Tissue fusion technology versus suture and staple in porcine bowel anastomosis: an in vivo study

Pan, Hong; Leung, Kevin Kai Chung; Ng, Enders Kwok Wai

doi:10.1590/1414-431x20209305

Cited by 9 publications

(10 citation statements)

References 20 publications

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“…High-frequency electric field welding (HFEW) induced by heat is a routine surgical procedure. The feasibility of the technology for induced small intestine anastomosis has been confirmed by previous ex vivo and in vivo experiments [ 1 , 2 ]. Tissue fusion is achieved by application of an alternating high frequency electric field for seconds, which creates soft tissue fusion [ 3 ].…”

Section: Introductionmentioning

confidence: 77%

“…As a new surgical suture method, HFEW has many advantages, such as the lack of foreign bodies left in the body, low price, and shorter operation time [ 11 , 19 ], and has received much attention from surgeons. It has been demonstrated in some studies that HFEW creates burst pressures as high as those formed by staplers [ 6 ], and the technique has been successfully used in in vivo small bowel anastomosis [ 1 , 20 ]. Collagen is widely distributed in small intestinal tissues ( Figure 2 A) and is also an important raw material for tissue welding.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics of Collagen Changes in Small Intestine Anastomoses Induced by High-Frequency Electric Field Welding

Zhu

et al. 2022

Biomolecules

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High-frequency electric field welding-induced tissue fusion has been explored as an advanced surgical method for intestinal anastomoses; however, intrinsic mechanisms remain unclear. The aim of this study was to investigate microcosmic changes of collagen within the fusion area, with various parameters. Ex vivo small intestine was fused with mucosa–mucosa. Four levels of compressive pressure (100 kPa, 150 kPa, 200 kPa, 250 kPa) were applied for 10s in order to fuse the colons under a power level of 140W. Then, collagen fibers of the fusion area were examined by fibrillar collagen alignment and TEM. Three levels of power (90 W, 110 W, 140 W) and three levels of time (5 s, 10 s, 20 s) were applied in order to fuse colons at 250kPa, and then collagen within the fusion area was examined by Raman spectroscopy. Fibrillar collagen alignment analysis showed that with the increase in compression pressure, alignment of the collagen in the fusion area gradually increased, and the arrangement of collagen fibers tended to be consistent, which was conducive to the adhesion of collagen fibers. TEM showed that pressure changed the distribution and morphology of collagen fibers. Raman spectroscopy showed that increased power and time within a certain range contributed to collagen cross linking. Peak positions of amide I band and amide III band changed. These results suggested that higher power and a longer amount of time resulted in a decrease in non-reducible cross links and an increase in reducible cross links. Compression pressure, power, and time can affect the state of collagen, but the mechanisms are different. Compressive pressure affected the state of collagen by changing its orientation; power and time denatured collagen by increasing temperature and improved the reducible cross linking of collagen to promote tissue fusion.

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Section: Introductionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Characteristics of Collagen Changes in Small Intestine Anastomoses Induced by High-Frequency Electric Field Welding

Zhu

et al. 2022

Biomolecules

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“…Previous studies in rat, pig, and human intestines have demonstrated the efficiency of RFDs in performing intestinal anastomoses in both in vivo and ex vivo models 8,10–19 . According to these studies, RFDs are efficient, easy to use, and appear to be sufficient as a stand‐alone method for performing intestinal anastomoses in ex vivo models, with a bursting pressure similar to that obtained with a stapler 13 …”

Section: Discussionmentioning

confidence: 97%

“…Second, the tissues of live animals undergo an inflammatory process to reabsorb and replace the necrotic material that forms because of thermal damage 17 . This process, as well as the healing of the anastomoses, could not be evaluated in our ex vivo model.…”

Section: Discussionmentioning

confidence: 99%

Ex vivo evaluation of a technique for equine jejunocecal anastomosis using radiofrequency thermofusion and a Cushing oversew

