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Small vessels endoscopic anastomosis: feasibility study

Epublication WebSurg.com, Mar 2014;14(03). URL: http://websurg.com/doi/lt03enrobert001

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  • 2014-03-07
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The size of incisions for free muscle flaps is often very large, and a source of deep adhesions and unesthetic scars but it is justified by performing the microsurgical step comfortably. In the hope of shortening the size of incisions, the objective of this work was to study the feasibility of vascular micro-anastomoses using an endoscopic approach. The material consisted of 2 cadavers, a tele-manipulator, and a vascular clamp. The antebrachial skin was detached, then distended by gas insufflations. Four incisions, one centimeter each, allowed for the set-up of 4 trocars connected to the tele-manipulator. The artery was dissected (radial or ulnar) and the vascular clamp was introduced under the skin through one of the trocars, and then positioned on the dissected artery. The vascular anastomosis was performed with the use of a 10/0 Nylon suture. The anastomosis lasted 2 hours under insufflation with no leaks. The 2 arteries were identified, then dissected without difficulty. The anastomosis was performed in adequate conditions. The mounting and demounting of the clamp were time-consuming. The main difficulties were caused by a long suture and a very fragile needle. Our results demonstrate the feasibility of vascular micro-anastomosis using an endoscopic approach. The next step is to perform the first clinical case (e.g., on a latissimus dorsi free muscle flap).