Innovation for fixation and hemostasis in surgery: cyanoacrylate glue

NICE recommendations: highlighting the role of surgical glue in implant fixation procedures in July 2022

The development of surgical adhesives in the mid-20th century brought about a new alternative to mechanical methods of wound fixation and closure, such as sutures and staples. The purpose of this new tissue adhesion method was to provide effective hemostasis and fixation between two tissues or between an implanted device and a tissue, while still reducing tissue trauma and speeding up the healing and recovery time of patients undergoing surgery. We now know the ideal properties of a surgical glue.¹:

• It must be biocompatible and biodegradable
• It must be as simple as possible to apply
• Its curing process must be relatively short
• Its mechanical strength and cohesion properties, as well as adhesion in a damp environment, must be adapted to its specific application
• It must not provoke an inflammatory reaction
• It must have a pharma-economically viable cost

Cyanoacrylate glues first appeared in the 1950s. They are now well known in the medical field and used in surgery, as their hydrophilic properties ensure proper diffusion in human tissue, they generate little heat during polymerization, which prevents tissue necrosis after application, they have good mechanical properties, including elasticity, and they are well tolerated, with low-toxicity degradation products, which are metabolized by the body. ¹

The new National Institute for Heath and Care Excellence (NICE) guidance on cyanoacrylate glue

In July 2022, NICE produced a study document on the benefits of using cyanoacrylate surgical glue to fixate reinforcement implants when treating hernias, as an alternative to mechanical fixation methods or fibrin glue. They brought together clinical data from 15 randomised clinical trials evaluating the efficacy and safety of cyanoacrylate glue in hernia repair procedures on a total of 1,374 patients. The results showed that cyanoacrylate glue was just as effective as comparative fixation methods (sutures, fibrin glue).

Experts have indicated that one of the innovative aspects of using cyanoacrylate glue in hernia surgery would be to limit post-operative traumatic complications and in particular the chronic pain associated with implant fixation. Using cyanoacrylate glue would also reduce the risk of hernia relapse, the length and cost of hospital stays and would enable patients to return earlier to work and normal activities. ² These recommendations support the use of cyanoacrylate glue as an alternative to other traditional methods to fixate reinforcement implants in hernia repair procedures.

Compared with the article: read the full NICE document – Medtech innovation briefing- Cyanoacrylate glue for hernia mesh fixation – 5 July 2022 by clicking on this link here.

When should cyanoacrylate glue be used in practice?

The new NICE guidelines pave the way for wider use of cyanoacrylate glue in surgical procedures. Its value in a variety of procedures has been the subject of several clinical studies in gastrointestinal, visceral and urogynaecological surgery, some of which are listed in the table below. Cyanoacrylate glue has also been described as a tissue adhesive for closing lesions in ophthalmology and neurosurgery, and for reinforcing suture lines in vascular surgery (studies not cited here). ¹

In all of these studies, the efficacy of fixation and hemostasis achieved with cyanoacrylate glue was comparable to other types of fixation, and potential improvements were noted in comfort during the operation for the practitioner and post-surgical comfort for the patient, with less pain associated with the procedure and a quicker return to their usual activities. ^3.4

Focus on 3-year efficacy data in urogynaecological surgery

The use of cyanoacrylate glue in your gastrointestinal, visceral and urogynaecological surgical procedures for fixation and hemostasis will provide you with a safe and effective alternative to traditional fixation and hemostasis methods with numerous benefits:

Benefits for your surgical teams^{: 1.3}

• Saves operating time
• Limits trauma to surrounding tissue
• Ergonomics

Benefits for your patients: ^1,3

• Reduces post-operative pain
• Absorbable biocompatible product
• Limits stress on tissues

Key words: Surgical glue, cyanoacrylate glue, implant fixation, breach closure, staple line reinforcement, suture line reinforcement, bariatric surgery, visceral surgery

References:

1. Mazur, M.; Zakrzewski,W.; Szymonowicz, M.; Rybak, Z. Medical Adhesives and Their Role in Laparoscopic Surgery—A Review of Literature. Materials 2022, 15, 5215.
2. Cyanoacrylate glue for hernia mesh fixation – NICE 2022- Medtech innovation briefing – Reference: MIB301 – Published: 05 July 2022-  nice.org.uk/guidance/mib301
3. Lamblin G, Chene G, Warembourg S, Jacquot F, Moret S, Golfier F. Glue mesh fixation in laparoscopic sacrocolpopexy: results at 3 years‘ follow-up. Int Urogynecol J. 2022 Sep;33(9):2533-2541.
4. Mercier G, Loureiro M, Georgescu V, Skalli EM, Nedelcu M, Ramadan M, Fabre JM, Lefebvre P, Nocca D. Surgical glue in laparoscopic sleeve gastrectomy: An initial experience and cost-effectiveness analysis. J Eval Clin Pract. 2017 Jun;23(3):614-619. doi: 10.1111/jep.12685. Epub 2017 Mar 21. PMID: 28322488.
5. Lamblin G, Dubernard G, de Saint Hilaire P, Jacquot F, Chabert P, Chene G, Golfier F. Assessment of Synthetic Glue for Mesh Attachment in Laparoscopic Sacrocolpopexy: A Prospective Multicenter Pilot Study. J Minim Invasive Gynecol. 2017 Jan 1;24(1):41-47
6. Dr JP. Estrade et al, 2015, «Laparoscopic sacrocolpopexy with a vaginal prosthetic adhesive» Gynecol Obstet Fertil 43(6): 419-423
7. Avallone, S. and C. Ferry (2013). Fixation des implants de renfort de paroi en appliquant la solution adhésive chirurgicale IfabondTM dans la cure de hernie inguinale avec la technique de Lichtenstein – Etude médico économique sur une série rétrospective de 24 cas. 1: 1-74.
8. Avallone, S. and C. Ferry (2015). Etude du retentissement de la douleur dans la cure de hernie avec la technique de Lichtenstein en appliquant la solution adhésive chirurgicale IfabondTM afin de fixer les implants de renfort de paroi – Série prospective de 40 cas. Péters Surgical. 1: 1-145
9. Bifulco G, Giampaolino P, Morra I, Tommaselli GA, Tarsitano F, Chiacchio G, Nappi C, Di Carlo C. Synthetic cyanoacrylic glue in the prevention of post-operative lymphocele after pelvic lymphadenectomy in patients with uterine malignancies: A prospective, single-blind, preliminary study. Gynecol Oncol. 2014 Sep;134(3):556-60.
10. Conte M.*, Payan R.**, Blanc B.*, Mathieu D.*, Penaranda G.***, Bidaut W.* (*) Hôpital Européen, 13003 Marseille (**) Clinique Belledonne, 38000 Grenoble, (***) Laboratoire Alphabio, 13003 Marseille, France