Sutureless liver repair and hemorrhage control using laser-mediated fusion of human albumin as a solder

• Published in: The journal of trauma Vol. 51; no. 1; p. 51
• Main Authors: Wadia, Y, Xie, H, Kajitani, M
• Format: Journal Article
• Language: English
• Published: United States 01.07.2001
• Subjects: Animals; Hemostasis, Surgical; Hepatectomy; Humans; Indocyanine Green; Lacerations - surgery; Laser Coagulation; Liver - injuries; Liver - surgery; Serum Albumin; Suture Techniques; Swine; Wound Healing - physiology; Wounds, Nonpenetrating - surgery; Wounds, Stab - surgery
• ISSN: 0022-5282
• DOI: 10.1097/00005373-200107000-00008

Major liver trauma has a high mortality because of immediate exsanguination and a delayed morbidity from septicemia, peritonitis, biliary fistulae, and delayed secondary hemorrhage. We evaluated laser soldering using liquid albumin for welding liver injuries. Fourteen lacerations (6 x 2 cm) and 13 nonanatomic resection injuries (raw surface, 8 x 2 cm) were repaired. An 805-nm laser was used to weld 53% liquid albumin-indocyanine green solder to the liver surface, reinforcing it by welding a free autologous omental scaffold. The animals were heparinized and hepatic inflow occlusion was used for vascular control. For both laceration and resection injuries, 16 soldering repairs were evaluated acutely at 3 hours. Eleven animals were evaluated chronically, two at 2 weeks and nine at 4 weeks. All 27 laser mediated-liver repairs had minimal blood loss compared with the suture controls. No dehiscence, hemorrhage, or bile leakage was seen in any of the laser repairs after 3 hours. All 11 chronic repairs healed without complication. This modality effectively seals the liver surface, joins lacerations with minimal thermal injury, and works independently of the patient's coagulation status.