Evaluating temperature and duration in arterial tissue fusion to maximize bond strength

Cezo, James D.; Passernig, Anna C.; Ferguson, Virginia L.; Taylor, Kenneth D.; Rentschler, Mark E.

doi:10.1016/j.jmbbm.2013.10.007

Cited by 20 publications

(11 citation statements)

References 34 publications

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“…Despite this desire, previous investigators, as well as our own testing, have shown the positive impact of time on obtaining optimal seals both with ultrasonics and electrosurgery. For example, using bipolar energy, longer periods of energy activation resulted in better seals, with periods of 15–20 seconds being ideal for traditional bipolar technologies 21–24. Similar findings have been shown with advanced bipolar technologies 10,11.…”

Section: Discussionsupporting

confidence: 64%

Sealing vessels up to 7 mm in diameter solely with ultrasonic technology

Timm¹,

Asher²,

Tellio³

et al. 2014

MDER

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IntroductionUltrasonic energy is a mainstay in the armamentarium of surgeons, providing multifunctionality, precision, and control when dissecting and sealing vessels up to 5 mm in diameter. Historically, the inability to seal vessels in the 5–7 mm range has been perceived as an inherent limitation of ultrasonic technology. The purpose of this study was to evaluate sealing of vessels up to 7 mm in diameter with an ultrasonic device that modulates energy delivery during the sealing period.MethodsIn ex vivo benchtop and in vivo acute and survival preclinical models, a new ultrasonic device, Harmonic ACE®+7 Shears (Harmonic 7), was compared with advanced bipolar devices in sealing vessels 1–7 mm in diameter with respect of burst pressure, seal reliability, and seal durability. Lateral thermal damage and transection time were also evaluated.ResultsEx vivo tests of Harmonic 7 demonstrated significantly greater median burst pressures than an advanced bipolar device both for vessels <5 mm in diameter (1,078 mmHg and 836 mmHg, respectively, P=0.046) and for those in the range of 5–7 mm (1,419 mmHg and 591 mmHg, P<0.001). In vivo tests in porcine and caprine models demonstrated similar rates of hemostasis between Harmonic 7 and advanced bipolar devices, with high success rates at initial transection and seal durability of 100% after a 30-day survival period.ConclusionSealing 5–7 mm vessels is not a limitation of the type of energy used but of how energy is delivered to tissue. These studies document the ability of ultrasonic energy alone to reliably seal large vessels 5–7 mm in diameter, with significantly greater burst pressure observed in in vitro studies than those observed with an advanced bipolar technology when energy delivery is modulated during the sealing cycle. Furthermore, the seals created in 5–7 mm vessels are shown to be reliable and durable in in vivo preclinical studies.

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Section: Discussionsupporting

confidence: 64%

Sealing vessels up to 7 mm in diameter solely with ultrasonic technology

Timm¹,

Asher²,

Tellio³

et al. 2014

MDER

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“…3 Results Figure 5 shows the temperature profile within the tissue at the end of a simulation (h max ¼ 170 C; t max ¼ 5 s). The temperature at the tissue center is then compared to published results by Cezo et al [27]. The results for the predicted temperature fall within one standard deviation of measured experimental results.…”

Section: -6 / Vol 140 March 2018supporting

confidence: 53%

“…Transactions of the ASME 2.9 Experimental Measurements. The experimental results used to evaluate the performance of the FE model were taken from data published within the literature [2,26,27] as well as supplemental experiments conducted by the first and third authors following the same procedures outlined in these papers. The temperature measurements were taken within the lumen of a compressed artery using an array of thermocouples.…”

Section: -6 / Vol 140 March 2018mentioning

confidence: 99%

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A Small Deformation Thermoporomechanics Finite Element Model and Its Application to Arterial Tissue Fusion

Fankell

Regueiro

Kramer

et al. 2018

Journal of Biomechanical Engineering

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Understanding the impact of thermally and mechanically loading biological tissue to supraphysiological levels is becoming of increasing importance as complex multiphysical tissue-device interactions increase. The ability to conduct accurate, patient specific computer simulations would provide surgeons with valuable insight into the physical processes occurring within the tissue as it is heated or cooled. Several studies have modeled tissue as porous media, yet fully coupled thermoporomechanics (TPM) models are limited. Therefore, this study introduces a small deformation theory of modeling the TPM occurring within biological tissue. Next, the model is used to simulate the mass, momentum, and energy balance occurring within an artery wall when heated by a tissue fusion device and compared to experimental values. Though limited by its small strain assumption, the model predicted final tissue temperature and water content within one standard deviation of experimental data for seven of seven simulations. Additionally, the model showed the ability to predict the final displacement of the tissue to within 15% of experimental results. These results promote potential design of novel medical devices and more accurate simulations allowing for scientists and surgeons to quickly, yet accurately, assess the effects of surgical procedures as well as provide a first step toward a fully coupled large deformation TPM finite element (FE) model.

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“…Thus, in a study on small bowel thermo-fused sealing a 10-mmHg increase in burst pressure was induced with increase in water inflation rate from 2 ~19 ml/min (Arya et al, 2013). For this reason, Hendriks (Hendriks and Mastboom, 1990) and Cezo (Cezo et al, 2014) proposed use of the breaking strength and shear stress as supplements to burst pressure. However, all these methods do not assess fusion strength without disrupting the anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Predicting burst pressure of radiofrequency-induced colorectal anastomosis by bio-impedance measurement

Zhao¹,

Zhou²,

Song³

et al. 2017

Physiol. Meas.

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The present study investigates the relationship between bio-impedance and burst pressure of colorectal anastomosis created by radiofrequency (RF)-induced tissue fusion. Colorectal anastomosis were created with ex vivo porcine colorectal segments, during which 5 levels of compression pressure were applied by a custom-made bipolar prototype, with 5 replicate experiments at each compression pressure. Instant anastomotic tensile strength was assessed by burst pressure. Bio-impedance of fused tissue was measured by Impedance Analyzer across frequency that 100 Hz to 3 MHz. Statistical analysis shows only a weak correlation between bio-impedance modulus and burst pressures at frequency of 445 kHz ( ρ s = −0.426, P = 0.099 > 0.05). In contrast, results demonstrated a highly significant negative correlation between reactance modulus and burst pressures ( ρ s = −0.812, P = 0.000 < 0.05). The decrease in mean reactance modulus with increasing burst pressures was highly significant (P = 0.019 < 0.05). The observed strong negative correlation between reactance modulus and burst pressures at frequency of 445 kHz indicates that reactance is likely to be a good index for tensile strength of RF-induced colorectal anastomosis, and should be considered for inclusion in a feedback loops in devices design. Institute of Physics and Engineering in Medicine3 Contribute equally.

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Evaluating temperature and duration in arterial tissue fusion to maximize bond strength

Cited by 20 publications

References 34 publications

Sealing vessels up to 7 mm in diameter solely with ultrasonic technology

Sealing vessels up to 7 mm in diameter solely with ultrasonic technology

A Small Deformation Thermoporomechanics Finite Element Model and Its Application to Arterial Tissue Fusion

Predicting burst pressure of radiofrequency-induced colorectal anastomosis by bio-impedance measurement

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