Abstract
Background
Radiofrequency-controlled tissue fusion is a novel technology but the associated lateral thermal damage has not been determined.
Methods
Lateral thermal spread of in vivo and ex vivo bowel in a live porcine model fused by radiofrequency energy was evaluated using dynamic infrared thermography and histology.
Results
Mean maximum thermal spread measured on histology was <1.2 mm, with no significant difference between thermal spreads for in vivo and ex vivo bowel for radiofrequency energy delivered at 50 V (p = 0.98) and 100 V (p = 0.85). Mean total maximum thermal spread measured by dynamic infrared thermography was <3.9 mm wide on both sides of the instrument with no significant difference between thermal spreads for in vivo and ex vivo bowel for radiofrequency energy delivered at 50 V (p = 0.34) and 100 V (p = 0.19). Fusion quality for in vivo tissue was better when radiofrequency energy was delivered at 100 V compared with 50 V. However, thermal spread measurements and maximum temperatures reached in the tissue were similar in well- and poorly fused bowel. Thermal changes in well-fused bowel were more uniform throughout the different bowel wall layers, whereas in poorly fused tissues, the mucosa did not show thermally induced changes. There were no significant differences between the maximum temperatures detected for in vivo and ex vivo bowel for radiofrequency energy delivered at 50 V (p = 0.25) and 100 V (p = 0.14).
Conclusions
The total thermal changes at both sides of fused bowel are <3.9 mm. The heat sink effect of the application instrument overshadowed any effects of perfusion on limiting thermal spread. Also, using greater amounts of radiofrequency energy at 100 V to achieve better quality fusion does not necessarily increase lateral thermal damage compared with 50 V.
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Acknowledgment
The authors thank Tyco Healthcare for funding this study. Tyco Healthcare had no involvement in (1) the study design, (2) the data collection, analysis, or interpretation, (3) the writing of the report, or (4) the decision to submit the paper for publication.
Disclosures
Dr. Chern Beverly Lim, Dr. Robert Goldin, Dr. Daniel Elson, Professor Lord Ara Darzi, and Professor George Hanna have no conflicts of interest or financial ties to disclose.
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Lim, C.B.B., Goldin, R.D., Elson, D.S. et al. In vivo thermography during small bowel fusion using radiofrequency energy. Surg Endosc 24, 2465–2474 (2010). https://doi.org/10.1007/s00464-010-0987-0
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DOI: https://doi.org/10.1007/s00464-010-0987-0