Exploring new technologies to facilitate laparoscopic surgery: creating intestinal anastomoses without sutures or staples, using a radio-frequency-energy-driven bipolar fusion device

Abstract

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.

Hartmann colostomy with ligasure

“…From this point of view, a similar closure was considered to be possible also in the intestine. In their anastomosis study on four pigs, Smulders et al (11) created eight anastomoses with the prototype tool they had developed themselves by using LigaSure only (11). It was seen that the pigs were healthy for seven days.…”

Surgical Efficacy Among Laparoscopic Ultrasonic Dissectors: Are We Advancing Safely? A Review of Literature

“…At the highest power setting, we found slightly less thermal injury caused by the Harmonic scalpel (127.48 lm) than LigaSure (144.18 lm), but that difference was nonsignificant. Certain studies, e.g., Diamantis et al; Sutton et al [26,28] in their studies, found that LigaSure (197.79 lm) might cause less thermal injury than Harmonic scalpel (205.61 lm) but that difference was not significant. Sartori and colleagues [18] found that the only real advantage between LigaSure and Harmonic scalpel was a shorter duration of surgery with the Harmonic scalpel, probably owing to its ability to coagulate and cut at the same time.…”

“…The device applies a precise amount of mechanical pressure and radiofrequency energy to tissue, causing fusion of the opposing layers by creating a seal of denatured collagen, which can then be transected [28,29]. The superiority of LigaSure over bipolar electrocautery is that the tissue fusion is created by the denaturation of proteins, thus forming a true seal rather than creating a proximal thrombus.…”

Application of high frequency bipolar electrocoagulation LigaSureTM in appendix vermiformis of rabbits with or without acute inflammatory process

“…This device applies a precise amount of mechanical pressure and radiofrequency energy to tissue, causing fusion of the opposing layers by creating a seal of denatured collagen, which can be transected 7 . The superiority of LigaSure TM is that the tissue fusion is created by the denaturation of proteins, thus forming a true seal rather than creation of a proximal thrombus.…”

“…Because collagen is abundantly present in intestinal wall, we assumed that the device would have been capable of creating intestinal walls seals, and would have had enabled secure appendectomy 7 .…”