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A prospective randomized experimental study to investigate the peritoneal adhesion formation after waterjet injection and argon plasma coagulation (HybridAPC) in a rat model

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

This prospective, randomized, controlled, single-blinded study investigates the peritoneal adhesion formation of HybridAPC (waterjet elevation of the peritoneum with subsequent argon plasma coagulation) versus only waterjet (elevation with the same instrument, but without subsequent argon plasma coagulation) in a rat model (24 female Wistar rats).

Materials and methods

Bilateral lesions were created on the abdominal wall with HybridAPC on one sidewall and waterjet elevation on the other sidewall of the peritoneum in a standard fashion. After 10 days, the rats were euthanized to evaluate the peritoneal trauma sites.

Main outcome measure(s)

Adhesion incidence, quantity, and quality were scored 10 days postoperatively and studied histopathologically.

Result(s)

Incidence of adhesion formation was 2.3% for HybridAPC; no adhesions occurred for peritoneal elevation with saline (p = 1.00). Histologic evaluation revealed no acute inflammation in both groups. An overall moderate degree of granulation tissue formation and myonecrosis was observed in the HybridAPC group, whereas no chronic inflammation and myonecrosis occurred after elevation without thermal ablation (p < 0.0001).

Conclusion(s)

This study investigates the effect of waterjet elevation of the peritoneum with and without subsequent thermal ablation on adhesion formation in a rat model for the first time. Peritoneal waterjet elevation with saline does not provide any risk of adhesion formation. Thermal coagulation with APC after waterjet elevation of the peritoneum creates advantageous peritoneal conditions due to a permanent moist tissue surface and the cooling effect of the injected solution, resulting in no significant difference in adhesion formation compared to peritoneal elevation without thermal ablation. HybridAPC can thus be regarded as a beneficial coagulation method with only minor adhesion formation due to positive tissue effects of the combined waterjet.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany

    Bernhard Kraemer, Simon Keckstein, Julia Dippon, Christos Tsaousidis, Sara Brucker, Florin-Andrei Taran, Stefan Kommoss & Ralf Rothmund

  2. Department of Pathology, University of Tuebingen, Liebermeisterstr. 8, 72076, Tübingen, Germany

    Marcus Scharpf & Falko Fend

  3. Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072, Tübingen, Germany

    Kristin Brunecker, Markus Dominik Enderle, Alexander Neugebauer & Daniela Nuessle

Authors
  1. Bernhard Kraemer
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  2. Marcus Scharpf
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  3. Simon Keckstein
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  4. Julia Dippon
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Contributions

BK: protocol/project development, data analysis, manuscript writing, and editing. MS: data collection, data analysis, and manuscript writing. SK: protocol/project development and data collection. JD: protocol/project development and data collection. CT: protocol/project development. KB: protocol/project development, data collection, data management, data analysis, and manuscript writing. MDE: protocol/project development and data analysis. AN: protocol/project development and data analysis. DN: data collection, data analysis, and manuscript writing. FF: protocol/project development and data analysis. SB: protocol/project development and data analysis. FAT: data analysis and editing. SK: data collection. RR: protocol/project development and data analysis.

Corresponding author

Correspondence to Bernhard Kraemer.

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Conflict of interest

The authors B. Kraemer, M. Scharpf, S. Keckstein, J. Dippon, C. Tsaousidis, F. Fend, S. Brucker, F. A. Taran, S. Kommoss, and R. Rothmund have no conflicts of interest to disclose in relation to the submitted manuscript. The authors K. Brunecker, M. D. Enderle, A. Neugebauer, and D. Nuessle are employees of Erbe research department, Germany.

Ethical approval

All applicable institutional guidelines for the care and use of animals were followed. All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted.

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Kraemer, B., Scharpf, M., Keckstein, S. et al. A prospective randomized experimental study to investigate the peritoneal adhesion formation after waterjet injection and argon plasma coagulation (HybridAPC) in a rat model. Arch Gynecol Obstet 297, 961–967 (2018). https://doi.org/10.1007/s00404-018-4661-4

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  • DOI: https://doi.org/10.1007/s00404-018-4661-4

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