Lasers in Medical Science

, Volume 32, Issue 6, pp 1343–1348 | Cite as

Endoluminal laser-assisted vascular anastomosis—an in vivo study in a pig model

  • Zacharia MbaidjolEmail author
  • David Kiermeir
  • Annemarie Schönfeld
  • Jörg Arnoldi
  • Martin Frenz
  • Mihai A. Constantinescu
Original Article


Microvascular surgery is time consuming and requires high expertise. Laser-assisted vascular anastomosis (LAVA) is a promising sutureless technique that has the potential to facilitate this procedure. In this study, we evaluate the handling of our soldering material and the 1-week patency rate in a porcine model. Six pigs were subjected to LAVA. For each pig, the saphenous artery on one side was transected while the contralateral side was used as control. A porous polycaprolactone scaffold soaked in 40% (w/w) bovine serum albumin solution in combination with 0.1% (w/w) indocyanine green was wrapped at the anastomosis site and at the control site. Both sides were then soldered with a diode laser coupled into a light diffuser fiber emitting radiation with a wavelength of 808 nm and a power of 2–2.2 W. Vessels were successfully soldered with a 100% immediate patency rate. The 1-week patency rate was 83% for the anastomoses versus 67% for the control side. Vessels irradiated for 80 to 90 s tended to maintain the highest patency rate. Macroscopically, there was no difference between the two sides. The patch was easy to handle provided that the environment could be kept dry. This study shows the potential and the limitations of endoluminal LAVA as a one-step procedure without the use of stay sutures. Further studies are needed to improve the soldering material, the long-term patency rate, and standardized irradiation parameters. The long-term effects of laser soldering on the vessel wall remain to be determined.


LAVA Soldering Sutureless anastomoses 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Role of funding source

This study was supported by a grant of the Swiss National Science Foundation (project number 108447).

Informed consent

This article does not contain any studies with human participants performed by any of the authors.

Ethical approval

All animal experimentations were performed after approval from the animal care committee of the Canton of Bern, Switzerland (Nr. BE72/07) and in agreement with international guidelines and the guidelines for the care and use of experimental animals of the National Institutes of Health.


  1. 1.
    Carrel A (1963) The operative technique of vascular anastomoses and the transplantation of viscera. Clin Orthop Relat Res 29:3–6Google Scholar
  2. 2.
    Ozkan O, Ozgentas HE (2005) Open guide suture technique for safe microvascular anastomosis. Ann Plast Surg 55:289–291CrossRefPubMedGoogle Scholar
  3. 3.
    Zeebregts CJ, Heijmen RH, van den Dungen JJ, van Schilfgaarde R (2003) Non-suture methods of vascular anastomosis. Br J Surg 90:261–271CrossRefPubMedGoogle Scholar
  4. 4.
    McNally KM, Sorg BS, Chan EK, Welch AJ, Dawes JM, Owen ER (1999) Optimal parameters for laser tissue soldering. Part I: tensile strength and scanning electron microscopy analysis. Lasers Surg Med 24:319–331CrossRefPubMedGoogle Scholar
  5. 5.
    Constantinescu MA, Alfieri A, Mihalache G, Stuker F, Ducray A, Seiler RW, Frenz M, Reinert M (2007) Effect of laser soldering irradiation on covalent bonds of pure collagen. Lasers Med Sci 22:10–14CrossRefPubMedGoogle Scholar
  6. 6.
    Bregy A, Bogni S, Bernau VJ, Vajtai I, Vollbach F, Petri-Fink A, Constantinescu M, Hofmann H, Frenz M, Reinert M (2008) Solder doped polycaprolactone scaffold enables reproducible laser tissue soldering. Lasers Surg Med 40:716–725CrossRefPubMedGoogle Scholar
  7. 7.
    Ott B, Zuger BJ, Erni D, Banic A, Schaffner T, Weber HP, Frenz M (2001) Comparative in vitro study of tissue welding using a 808 nm diode laser and a Ho:YAG laser. Lasers Med Sci 16:260–266CrossRefPubMedGoogle Scholar
  8. 8.
    Ott B, Constantinescu MA, Erni D, Banic A, Schaffner T, Frenz M (2004) Intraluminal laser light source and external solder: in vivo evaluation of a new technique for microvascular anastomosis. Lasers Surg Med 35:312–316CrossRefPubMedGoogle Scholar
  9. 9.
    Perry MO, Thal ER, Shires GT (1971) Management of arterial injuries. Ann Surg 173:403–408CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Suominen S, Asko-Seljavaara S (1995) Free flap failures. Microsurgery 16:396–399CrossRefPubMedGoogle Scholar
  11. 11.
    Swindle MM, Makin A, Herron AJ, Clubb FJ Jr, Frazier KS (2012) Swine as models in biomedical research and toxicology testing. Vet Pathol 49:344–356CrossRefPubMedGoogle Scholar
  12. 12.
    Bogni S, Stumpp O, Reinert M, Frenz M (2010) Thermal model for optimization of vascular laser tissue soldering. J Biophotonics 3:284–295CrossRefPubMedGoogle Scholar
  13. 13.
    Fingar VH (1996) Vascular effects of photodynamic therapy. J Clin Laser Med Surg 14:323–328PubMedGoogle Scholar
  14. 14.
    Nightingale G, Fogdestam I, O'Brien BM (1980) Scanning electron microscope study of experimental microvascular anastomoses in the rabbit. Br J Plast Surg 33:283–298CrossRefPubMedGoogle Scholar
  15. 15.
    Marchese E, Albanese A, Denaro L, Vignati A, Fernandez E, Maira G (2005) Intraoperative microvascular Doppler in intracranial aneurysm surgery. Surg Neurol 63:336–342 discussion 342 CrossRefPubMedGoogle Scholar
  16. 16.
    Wolf-de Jonge IC, Beek JF, Balm R (2004) 25 years of laser assisted vascular anastomosis (LAVA): what have we learned? Eur J Vasc Endovasc Surg 27:466–476CrossRefPubMedGoogle Scholar
  17. 17.
    Quigley MR, Bailes JE, Kwaan HC, Cerullo LJ, Brown JT, Fitzsimmons J (1985) Comparison of bursting strength between suture- and laser-anastomosed vessels. Microsurgery 6:229–232CrossRefPubMedGoogle Scholar
  18. 18.
    Chen C, Peng F, Xu D, Cheng Q (2009) A meta-analysis of aneurysm formation in laser assisted vascular anastomosis (LAVA). Proc SPIE 7519, Eighth international conference on photonics and imaging in biology and medicine 7519Google Scholar

Copyright information

© Springer-Verlag London Ltd. 2017

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive SurgeryInselspital Bern, University of BernBernSwitzerland
  2. 2.Institute of Applied PhysicsUniversity of BernBernSwitzerland

Personalised recommendations