Techniques and instrumentation
Intelligent, impedance-regulated, pulsed coagulation in a porcine renal artery model

Presented as a poster at the 33rd Annual Meeting of the American Association of Gynecological Laparoscopists in San Francisco, California, November 10–13, 2004. In addition, a summary of the findings was presented at the 14th Annual Congress of the International Society for Gynecological Endoscopy, London, United Kingdom, April 2–6, 2005.
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Objective

To compare the efficacy of conventional pulsed coagulation (CPC) and newly developed intelligent, impedance-regulated, pulsed coagulation (IPC) in the sealing of porcine renal arteries.

Design

Prospective, randomized experimental study.

Setting

Isolated porcine artery model in an academic research environment.

Animal(s)

Female Swabian Hall pigs.

Intervention(s)

Renal arteries were harvested from Swabian pigs, flushed with saline, and sealed with bipolar open forceps by using high-frequency modulations of CPC (CPC-I: 800-ms pulse, 30-ms pause; CPC-II: 800-ms pulse, 300-ms pause) or IPC (self-regulation of the current flow to tissue impedance during thermal alteration). Additional vessels underwent multiple CPC. Burst pressure and seal failure were measured by increasing the pressure in the sealed arteries with saline infusion until rupture of the seal or the vessel wall.

Main Outcome Measure(s)

Mean burst pressure, number of instant and secondary seal failures, and relation of burst pressure to vessel diameter.

Result(s)

Mean burst pressure after IPC (585.5 ± 56.8 mm Hg) was statistically significantly higher than that after CPC (CPC-I: 372.6 ± 40.0 mm Hg; CPC-II: 334.2 ± 44.2 mm Hg). Only 5.0% of the vessel seals after IPC, but 34.0% and 39.5% after CPC-I and CPC-II, showed instant or secondary seal failures, which also was a statistically significant difference. Seal quality after multiple CPC was comparable to that observed after the single IPC application (burst pressure, 597.3 ± 60.1 [MCPC-I] mm Hg and 656.2 ± 56.5 mm Hg [MCPC-II]; seal failure rate, 0).

Conclusion(s)

In an isolated porcine renal artery model, self-regulating modulation of energy-based vessel coagulation achieved superior thermal fusion of vascular tissue than did CPC. This promising novel technique should be analyzed further to determine its in vivo efficacy in long-term studies.

Key Words

Vessel sealing
bipolar coagulation
burst pressure
burst strength

Cited by (0)

Supported by the German Ministry of Education and Research (BMBF) (Berlin, Germany) within the project “Minimal invasive Technologie und Therapieverfahren” (grant 16SV 1352) and by a research grant from ERBE Elektromedizin GmbH (Tübingen, Germany).