Lacitignola Luca, Imperante Annarita, Trisciuzzi Rodrigo, Zizzo Nicola, Crovace Alberto Maria, Staffieri Francesco
Dipartimento dell'Emergenze e Trapianti di Organi (D.E.T.O.), Sezione di Cliniche Veterinarie e Produzioni Animali, Università degli Studi di Bari "Aldo Moro", 70124 Bari, Italy.
Dottorato di Ricerca in "Trapianti di Tessuti ed Organi e Terapie Cellulari", Dipartimento dell'Emergenza e Trapianti di Organi (D.E.T.O.), Università degli Studi di Bari "Aldo Moro", 70124 Bari, Italy.
Vet Sci. 2021 Feb 22;8(2):34. doi: 10.3390/vetsci8020034.
This study aimed to evaluate the sealing quality of swine small intestine using different laparoscopic radiofrequency vessel sealing devices (two 5 mm: RFVS-1 and -2; one 10 mm: RFVS-3) and a harmonic scalpel (HS) compared to golden standard closure technique. The study was divided into two arms. In study arm 1: n = 50 swine intestinal loops (10 per group) were transected with each instrument and the loops in which the devices provided complete sealing, at the gross inspection, were tested for maximum burst pressure (BP) and histological evaluation and compared to an automatic linear stapler. After the BP tests, the devices that achieved significantly lower BP values were excluded from the second arm. The RFVS-1 and -3 provided statistically significant results and were used in study arm 2, to obtain full-thickness biopsies along the antimesenteric border of the loop and were compared with hand-sewn intestinal closure (n = 30; 10 per group). The biopsies were histologically evaluated for thermal injury and diagnostic features, and intestinal loops tested for BP. RFVS-3 achieved comparable results (69.78 ± 4.23 mmHg, interquartile range (IQR) 5.8) to stapler closing technique (71.09 ± 4.22 mmHg, IQR 4.38; > 0.05), while the RFVS-1 resulted in significantly ( < 0.05) lower BP (45.28 ± 15.23 mmHg, IQR 24.95) but over the physiological range, conversely to RFVS-2 (20.16 ± 7.19 mmHg, IQR 12.02) and HS (not measurable). RFVS-3 resulted not significantly different ( > 0.05) (45.09 ± 8.75 mmHg, IQR 10.48) than Suture (35.71 ± 17.51 mmHg, IQR 23.77); RFVS-1 resulted significantly lower values (23.96 ± 10.63 mmHg, IQR 9.62; < 0.05). All biopsies were judged diagnostic. Data confirmed that RFVS-1 and -3 devices provided suitable intestinal sealing, with BP pressures over the physiological range. Conversely, the HS and RFVS-2 should not be considered for intestinal sealing. RFVS devices could be employed to obtain small intestine stump closure or full-thickness biopsies. However, further studies should be performed in live animals to assess the role of the healing process.
本研究旨在评估使用不同的腹腔镜射频血管闭合装置（两种5毫米的：RFVS - 1和 - 2；一种10毫米的：RFVS - 3）和超声刀（HS）与金标准闭合技术相比，猪小肠的闭合质量。该研究分为两个组。在研究组1中：50个猪肠袢（每组10个）用每种器械横断，在大体检查中装置实现完全闭合的肠袢进行最大破裂压力（BP）测试和组织学评估，并与自动线性缝合器进行比较。在BP测试后，BP值显著较低的装置被排除在第二组之外。RFVS - 1和 - 3产生了具有统计学意义的结果，并用于研究组2，沿着肠袢的系膜对侧缘获取全层活检组织，并与手工缝合肠闭合（n = 30；每组10个）进行比较。对活检组织进行热损伤和诊断特征的组织学评估，并对肠袢进行BP测试。RFVS - 3取得了与缝合器闭合技术相当的结果（69.78±4.23 mmHg，四分位间距（IQR）5.8）（71.09±4.22 mmHg，IQR 4.38；P>0.05），而RFVS - 1导致BP显著（P<0.05）更低（45.28±15.23 mmHg，IQR 24.95），但超过生理范围，与RFVS - 2（20.16±7.19 mmHg，IQR 12.02）和HS（无法测量）相反。RFVS - 3与缝合（35.71±17.51 mmHg，IQR 23.77）相比无显著差异（P>0.05）（45.09±8.75 mmHg，IQR 10.48）；RFVS - 1导致的值显著更低（23.96±10.63 mmHg，IQR 9.62；P<0.05）。所有活检组织均被判定为具有诊断价值。数据证实，RFVS - 1和 - 3装置提供了合适的肠闭合，BP压力超过生理范围。相反，HS和RFVS - 2不应用于肠闭合。RFVS装置可用于获得小肠残端闭合或全层活检组织。然而，应在活体动物中进行进一步研究以评估愈合过程的作用。
