J reconstr Microsurg 2018; 34(01): 071-076
DOI: 10.1055/s-0037-1606540
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Economic Comparison of Hand-Sutured and Coupler-Assisted Microvascular Anastomoses

Linden K. Head
1  Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada
Douglas R. McKay
2  Division of Plastic Surgery, Queen's University, Kingston, Ontario, Canada
› Author Affiliations
Further Information

Publication History

29 May 2017

31 July 2017

Publication Date:
25 September 2017 (eFirst)


Background Compared with hand-sewn anastomoses, microvascular anastomotic coupling devices (MACDs) provide equivalent flap survival and reduced operative time. To date, an economic analysis of MACDs has not been reported. The objective of this study was to evaluate the economics of a venous anastomosis performed using a coupling device compared with a hand-sewn anastomosis.

Methods Economics were modeled for a single free tissue transfer (FTT) requiring one venous anastomosis performed with either hand-sewn sutures or with a coupler-assisted anastomosis using the GEM COUPLER. Fixed and variable costs incurred with each anastomotic technique were identified with an activity-based cost analysis. Price lists were retrieved from suppliers to quantify disposable costs and capital expenditures. Two literature reviews were executed to identify microsurgical operating room (OR) costs and operating time reductions with coupler-assisted anastomoses.

Results For each venous anastomosis, the use of the anastomotic coupler increased disposable costs by $284.40 compared with a hand-sutured anastomosis. Total fixed and variable OR costs were $30.82 per minute. Operating time was reduced by a mean of 16.9 minutes with a coupler-assisted anastomosis, decreasing OR costs by $519.29. Total savings of $234.89 were generated for each coupler-assisted anastomosis, recuperating the device's capital expenditure after 13 uses.

Conclusion Compared with a hand-sewn venous anastomosis, an MACD produces savings with each case and quickly recoups the device's capital expenditure. Despite its limitations and simplicity, this study provides a practical economic analysis that can help inform purchasing decisions, particularly for smaller volume centers where the economic rationale may be less clear.


The study was presented at Plastic Surgery The Meeting 2015, October 16–20, 2015 in Boston, MA. A similar study focusing on the economics in a Canadian context was presented at the Canadian Society of Plastic Surgeons Annual Meeting, June 2–6, 2015 in Victoria, BC.


This study exclusively uses published/publicly reported data and is exempt from Institutional Review Board approval under the Tri-Council Policy Statement: Ethical Conduct of Research Involving Humans, 2nd edition (TCPS 2).

Financial Disclosures

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

Products referenced

– GEM Microvascular Anastomotic COUPLER System were retrieved from Synovis Micro Companies Alliance Incorporated (Birmingham, AL)

– 8–0, Nylon, ETHILON, monofilament suture (Ethicon Endo-Surgery Incorporated; Cornelia, Georgia, GA)


Both authors contributed equally in conception, analysis, interpretation, and the drafting and revision of the manuscript.