1
|
Gandini M, Cerullo A, Gallo L, Iussich S, Minoli L, Giusto G. Ex vivo evaluation of a technique for equine jejunocecal anastomosis using radiofrequency thermofusion and a Cushing oversew. Vet Surg 2023; 52:545-553. [PMID: 36922367 DOI: 10.1111/vsu.13946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 01/04/2023] [Accepted: 02/15/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE 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 TF (15.8 [14.4-16.8]) was not significantly different from that for the HS (25.5 [24.2-26.3]) and ST (10.8 [9.7-12.5]) 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 +/- 17.5) was higher than that for RFA (76 +/- 15) and ST groups (48 +/- 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.
Collapse
Affiliation(s)
- Marco Gandini
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - Anna Cerullo
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - Livio Gallo
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - Selina Iussich
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - Lucia Minoli
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - Gessica Giusto
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| |
Collapse
|
2
|
Tu L, Zhou YU, Wang P, Wang H, Mao LIN, Hou J, Liu Z, Song C. Minimizing thermal damage using self-cooling jaws for radiofrequency intestinal tissue fusion. MINIM INVASIV THER 2023; 32:33-41. [PMID: 36519801 DOI: 10.1080/13645706.2022.2155064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Radiofrequency (RF)-induced tissue fusion shows great potential in sealing intestinal tissue without foreign materials. To improve the performance of RF-induced tissue fusion, a novel self-cooling jaw has been designed to minimize thermal damage during the fusion. MATERIAL AND METHODS The prototype of self-cooling jaws was developed and manufactured. A total number of 60 mucosa-to-mucosa fusions were conducted using ex-vivo porcine intestinal segments with the proposed design and conventional bipolar jaws. The effects of intestinal fusion were evaluated based on temperature curves, burst pressure, thermal damage, and histological appearances. RESULTS The self-cooling jaws showed significant decrease in temperature during the fusion process. An optimal burst pressure (5.7 ± 0.5 kPa) and thermal damage range (0.9 ± 0.1 mm) were observed when the applied RF power was 100 W. The thermal damage range of the prototype has almost decreased 36% in comparison with the conventional bipolar jaws (1.4 ± 0.1 mm). The histological observation revealed that a decrease of thermal damage was achieved through the application of self-cooling jaws. CONCLUSIONS The self-cooling jaws were proved to be effective for reducing the thermal damage during RF-induced tissue fusion, which could potentially promote the clinical application of tissue fusion techniques in the future.
Collapse
Affiliation(s)
- Liangyong Tu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Y U Zhou
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Peiyao Wang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Haochen Wang
- School of Mechanical Engineering, Suzhou University of Science and Technology, Suzhou, China
| | - L I N Mao
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Jian Hou
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Ziyue Liu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Chengli Song
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| |
Collapse
|
3
|
Lacitignola L, Crovace A, Passantino G, Staffieri F. Ex-Vivo Evaluation of "First Tip Closing" Radiofrequency Vessel Sealing Devices for Swine Small Intestinal Transection. Vet Sci 2022; 9:vetsci9080445. [PMID: 36006360 PMCID: PMC9415842 DOI: 10.3390/vetsci9080445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 12/02/2022] Open
Abstract
This study compared burst pressure (BP), number of activations, and histological assessment of ex vivo swine small intestine loops transected by stapler, a single fulcrum radiofrequency vessel sealing (RFVS) device, and the newly-developed jaws RFVS. Fifty (n = 50) 20 cm long jejunal loops were randomly assigned to be transected with RFVS devices and linear stapler (Caiman5, Caiman Maryland, Caiman12, Ligasure Atlas, and Stapler group as control respectively). Caiman5, Caiman12 and stapler required only one activation to complete the sealing. The mean BP in Caiman5 and Caiman Maryland groups were significantly lower (p < 0.05) than the S group as control and the other RFVS devices studied. RFVS Caiman12 and Ligasure Atlas produced mean BP values that were close to the Control and did not differ between them. The lumen was totally closed in the Caiman12 and Ligasure Atlas groups. The findings of this investigation were promising; we discovered that Caiman12 and Ligasure Atlas produce comparable mechanical capabilities as well as stapled intestinal closure, however Caiman12 need a single activation to complete the transection.
