Histologic characteristics of laparoscopic saline-enhanced electrosurgery of liver and splenic injuries.
BACKGROUND
Hemostasis is crucial during laparoscopic surgery. Unlike conventional electrosurgery, saline-enhanced electrosurgery (SEE) improves the electrode-to-tissue interface. This study investigated SEE as a means of achieving hemostasis in liver and splenic injuries and assessed the associated histologic changes.


METHODS
Nine anesthetized pigs underwent laparoscopic liver tip and splenic wedge amputations. Injuries were treated with SEE (25-35 and 35-45 W, respectively). Animals were sacrificed postprocedure and at 1 and 4 weeks. Depth of necrosis was analyzed using a mixed model analysis of variance.


RESULTS
Liver mean depth of necrosis was 5.3 mm (acute), 6.0 mm (1 week), and 5.3 mm (4 weeks) ( p = not significant). Splenic mean depth of necrosis was 7.0 mm (acute), 7.0 mm (1 week), and 2.7 mm (4 weeks). ( p < 0.01) Acute injuries demonstrated thermal coagulation necrosis that healed with well-defined bands of collagen at 1 and 4 weeks.


CONCLUSIONS
SEE provides effective hemostasis and results in an acceptable depth of necrosis with satisfactory wound healing in a porcine model of solid organ injury.
Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Hurlbut Room, Boston, MA 02214, USA. csims@partners.org
C
C
Sims
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N
Stylopoulos
J
J
Clavijo
C
C
Barlow
D000818:Animals; D003094:Collagen / Q000032:analysis; D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006400:Hematocrit; D006488:Hemostasis, Surgical / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008099:Liver / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D009336:Necrosis; D012965:Sodium Chloride / Q000008:administration & dosage*; D013154:Spleen / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D013552:Swine; D007507:Therapeutic Irrigation / Q000379:methods*; D014945:Wound Healing
D012965:Sodium Chloride; D003094:Collagen