David Simhon

Immediate tight sealing of skin incisions using an innovative temperature-controlled laser soldering device: in vivo study in porcine skin.

Background:A feedback temperature-controlled laser soldering system (TCLS) was used for bonding skin incisions on the backs of pigs. The study was aimed: 1) to characterize the optimal soldering parameters, and 2) to compare the immediate and long-term wound healing outcomes with other wound closure modalities. Materials and Methods:A TCLS was used to bond the approximated wound margins of skin incisions on porcine backs. The reparative outcomes were evaluated macroscopically, microscopically, and immunohistochemically. Results:The optimal soldering temperature was found to be 65°C and the operating time was significantly shorter than with suturing. The immediate tight sealing of the wound by the TCLS contributed to rapid, high quality wound healing in comparison to Dermabond or Histoacryl cyanoacrylate glues or standard suturing. Conclusions:TCLS of incisions in porcine skin has numerous advantages, including rapid procedure and high quality reparative outcomes, over the common standard wound closure procedures. Further studies with a variety of skin lesions are needed before advocating this technique for clinical use.

In vivo laser soldering of incisions in juvenile pig skins using GaAs or CO2 lasers and a temperature control system

Two temperature controlled laser soldering systems were compared, one based on a GaAs laser and the other on a CO2 laser. Both systems were used for bonding full thickness incisions. Methods: 47% bovine serum albumin (BSA) solder was used in the CO2 laser soldering experiments. BSA with 1.8 mg/ml Indocyanine Green (ICG) was used for the GaAs soldering experiments. In both cases the solder was applied onto cuts created in juvenile pig skin and an infrared fiberoptic system was used to monitor and control different temperature and time settings. Differences in tensile strength and wound reparative parameters were compared between GaAs laser, CO2 laser, and Dermabond glued incisions on the seventh day after the operation. Results: The tensile strength of CO2 laser-soldered and Dermabond glued incisions were found to be higher than that of the GaAs laser-soldered incisions. Histological study showed better and faster wound healing characteristics of the CO2 laser soldered incisions, as compared to the GaAs laser-soldered and glued incisions. Conclusions: Preliminary results of temperature controlled CO2 laser soldered incisions suggest a better wound reparative process over the temperature controlled GaAs laser soldered incisions. Laser soldering offers many advantages over gluing techniques.

Laser soldering of rabbit skin using IR fiber optic temperature control system

Laser soldering of tissues is based on the application of a biological solder on the approximated edges of a cut. Our goal was to use laser soldering for sealing cuts in skin under temperature feedback control and compare the results with ones obtained using standard sutures. Albumin solder was applied onto the approximated edges of cuts created in rabbit skin. A fiberoptic system was used to deliver the radiation of a CO2 laser, to heat a spot near the cut edges, and to monitor and control the temperature. Laser soldering was carried out, spot by spot.

Errata: Temperature-controlled laser-soldering system and its clinical application for bonding skin incisions.

Laser tissue soldering is a method of repairing incisions. It involves the application of a biological solder to the approximated edges of the incision and heating it with a laser beam. A pilot clinical study was carried out on 10 patients who underwent laparoscopic cholecystectomy. Of the four abdominal incisions in each patient, two were sutured and two were laser soldered. Cicatrization, esthetical appearance, degree of pain, and pruritus in the incisions were examined on postoperative days 1, 7, and 30. The soldered wounds were watertight and healed well, with no discharge from these wounds or infection. The total closure time was equal in both methods, but the net soldering time was much shorter than suturing. There was no difference between the two types of wound closure with respect to the pain and pruritus on a follow-up of one month. Esthetically, the soldered incisions were estimated as good as the sutured ones. The present study confirmed that temperature-controlled laser soldering of human skin incisions is clinically feasible, and the results obtained were at least equivalent to those of standard suturing.

