Introduction: Intestinal anastomotic healing requires apposition of the collagencontaining submucosal layers of the opposing intestinal walls, which is traditionallyachieved by staples or sutures. Recently, a feedbackcontrolled bipolar sealingsystem (LigaSure) has been successfully introduced to seal and transect vessels.Since this technology depends on fusion of collagen fibres which are abundantlypresent in the intestinal wall, the possibility to create intestinal anastomoses usingthis technology was investigated in the present study. Materials and methods: For this purpose a newgeneration radiofrequency(RF) generator and a prototype of the Ligasure Anastomotic Device (LAD) have beendeveloped. The generator incorporates a closed loop control system which monitorstissue fusion, compares it with a mathematical model of ideal fusion based on thedensity and compliance of intestinal tissue and adjusts energy output accordingly. Intotal 8 anastomoses were created in a porcine model (4 pigs, 2 anastomoses each)and healing was assessed by macroscopic and histological examination. Results: All seals were macroscopic intact both immediate after creation and atsacrifice at the 7th postoperative day. Between operations, pigs appeared healthy andhad normal intestinal passage. Histological examination of the anastomoses revealedundisturbed healing with granulation tissue, newly synthesised collagen in thesubmucosa and re-epithelialization at the borders of the seals. Conclusion: These results confirm the feasibility to create experimental intestinalanastomoses using LigaSure technology. This may be an important step towards thedevelopment of new laparoscopic equipment combining dissecting and reconstructiveproperties within one single instrument.
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