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Trends in Neurovascular Surgery pp 45–53Cite as

Tissue Fusion, a New Opportunity for Sutureless Bypass Surgery

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Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 112))

Abstract

Microsurgical suturing is the standard for cerebral bypass surgery, a technique where temporary occlusion is usually necessary. Non-occlusive techniques such as excimer laser-assisted non-occlusive anastomosis (ELANA) have certainly widened the spectrum of treatment of complex cerebrovascular situations, such as giant cerebral aneurysms, that were otherwise non-treatable. Nevertheless, the reduction of surgical risks while widening the spectrum of indications, such as a prophylactic cerebral bypass, is still a main aim, that we would like to pursue with our sutureless tissue fusion research. The primary concern in sutureless tissue fusion- and especially in tissue fusion of cerebral vessels- is the lack of reproducibility, often caused by variations in the thermal damage of the vessel. This has prevented this novel fusion technique from being applicable in daily surgical use. In this overview, we present three ways to further improve the laser tissue soldering technique.

In the first section entitled “Laser Tissue Soldering Using a Biodegradable Polymer,” a porous polymer scaffold doped with albumin (BSA) and indocyanine green (ICG) is presented, leading to strong and reproducible tensile strengths in tissue soldering. Histologies and future developments are discussed.

In the section “Numerical Simulation for Improvement of Laser Tissue Soldering,” a powerful theoretical simulation model is used to calculate temperature distribution during soldering. The goal of this research is to have a tool in hand that allows us to determine laser irradiation parameters that guarantee strong vessel fusion without thermally damaging the inner structures such as the intima and endothelium.

In a third section, “Nanoparticles in Laser Tissue Soldering,” we demonstrate that nanoparticles can be used to produce a stable and well-defined spatial absorption profile in the scaffold, which is an important step towards increasing the reproducibility. The risks of implanting nanoparticles into a biodegradable scaffold are discussed.

Step by step, these developments in sutureless tissue fusion have improved the tensile strength and the reproducibility, and are constantly evolving towards a clinically applicable anastomosis technique.

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Author information

Authors and Affiliations

  1. Institute of Applied Physics, University of Bern, Bern, Switzerland

    Serge Bogni, Martin Frenz & Michael Reinert

  2. Department of Neurosurgery, Inselspital Bern, University of Bern, Bern, Switzerland

    Daniel Schöni, Amadé Bregy & Andreas Raabe

  3. Department of Plastic and Reconstructive Surgery, Inselspital Bern, University of Bern, Bern, Switzerland

    Mihai Constantinescu

  4. Institute for Chemistry and Bioanalytics, Fachhochschule Nordwestschweiz, Basel, Switzerland

    Amina Wirth & Uwe Pieles

  5. Institute of Pathology, University of Bern, Bern, Switzerland

    Istvan Vajtai

  6. Department of Neurosurgery, Inselspital Bern, 3010, Bern, Switzerland

    Michael Reinert

Authors
  1. Serge Bogni
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  2. Daniel Schöni
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  3. Mihai Constantinescu
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  4. Amina Wirth
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  5. Istvan Vajtai
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  6. Amadé Bregy
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  7. Andreas Raabe
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  8. Uwe Pieles
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  9. Martin Frenz
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  10. Michael Reinert
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Corresponding author

Correspondence to Michael Reinert .

Editor information

Editors and Affiliations

  1. Dept. Neurosurgery, Kyoto National Hospital, Mukaihata-cho 1-1, Kyoto, 612-8555, Japan

    Tetsuya Tsukahara

  2. University Medical Center, Department of Neurosurgery, Rudolf Magnus Institute of Neuroscience, Heidelberglaan 100, Utrecht, 3508 GA, Netherlands

    Luca Regli

  3. Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Moorenstraße 5, Düsseldorf, 40225, Germany

    Daniel Hänggi

  4. Universitätsklinikum Düsseldorf, Institut für Radiologie, Moorenstraße 5, Düsseldorf, 40335, Germany

    Bernd Turowski

  5. Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Moorenstr. 5, Düsseldorf, 40225, Germany

    Hans-Jakob Steiger

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Bogni, S. et al. (2011). Tissue Fusion, a New Opportunity for Sutureless Bypass Surgery. In: Tsukahara, T., Regli, L., Hänggi, D., Turowski, B., Steiger, HJ. (eds) Trends in Neurovascular Surgery. Acta Neurochirurgica Supplementum, vol 112. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0661-7_9

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  • DOI: https://doi.org/10.1007/978-3-7091-0661-7_9

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  • Print ISBN: 978-3-7091-0660-0

  • Online ISBN: 978-3-7091-0661-7

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