Pilot study of bipolar radiofrequency-induced anastomotic thermofusion-exploration of therapy parameters ex vivo.
OBJECTIVE
Vessel sealing has been well-established in surgical practice in recent years. Bipolar radiofrequency-induced thermofusion (BIRTH) of intestinal tissue might replace traditionally used staples or sutures in the near future. In this experimental study, the influence of compressive pressure, fusion temperature, and duration of heating on the quality of intestinal anastomosis was investigated to obtain the relevant major parameters for the in vivo use of this system.


METHODS
An experimental setup for a closed-loop temperature-controlled bipolar radiofrequency-induced thermofusion of porcine intestinal tissue was developed. Twenty-four colon samples were harvested from nine different Saalower-Kräuter pigs and then anastomosed altering compressive pressure on five different levels to explore its influence on anastomotic bursting pressure.


RESULTS
The anastomotic bursting strength depends on the compressive pressure applied to the colonic fusion site. An optimal interval of compressive pressure (CP = 1.125 N/mm(2)) in respect of a high amount of burst pressure was detected. A correlation (r = 0.54, p = 0.015) of burst pressure to delta compression indicated that increasing colonic wall thickness probably strengthens the anastomotic fusion.


CONCLUSIONS
This study is a first step to enlighten the major parameters of tissue fusion, though effects and interactions of various main parameters of bipolar radiofrequency-induced thermofusion of colonic tissue remain unclear. Further studies exploring the main effects and interactions of tissue and process parameters to the quality of the fusion site have to follow.
Winter
Hanno
H
Fachgebiet Medizintechnik, Institut für Konstruktion, Mikro- und Medizintechnik, Technische Universität Berlin, Germany. hanno.winter@tu-berlin.de
Holmer
Christoph
C
Buhr
Heinz-Johannes
HJ
Lindner
Gerd
G
Lauster
Roland
R
Kraft
Marc
M
Ritz
Jörg-Peter
JP
D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D003106:Colon / Q000473:pathology / Q000601:surgery; D010865:Pilot Projects; D011312:Pressure; D011846:Radio Waves; D012044:Regression Analysis; D034421:Sus scrofa / Q000601:surgery; D013552:Swine; D013696:Temperature
Urol Res. 1992;20(6):425-7
1462482
Lasers Med Sci. 2007 Mar;22(1):10-4
17115238
Lasers Surg Med. 1992;12(5):500-5
1406002
Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004320
17636751
Colorectal Dis. 2004 Jul;6(4):275-9
15206973
Cochrane Database Syst Rev. 2001;(3):CD003144
11687041
World J Surg. 2009 Jun;33(6):1292-7
19363687
Lasers Surg Med. 1995;17(4):315-49
8684236
J Minim Invasive Gynecol. 2008 Sep-Oct;15(5):605-10
18640881