Sutureless anastomotic devices present several advantages over traditional suture anastomosis,including expanded global access to microvascular surgery,shorter operation and ischemic times,and reduced costs.However,th...Sutureless anastomotic devices present several advantages over traditional suture anastomosis,including expanded global access to microvascular surgery,shorter operation and ischemic times,and reduced costs.However,their adaptation for arterial use remains a challenge.This review aims to provide a comprehensive overview of sutureless anastomotic approaches that are either FDA-approved or under investigation.These approaches include extraluminal couplers,intraluminal devices,and methods assisted by lasers or vacuums,with a particular emphasis on tissue adhesives.We analyze these devices for artery compatibility,material composition,potential for intimal damage,risks of thrombosis and restenosis,and complications arising from their deployment and maintenance.Additionally,we discuss the challenges faced in the development and clinical application of sutureless anastomotic techniques.Ideally,a sutureless anastomotic device or technique should eliminate the need for vessel eversion,mitigate thrombosis through either biodegradation or the release of antithrombotic drugs,and be easily deployable for broad use.The transformative potential of sutureless anastomotic approaches in microvascular surgery highlights the necessity for ongoing innovation to expand their applications and maximize their benefits.展开更多
Lymphedema is a debilitating disorder caused by impaired drainage of the lymphatic system.In the Western world,lymphedema most often arises secondary to the treatment of malignancy.Patients with lymphedema experience ...Lymphedema is a debilitating disorder caused by impaired drainage of the lymphatic system.In the Western world,lymphedema most often arises secondary to the treatment of malignancy.Patients with lymphedema experience progressive swelling,pain,numbness,and tingling,and decreased quality of life.Those with persistent symptoms may be subject to chronic cellulitis.The advent of microsurgery has enabled clinicians to transplant donor lymph nodes and their blood supply from a healthy site to the affected area in a procedure known as vascularized lymph node transplant(VLNT).One donor region is the omentum.Vascularized omental lymph node transfer(VOLT)has been shown to decrease limb volume,circumference,and subjective symptoms of lymphedema.The immunologic properties of the omentum make it a particularly useful lymph node donor site for patients with lymphedemarelated cellulitis.The omentum may be harvested laparoscopically,with robotic assistance,or through a small laparotomy incision.In this review,we describe the relevant anatomy and history of VOLT as well as operative techniques.The risks,benefits,and relevant outcome studies will be reviewed.Recent applications of robotic surgery to VOLT will be addressed.展开更多
基金funding support received from the Institute of Materials Science and Engineering,and the Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences of the NIH,DoD Peer Reviewed Medical Research Program Discovery Award(HT94252310022 to Li and Sacks)Traumatic Brain Injury and Psychological Health Research Program Idea Development Award(W81XWH-22-1-0785 to Li),and NIH R01HL168513(Li).
文摘Sutureless anastomotic devices present several advantages over traditional suture anastomosis,including expanded global access to microvascular surgery,shorter operation and ischemic times,and reduced costs.However,their adaptation for arterial use remains a challenge.This review aims to provide a comprehensive overview of sutureless anastomotic approaches that are either FDA-approved or under investigation.These approaches include extraluminal couplers,intraluminal devices,and methods assisted by lasers or vacuums,with a particular emphasis on tissue adhesives.We analyze these devices for artery compatibility,material composition,potential for intimal damage,risks of thrombosis and restenosis,and complications arising from their deployment and maintenance.Additionally,we discuss the challenges faced in the development and clinical application of sutureless anastomotic techniques.Ideally,a sutureless anastomotic device or technique should eliminate the need for vessel eversion,mitigate thrombosis through either biodegradation or the release of antithrombotic drugs,and be easily deployable for broad use.The transformative potential of sutureless anastomotic approaches in microvascular surgery highlights the necessity for ongoing innovation to expand their applications and maximize their benefits.
文摘Lymphedema is a debilitating disorder caused by impaired drainage of the lymphatic system.In the Western world,lymphedema most often arises secondary to the treatment of malignancy.Patients with lymphedema experience progressive swelling,pain,numbness,and tingling,and decreased quality of life.Those with persistent symptoms may be subject to chronic cellulitis.The advent of microsurgery has enabled clinicians to transplant donor lymph nodes and their blood supply from a healthy site to the affected area in a procedure known as vascularized lymph node transplant(VLNT).One donor region is the omentum.Vascularized omental lymph node transfer(VOLT)has been shown to decrease limb volume,circumference,and subjective symptoms of lymphedema.The immunologic properties of the omentum make it a particularly useful lymph node donor site for patients with lymphedemarelated cellulitis.The omentum may be harvested laparoscopically,with robotic assistance,or through a small laparotomy incision.In this review,we describe the relevant anatomy and history of VOLT as well as operative techniques.The risks,benefits,and relevant outcome studies will be reviewed.Recent applications of robotic surgery to VOLT will be addressed.
