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Kashimé: A Novel Knotless Surgical Suture to Simplify Dural Stitches in Endoscopic Transnasal Surgery
Hirotaka Hasegawa1, Yuki Shinya1, Minoru Ono2
1Department of Neurosurgery, The University of Tokyo, Bunkyo, Tokyo, Japan.
Background:
Dural suturing is an effective adjunct to skull base dural repair in endoscopic transnasal surgery, although it is technically cumbersome. Here, we presented a novel surgical suture "Kashimé" (Kono Seisakusho) that can be tightened without tying.
Objective:
To examine the efficacy of Kashimé for skull base dural repair in endoscopic transnasal surgery.
Methods:
Kashimé was used in 8 patients with skull base dural defects during nonpedicled flap-based multilayered skull base reconstruction to close or approximate the gaps between the dural edges or secure a free fascial graft. The time required for each dural stitch (passing a needle through the dura, pulling out the thread, and tightening it) and the incidence of postoperative cerebrospinal fluid leakage were the study end points.
Results:
Based on our preliminary experiences with 12 stitches used, no postoperative cerebrospinal fluid leakage was observed. The learning curve was steep, and the mean (±SD) time was 127 (±44) seconds for a single stitching procedure, except for the first case. Regarding the metal artifact, although a beam hardening artifact was not observed on computed tomography, a 4- to 9-mm diameter image defect was observed on magnetic resonance imaging.
Conclusion:
Kashimé can help surgeons to complete a single dural stitch in endoscopic transnasal surgery for approximately 2 minutes. It may be an optimal tool for skull base reconstruction, but the efficacy and safety need to be investigated.
