An Early Investigation into Possible Alternatives to Stapled Hysterotomy in Open Fetal Surgery

被引:6
|
作者
Church, Joseph T. [1 ]
McLeod, Jennifer S. [1 ]
Coughlin, Megan A. [1 ]
Bergin, Ingrid L. [2 ]
Perkins, Elena M. [1 ]
Hoffman, Hayley R. [1 ]
Bilger, Mark [1 ]
Rojas-Pena, Alvaro [1 ]
Treadwell, Marjorie C. [3 ]
Berman, Deborah R. [3 ]
Jarboe, Marcus D. [4 ]
Mychaliska, George B. [4 ]
Perrone, Erin E. [4 ]
机构
[1] Univ Michigan, Extracorporeal Life Support Lab, Dept Surg, Michigan Med, Ann Arbor, MI 48109 USA
[2] Univ Michigan, Unit Lab Anim Med, Ann Arbor, MI 48109 USA
[3] Univ Michigan, Dept Obstet & Gynecol, Fetal Diag & Treatment Ctr, Michigan Med, Ann Arbor, MI 48109 USA
[4] Univ Michigan, Dept Surg, Fetal Diag & Treatment Ctr, Michigan Med, Ann Arbor, MI 48109 USA
关键词
hysterotomy; prenatal; Harmonic; LigaSure; AutoSuturePremium Poly CS*-57 Stapler; surgical energy; HARMONIC SCALPEL; REPRODUCTIVE OUTCOMES; MATERNAL MORBIDITY; THYROID-SURGERY; HEMOSTASIS; LIGASURE; METAANALYSIS;
D O I
10.1055/s-0038-1673664
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Purpose We hypothesized that surgical energy could be used to create hysterotomies in open fetal surgery. Study Design Initial studies compared the LigaSure Impact and Harmonic ACE+7 Shears in the efficiency of hysterotomy and thermal damage. Pregnant ewes at an estimated gestational age (EGA) of 116 to 120 days (term=145; n =7) underwent hysterotomy using either device. Hysterotomy edges were resected, and thermal injury extent was determined by histopathological assessment. Upon determining a superior device, subsequent studies compared this to the AutoSuture Premium Poly CS*-57 Stapler in uterine healing. Pregnant ewes ( n =6) at an EGA of 87 to 93 days underwent 6-cm hysterotomy in each gravid horn with either the stapler ( n =5) or Harmonic ( n =5) followed by closure and animal recovery. After 37 to 42 days, uterine healing was assessed by evaluating tensile strength and histopathology. Results Thermal damage was more extensive with the LigaSure ( n =11 hysterotomies) than with the Harmonic ( n =11; 5.61 vs. 3.1 +/- 0.6mm; p <0.0001);therefore, the Harmonic was selected for healing studies. Gross scar appearance and tensile strength were the same between the Harmonic and stapler. The stapler caused more fibrosis (4/7 samples with moderate fibrosis vs. 0/8 with the Harmonic; p =0.02). Conclusion The Harmonic ACE+7 caused less thermal injury than the LigaSure Impact and performed similar to the CS*-57 Stapler in uterine healing with continued gestation.
引用
收藏
页码:742 / 750
页数:9
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