Skin Closure in Laparoscopic Living Donor Nephrectomy: Modern Tissue Adhesive versus Conventional Intracutaneous Suture—A Randomized Study

Purpose. To compare the modern tissue adhesive cyanoacrylate (Liquiband) to conventional, intracutaneous suture and dressing, with regard to wound characteristics, time consumption, donors’ self-satisfaction, and cost. Methods. Sixty-four kidney donors, subjected to laparoscopic hand-assisted nephrectomy, were randomly assigned to skin closure either with tissue adhesive ( ) or suture ( ). The follow-up assessments were carried out on postoperative days 2, 4 and at departure, evaluated by the use of a previously set numerical scale for rubor, secretion, gaps, oedema, and blisters. Infections and complications/reinterventions were recorded, as well as operative/skin closure time and costs. The donors’ self-satisfaction was evaluated by means of a questionnaire. Results. There were significant results in favour of tissue adhesive regarding wound closure time and the wound characteristics “rubor,” “blisters,” and “oedema.” Although, the wound parameters “secretion” and “gaps” altogether showed a rather evident tendency in favour of suture, partially at significant levels. A low rate of complications/reoperations/infections did not give rise to any significant differences. Conclusion. Our study concludes that gluing is significantly faster, less traumatic by avoiding needle penetrations, but associated with an increased rate of secretion and gaps—presumably depending on gluing technique. Glue seems particularly suitable for small, laparoscopic/trocar incisions. 1. Introduction In the past, the options for wound closure have mostly been limited to sutures and staples. Adhesive tapes and tissue adhesives have entered clinical practice more recently. Various kinds of tissue adhesives/glues have been used since the 1950’s [1]. The adhesives used previously were appropriate for superficial lacerations and small incisions, but their limited physical properties prevented their use in the management of larger wounds [1]. Further development led to the introduction of n-2-butylcyanoacrylates that were purer and stronger [1]. However, the clinical performances of these adhesives were limited by low tensile strength and brittleness [2, 3]. More recently, stronger tissue adhesives have been developed by combining plasticisers and stabilisers to increase flexibility and reduce toxicity when applied topically for skin closure [4]. Cyanoacrylate was introduced in 1949 and was used for skin closure since 1959 [1]. Since 2000, there have been many reports including Cochrane reviews on the use and safety of tissue adhesive for skin closure [1, 5]. These publications indicate