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Radiofrequency-induced small bowel thermofusion: an ex vivo study of intestinal seal adequacy using mechanical and imaging modalities

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Abstract

Background

Bipolar radiofrequency (RF) induced tissue fusion is believed to have the potential to seal and anastomose intestinal tissue thereby providing an alternative to current techniques which are associated with technical and functional complications. This study examines the mechanical and cellular effects of RF energy and varying compressive pressures when applied to create ex vivo intestinal seals.

Methods

A total of 299 mucosa-to-mucosa fusions were formed on ex vivo porcine small bowel segments using a prototype bipolar RF device powered by a closed-loop, feedback-controlled RF generator. Compressive pressures were increased at 0.05 MPa intervals from 0.00 to 0.49 MPa and RF energy was applied for a set time period to achieve bowel tissue fusion. Seal strength was subsequently assessed using burst pressure and tensile strength testing, whilst morphological changes were determined through light microscopy. To further identify the subcellular tissue changes that occur as a result of RF energy application, the collagen matrix in the fused area of a single bowel segment sealed at an optimal pressure was examined using transmission electron microscopy (TEM).

Results

An optimal applied compressive pressure range was observed between 0.10 and 0.25 MPa. Light microscopy demonstrated a step change between fused and unfused tissues but was ineffective in distinguishing between pressure levels once tissues were sealed. Non uniform collagen damage was observed in the sealed tissue area using TEM, with some areas showing complete collagen denaturation and others showing none, despite the seal being complete. This finding has not been described previously in RF-fused tissue and may have implications for in vivo healing.

Conclusions

This study shows that both bipolar RF energy and optimal compressive pressures are needed to create strong intestinal seals. This finding suggests that RF fusion technology can be effectively applied for bowel sealing and may lead to the development of novel anastomosis tools.

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Acknowledgments

The authors acknowledge the help of Dr. Michael Hollinshead of the Wellcome Imaging Centre, St. Mary’s Hospital, Imperial College London, in obtaining the transmission electron micrographs presented in this study, and Dr. Melody Ni of the Department of Surgery, Academic Surgical Unit, St. Mary’s Hospital, Imperial College London, in advising the statistical analysis presented.

Disclosures

This report is independent research funded by the Department of Health under the Health Technology Devices programme (HTD240). The views expressed in this publication are those of the authors and not necessarily those of the NHS or the Department of Health. Mr. Arya, Dr. Lei, Mrs. Kudo, and Professor Hanna receive funding from the UK Department of Health and Covidien under the Health Technology Devices programme (HTD240). Ms. Hadjievangelou, Dr. Elson, and Professors Goldin and Darzi have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Surgery, Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, 10th Floor, QEQM Building, South Wharf Road, London, W2 1NY, UK

    Shobhit Arya, Nancy Hadjievangelou, Su Lei, Ara W. Darzi, Daniel S. Elson & George B. Hanna

  2. Centre for Pathology, Department of Cellular Pathology, St. Mary’s Hospital, South Wharf Road, London, W2 1NY, UK

    Hiromi Kudo & Robert D. Goldin

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  1. Shobhit Arya
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  2. Nancy Hadjievangelou
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  3. Su Lei
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Correspondence to George B. Hanna.

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Arya, S., Hadjievangelou, N., Lei, S. et al. Radiofrequency-induced small bowel thermofusion: an ex vivo study of intestinal seal adequacy using mechanical and imaging modalities. Surg Endosc 27, 3485–3496 (2013). https://doi.org/10.1007/s00464-013-2935-2

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  • DOI: https://doi.org/10.1007/s00464-013-2935-2

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