In vivo thermography during small bowel fusion using radiofrequency energy

Radiofrequency-controlled tissue fusion is a novel technology but the associated lateral thermal damage has not been determined.

Lateral thermal spread of in vivo and ex vivo bowel in a live porcine model fused by radiofrequency energy was evaluated using dynamic infrared thermography and histology.

Mean maximum thermal spread measured on histology was <1.2 mm, with no significant difference between thermal spreads for in vivo and ex vivo bowel for radiofrequency energy delivered at 50 V (p = 0.98) and 100 V (p = 0.85). Mean total maximum thermal spread measured by dynamic infrared thermography was <3.9 mm wide on both sides of the instrument with no significant difference between thermal spreads for in vivo and ex vivo bowel for radiofrequency energy delivered at 50 V (p = 0.34) and 100 V (p = 0.19). Fusion quality for in vivo tissue was better when radiofrequency energy was delivered at 100 V compared with 50 V. However, thermal spread measurements and maximum temperatures reached in the tissue were similar in well- and poorly fused bowel. Thermal changes in well-fused bowel were more uniform throughout the different bowel wall layers, whereas in poorly fused tissues, the mucosa did not show thermally induced changes. There were no significant differences between the maximum temperatures detected for in vivo and ex vivo bowel for radiofrequency energy delivered at 50 V (p = 0.25) and 100 V (p = 0.14).

The total thermal changes at both sides of fused bowel are <3.9 mm. The heat sink effect of the application instrument overshadowed any effects of perfusion on limiting thermal spread. Also, using greater amounts of radiofrequency energy at 100 V to achieve better quality fusion does not necessarily increase lateral thermal damage compared with 50 V.