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P&S Journal

P&S Journal: Winter 1997, Vol.17, No.1
Improving Pediatric Surgery Through Laser Soldering

A new laser soldering technique developed at CPMC may reduce complications in reconstructive surgery of the urinary tracts of boys. Dr. Andrew J. Kirsch, former chief resident in urology at CPMC and now a fellow in pediatric urology at Children's Hospital of Philadelphia, combined two existing technologies--a diode laser and protein solder--to repair hypospadias.

Hypospadias, a condition in which the urethra opens in an abnormal location, occurs in 1 out of every 200 boys. It is generally repaired with skin grafts or flaps to restore the urethral opening to its normal location, but the complication rate for the operation can be as high as 30 percent because the sutures that anchor the graft can lead to a foreign body reaction or may cause fistulas and urine leakage. Approximately 8,000 hypospadias repairs are performed in the United States each year.

In an initial study, Dr. Kirsch found that using laser soldering instead of sutures decreased the complication rate by eliminating leaks, fistulas, and foreign body reactions. The operation relies on a protein solder developed at CPMC by Drs. Lawrence Bass, Steven Libutti, and Alex Eaton. The solder, which is made of human serum albumin, sodium hyaluronate, and indocyanine green dye, is applied as a thin layer over the area to be repaired. Once the laser light hits it, the solder changes color, indicating that it is dry. The protein solder is absorbed by the body in 7 to 10 days, enough time for the wound to heal.

In one study of the technique used on 27 patients, only four developed fistulas. Three operations were performed without any sutures at all; the others used some sutures to temporarily hold the grafts in place. Of the sutureless operations, one developed complications. The study was presented at a joint meeting of the American Urologic Association and the American Society for Laser Medicine Surgery, where Dr. Kirsch was granted the prestigious presidential award for best clinical paper.

In addition to its application to hypospadias repair, laser tissue soldering has other potential uses, says Dr. Terry W. Hensle, director of pediatric urology. For instance, laser tissue soldering could conceivably be used during laparoscopic surgery, allowing surgeons to bond tissues together without sutures. "This is potentially very significant and it could be a real boon to surgeons everywhere," says Dr. Hensle.

At Children's Hospital of Philadelphia, an institution world-renowned for the study of hypospadias, Dr. Kirsch is studying the molecular biology of wound healing following laser tissue soldering. His work at CPMC will be continued by another urology resident, Dr. Michael Stifelman, under the direction of Dr. Hensle.

A case of sutureless flip-flap
repair for hypospadias

The inferior skin flap is created with fine scissors up to the level of the hypospadic meatus

A thin "priming" layer of solder is placed on and between the tissue edges

On the left side, a completed solder line (sutures removed);
on the right side, laser
activation of
liquid solder.

Illustrations by David Rosenzweig

copyright ©, Columbia-Presbyterian Medical Center

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