Jude S. Sauer

Automated Remote Transapical Wound Closure System Study

PURPOSE A readily applied and reliable means to create and close transapical wound access sites through a small intercostal opening could benefit many cardiac patients. Using relevant surgical tissue models, this research evaluated a new approach to enable single-port transapical wound site closure toward the eventual development of safe percutaneous access to the left ventricle. DESCRIPTION Novel techniques and technologies were developed and successfully tested for remote automated placement of 2 pledgeted horizontal mattress sutures delivered concentrically around a transmural apical guidewire, which provided a tract to enable therapeutic intervention. Mechanical pledgeted knots secured these sutures after cannula removal. EVALUATION Automated transapical closures were created in 47 ex vivo porcine hearts and in 10 human cadavers, 8 through a thoracotomy and 2 thoracoscopically. Automated apical closures achieved hemostasis in an acute beating heart thoracotomy model in 3 anesthetized pigs. An ex vivo porcine heart pressurized infusate model demonstrated the intraventricular pressure tolerated by automated closures (mean, 327 mm Hg) compared with hand-sutured closures (mean, 303 mm Hg). CONCLUSIONS All automated apical closures were effective. Early results encourage further evaluation.

Novel Automated Suturing Technology for Minimally Invasive Aortic Valve Replacements

PURPOSE Annular suture placement during minimally invasive right anterior thoracotomy aortic valve replacements (MI-AVR) can be challenging. We present the early clinical experience with novel automated suturing technology that may reduce the technical difficulty of this operation. DESCRIPTION The technology presented involves an automated articulating suturing device that simultaneously drives dual-curved needles through the aortic annulus to place a pledgeted horizontal mattress suture remotely; a second device with 2 straight needles places suture through the sewing cuff of a prosthetic heart valve. EVALUATION Automated annular suturing was used in five MI-AVR procedures, which were successfully completed, with no paravalvular leaks detected and a mean aortic valve gradient of 6.4 mm Hg postprocedure. Mean aortic cross-clamp and cardiopulmonary bypass times were 100 and 134 minutes, respectively. All 5 patients were successfully discharged home, with a mean intensive care unit and total length of stay of 2 and 7 days, respectively. CONCLUSIONS Automated suturing during MI-AVRs is feasible and may reduce the technical challenge of this operation. Further research is necessary to determine its effect on patient outcomes.

An automated approach to laser tissue welding: the Exoscope System

The Exoscope System for laser welding surgical connections between tubular tissue is designed for use in human gastrointestinal, genitourinary and vascular surgical procedures. It is asserted that excellent anastomoses can be constructed more quickly and with less technical difficulty by using the automated Exoscope System technique than with other contemporary methods and that the resulting laser-welded tissue bonds can be physiologically superior.<<ETX>>