CO 2 temperature-controlled laser soldering of pig trachea incisions in vitro using flexible albumin bands

Resection of a segment of the trachea is a procedure applied for the removal of cervical tumors invading the trachea, or for the treatment of severe tracheal stenosis. The current method of anastomosis is based on multiple sutures. The main drawbacks of this method are: 1) A long procedure time, 2) An air leakage, and 3) An inflammatory response to the sutures. In this study we evaluated the feasibility and effectiveness of the use of temperature controlled CO2 laser soldering of incisions in pig tracheas in vitro. A transverse incision was made in a separated pig trachea. A flexible albumin band was prepared and was laser soldered with albumin solder to the outer surface of the trachea, covering the incision. The soldered trachea ends were sealed and the burst pressure was measured. In a series of in vitro experiments, the mean burst pressure was found to be 230 mm Hg. These preliminary results demonstrated that laser soldering using a flexible albumin band may be a useful method for sealing an incision in the trachea.

End-to-end small bowel anastomosis by temperature controlled CO 2 laser soldering and an albumin stent: a feasibility study

Introduction: A feasibility study of small intestinal end to end anastomosis was performed in a rabbit model using temperature controlled CO2 laser system and an albumin stent. Compared with standard suturing or clipping, this method does not introduce foreign materials to the repaired wound and therefore, may lead to better and faster wound healing of the anastomotic site. Methods: Transected rabbits small intestines were either laser soldered using 47% bovine serum albumin and intraluminal albumin stent or served as controls in which conventional continuous two-layer end to end anastomosis was performed manually. The integrity of the anastomosis was investigated at the 14th postoperative day. Results: Postoperative course in both treatments was uneventful. The sutured group presented signs of partial bowel obstruction. Macroscopically, no signs of intraluminal fluid leakage were observed in both treatments. Yet, laser soldered intestinal anastomoses demonstrated significant superiority with respect to adhesions and narrowing of the intestinal lumen. Serial histological examinations revealed better wound healing characteristics of the laser soldered anastomotic site. Conclusion: Laser soldering of intestinal end to end anastomosis provide a faster surgical procedure, compared to standard suture technique, with better wound healing results. It is expected that this technique may be adopted in the future for minimal invasive surgeries.

Wound healing studies of skin incisions in animal models: laser soldering versus other bonding methods

In the past, we have successfully used laser soldering for bonding cuts in the skin of medium and large size animal models. In this work, we have used the same method for bonding cuts on the backs of rabbits and mature pigs model. Cuts were created in dorsally depilated skins of rabbits and mature pigs. 47% bovine serum albumin (BSA) solder was applied onto the approximated edges of each cut, using a special approximation device. An infrared fiberoptic CO2 laser system was used to heat a spot on the cut, under good temperature control, to 65°C for 10 seconds. Other glued or sutured cuts, served as controls. Immediate tensile strength measurements were done on bonded incisions in rabbit skins. We found that laser soldered incisions exhibited similar strength to one bonded by cayanoacrylate glue. No dehiscence of wound edges was found in both treatments. The laser soldering procedure was 25% faster then suturing. A 14-day follow up of the bonded pig skin incisions was carried out, using punch biopsies. We found better aesthetic appearance of the soldered incisions. We observed better and faster wound repair in the laser-soldered scars, using histological and molecular staining. The temperature controlled laser soldering offers immediate strength similar to that of cyanoacrylate glues and better aesthetic and wound healing properties, in comparison to suturing techniques. We have clearly demonstrated the potential of this novel technique, which will pave thw way for clinical studies.

Laser soldering of pig skin in vivo using IR fiber optic temperature control system

Background and objectives: A feedback temperature controlled laser soldering system was used for bonding cut wounds on the skins of young and mature pigs. This is a step towards clinical implantation of this promising novel technique. Materials and methods: 47% bovine serum albumin (BSA) solder was applied onto cuts created in dorsally d epilated skin on the backs of pigs, weighing 8 -10Kg or 74Kg. A temperature fiberoptic CO2 laser system was used to monitor and control the temperature of a spot on the cut at a desired temperature. For given values of time and temperature, a 28 days follow up of the soldered scars was obtained and compared with standard suturing. Results: Optimal soldering temperature was found to be 65oC. The tensile strength of laser-soldered cuts was measured after 3-28 days postoperatively and was found similar to that of sutured cuts. Macroscopic and microscopic studies showed better and faster wound healing of soldered scars compared with standard sutures. All soldered scars in the mature pig, demonstrated excellent healing with no signs of dehiscence. Conclusions: Temperature controlled laser soldering of cut wounds in pig skin offers several advantages over standard suturing techniques. This novel method should be tested clinically.