An Early Investigation into Possible Alternatives to Stapled Hysterotomy in Open Fetal Surgery

Joseph T. Church; Jennifer S. McLeod; Megan A. Coughlin; Ingrid L. Bergin; Elena M. Perkins; Hayley R. Hoffman; Mark Bilger; Alvaro Rojas-Peña; Marjorie C. Treadwell; Deborah R. Berman; Marcus D. Jarboe; George B. Mychaliska; Erin E. Perrone

doi:10.1055/s-0038-1673664

American Journal of Perinatology, Table of Contents

Am J Perinatol 2019; 36(07): 742-750
DOI: 10.1055/s-0038-1673664

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

An Early Investigation into Possible Alternatives to Stapled Hysterotomy in Open Fetal Surgery

Joseph T. Church

¹Extracorporeal Life Support Laboratory, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan

,

Jennifer S. McLeod

¹Extracorporeal Life Support Laboratory, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan

,

Megan A. Coughlin

¹Extracorporeal Life Support Laboratory, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan

,

Ingrid L. Bergin

²Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan

,

Elena M. Perkins

¹Extracorporeal Life Support Laboratory, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan

,

Hayley R. Hoffman

¹Extracorporeal Life Support Laboratory, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan

,

Mark Bilger

¹Extracorporeal Life Support Laboratory, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan

,

Alvaro Rojas-Peña

¹Extracorporeal Life Support Laboratory, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan

,

Marjorie C. Treadwell

³Department of Obstetrics and Gynecology, Fetal Diagnosis and Treatment Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan

,

Deborah R. Berman

³Department of Obstetrics and Gynecology, Fetal Diagnosis and Treatment Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan

,

Marcus D. Jarboe

⁴Department of Surgery, Fetal Diagnosis and Treatment Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan

,

George B. Mychaliska

⁴Department of Surgery, Fetal Diagnosis and Treatment Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan

,

Erin E. Perrone

⁴Department of Surgery, Fetal Diagnosis and Treatment Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan

› Author Affiliations

Abstract

Purpose We hypothesized that surgical energy could be used to create hysterotomies in open fetal surgery.

Study Design Initial studies compared the LigaSure Impact and Harmonic ACE + 7 Shears in the efficiency of hysterotomy and thermal damage. Pregnant ewes at an estimated gestational age (EGA) of 116 to 120 days (term = 145; n = 7) underwent hysterotomy using either device. Hysterotomy edges were resected, and thermal injury extent was determined by histopathological assessment. Upon determining a superior device, subsequent studies compared this to the AutoSuture Premium Poly CS*-57 Stapler in uterine healing. Pregnant ewes (n = 6) at an EGA of 87 to 93 days underwent 6-cm hysterotomy in each gravid horn with either the stapler (n = 5) or Harmonic (n = 5) followed by closure and animal recovery. After 37 to 42 days, uterine healing was assessed by evaluating tensile strength and histopathology.

Results Thermal damage was more extensive with the LigaSure (n = 11 hysterotomies) than with the Harmonic (n = 11; 5.6 ± 1 vs. 3.1 ± 0.6 mm; p < 0.0001);therefore, the Harmonic was selected for healing studies. Gross scar appearance and tensile strength were the same between the Harmonic and stapler. The stapler caused more fibrosis (4/7 samples with “moderate” fibrosis vs. 0/8 with the Harmonic; p = 0.02).

Conclusion The Harmonic ACE + 7 caused less thermal injury than the LigaSure Impact and performed similar to the CS*-57 Stapler in uterine healing with continued gestation.

Keywords

hysterotomy - prenatal - Harmonic - LigaSure - AutoSuturePremium Poly CS*-57 Stapler - surgical energy

Full Text

References

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