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Novel concave–convex electrode for colonic anastomoses by radiofrequency thermo-fusion

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Abstract

Background

Successful vascular sealing by radiofrequency (RF)-induced tissue fusion is well established. The present study reports on a novel electrode structure design together with its experimental assessment for RF thermo-fusion of porcine colonic segments.

Materials and methods

Two types of electrode were constructed and used in the present study: one with a conventional smooth surface (S) and the other with a novel reciprocating concave–convex (CC) configuration. Finite element modeling was used to study the thermal distribution profile of the CC electrode. Ex vivo porcine colonic segments were used to create end-to-end serosa-to-serosa colonic anastomoses by applying a pulse of 160 W RF power for 20 s. Different compression pressures (S1, S2, S3) and (C1, C2, C3, C4, C5), were applied, via specially designed ring carriers, to the S and CC electrodes, respectively. Assessment was based on anastomotic burst pressures and histological appearances using light microscopy of paraffin sections.

Results

In total, 22 RF-induced circular anastomoses were performed. Similar burst pressures were observed for anastomoses created by the two types of electrodes (S, CC) performed under the same compression pressure. In contrast, significant differences were observed on histological examination of tissue anastomotic site. In particular, fusion areas between gaps of the CC electrode showed normal histological appearance, while the S electrode produced a completely flat featureless appearance. Furthermore, the CC electrode produced significantly different burst pressures depending on the applied compression pressure during thermo-fusion: compression pressures C1 vs. C4 produced circular anastomotic fusions with burst pressures of \(21.9 \pm 9.3\) vs. \(44.6 \pm 8.9\;{\text{mmHg}}\), (p = 0.034); but the burst pressure beyond C4, declined significantly, with C4 vs. C5, burst pressures of 44.6 ± 8.9 vs. \(24.7 \pm 8.0\;{\text{mmHg}}\), (p = 0.034).

Conclusions

The CC electrode exhibits larger and faster thermal diffusion profiles resulting in normal histological appearances in the gaps between CC electrode by protecting tissue from mechanical and thermal damage.

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References

  1. Yu BM (2008) Current status and prospect of surgical treatment for colorectai cancer. Chin J Bases Clin General Surg 15:631–636

    Google Scholar 

  2. Schrock TR, Deveney CW, Dunphy E (1973) Factors contributing to leakage of colonic anastomoses. Ann Surg 177:513–518

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Li XX, Zheng CZ, Yin K, Cai JL, Rosenthal RJ (2008) Application of laparoscopic compression anastomosis clip for laparoscopic gastrointestinal anastomosis. Chin J Gastrointest Surg 11:228–230

    Google Scholar 

  4. Li XX, Cai SJ, Guan ZQ, Xu Y, Cai GX, Huang LY (2010) Compression anastomosis ring: a novel technique for colorectal anastomosis. Chin J Gastrointest Surg 13:330–332

    Google Scholar 

  5. Li XX, Cai SJ, Gao J, Shi DB, Gu WL, Guan ZQ, Xu Y, Liu FQ, Huang L (2011) Prospective study on the use of nickel–titanium temperature-dependent memory-shape device (CAR27) for anastomosis after colorectal surgery. Chin J Gastrointest Surg 14:330–332

    Google Scholar 

  6. Smulders JF, de Hingh IHJT, Stavast J, Jackimowicz JJ (2007) Exploring new technologies to facilitate laparoscopic surgery: creating intestinal anastomoses without sutures or staples, using a radio-frequency-energy-driven bipolar fusion device. Surg Endosc 21:2105–2109

    Article  CAS  PubMed  Google Scholar 

  7. Winter H, Holmer C, Buhr H-J, Lindner G, Lauster R, Kraft M, Ritz J-P (2010) Pilot study of bipolar radiofrequency-induced anastomotic thermofusion-exploration of therapy parameters ex vivo. Int J Colorectal Dis 25:129–133

    Article  PubMed  Google Scholar 

  8. Holmer C, Winter H, Kroeger M, Nagel A, Jaenicke A, Lauster R, Kraft M, Buhr HJ, Ritz J-P (2011) Bipolar radiofrequency-induced thermofusion of intestinal anastomoses-feasibility of a new anastomosis technique in porcine and rat colon. Langenbecks Arch Surg 396:529–533

    Article  PubMed  Google Scholar 

  9. Zhao LX, Zhou Y, Zhuo CH, Li XX, Li DL, Yan SJ, Yan BW, Ou KW, Song CL (2013) Preliminary study of radio-frequency induced tissue fusion in colorectal anastomosis. Chin J Biomed Eng 32:24–28

    Google Scholar 

  10. Dilley AV, Friend M-AG, Morris DL (1995) An experimental study of optimal parameters for bipolar electrocoagulation. Gastrointest Endosc 42:27–30

    Article  CAS  PubMed  Google Scholar 

  11. Laine L, Long GL, Bakos GJ, Vakharia OJ, Cunningham C (2008) Optimizing bipolar electrocoagulation for endoscopic hemostasis: assessment of factors influencing energy delivery and coagulation. Gastrointest Endosc 67:502–508

    Article  PubMed  Google Scholar 

  12. Reyes DAG, Brown SI, Cochrane L, Motta LS, Cuschieri A (2012) Thermal fusion: effects and interaction of temperature, compression, and duration variables. Surg Endosc 26:3626–3633

    Article  PubMed  Google Scholar 

  13. Lim CBB, Goldin RD, Elson DS, Darzi A, Hanna GB (2010) In vivo thermography during small bowel fusion using radiofrequency energy. Surg Endosc 24:2465–2474

