Urology Video Journal (Jun 2020)
A surgical “sewing machine” for rapid graft quilting and suturing in challenging spaces
Abstract
Background: The use of grafts is commonly employed in urologic reconstructive surgery. In poorly accessible surgical areas, graft fixation can be difficult. To improve the efficiency of quilting and suturing in challenging spaces, an improvised surgical “sewing machine” (ISSM) was developed. Materials and Methods: Preoperatively, all patients were confirmed to have lumen stenosis (vaginal, urethra, bladder neck). Intraoperatively, following incision through the stenosed segments and harvesting buccal mucosa graft (BMG), the ISSM device was assembled using materials readily available in the operating room. The device was assembled by threading absorbable 4–0 barbed suture through a 20-gauge hollow needle. The parts lacking the barbs were excised. For graft quilting the needle was introduced in and out of the graft positioned on the graft bed tissue. The barbs held the suture in place allowing for easy needle removal, forward advancement and reintroduction into the tissue to create a continuous running suture for graft quilting. Results: A total of 13 patients (11 men, 1 cis-gender female and 1 transgender female) with a mean age of 68 years (29–79 years) underwent buccal mucosa graft (BMG) quilting with the ISSM between January 2017 and October 2019. Surgeries performed included 8 posterior urethroplasties with BMG augmentation [1–2], 1 transvesical bladder neck reconstruction [3], 2 augmented perineal urethrostomy [4], 1 female dorsal only BMG urethroplasty [5] and 1 revision vaginoplasty. Of these, 7 patients had prior pelvic radiation. At a mean follow-up of 46 weeks (6–127 weeks) graft survival was demonstrated in all patients and there was no disease recurrence. Suture resorption occurred between 12–20 weeks postoperatively. Conclusion: The improvised surgical “sewing machine”, ISSM can be used in a variety of complex reconstructive surgeries, including those involving radiated tissue, where graft fixation and suturing is challenging without compromising surgical outcomes. Future applications in endoscopic and laparoscopic surgery are possible.
