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Research Papers

Bond Strength of Thermally Fused Vascular Tissue Varies With Apposition Force

[+] Author and Article Information
Nicholas S. Anderson

Department of Mechanical Engineering,
University of Colorado at Boulder,
427 UCB, 1111 Engineering Drive,
Boulder, CO 80309-0427

Eric A. Kramer

Department of Mechanical Engineering,
University of Colorado at Boulder,
427 UCB, 1111 Engineering Drive,
Boulder, CO 80309-0427
e-mail: eric.kramer@Colorado.edu

James D. Cezo

Department of Mechanical Engineering,
University of Colorado at Boulder,
427 UCB, 1111 Engineering Drive,
Boulder, CO 80309-0427
e-mail: James.Cezo@Colorado.edu

Virginia L. Ferguson

Associate Professor
Department of Mechanical Engineering,
BioFrontiers Institute,
Materials Science and Engineering Program,
University of Colorado at Boulder,
427 UCB, 1111 Engineering Drive,
Boulder, CO 80309-0427
e-mail: Virginia.Ferguson@Colorado.edu

Mark E. Rentschler

Assistant Professor
Department of Mechanical Engineering,
University of Colorado at Boulder,
427 UCB, 1111 Engineering Drive,
Boulder, CO 80309-0427
e-mail: Mark.Rentschler@Colorado.edu

1Corresponding author.

Manuscript received June 10, 2015; final manuscript received October 15, 2015; published online November 9, 2015. Assoc. Editor: David Corr.

J Biomech Eng 137(12), 121010 (Nov 09, 2015) (6 pages) Paper No: BIO-15-1293; doi: 10.1115/1.4031891 History: Received June 10, 2015; Revised October 15, 2015

Surgical tissue fusion devices ligate blood vessels using thermal energy and coaptation pressure, while the molecular mechanisms underlying tissue fusion remain unclear. This study characterizes the influence of apposition force during fusion on bond strength, tissue temperature, and seal morphology. Porcine splenic arteries were thermally fused at varying apposition forces (10–500 N). Maximum bond strengths were attained at 40 N of apposition force. Bonds formed between 10 and 50 N contained laminated medial layers; those formed above 50 N contained only adventitia. These findings suggest that commercial fusion devices operate at greater than optimal apposition forces, and that constituents of the tunica media may alter the adhesive mechanics of the fusion mechanism.

