Preclinical Methods to Assess Collateral Mechanical Damage to Tissues Caused by Surgical Procedures and Devices

Ishijima, Ayumu; Koseki, Yoshihiko; Ando, Takehiro; Sakuma, Ichiro; Kobayashi, Etsuko

doi:10.5759/jscas.18.19

Cited by 3 publications

(2 citation statements)

References 70 publications

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“…The main disadvantage of using metal is that metal is a much stiffer material than delicate gastrointestinal tissues and as such, compressing tissue with metal graspers can cause damage at the cellular level (such as mechanical destruction of the cell membrane or nucleus) or tissue level (such as rupture of muscle fibers or ischemia from the destruction of blood vessels). 12 Graspers also come in a variety of jaw geometries and teeth profiles such as straight or flared, fenestrated with waves or solid and single or dual action, which contribute both to their function and damage potential. For example, when a grasper’s jaw is serrated, increasing the size of the teeth will help prevent slippage but also causes more damage to tissue.…”

Section: Introductionmentioning

confidence: 99%

Tissue stress from laparoscopic grasper use and bowel injury in humans: establishing intraoperative force boundaries

Khan

MacDonald

Streutker

et al. 2021

BMJ Surg Interv Health Technologies

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ObjectivesWe aim to determine what threshold of compressive stress small bowel and colon tissues display evidence of significant tissue trauma during laparoscopic surgery.DesignThis study included 10 small bowel and 10 colon samples from patients undergoing routine gastrointestinal surgery. Each sample was compressed with pressures ranging from 100 kPa to 600 kPa. Two pathologists who were blinded to all study conditions, performed a histological analysis of the tissues. Experimentation: November 2018–February 2019. Analysis: March 2019–May 2020.SettingAn inner-city trauma and ambulatory hospital with a 40-bed inpatient general surgery unit with a diverse patient population.ParticipantsPatients were eligible if their surgery procured healthy tissue margins for experimentation (a convenience sample). 26 patient samples were procured; 6 samples were unusable. 10 colon and 10 small bowel samples were tested for a total of 120 experimental cases. No patients withdrew their consent.InterventionsA novel device was created to induce compressive “grasps” to simulate those of a laparoscopic grasper. Experimentation was performed ex-vivo, in-vitro. Grasp conditions of 0–600 kPa for a duration of 10 s were used.ResultsSmall bowel (10), M:F was 7:3, average age was 54.3 years. Colon (10), M:F was 1:1, average age was 65.2 years. All 20 patients experienced a significant difference (p<0.05) in serosal thickness post-compression at both 500 and 600 kPa for both tissue types. A logistic regression analysis with a sensitivity of 100% and a specificity of 84.6% on a test set of data predicts a safety threshold of 329–330 kPa.ConclusionsA threshold was discovered that corresponded to both significant serosal thickness change and a positive histological trauma score rating. This “force limit” could be used in novel sensorized laparoscopic tools to avoid intraoperative tissue injury.

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Section: Introductionmentioning

confidence: 99%

Tissue stress from laparoscopic grasper use and bowel injury in humans: establishing intraoperative force boundaries

Khan

MacDonald

Streutker

et al. 2021

BMJ Surg Interv Health Technologies

View full text Add to dashboard Cite

show abstract

“…Laparoscopic graspers have jaws traditionally made from stainless steel due to its durability and ease of sterilization. The main disadvantage of using metal is that metal is a much stiffer material than delicate gastrointestinal tissues and as such, compressing tissue with metal graspers can cause damage at the cellular level (such as mechanical destruction of the cell membrane or nucleus) or tissue level (such as rupture of muscle fibers or ischemia from the destruction of blood vessels) [13]. Graspers also come in a variety of jaw geometries and teeth profiles such as straight or flared, fenestrated with waves or solid and single or dual action, which contribute both to their function and damage potential.…”

Section: Introductionmentioning

confidence: 99%

Tissue Stress from Laparoscopic Grasper Use and Bowel Injury in Humans: Establishing Intraoperative Force Boundaries

Khan

MacDonald

Streutker

et al. 2021

Preprint

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Background: Inappropriate force in laparoscopic surgery can lead to inadvertent tissue injury. It is currently unknown however at what magnitude of compressive stress trauma occurs in gastrointestinal tissues. Methods: This study included 10 small bowel and 10 colon samples. Each was compressed with pressures ranging from 100 kPa to 600 kPa by a novel device to induce compressive grasps to simulate those of a laparoscopic grasper. Experimentation was performed ex-vivo, in-vitro. Grasp conditions of 0 to 600 kPa for a duration of 10 seconds were utilized. Two pathologists who were blinded to all study conditions, performed a histological analysis of the tissues. Patients were eligible if their surgery procured healthy tissue margins for experimentation (a convenience sample). 26 patient samples were procured; six samples were unusable. 10 colon and 10 small bowel samples were tested for a total of 120 experimental cases. No patients withdrew their consent. Two metrics of damage were quantified: an intestinal layer thickness calculation where the serosa layer was measured in the area of compression and compared to a local control and a histological scoring scale for tissue trauma. Results: Small bowel (10), M:F was 7:3, average age was 54.3 years. Colon (10), M:F was 1:1, average age was 65.2 years. All 20 patients experienced a significant difference (p<0.05) in serosal thickness post-compression at both 500 and 600 kPa for both tissue types. A logistic regression analysis with a sensitivity of 100% and a specificity of 84.6% on a test set of data predicts a safety threshold of 329-330 kPa. Conclusion: A threshold was discovered that corresponded to both significant serosal thickness change and a positive histological trauma score rating. This force limit could be used in novel sensorized laparoscopic tools to avoid intraoperative tissue injury.

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Survey on Preclinical Methods to Assess Collateral Thermal Damage to Tissues Caused by Surgical Devices

Ishijima

Koseki

Azuma

et al. 2017

JJSCAS

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Here we review the preclinical evaluation methodologies of thermal induced damage to tissues caused by surgical devices. Many innovative surgical devices based on thermal energy sources have been studied to offer less invasive treatment with fewer complications. Before these devices are used clinically, their safety must be validated using various methods to simulate the clinical situation with reasonable accuracy. We surveyed various preclinical studies and summarized methodologies to evaluate thermal induced damages. All the methodologies were categorized according to their invasiveness and measurement parameters(physical or biological parameters). In these studies, the damage was evaluated by one or more sub-assessments and attempted to clarify effective intensity and distribution of intervention to minimize the damage. For damage evaluation research, choice of techniques is extensive but decisions must be based on the nature of intervention.

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Preclinical Methods to Assess Collateral Mechanical Damage to Tissues Caused by Surgical Procedures and Devices

Cited by 3 publications

References 70 publications

Tissue stress from laparoscopic grasper use and bowel injury in humans: establishing intraoperative force boundaries

Tissue stress from laparoscopic grasper use and bowel injury in humans: establishing intraoperative force boundaries

Tissue Stress from Laparoscopic Grasper Use and Bowel Injury in Humans: Establishing Intraoperative Force Boundaries

Survey on Preclinical Methods to Assess Collateral Thermal Damage to Tissues Caused by Surgical Devices

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