et al. 2023

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To describe a technique for a side-to-side jejunocecal anastomosis in horses using radiofrequency thermofusion (TF) of the intestines supported by a Cushing oversew and to compare this anastomosis to handsewn and stapled techniques.Study design: Ex vivo study. Sample population: Intestinal tracts from 24 slaughtered horses.Methods: A radiofrequency device was used to perform a jejunocecal anastomosis (Group RFA). The construction time and bursting pressure of this construct were compared with those of a hand-sewn double layer (Group HS) and stapled anastomoses (Group ST) without oversew of the staple line.Histology was also performed for the TF anastomoses to evaluate the extent of the thermal damage. Results: The median (range) construction time (min) for the was not significantly different from that for the HS (25.5 [24.2-26.3]) and ) groups (p = .07). The construction time for ST was shorter than that for HS group (p < .001). The average (standard deviation) bursting pressure (mmHg) for HS (153.1 +/À 17.5) was higher than that for RFA (76 +/À 15) and ST groups (48 +/À 13; p < .001). The bursting pressure of the RFA was higher than that of the ST anastomoses (p = .001). The thermal damage caused by the device was within the suture oversew in the deeper layers, whereas it extended a few mm beyond the suture line in the serosa. Conclusion: Radiofrequency assisted anastomoses provide similar construction times to current techniques and have a higher bursting pressure than ST anastomoses. Clinical significance: Radiofrequency-assisted anastomoses with a suture oversew demonstrated comparable bursting pressures to ST anastomoses. The use of the radiofrequency device on the intestine is extra label and causes serosal tissue damage, which may increase the risk of adhesions.

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“…Elemen et al reported increasing BP when tested on post-operative day 7 [ 39 ]. Recently, in a swine model of thermofused anastomosis [ 40 ], the percentage of intact anastomoses, after 2 weeks from surgery, was 73.3–93.3%, according to the different setting modes of the RFVS device applied. Moreover, the authors demonstrated that collagen fibers that were accumulated in the frame and filled in the gap between the two extremities of the muscle layer were considered as the main mechanical factors for the safety of anastomoses.…”

Section: Discussionmentioning

confidence: 99%

Swine Small Intestine Sealing Performed by Different Vessel Sealing Devices: Ex-Vivo Test

Lacitignola

Imperante

Trisciuzzi

et al. 2021

Veterinary Sciences

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This study aimed to evaluate the sealing quality of swine small intestine using different laparoscopic radiofrequency vessel sealing devices (two 5 mm: RFVS-1 and -2; one 10 mm: RFVS-3) and a harmonic scalpel (HS) compared to golden standard closure technique. The study was divided into two arms. In study arm 1: n = 50 swine intestinal loops (10 per group) were transected with each instrument and the loops in which the devices provided complete sealing, at the gross inspection, were tested for maximum burst pressure (BP) and histological evaluation and compared to an automatic linear stapler. After the BP tests, the devices that achieved significantly lower BP values were excluded from the second arm. The RFVS-1 and -3 provided statistically significant results and were used in study arm 2, to obtain full-thickness biopsies along the antimesenteric border of the loop and were compared with hand-sewn intestinal closure (n = 30; 10 per group). The biopsies were histologically evaluated for thermal injury and diagnostic features, and intestinal loops tested for BP. RFVS-3 achieved comparable results (69.78 ± 4.23 mmHg, interquartile range (IQR) 5.8) to stapler closing technique (71.09 ± 4.22 mmHg, IQR 4.38; p > 0.05), while the RFVS-1 resulted in significantly (p < 0.05) lower BP (45.28 ± 15.23 mmHg, IQR 24.95) but over the physiological range, conversely to RFVS-2 (20.16 ± 7.19 mmHg, IQR 12.02) and HS (not measurable). RFVS-3 resulted not significantly different (p > 0.05) (45.09 ± 8.75 mmHg, IQR 10.48) than Suture (35.71 ± 17.51 mmHg, IQR 23.77); RFVS-1 resulted significantly lower values (23.96 ± 10.63 mmHg, IQR 9.62; p < 0.05). All biopsies were judged diagnostic. Data confirmed that RFVS-1 and -3 devices provided suitable intestinal sealing, with BP pressures over the physiological range. Conversely, the HS and RFVS-2 should not be considered for intestinal sealing. RFVS devices could be employed to obtain small intestine stump closure or full-thickness biopsies. However, further studies should be performed in live animals to assess the role of the healing process.

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Tissue fusion technology versus suture and staple in porcine bowel anastomosis: an in vivo study

Cited by 9 publications

References 20 publications

Characteristics of Collagen Changes in Small Intestine Anastomoses Induced by High-Frequency Electric Field Welding

Characteristics of Collagen Changes in Small Intestine Anastomoses Induced by High-Frequency Electric Field Welding

Ex vivo evaluation of a technique for equine jejunocecal anastomosis using radiofrequency thermofusion and a Cushing oversew

Swine Small Intestine Sealing Performed by Different Vessel Sealing Devices: Ex-Vivo Test

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