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References

Alimova, A. , Chakraverty, R. , Muthukattil, R. , Elder, S. , Katz, A. , Sriramoju, V. , Lipper, S. , and Alfano, R. R. , 2009, “ In Vivo Molecular Evaluation of Guinea Pig Skin Incisions Healing After Surgical Suture and Laser Tissue Welding Using Raman Spectroscopy,” J. Photochem. Photobiol., B, 96(3), pp. 178–183. [CrossRef]
Hambley, R. , Hebda, P. A. , Abell, E. , Cohen, B. A. , and Jegasothy, B. V. , 1988, “ Wound Healing of Skin Incisions Produced by Ultrasonically Vibrating Knife, Scalpel, Electrosurgery, and Carbon Dioxide Laser,” J. Dermatol. Surg. Oncol., 14(11), pp. 1213–1217. [CrossRef] [PubMed]
Entezari, K. , Hoffmann, P. , Goris, M. , Peltier, A. , and Velthoven, R. V. , 2007, “ A Review of Currently Available Vessel Sealing Systems,” Minimally Invasive Ther. Allied Technol. MITAT Off. J. Soc. Minimally Invasive Ther., 16(1), pp. 52–57. [CrossRef]
Talmor, M. , Bleustein, C. B. , and Poppas, D. P. , 2001, “ Laser Tissue Welding a Biotechnological Advance for the Future,” Arch. Facial Plast. Surg., 3(3), pp. 207–213. [CrossRef] [PubMed]
Hu, L. , Lu, Z. , Wang, B. , Cao, J. , Ma, X. , Tian, Z. , Gao, Z. , Qin, L. , Wu, X. , Liu, Y. , and Wang, L. , 2011, “ Closure of Skin Incisions by Laser-Welding With a Combination of Two Near-Infrared Diode Lasers: Preliminary Study for Determination of Optimal Parameters,” J. Biomed. Opt., 16(3), p. 038001. [CrossRef] [PubMed]
Richter, S. , Kollmar, O. , Neunhoeffer, E. , Schilling, M. K. , Menger, M. D. , and Pistorius, G. , 2006, “ Differential Response of Arteries and Veins to Bipolar Vessel Sealing: Evaluation of a Novel Reusable Device,” J. Laparoendosc. Adv. Surg. Tech. A, 16(2), pp. 149–155. [CrossRef] [PubMed]
Arya, S. , Hadjievangelou, N. , Lei, S. , Kudo, H. , Goldin, R. D. , Darzi, A. W. , Elson, D. S. , and Hanna, G. B. , 2013, “ Radiofrequency-Induced Small Bowel Thermofusion: An Ex Vivo Study of Intestinal Seal Adequacy Using Mechanical and Imaging Modalities,” Surg. Endosc., 27(9), pp. 3485–3496. [CrossRef] [PubMed]
Floume, T. , Syms, R. R. A. , Darzi, A. W. , and Hanna, G. B. , 2010, “ Optical, Thermal, and Electrical Monitoring of Radio-Frequency Tissue Modification,” J. Biomed. Opt., 15(1), p. 018003. [CrossRef] [PubMed]
Bass, L. S. , Moazami, N. , Pocsidio, J. , Oz, M. C. , Logerfo, P. , and Treat, M. R. , 1992, “ Changes in Type I Collagen Following Laser Welding,” Lasers Surg. Med., 12(5), pp. 500–505. [CrossRef] [PubMed]
Murray, L. W. , Su, L. , Kopchok, G. E. , and White, R. A. , 1989, “ Crosslinking of Extracellular Matrix Proteins: A Preliminary Report on a Possible Mechanism of Argon Laser Welding,” Lasers Surg. Med., 9(5), pp. 490–496. [CrossRef] [PubMed]
Tang, J. , Godlewski, G. , Rouy, S. , and Delacrétaz, G. , 1997, “ Morphologic Changes in Collagen Fibers After 830 nm Diode Laser Welding,” Lasers Surg. Med., 21(5), pp. 438–443. [CrossRef] [PubMed]
Tang, J. , O'Callaghan, D. , Rouy, S. , and Godlewski, G. , 1998, “ Quantitative Changes in Collagen Levels Following 830-nm Diode Laser Welding,” Lasers Surg. Med., 22(4), pp. 207–211. [CrossRef] [PubMed]
Figueiredo, R. L. P. , Dantas, M. S. S. , and Oréfice, R. L. , 2011, “ Thermal Welding of Biological Tissues Derived From Porcine Aorta for Manufacturing Bioprosthetic Cardiac Valves,” Biotechnol. Lett., 33(8), pp. 1699–1703. [CrossRef] [PubMed]
Miles, C. A. , Avery, N. C. , Rodin, V. V. , and Bailey, A. J. , 2005, “ The Increase in Denaturation Temperature Following Cross-Linking of Collagen is Caused by Dehydration of the Fibres,” J. Mol. Biol., 346(2), pp. 551–556. [CrossRef] [PubMed]
Wright, N. T. , and Humphrey, J. D. , 2002, “ Denaturation of Collagen Via Heating: An Irreversible Rate Process,” Annu. Rev. Biomed. Eng., 4(1), pp. 109–128. [CrossRef] [PubMed]
Cezo, J. D. , Kramer, E. A. , Schoen, J. A. , Ferguson, V. L. , Taylor, K. D. , and Rentschler, M. E. , 2015, “ Tissue Storage Ex Vivo Significantly Increases Vascular Fusion Bursting Pressure,” Surg. Endosc., 29(7), pp. 1999–2005. [CrossRef] [PubMed]
