Saline enhanced thermal sealing of tissue: Potential for bloodless surgery

A new technology has been introduced that combines radiofrequency (RF) energy with simultaneous saline irrigation. We present a description of the technology, its fundamental effect on tissue, selected preclinical results, and early clinical outcomes in a variety of surgical disciplines. The initial product that incorporates this technology is the TissueLink Floating Ball™, a monopolar surface coagulator, available in both laparoscopic and open shaft lengths. The low flow rate of saline couples RF to tissue and provides Cooling to limit the tissue temperature to no greater than 100°C. This prevents desiccation, eschar, smoke, and sticking associated with conventional dry electrosurgical devices with dry electrodes. The primary tissue effect OCcurs at tissue temperatures in the range of 60-80°C and involves the shrinkage of the Type I collagen that OCcurs in the walls of blood vessels, airways, bile ducts and other biological vessels. The shrinkage of the collagen closes the lumen and seals the vessel. Data is presented on the depth of the tissue effect and the chronic healing response in porcine liver. Early clinical results in the form of case reports are presented for both general and thoracic surgical applications, particularly for highly vascularized parenchymatous organs such as liver and lung. The use of the TissueLink device for liver resections has shown the potential to dramatically reduce blood loss. Its use in thoracic surgery has demonstrated it is capable of achieving both hemostasis and aerostasis.