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

Abstract

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.

Hybrid argon plasma coagulation (HybridAPC) versus sharp excision for the treatment of endometriosis: a prospective randomized clinical trial

“…In this present trial, HybridAPC led to fewer adhesions than excision of the endometriotic lesion, but the difference was not significant (5.3 vs. 10.5%). This complements the results from our study on a well-established rat peritoneum model: waterjet injection, to elevate a distinct area of peritoneum, does not tend to induce peritoneal adhesions [18]. Furthermore, argon plasma coagulation after waterjet elevation (HybridAPC) led to less adhesions than argon plasma coagulation (APC) alone, with only 2% versus 50% at the same energy intake in the before mentioned animal model [11,18].…”

“…HybridAPC technology makes it possible to bluntly emit a saline jet, which perforates the peritoneum, building a fluid cushion underneath. The thermal penetration depth can be significantly reduced by the fluid cushion [11,14,18]. A desired thermal effect can hereby be concentrated on the surface, whilst the fluid cushion limits the risk of heat damage at depth.…”

“…The benefit of HybridAPC for peritoneal conditions with regard to the influence of electrosurgical trauma with minor adhesion formation due to positive effects of combined waterjet technology have been previously investigated by our group in an experimental animal model [18].…”

Adhesion prevention after endometriosis surgery — results of a randomized, controlled clinical trial with second-look laparoscopy

“…Specifically, for the resection of deep endometriosis, peritoneal full conditioning in combination with a barrier has reduced adhesion formation in a small clinical RCT [45]. In this aspect, a comprehensive analysis for 4DryField ® PH is not available yet, thus it can be speculated how the characteristics interact with the peritoneal surface: supposedly, the gel formulation (intervention group) prevents desiccation and reduces the irritating effect and hypoxia by pure CO 2 ; however, saline solution only (control) has also demonstrated a favorable impact on peritoneal conditioning [46,47] and may reduce adhesion formation after surgical trauma [48,49]. This appears to be related to altered peritoneal fibrinolytic activity as higher tPA and tPA activity levels were measured [48].…”

Regional therapy trials in peritoneal metastases: The path to standardization—Colorectal cancer

“…Several surgical technologies such as argon beam electrocoagulation and cavitronic ultrasonic surgical aspirator have been developed along with improved surgical techniques which allow removal of surface disease with organ preservation. [1][2][3][4][5] In the setting of invasive peritoneal disease, the parietal layer can be resected by peritonectomy procedures while the visceral layer can either be stripped from the surface or removed by resecting the organ(s) involved with surface tumor. Often peritoneal metastases are referred to as peritoneal surface malignancies to reflect this concept of this metastatic dissemination along the peritoneal lining surface.…”