Collapse
Affiliation(s)
- Luca Lacitignola
- Department of Emergencies and Organ Transplantation, Section of Veterinary Clinics and Animal Production, University of Bari, Valenzano, 70010 Bari, Italy
- Correspondence:
| | - Alberto Crovace
- Department of Emergencies and Organ Transplantation, Section of Veterinary Clinics and Animal Production, University of Bari, Valenzano, 70010 Bari, Italy
| | - Giuseppe Passantino
- Department of Veterinary, Medicine University of Bari, Valenzano, 70010 Bari, Italy
| | - Francesco Staffieri
- Department of Emergencies and Organ Transplantation, Section of Veterinary Clinics and Animal Production, University of Bari, Valenzano, 70010 Bari, Italy
| |
Collapse
|
4
|
Effects of GLUBRAN-2 on the Burst Pressure of Jejunal Loops Thermofused With Vessel Sealing Devices. J Surg Res 2022; 275:235-243. [DOI: 10.1016/j.jss.2022.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/20/2022]
|
5
|
Gadiyaram S, Nachiappan M. LigaSure Vessel Sealing System for Small Bowel Transection During Roux Limb Construction. Cureus 2022; 14:e21287. [PMID: 35186549 PMCID: PMC8845450 DOI: 10.7759/cureus.21287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/12/2022] Open
Abstract
Roux limb construction is an essential part of several major reconstructive hepatobiliary and upper gastrointestinal surgeries. This can be achieved with a stapling device or suturing. For over two decades, the LigaSure vessel sealing systems (Medtronic, MN, USA) have been in use for omental division, mesenteric transection, and sealing of vessels. We used the LigaSure vessel sealing system with a ForceTriad energy platform (Medtronic) for transection of the bowel during the formation of the Roux limb for a Roux-en-Y reconstruction. Between July 2019 and December 2020, patients who had Roux limb construction as part of a pancreato-enteric anastomosis in surgery for chronic pancreatitis were analysed. The data was reviewed from a prospectively maintained database. Fifteen patients had undergone surgery for chronic pancreatitis. The mentioned technique takes approximately eight minutes to construct a Roux limb. There was no bleeding from the gut ends that had been transected. There was no breach in the bowel’s seal. The field was free of enteric contamination. In the post-operative course of these individuals, there was no Roux limb-related morbidity. This procedure is useful because it is cost-effective, time-saving, dependable, and prevents contamination and blood loss. It is also simple to learn and apply.
Collapse
|
6
|
Lacitignola L, Imperante A, Trisciuzzi R, Zizzo N, Crovace AM, Staffieri F. Swine Small Intestine Sealing Performed by Different Vessel Sealing Devices: Ex-Vivo Test. Vet Sci 2021; 8:vetsci8020034. [PMID: 33671834 PMCID: PMC7926574 DOI: 10.3390/vetsci8020034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/19/2021] [Indexed: 02/01/2023] Open
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.
Collapse
Affiliation(s)
- Luca Lacitignola
- Dipartimento dell’Emergenze e Trapianti di Organi (D.E.T.O.), Sezione di Cliniche Veterinarie e Produzioni Animali, Università degli Studi di Bari “Aldo Moro”, 70124 Bari, Italy;
- Correspondence:
| | - Annarita Imperante
- Dottorato di Ricerca in “Trapianti di Tessuti ed Organi e Terapie Cellulari”, Dipartimento dell’Emergenza e Trapianti di Organi (D.E.T.O.), Università degli Studi di Bari “Aldo Moro”, 70124 Bari, Italy; (A.I.); (R.T.)
| | - Rodrigo Trisciuzzi
- Dottorato di Ricerca in “Trapianti di Tessuti ed Organi e Terapie Cellulari”, Dipartimento dell’Emergenza e Trapianti di Organi (D.E.T.O.), Università degli Studi di Bari “Aldo Moro”, 70124 Bari, Italy; (A.I.); (R.T.)
| | - Nicola Zizzo
- Dipartimento di Medicina Veterinaria, Sez. di Anatomia Patologica, Università degli Studi di Bari “Aldo Moro”, 70010 Bari, Italy;
| | - Alberto Maria Crovace
- Dipartimento di Scienze Mediche di Base, Neuroscienze e Organi di Senso, Università degli Studi di Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Francesco Staffieri
- Dipartimento dell’Emergenze e Trapianti di Organi (D.E.T.O.), Sezione di Cliniche Veterinarie e Produzioni Animali, Università degli Studi di Bari “Aldo Moro”, 70124 Bari, Italy;
| |
Collapse
|
7
|
Sanchez Trejo HA, Hakakian D, Rolandelli RH, Nouri AM, Antonioli L, Nemeth ZH. "Cecal Resection with Bipolar Sealing in a Rat Model": A Promising Approach for Future Human Studies. J INVEST SURG 2018; 33:67-68. [PMID: 30339486 DOI: 10.1080/08941939.2018.1483450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Daniel Hakakian
- Department of Surgery, Morristown Medical Center, Morristown, NJ, USA
| | | | - Andrew M Nouri
- Department of Surgery, Morristown Medical Center, Morristown, NJ, USA
| | - Luca Antonioli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Zoltan H Nemeth
- Department of Surgery, Morristown Medical Center, Morristown, NJ, USA.,Columbia University Medical Center, New York, NY, USA
| |
Collapse
|