Munich, Germany. A commercial firm in Germany has introduced a prototype suturing tool that brings laser stitching closer to clinical application.

Formally known as photochemical tissue bonding (or laser-assisted nanosuturing), some research hospitals are using the technology to close wounds and surgical openings. Initially designed for use in abdominal surgery, the tool has potential for organ-specific applications, such as heart surgery, and a wide range of soft-tissue scenarios.


However, practical use in the field depends on the availability of products that are safe, reliable, portable, and cost-appropriate.



Researchers of the Fraunhofer Institute for Production Technology (IPT) in Aachen developed this instrument successfully carrird out the suturing process during laboratory tests.

"We were able to achieve the best results with a suture tension of zero to five Newton and a lasering time of 0.1 seconds."

The preclinical studies are slated to start later this year at the University Hospital Aachen (UKA).

To begin with, the suturing instrument will be utilized for minimally invasive surgeries in the abdominal area.

Fraunhofer IPT is convinced that it can also be adapted to keyhole surgeries of the heart.

Other soft tissue and reconstructive surgeries may require further modification but the general principles involved are much the same, limiting any potential development delays.

Researchers from the IPT displayed a prototype of the minimally invasive suturing instrument at the MEDTEC Europe Fair in Stuttgart, Germany (March 22-24, 2011).More and more often, abdominal surgeries are being carried out in a minimally invasive manner. A small incision in the abdominal wall is sufficient for the surgeon to be able to insert the instrument and make the organs visible with an endoscope. This technique is gentler and does not stress the body as much as traditional surgeries do.

The current state-of-practice emphasizes the use of the endoscope, an exacting instrument that requires a surgoen to have special training and capabilities. The tissue suturing and the setting of the knots, in particular, is very complicated due to the lack of space for movement. A new, minimally invasive suturing tool simplifies the procedure. In the future, the suture material will no longer be knotted, but welded with a laser.

However, these minimally invasive surgeries pose a special challenge to the surgeons. In particular, the suturing — meaning joining the tissue with needle and suture material — demands great skill and dexterity. Very often, piercing the tissue and tying the knots is difficult — after all, the surgeons must perform surgeries in very tight quarters, while having very little room to move.

Unlike when sewing textiles, a knot must be made after every stitch, which is a very exacting process that stresses the patient and can cause a number of complications. If the suture is too tight, there is the danger of a minor hemorrhage. In addition, the suture material can cut into the tissue and strangulate vessels. In worst cases the tissue may even die. However, if the suture is too loose, there may be bleeding at the edges of the wound.

Currently, setting the correct suture tension depends on the experience of the surgeon. It requires a subjective estimate of the optimum tension — and every surgery is treated as a special case that requires another estimate.

This is because there is no reproducible or standardized setting for the procedure. In the future, a minimally invasive suturing instrument shall make suturing easier.

In a new, semi-automatic process the suturing instrument enables the surgeon to connect the suture material with a previously set, predefined tension. Not only does it shorten the suturing process with respect to time, it also hastens the healing of the wound. The patient is able to recover more quickly.

"With our new device, the edges of the wound can be joined quickly and safely, since it automatically ensures the optimum tension for the suture. The surgeon no longer has to deal with that. In the future, the difficult task of knotting the ends of the suture material will no longer be necessary, since they simply will be welded with the laser," explains Adrian Schütte, a scientist at the IPT.

The idea for this process is based on the laser welding process for plastics. Two thermo-plastic pieces to be lasered together are welded by means of laser energy.

Adrian Schütte said: "In our case, the suture material is one of the two pieces to be lasered together, the other one is the sleeve. It is located in the tip of the new suturing device, which has a diameter of ten millimeters."

• First, the surgeons access the abdominal cavity through a small tube — the experts call it a trocar.
  
  
• After they pierce the tissue with a needle, they pull the end of the suture material out with the surgical forceps, through the trocar, and clip it into the sleeve.
  
  
• A defined tension can be set for the suture by pushing the sleeve through the trocar and simultaneously tensioning the suture.
  
  
• Once the desired tension has been achieved, the suture material is welded to the sleeve by laser. The laser is located at the end of the suturing instrument, the laser beam is sent via the light conducting fiber through the instrument. The superfluous suturing material is cut off behind the sleeve.
  
  
• And, as a last step, the surgeons pull the suturing instrument out through the trocar. After the lasering, the sleeve remains in the abdominal cavity.

Schütte remarked: "Currently, the sleeve consists of polypropylene, in the future we would like to manufacture it from resorbing materials."

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