V09-05: An Improvised Surgical “Sewing Machine” for Rapid Graft Quilting and Suturing in Challenging Spaces
The use of buccal mucosal graft (BMG) is commonly employed in urologic reconstructive surgery. In poorly accessible surgical areas, graft fixation can be especially difficult. To improve the efficiency of quilting and suturing in challenging spaces, an improved surgical sewing machine was developed and implemented. The aim of our presentation is to demonstrate the feasibility and ease of this technique for a variety of surgeries incorporating BMG.
A retrospective review was completed of surgeries where the improvised surgical sewing machine was used in areas traditionally difficult to access during reconstruction. All patients were confirmed to have strictures requiring reconstruction with BMG. Following incision through the stenosed segments, BMG was harvested. The graft was quilted with the improvised surgical sewing machine composed of materials routinely used and available in the operating room. The device was easily assembled by threading absorbable barbed suture through a hollow needle. After the parts lacking the barb were removed, the needle was introduced in and out of the tissue. The barbs held the suture in place allowing for needle advancement and creation of a continuous running suture for graft fixation. Patients undergoing the technique were seen in the early postoperative period and then followed at 4 month intervals to assess disease recurrence, graft survival and suture resorption.
Seven total patients (5 men, 1 woman and 1 transfemale) with a mean age of 57 years (29-79 years) underwent BMG quilting with the new device between January 2017 and October 2017. Surgeries in which the technique was utilized included 3 posterior urethroplasties, 1 augmented urethrostomy, 1 transvesical bladder neck reconstruction, 1 female dorsal BMG onlay urethroplasty and 1 revision vaginoplasty. At an average follow-up of 38 weeks (13-68 weeks) there was no recurrence of disease and graft survival was demonstrated in all patients. Suture resorption was visualized between 12-16 weeks postoperatively.
This new method employing an improved surgical sewing machine allows for rapid graft quilting and suturing in challenging spaces without compromising surgical outcomes. The technique can be used in a variety of surgeries and has the potential for endoscopic and laparoscopic use.