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Currently, the majority of spontaneous pneumothorax surgeries
are performed with wedge apical resection and parietal pleurectomy.
The tissue welding method consists of bonding live tissues
using a patented radio frequency current method. This process
ensures leakproof bonding of tissues. Through mid- 2006 several
Ukrainian clinics have performed over 6,000 successful human
surgeries using the tissue welding process. Based on the results
of previous experimental and clinical studies we undertook
surgical research of the tissue welding method for management
of spontaneous pneumothorax. Bipolar, radio frequency used
in the tissue welding technology current allows ablation of
the bullae, which are caused by late-stage emphysema, and
allows closure of broncho-pleural communication thus eliminating
a condition of air leakage into the chest cavity thus restoring
the normal function of the visceral pleura.
We performed a study on the effect of lung tissue welding
compared to conventional stapling in surgical management of
spontaneous pneumothorax. The following are the results of
this study.
All preoperative procedures as well as operative management
procedures were done by eight surgeons with different experiences
who were not informed of the objective of the study. Patients
were randomly selected for the controlled study and put either
into the tissue welding group "TW group" or the
conventional treatment group "CT group".
During the period between May 2005 - January 2006, 41 consecutive
patients were operated on for spontaneous pneumothorax.
From these 41 patients, 24 patients with an average age of
28.1 yrs were included in the TW group. Indications for surgery
of the TW group were: recurrence of pneumothorax in 13 cases
(54%), prolonged air leakage in 9 (37%), haemopneumothorax
in 1, major bullous changes viewed on direct thoracoscopy
in 1 case. On the day of their surgeries, 12 patients had
been observed with prolonged air leakage ranging from 2 to
5 days.
Of the original 41 patients, 17 patients were included in
the CT group with an average age of 26.5 yrs. Indications
for surgery were: recurrence of pneumothorax in 13 (76%) cases,
prolonged air leakage in 2 cases, spontaneous pneumohaemothorax
in 2 cases, 5 patients from the CT group were observed with
an air leakage prior to the surgery.
In the both groups surgery was made through limited lateral
thoracotomy. In the TW group by applying the RF tissue welding,
the bullae were reduced allowing the visceral pleura to form
a natural seal of the alveoli thus eliminating air leakage
without lung resection, tissue removal, or other surgery with
the original bipolar welding device without the use of staples,
glues, sutures or sealants. In the CT group, we performed
apical wedge resection removing portions of the lung and using
a conventional stapler as the lung closing device. Abrasion
and coagulation of parietal pleura was done in both groups.
In all patients of the tissue welding group where air leakage
was observed prior to surgery, the tissue welding technology
achieved sealing the lungs without resection or use of sutures,
glues, sealants or staples.
Operating time in the tissue welding as compared to the
control groups was 67 and 75 minutes respectively (p>0.05),
chest drains were removed on an average of 2.58 and 3.35 days
postoperatively (p<0.05), postoperative hospital stay was
5.04 and 5.7 days (p>0.05). In the CT group, 2 patients
also had prolonged air leakage and incomplete lung expansion
after surgery while the TW group had no air leakage or incomplete
lung expansion after surgery. During the follow-up period
that ranged from 1 to 12 months there were no recurrences
that appeared in either group.
Welding on lung tissue is easy to use and allows repair
of the lung without resection and removal of lung portions
thus sealing the lungs and avoiding removal of portions of
this key organ without the use of foreign matters such as
staples, sutures, glues or sealants, and prevents post-surgery
air leakage in spontaneous pneumothorax. Lung tissue welding
can also be performed using the thoracoscopic approach. At
the time of this report we have performed 30 video-thoracoscopic
welding procedures. It is possible for this technique to replace
conventional surgical methods such as sutures and staples
while providing reduced operating time, shorter patient healing
time and shorter hospital stays.
In expansion of surgical uses and techniques of the thoracic
applications of the tissue welding technology we are cataloguing
the long-term results and morphological studies to develop
a long-term expanded data base as the number of patients grows.
The tissue welding/bonding technology for repair and reconnection
of tissue and hollow organs is smokeless, with little heat
migration in the tissue, results in no necrosis and is without
the use of foreign matter or conventional wound-closing devices,
such as of staples, sutures, glues or sealants. The procedures
are almost bloodless while bonding and reconnecting incised
or damaged tissue aimed at restoring the normal functions
of the live organs and tissue. The technology leaves little
or no scar visible to the naked eye.
Surgeons at 10 Ukraine hospitals and clinics are using the
tissue welding/bonding technology in clinical trials, have
completed more than 6,000 human surgeries using over 70 types
of open and laparoscopic surgical procedures and have demonstrated
that the technology is universal in its ability to repair
soft biological tissue. These surgeries included lung, neuro-surgery,
nasal septum, intestine, stomach, skin, gall bladder, liver,
spleen, blood vessels, nerves, alba linea, uterus, bladder,
gynecology, fallopian tube, ovary and testicles and dura-matter.
Acknowledgements: CSMG Technologies, Inc. owns the technology
and financed R&D managed by International Association
"Welding" of the E. O. Paton Electric Welding Institute
were the technology was invented.
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