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01.10.2014 | Original Article | Ausgabe 7/2014

Langenbeck's Archives of Surgery 7/2014

Bipolar vessel sealing: instrument contamination and wear have little effect on seal quality and success in a porcine in vitro model

Zeitschrift:
Langenbeck's Archives of Surgery > Ausgabe 7/2014
Autoren:
Christian W. Wallwiener, Susanna H. Junginger, Wolfgang Zubke, Sara Y. Brucker, Markus D. Enderle, Alexander Neugebauer, Birgitt Schönfisch, Markus Wallwiener

Abstract

Purpose

The aim of this study is to systematically investigate under standardized experimental conditions the effects of instrument contamination and wear on the quality of bipolar vessel sealing (BVS) achieved using a reusable instrument.

Methods

The study was designed as a prospective, randomized, and controlled in vitro study and conducted in an academic research environment. Reusable bipolar coagulation forceps (BiClamp® 200 C, ERBE Elektromedizin) were used to apply sealing pressures of 300–1,100 mN/mm2 to 239 renal arteries from commercially slaughtered female pigs (Swabian-Hall Swine). Forceps jaws were coated with porcine blood, blood and collagen, or blood, collagen, and fat to simulate instrument contamination with biological material during surgery. Clinical wear was mimicked by sandpaper abrasion. The main outcome measures were seal success (resistance to 250 mmHg intraluminal pressure for 2 min) and seal stability (burst pressure).

Results

Sealing pressure had a significant impact, with 800 mN/mm2 producing the best sealing results. Seal success increased with total energy applied to the tissue, a higher maximum temperature, and longer coagulation as indicated by desiccation time. Experimental contamination had no significant impact on seal success and only a limited effect on seal stability. Similarly, abrasive wear also had no significant effect on either seal quality or seal strength.

Conclusions

The impact of bipolar forceps contamination and wear on seal success and quality was negligible in our in vitro model. To achieve high-quality seals, it is essential to use adequate sealing pressures. Our findings could have direct implications for the design and clinical handling of BVS instruments.

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