator coupled to a Zeiss operating microscope with a focused spot of 300 mum in diamete r. After placement of three 10.0 stitches for edge coaptation, the LAM A was achieved using laser shots (average 3) of 500 mW power, 4.5 s du ration, and 700 W/cm2 irradiance each. The CMA was performed by means of six 10.0 stitches. The good vascular flow was confirmed by Doppler spectral analysis (n = 466) carried out from day 0 to day 90. Light an d scanning electron microscopy (n = 82) showed that re-endothelializat ion after LAMA was gaining ground on day 3, whereas collagenous networ k developed in the media scar by day 10. In contrast, after CMA the ar terial repair was delayed on day 20, inducing a media fibrotic scar. T he patency rate was 93% in both anastomoses. The shorter operating tim e (13 min for LAMA vs. 22 min for CMA) and the noncontact laser techni que are the main intraoperative advantages. The technical benefits of the diode laser are pointed out. (C) 1994 Wiley-Liss, Inc.