The impedance analysis of small intestine fusion by pulse source

Assessing the influence of parameters on tissue welding in small bowel end-to-end anastomosis in vitro and in vivo

BACKGROUND

The use of high-frequency electric welding technology for intestinal end-to-end anastomosis holds significant promise. Past studies have focused on in vitro, and the safety and efficacy of this technology is uncertain, severely limiting the clinical application of this technology. This study investigates the impact of compression pressure, energy dosage, and duration on anastomotic quality using a homemade anastomosis device in both in vitro and in vivo settings.

METHODS

Two hundred eighty intestines and 5 experimental pigs were used for in vitro and in vivo experiments, respectively. The in vitro experiments were conducted to study the effects of initial pressure (50-400 kpa), voltage (40-60 V), and time (10-20 s) on burst pressure, breaking strength, thermal damage, and histopathological microstructure of the anastomosis. Optimal parameters were then inlaid into a homemade anastomosis and used for in vivo experiments to study the postoperative porcine survival rate and the pathological structure of the tissues at the anastomosis and the characteristics of the collagen fibers.

RESULTS

The anastomotic strength was highest when the compression pressure was 250 kPa, the voltage was 60 V, and the time was 15 s. The degree of thermal damage to the surrounding tissues was the lowest. The experimental pigs had no adverse reactions after the operation, and the survival rate was 100%. 30 days after the operation, the surgical site healed well, and the tissues at the anastomosis changed from immediate adhesions to permanent connections.

CONCLUSION

High-frequency electric welding technology has a certain degree of safety and effectiveness. It has the potential to replace the stapler anastomosis in future and become the next generation of new anastomosis device.

Characteristics of Collagen Changes in Small Intestine Anastomoses Induced by High-Frequency Electric Field Welding

High-frequency electric field welding-induced tissue fusion has been explored as an advanced surgical method for intestinal anastomoses; however, intrinsic mechanisms remain unclear. The aim of this study was to investigate microcosmic changes of collagen within the fusion area, with various parameters. Ex vivo small intestine was fused with mucosa-mucosa. Four levels of compressive pressure (100 kPa, 150 kPa, 200 kPa, 250 kPa) were applied for 10 s in order to fuse the colons under a power level of 140 W. Then, collagen fibers of the fusion area were examined by fibrillar collagen alignment and TEM. Three levels of power (90 W, 110 W, 140 W) and three levels of time (5 s, 10 s, 20 s) were applied in order to fuse colons at 250 kPa, and then collagen within the fusion area was examined by Raman spectroscopy. Fibrillar collagen alignment analysis showed that with the increase in compression pressure, alignment of the collagen in the fusion area gradually increased, and the arrangement of collagen fibers tended to be consistent, which was conducive to the adhesion of collagen fibers. TEM showed that pressure changed the distribution and morphology of collagen fibers. Raman spectroscopy showed that increased power and time within a certain range contributed to collagen cross linking. Peak positions of amide I band and amide III band changed. These results suggested that higher power and a longer amount of time resulted in a decrease in non-reducible cross links and an increase in reducible cross links. Compression pressure, power, and time can affect the state of collagen, but the mechanisms are different. Compressive pressure affected the state of collagen by changing its orientation; power and time denatured collagen by increasing temperature and improved the reducible cross linking of collagen to promote tissue fusion.

Dynamic Impedance Analysis of Intestinal Anastomosis during High-Frequency Electric Field Welding Process

The success rate of the electrosurgical high-frequency electric field welding technique lies in reasonable control of the welding time. However, the final impedance value used to control the welding time varies due to differences in tissue size and the welding method during the welding process. This study aims to introduce a new reference indicator not limited by impedance size from dynamic impedance to achieve an adequate weld strength with minimal thermal damage, providing feedback on the tissue welding effect in medical power supplies. End-to-end anastomosis experiments were conducted with porcine small intestine tissue under seven levels of compression pressure. The dynamic impedance changes were analyzed, combined with compression pressure, temperature, moisture, and collagen during welding. The welding process was divided into three stages according to the dynamic impedance, with impedance decreasing in Period Ⅰ and impedance increasing in Period Ⅲ. Period Ⅲ was the key to high-strength connections due to water evaporation and collagen reorganization. The dynamic impedance ratio is defined as the final impedance divided by the minimum impedance, and successful welding would be predicted when detecting the dynamic impedance ratio over 4 (n = 70, p < 0.001). Dynamic impedance monitoring can be used as a macroscopic real-time prediction of the anastomosis effect.