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

Abstract

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.

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

“…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 …”

“…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][11][12][13][14][15][16][17][18][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 In the current study, the use of RFD maintained the intestine in position during completion of the anastomosis and was similar in construction time to other methods for jejunocecal anastomosis.…”

“…10,11 The seal produced by the device depends on the type of tissue that is fused. 11 Several in vivo and ex vivo studies on rats, pigs, and humans have evaluated the effectiveness of RFDs in intestinal transection and anastomosis; [8][9][10][11][12][13][14][15][16][17][18][19] however, to date, no studies have evaluated this in horses. Based on the literature, tissue thickness may alter impedance and affect the device's ability to fuse the tissues.…”