title: Bipolar vessel sealing: instrument contamination and wear have little effect on seal quality and success in a porcine in vitro model.
abstract: OBJECTIVE
  The aim of this study is to systematically investigate under standardized experimental conditions the effects of instrument contamination and wear on the quality of bipolar vessel sealing (BVS) achieved using a reusable instrument.
  
  
  METHODS
  The study was designed as a prospective, randomized, and controlled in vitro study and conducted in an academic research environment. Reusable bipolar coagulation forceps (BiClamp® 200 C, ERBE Elektromedizin) were used to apply sealing pressures of 300-1,100 mN/mm(2) to 239 renal arteries from commercially slaughtered female pigs (Swabian-Hall Swine). Forceps jaws were coated with porcine blood, blood and collagen, or blood, collagen, and fat to simulate instrument contamination with biological material during surgery. Clinical wear was mimicked by sandpaper abrasion. The main outcome measures were seal success (resistance to 250 mmHg intraluminal pressure for 2 min) and seal stability (burst pressure).
  
  
  RESULTS
  Sealing pressure had a significant impact, with 800 mN/mm(2) producing the best sealing results. Seal success increased with total energy applied to the tissue, a higher maximum temperature, and longer coagulation as indicated by desiccation time. Experimental contamination had no significant impact on seal success and only a limited effect on seal stability. Similarly, abrasive wear also had no significant effect on either seal quality or seal strength.
  
  
  CONCLUSIONS
  The impact of bipolar forceps contamination and wear on seal success and quality was negligible in our in vitro model. To achieve high-quality seals, it is essential to use adequate sealing pressures. Our findings could have direct implications for the design and clinical handling of BVS instruments.
authors: Department of Obstetrics and Gynecology, University of Tübingen, Calwerstr. 7, 72076, Tübingen, Germany, cwallwiener@googlemail.com.
authors: Christian W
authors: CW
authors: Wallwiener
authors: Susanna H
authors: SH
authors: Junginger
authors: Wolfgang
authors: W
authors: Zubke
authors: Sara Y
authors: SY
authors: Brucker
authors: Markus D
authors: MD
authors: Enderle
authors: Alexander
authors: A
authors: Neugebauer
authors: Birgitt
authors: B
authors: Schönfisch
authors: Markus
authors: M
authors: Wallwiener
mesh_terms: D000818:Animals; D004564:Electrocoagulation / Q000295:instrumentation*; D004866:Equipment Contamination; D017743:Equipment Reuse; D005260:Female; D008026:Ligation / Q000295:instrumentation; D011312:Pressure; D011446:Prospective Studies; D012077:Renal Artery / Q000601:surgery*; D013525:Surgical Instruments; D013552:Swine; D014656:Vascular Surgical Procedures / Q000295:instrumentation