Sutureless Techniques in Microvascular Anastomosis

Sutureless microvascular anastomosis encompasses a range of emerging strategies designed to join small blood vessels without traditional needle-and-thread techniques. By employing bioadhesives, absorbable couplers and intraluminal stents, these approaches aim to reduce operative time, minimise vessel trauma and lower the risk of thrombosis. Advances in material science—particularly in shape-memory alloys and biodegradable polymers—have enabled devices that conform to vessel geometry, maintain haemostasis under physiological pressures and degrade safely over time. Such innovations hold promise for applications in reconstructive microsurgery, cerebral revascularisation and organ transplantation, where precision and reproducibility are paramount. Despite encouraging ex vivo and in vivo results, translation into routine clinical practice will depend on rigorous evaluation of long-term patency, biocompatibility and ease of use across diverse surgical settings.

Research from Nature Portfolio

Recent studies have explored adhesive-based alternatives and absorbable coupling systems. One investigation combined an intraluminal nitinol stent with a novel polymer adhesive, achieving burst pressures on par with native vessels while reducing anastomosis time by over 50 percent in ex vivo coronary models. Another report introduced a two-ring absorbable microvascular coupler composed of poly(lactic-co-glycolic acid), demonstrating complete vessel patency in rabbit jugular vein anastomoses throughout device degradation by eight months and significantly shorter operative times compared with hand-sewn controls. These contributions underscore the feasibility of integrating biomaterial-driven devices to streamline microvascular repair.

Sutureless Techniques in Microvascular Anastomosis publication trend

The graph below shows the total number of articles in sutureless techniques in microvascular anastomosis across all publications each year (not limited to Nature Index journals).

Technical terms

Anastomosis: A surgical connection between two tubular structures, most commonly blood vessels.

Anastomotic patency: The state of an anastomosis remaining open and unobstructed, allowing unimpeded blood flow.

Nitinol: A nickel–titanium alloy with shape-memory and superelastic characteristics, often used for intraluminal stents.

Poly(lactic-co-glycolic acid) (PLGA): A biodegradable copolymer employed in absorbable medical devices and tissue engineering.

Hydrostatic strength: The capacity of a vessel or anastomotic construct to resist leakage under internal fluid pressure.

References

1. Sutureless microvascular anastomosis assisted by an expandable shape-memory alloy stent. PLOS ONE (2017).
2. Mechanical strength and hydrostatic testing of VIVO adhesive in sutureless microsurgical anastomoses: an ex vivo study. Scientific Reports (2021).
3. New Absorbable Microvascular Anastomotic Devices Representing a Modified Sleeve Technique: Evaluation of Two Types of Source Material and Design. Scientific Reports (2019).
4. Evaluation of BioGlue surgical adhesive for the performance of microsurgical arterial anastomoses: impact on the flow of vessels greater than 1 mm (rat aorta) and less than 1 mm (rat femoral). Issues of Reconstructive and Plastic Surgery (2022).
5. Experimental Study of L-shaped Silastic Stents for Microvascular Anastomosis. The Journal of Hand Surgery (Asian-Pacific Volume) (2023).