Medical adhesives and sealants often require that long-term adhesiveness is achieved. In this work, nanostructured coatings consisting of chitosan and the adhesive bacterial exopolysaccharide levan are fabricated using layer-by-layer (LbL) assembly. Taking advantage of the electrostatic self-assembly mechanism of LbL, the charges of both chitosan and a phosphonate-derivatized levan (Ph-levan) are measured and the feasibility of constructing hybrid films is monitored and confirmed using a quartz crystal microbalance with dissipation monitoring (QCM-D). The adhesive properties between two identical bonded films with a total of 100 layers are compared to control films in which Ph-levan is replaced by alginate, revealing that the detachment force of the former is about 3 times higher than the control. Scanning electron microscopy of the films surface shows that the surface of Ph-levan films is smooth and homogeneous. Cell adhesion tests were conducted using a L929 cell line. Early cell adhesion is significantly higher in chitosan/Ph-levan films when compared to chitosan/alginate controls. These findings establish levan derivatives as bioinspired ingredients for conceiving medical adhesive devices that allow achieving enhanced mechanical and biological performance.

Precise needle puncture of the renal collecting system is an essential but challenging step for successful percutaneous nephrolithotomy. We evaluated the efficiency of a new real-time electromagnetic tracking system for in vivo kidney puncture. Six anesthetized female pigs underwent ureterorenoscopy to place a catheter with an electromagnetic tracking sensor into the desired puncture site and ascertain puncture success. A tracked needle with a similar electromagnetic tracking sensor was subsequently navigated into the sensor in the catheter. Four punctures were performed by each of 2 surgeons in each pig, including 1 each in the kidney, middle ureter, and right and left sides. Outcome measurements were the number of attempts and the time needed to evaluate the virtual trajectory and perform percutaneous puncture. A total of 24 punctures were easily performed without complication. Surgeons required more time to evaluate the trajectory during ureteral than kidney puncture (median 15 seconds, range 14 to 18 vs 13, range 11 to 16, p=0.1). Median renal and ureteral puncture time was 19 (range 14 to 45) and 51 seconds (range 45 to 67), respectively (p=0.003). Two attempts were needed to achieve a successful ureteral puncture. The technique requires the presence of a renal stone for testing. The proposed electromagnetic tracking solution for renal collecting system puncture proved to be highly accurate, simple and quick. This method might represent a paradigm shift in percutaneous kidney access techniques.