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Histologic characteristics of laparoscopic saline-enhanced electrosurgery of liver and splenic injuries
C Sims1, N Stylopoulos, J Clavijo
1Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Hurlbut Room, Boston, MA 02214, USA. csims@partners.org
Background:
Hemostasis is crucial during laparoscopic surgery. Unlike conventional electrosurgery, saline-enhanced electrosurgery (SEE) improves the electrode-to-tissue interface. This study investigated SEE as a means of achieving hemostasis in liver and splenic injuries and assessed the associated histologic changes.
Methods:
Nine anesthetized pigs underwent laparoscopic liver tip and splenic wedge amputations. Injuries were treated with SEE (25-35 and 35-45 W, respectively). Animals were sacrificed postprocedure and at 1 and 4 weeks. Depth of necrosis was analyzed using a mixed model analysis of variance.
Results:
Liver mean depth of necrosis was 5.3 mm (acute), 6.0 mm (1 week), and 5.3 mm (4 weeks) ( p = not significant). Splenic mean depth of necrosis was 7.0 mm (acute), 7.0 mm (1 week), and 2.7 mm (4 weeks). ( p < 0.01) Acute injuries demonstrated thermal coagulation necrosis that healed with well-defined bands of collagen at 1 and 4 weeks.
Conclusions:
SEE provides effective hemostasis and results in an acceptable depth of necrosis with satisfactory wound healing in a porcine model of solid organ injury.