Since the first experimental report of the vascular anastomosis surgical technique for organ transplantation by Dr. Alex Carrel in 1902, its clinical use has become widespread and has come to define the surgical course in the 20th century. Among the various surgical techniques used during organ transplantation, a common technique includes blocking of blood vessels to prevent blood flow to the target organ, thereby reducing perfusion. However, warm ischemia, or the exposure of the tissue parenchyma to ischemia under normothermic conditions, has recently been established as a concern during transplantation. Herein, we describe a technique of establishing vascular anastomoses the organ undergoing transplantation involving tubes that can be inserted into the organ. By using this technique, it is possible to quickly establish anastomotic blood vessels without the loss of blood flow.
The inserting tubes holds the cross section of blood vessel in a triangular shape when the triple-stapled anastomosis of Carrel is operated. As a result, blood vessel anastomoses can easily and quickly be established while the organ is in an intubated state. In addition, the triangle shape enhances the rigidity of the tube, thereby reducing the risk of defects that result in perforation due to twisting or kinking of the tubes, which are made of soft materials. Additionally, it improves the stability of the tubes used during this procedure (Figure1)
We operated 6 porcine transplantation to evaluate this technic. Perfusion flows was maintained during the vascular anastomosis without excessive pressure fluctuations. In addition, compared with previous ways of suturing blood vessels, it was possible to shorten the anastomotic time using this technique, and it could be suppressed within 1 minute from stop of perfusion to restart of blood flow. This technique reduces the severity of warm ischemia during organ transplantation and remarkably improves the health of the donor organs from cardiac death, as shown in porcine models. Therefore, this medical device merits consideration for use as a novel surgical technology.