Surgical Diathermy is not suitable for Vascular Tissue Welding

Abstract

SUMMARY: The possibility of using radiofrequency energy (RFE) to produce a suture less anastomosis is attractive both to the military surgeon and on the grounds of cost and simplicity. To investigate this, fresh rabbit aorta was divided lengthways into 4 mm strips and apposed, intima-to-itima. A Valleylab Force 30 Electrosurgery machine supplied RFE at 500 kHz. The energy was applied using standard bipolar forceps and 121 attempts were made to weld the tissue. Seventy seven welds resulted of which 36 were able to withstand a distraction force of greater than O.lN: the strongest weld was disrupted at 0.35N. Intact tissue withstood a distraction force of greater than 2N, whilst sutured joints disrupted at 0.97 N. It is concluded therefore that radiofrequency energy at 500 kHz does not satisfactorily weld vascular tissue.

Técnica de implante e exequibilidade, “in vitro” em aortas porcinas, de anastamose vascular término-terminal

“…Muitas foram as técnicas experimentadas para evitar a presença do fio de sutura na luz da anastomose, entre elas o laser de Ytrio Alumínio Granada (Gomes et al 1982;Schmiedt et al, 1994;Corner & Smith, 1994), suturas com fios absorvíveis7 e energia de radiofrequência (Werker & Kon, 1997). Outras foram utilizadas para reduzir a hiperplasia da íntima como dexametasona3 e fator tecidual relacionado à trombogenicidade microvascular humana (Dumanian et al ,1995).…”

“…Na prática clínica estes novos dispositivos, mecanismos e técnicas ainda não encontraram seu lugar (Schmiedt et al, 1994;Corner & Smith, 1994;Werker & Kon, 1997), exceto o uso de próteses intraluminais na confecção de anastomoses términoterminais com clampeamento e sem sutura em reconstrução da aorta torácica e abdominal (Lemole et al, 1982;Oz et al,1990;Research, Society andDevelopment, v. 10, n. 14, e334101422113, 2021 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v10i14.22113 3 Berger et al,1992;Bernardes et al, 1995).…”

Historical aspects and perspectives of electrosurgery (literature review)

“…Поэтому сварное соединение как минимум не должно уступать указанным по прочности. Установлено, что природная прочность стенок артерий составляет в среднем от (248,51 ± 31,58) до (359,97 ± 12,67) кПа, венозных сосудовот (196,38 ± 49,59) до (257,58 ± 24,66) кПа в зависимости от их диаметра [8,16].…”

“…Достаточно получить гарантированную минимально необходимую прочность. При сварке сосудов диаметром (2,57 ± 1,35) мм с адаптивной системой управления LigaSure (Valleylab) получена прочность соединений (119,06 ± 71,99) кПа, а при автоматической стабилизации мощности (технология Instance Response TМ ) -(119,87 ± 30,33) кПа [16,19].…”