Open AccessEfficacy of a Novel Medical Adhesive for Sealing Lung Parenchyma: An in vitro Study in Rabbit Lungs
Author(s) -
Sebastian Kalverkamp,
Anna Mantas,
Jan Spillner,
Flutura Hima,
Stephanie Kanzler,
Thaddäus Stopinski,
René Tolba,
Rashad Zayat
Publication year - 2021
Publication title -
european surgical research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 46
eISSN - 1421-9921
pISSN - 0014-312X
DOI - 10.1159/000517173
Subject(s) - in vivo , fibrous joint , medicine , surgery , leak , lung , parenchyma , anesthesia , pathology , biology , microbiology and biotechnology , environmental engineering , engineering
During thoracic resection procedures, complete hemostasis and aerostasis are priorities. A persistent alveolar air leak is associated with increased morbidity and mortality rates. This study aimed to evaluate whether the novel medical adhesive VIVO (Adhesys Medical GmbH Aachen, Germany) is a reliable alternative sealing technique to routine surgical procedures. Methods: We conducted an in vitro animal study by analyzing 21 lungs of New Zealand ( n = 19) and Chinchilla Bastard ( n = 2) rabbits (age, 11–18 weeks; weight, 2,400–3,600 g). Three groups, each comprising 7 animals, were evaluated. VIVO (VIVO-group) was compared with standard surgical lung parenchymal lesion closure with a polypropylene suture (Suture-group) and TachoSil® (TachoSil-group). We adopted a stable, pressure-controlled ventilation protocol. After explantation, a surgical incision 0.5-cm deep and 1.5-cm wide was made in the lungs using a customized template. Air leak was measured quantitatively (mL/min) using a respirator and visualized qualitatively by 2 observers who made independent judgments. Next, the leak was closed using VIVO, suture, or TachoSil® as specified by the manufacturer. Subsequently, positive end-expiratory pressure (PEEP) and inspiratory pressure were gradually increased until a maximum of 15 and 30 mbar were attained, respectively. Results: At PEEPs of 8, 10, and 15 mbar, VIVO achieved complete sealing of the profound parenchymal defect in all ( n = 7) lungs. After closure of the incision, we observed an air leak variation of 127 ± 114 mL/min (Suture-group), 31 ± 49 mL/min (VIVO-group), and 114 ± 134 mL/min (TachoSil-group). VIVO showed a significantly lower air leak than surgical sutures ( p = 0.031) and TachoSil® ( p = 0.046). Conclusion: VIVO offers sufficient closure of the lung parenchymal lesions. The novel adhesive enabled significantly better sealing with lower persistent air leakage than TachoSil® or surgical sutures. Further investigation using in vivo models is strongly encouraged to confirm our findings.