    Article  PubMed  Google Scholar 

  14. Tucker RD, Platz CE, Landas SK (1997) Histologic characteristics of electrosurgical injuries. J Am Assoc Gynecol Laparosc 4:201–206

    Article  CAS  PubMed  Google Scholar 

  15. Ls B, Mr T (1995) Laser tissue welding: a comprehensive review of current and future clinical applications. Lasers Surg Med 17:315–349

    Article  Google Scholar 

  16. Wallwiener CW, Med C, Rajab TK, Zubke W, Isaacson KB, Enderle M, Schaller D, Wallwiener M (2008) Thermal conduction, compression, and electrical current: an evaluation of major parameters of electrosurgical vessel sealing in a porcine in vitro model. J Minim Invasive Gynecol 15:605–610

    Article  PubMed  Google Scholar 

  17. Richter S, Kollmar O, Schilling MK, Pistorius GA, Menger MD (2006) Efficacy and quality of vessel sealing: comparison of a reusable with a disposable device and effects of clamp surface geometry and structure. Surg Endosc 20:890–894

    Article  CAS  PubMed  Google Scholar 

  18. Arya S, Hadjievangelou N, Lei S, Kudo H, Goldin RD, Darzi AW, Elson DS, Hanna GB (2013) Radiofrequency-induced small bowel thermofusion: an ex vivo study of intestinal seal adequacy using mechanical and imaging modalities. Surg Endosc 27:3485–3496

    Article  PubMed  Google Scholar 

  19. Kennedy JS, Stranahan PL, Taylor KD, Chandler JG (1998) High-burst-strength, feedback-controlled bipolar vessel sealing. Surg Endosc 12:876–878

    Article  CAS  PubMed  Google Scholar 

  20. Seehofer D, Mogl M, Boas-Knoop S, Unger J, Schirmeier A, Chopra S, Eurich D (2012) Safety and efficacy of new integrated bipolar and ultrasonic scissors compared to conventional laparoscopic 5-mm sealing and cutting instruments. Surg Endosc 26:2541–2549

    Article  PubMed Central  PubMed  Google Scholar 

  21. Materials ASoT (2004) Standard test method for burst strength of surgical sealants. Test procedure

  22. Krane C, Pinnell M, Gardner C, Thompson M, Coleman J, Wilkens R (2011) Mechanical test methods for assessing porcine carotid and uterine artery burst pressure following ex vivo ultrasonic ligature seal and transection. J Test Eval 39:514–521

    Google Scholar 

  23. Katsuno G, Nagakari K, Fukunaga M (2010) Comparison of two different energy-based vascular sealing systems for the hemostasis of various types of arteries: a porcine model-evaluation of Ligasure Forcetriad (TM). J Laparoendosc Adv Surg Tech 20:747–751

    Article  Google Scholar 

  24. Elliott SP, Joel AB, Meng MV, Stoller ML (2005) Bursting strength with various methods of renal artery ligation and potential mechanisms of failure. J Endourol 19:307–311

    Article  PubMed  Google Scholar 

  25. Hou XH (1998) Kinesiology of digest tract. Science Publishing, Beijing

    Google Scholar 

  26. Zhang YL (2005) Fractal dimension analysis of intestinal pressure data and researches on extraction of human colonic motility index. Master thesis, Shanghai Jiao Tong University, Shanghai

  27. Hendriks T, Mastboom WJ (1990) Healing of experimental intestinal anastomoses: parameters for repair. Dis Colon Rectum 33:891–901

    Article  CAS  PubMed  Google Scholar 

  28. Nelsen TS, Anders CJ (1966) Dynamic aspects of small intestinal rupture with special consideration of anastomotic strength. Arch Surg 93:309–314

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The study was supported by research Grants from National Natural Science Foundation of China (NO. 51377024), Basic Research Project (NO. 13JC1407202) and Innovation Project (NO. 13441900802) of Shanghai Science and Technology Commission and the Innovation Fund Project for Graduate Student of Shanghai (NO. JWCXSL1201). The authors would like to acknowledge the assistance of Mr. Dick Lee at Covidien Center of Innovation in Shanghai.

Disclosures

Lingxi Zhao, Chengli Song, Zhigang Wang, Yu Zhou, Xinxiang Li, Wei Zhu, Alfred Cuschieri have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China

    Lingxi Zhao, Chengli Song, Yu Zhou & Wei Zhu

  2. Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China

    Xinxiang Li

  3. Institute for Medical Science and Technology, University of Dundee, 1 Wurzburg Loan, Dundee MediPark, Dundee, DD2 1FD, UK

    Zhigang Wang & Alfred Cuschieri

  4. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China

    Xinxiang Li

Authors
  1. Lingxi Zhao
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  2. Chengli Song
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  3. Zhigang Wang
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  4. Yu Zhou
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  5. Xinxiang Li
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  6. Wei Zhu
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  7. Alfred Cuschieri
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Corresponding authors

Correspondence to Lingxi Zhao, Chengli Song or Xinxiang Li.

Additional information

Chengli Song and Xinxiang Li are co-corresponding authors.

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Zhao, L., Song, C., Wang, Z. et al. Novel concave–convex electrode for colonic anastomoses by radiofrequency thermo-fusion. Surg Endosc 29, 1809–1816 (2015). https://doi.org/10.1007/s00464-014-3864-4

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  • DOI: https://doi.org/10.1007/s00464-014-3864-4

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