Surgical suture assembled with polymeric drug-delivery sheet for sustained,local pain relief

Surgical suture is a strand of biocompatible material designed for wound closure, and therefore can be a medical device potentially suitable for local drug delivery to treat pain at the surgical site. However, the preparation methods previously introduced for drug-delivery sutures adversely influenced the mechanical strength of the suture itself – strength that is essential for successful wound closure. Thus, it is not easy to control drug delivery with sutures, and the drug-delivery surgical sutures available for clinical use are now limited to anti-infection roles. Here, we demonstrate a surgical suture enabled to provide controlled delivery of a pain-relief drug and, more importantly, we demonstrate how it can be fabricated to maintain the mechanical strength of the suture itself. For this purpose, we separately prepare a drug-delivery sheet composed of a biocompatible polymer and a pain-relief drug, which is then physically assembled with a type of surgical suture that is already in clinical use. In this way, the drug release profiles can be tailored for the period of therapeutic need by modifying only the drug-loaded polymer sheet without adversely influencing the mechanical strength of the suture. The drug-delivery sutures in this work can effectively relieve the pain at the surgical site in a sustained manner during the period of wound healing, while showing biocompatibility and mechanical properties comparable to those of the original surgical suture in clinical use.     

Robotic single-incision anterior resection for sigmoid colon cancer: access port creation and operative technique

Background

Potential morbidities related to multiport laparoscopic surgeries have led to the current excitement about single-incision laparoscopic techniques. However, multiport laparoscopy is technically demanding and ergonomically challenging. We present our technique of using the Alexis wound retractor and a surgical glove to fashion an access port and the da Vinci surgical robot to perform single-incision anterior resection.

Methods

Through a small transumbilical incision, an Alexis wound retractor and a surgical glove are fashioned as an access port. Appropriate trocars are then inserted through the cut fingertips of the glove and secured. A three-arm da Vinci robot with a 30° up-scope was used.

Results

Twenty-two patients (12 males, 10 females) with a mean age of 58.5 years (range = 35–70) underwent robotic single-incision anterior resection for sigmoid colon cancer with this technique. There was no conversion to open surgery and one case was converted to multiport surgery. The mean estimated blood loss was 24.5 ml (range = 5–230), the mean operating time was 167.5 min (range = 112–251), the median skin incision length was 4.7 cm (range = 4.2–8.0), the mean proximal and distal resection margins were 12.9 cm (range = 7.5–25.1) and 12.3 cm (range = 4.5–19.2), respectively, and the mean lymph node harvest was 16.8 (range = 0–42). The immediate postoperative pain score was 2.8 (range = 1–5) and on postoperative day 1 it was 1.4 (range = 1–3). The mean length of hospital stay was 6 days (range = 5–9).

Conclusion

Robotic single-incision anterior resection is a safe and viable option for selected patients. Merging the principles of reduced parietal trauma and better cosmesis with the ergonomic advantages of the robotic system is a novel evolution of single-incision laparoscopic surgery.