A different technique for sutureless coronary bypass grafting

Introduction Many coronary anastomotic devices have been designed to replace manual stitching in coronary surgery; however, interestingly, none of them became widespread. Our aim was to work out an easy and fast endoluminal vessel-to-vessel stent bridge distal anastomotic technique. Materials and methods Ten coronary arteries of eight fresh human hearts were used in this study. The anastomosis was performed with the implantation of a graft vessel into the lumen of the coronary artery by performing stent fixation. The technique is described and photo documented in detail. The durability and the conductibility of the anastomosis were examined with intraluminal endoscopy, functional streaming test, and a coloring of the vessels. Results The anastomosis had great results in all cases. Obstruction, dissection, or dislocation of the vessels was not observable. Conclusions This study confirmed the ex-vivo feasibility of the described technique. This method can be an easy, fast, and reliable method applied in the endoscopic distal coronary artery anastomosis surgery. The development of stents adapted to this method and the in-vivo testing of this technique are necessary for the future.

Feasibility of Rectal Stent Development for Fecal Diversion: A Porcine Experiment

Objective Since low rectal anastomosis leakage may cause severe morbidity, surgeons create diversion stoma to prevent complication. However, stoma requires additional surgery with morbidity. Therefore, rectal stent may help prevent these problems. This preliminary report details the development of new rectal stent in animal experiment. Thirteen female 12 week-old pigs weighing 30–35 kg each (four in the control group, nine in the experimental group) were included. Under general anesthesia, pigs underwent laparoscopic low anterior resection. In experimental group, a Niti-S fully covered stent (Taewoong Medical Inc.) was inserted by guidewire, under direct laparoscopic vision, and affixed near the anus. All pigs were sacrificed for autopsy. Including the anastomosis line, 10 cm length of bowel was obtained and a water-air leak and barium leakage X-ray tests were performed to confirm anastomosis integrity. Results Among the four control pigs, anastomosis leakage was confirmed in only one. For the experimental pigs, 36-mm-diameter stent was used. The last three pigs were subjected to additional intra-abdominal stent fixation by laparoscopic guidance, but all stents were removed. Despite natural stent removal, there were only two cases of intraoperative leakage. To overcome rectal pressure and fecal bulk, rectal stent development requires further investigation.

Esophageal overtubes provide no benefit to safety or technical success in upper gastrointestinal tract endoscopic suturing

Background and study aim The role of esophageal overtubes in upper gastrointestinal endoscopic suturing is unknown. This study aimed to determine whether overtube use was associated with technical success or adverse events. Patients and methods A retrospective review of consecutive patients who underwent endoscopic suturing for various indications was performed. Results A total of 719 patients underwent endoscopic suturing for various indications, including endoscopic bariatric procedures in 262, stent fixation in 258, defect closure in 190, and hemostasis in nine. An overtube was used in 186 procedures (25.9 %). Technical success was achieved in all cases. Minor mucosal trauma occurred in 15 cases (8.1 %) with use of an overtube, and none without an overtube (P < 0.0001). No full-thickness esophageal perforation or hemorrhage related to overtube use or the suturing device occurred. Conclusions Endoscopic suturing can be performed safely for a variety of indications, including endoscopic bariatric procedures, defect repair, and stent fixation without an esophageal overtube. Minor esophageal mucosal trauma and equipment cost are increased when an overtube is used.