Dye-Enhanced Tissue Welding Using Fibrinogen and Continuous-Wave Argon Lasers

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Abstract
Despite their theoretical advan tages, laser-welded anastomoses ini tially appear prone to rupture. Furthermore, the repair of defects seen in the weld following laser energy expo sure is often hindered by thermal in jury to the tissue edges. In this study, the immediate strength of these welds has been increased by the application of fibrinogen combined with a laser-en ergy-absorbing dye, fluorescein isothiocyanate (FITC, maximum absorbance 490 nm), to the anasto motic site prior to continuous-wave argon laser exposure (488-514 nm, 5.66 watts/cm2). A rabbit abdominal aorto tomy model was employed. Data ob tained immediately after welding demonstrated that the mean bursting pressure of welds created without fi brinogen (184 ± 65 mm Hg, n = 12) was significantly less than that of re pairs with fibrinogen (407 ± 72 mm Hg, n = 11) (p<.001). Defects seen in the weld immediately after laser expo sure could be easily repaired by addi tional application of fibrinogen and repeated laser treatment. Histologi cally, aortotomies repaired with fibrin ogen demonstrate less thermal injury to host tissues than nonsolder repairs do. Laser soldering with exogenous fi brinogen significantly improves the bursting strength of primary laser- welded anastomoses and mitigates technical difficulties with laser tissue welding.