Cezo, J. D. , Kramer, E. A. , Taylor, K. D. , Ferguson, V. L. , and Rentschler, M. E. , 2013, “ Tissue Fusion Bursting Pressure and the Role of Tissue Water Content,” Proc. SPIE, 8584, p. 85840M.
Lamberton, G. R. , Hsi, R. S. , Jin, D. H. , Lindler, T. U. , Jellison, F. C. , and Baldwin, D. D. , 2008, “ Prospective Comparison of Four Laparoscopic Vessel Ligation Devices,” J. Endourol./Endourol. Soc., 22(10), pp. 2307–2312. [CrossRef]
Carbonell, A. M. , Joels, C. S. , Kercher, K. W. , Matthews, B. D. , Sing, R. F. , and Heniford, B. T. , 2003, “ A Comparison of Laparoscopic Bipolar Vessel Sealing Devices in the Hemostasis of Small-, Medium-, and Large-Sized Arteries,” J. Laparoendosc. Adv. Surg. Tech. A, 13(6), pp. 377–380. [CrossRef] [PubMed]
Harold, K. L. , Pollinger, H. , Matthews, B. D. , Kercher, K. W. , Sing, R. F. , and Heniford, B. T. , 2003, “ Comparison of Ultrasonic Energy, Bipolar Thermal Energy, and Vascular Clips for the Hemostasis of Small-, Medium-, and Large-Sized Arteries,” Surg. Endosc., 17(8), pp. 1228–1230. [CrossRef] [PubMed]
Landman, J. , Kerbl, K. , Rehman, J. , Andreoni, C. , Humphrey, P. A. , Collyer, W. , Olweny, E. , Sundaram, C. , and Clayman, R. V. , 2003, “ Evaluation of a Vessel Sealing System, Bipolar Electrosurgery, Harmonic Scalpel, Titanium Clips, Endoscopic Gastrointestinal Anastomosis Vascular Staples and Sutures for Arterial and Venous Ligation in a Porcine Model,” J. Urol., 169(2), pp. 697–700. [CrossRef] [PubMed]
Hruby, G. W. , Marruffo, F. C. , Durak, E. , Collins, S. M. , Pierorazio, P. , Humphrey, P. A. , Mansukhani, M. M. , and Landman, J. , 2007, “ Evaluation of Surgical Energy Devices for Vessel Sealing and Peripheral Energy Spread in a Porcine Model,” J. Urol., 178(6), pp. 2689–2693. [CrossRef] [PubMed]
Newcomb, W. L. , Hope, W. W. , Schmelzer, T. M. , Heath, J. J. , Norton, H. J. , Lincourt, A. E. , Heniford, B. T. , and Iannitti, D. A. , 2009, “ Comparison of Blood Vessel Sealing Among New Electrosurgical and Ultrasonic Devices,” Surg. Endosc., 23(1), pp. 90–96. [CrossRef] [PubMed]
Cezo, J. D. , Kramer, E. , Taylor, K. D. , Ferguson, V. , and Rentschler, M. E. , 2013, “ Temperature Measurement Methods During Direct Heat Arterial Tissue Fusion,” IEEE Trans. Biomed. Eng., 60(9), pp. 2552–2558. [CrossRef] [PubMed]
Person, B. , Vivas, D. A. , Ruiz, D. , Talcott, M. , Coad, J. E. , and Wexner, S. D. , 2008, “ Comparison of Four Energy-Based Vascular Sealing and Cutting Instruments: A Porcine Model,” Surg. Endosc., 22(2), pp. 534–538. [CrossRef] [PubMed]
Burt, J. D. , Siddins, M. , and Morrison, W. , 2001, “ Laser Photoirradiation in Digital Flexor Tendon Repair,” Plast. Reconstr. Surg., 108(3), pp. 688–694. [CrossRef] [PubMed]
Klar, M. , Haberstroh, J. , Timme, S. , Fritzsch, G. , Gitsch, G. , and Denschlag, D. , 2011, “ Comparison of a Reusable With a Disposable Vessel-Sealing Device in a Sheep Model: Efficacy and Costs,” Fertil. Steril., 95(2), pp. 795–798. [CrossRef] [PubMed]
Valleylab, 2004, 510(k) Notification. Summary of Safety and Effectiveness Information: LigaSure Vessel Sealing System, Food and Drug Administration, Dallas, TX.
Kinoshita, T. , Kanehira, E. , Omura, K. , Kawakami, K. , and Watanabe, Y. , 1999, “ Experimental Study on Heat Production by a 23.5-kHz Ultrasonically Activated Device for Endoscopic Surgery,” Surg. Endosc., 13(6), pp. 621–625. [CrossRef] [PubMed]
Campbell, P. A. , Cresswell, A. B. , Frank, T. G. , and Cuschieri, A. , 2003, “ Real-Time Thermography During Energized Vessel Sealing and Dissection,” Surg. Endosc., 17(10), pp. 1640–1645. [CrossRef] [PubMed]
Song, C. , Tang, B. , Campbell, P. A. , and Cuschieri, A. , 2009, “ Thermal Spread and Heat Absorbance Differences Between Open and Laparoscopic Surgeries During Energized Dissections by Electrosurgical Instruments,” Surg. Endosc., 23(11), pp. 2480–2487. [CrossRef] [PubMed]
Reyes, D. A. G. , Brown, S. I. , Cochrane, L. , Motta, L. S. , and Cuschieri, A. , 2012, “ Thermal Fusion: Effects and Interactions of Temperature, Compression, and Duration Variables,” Surg. Endosc., 26(12), pp. 3626–3633. [CrossRef] [PubMed]
Anderson, N. , Kramer, E. , Cezo, J. , Ferguson, V. , and Rentschler, M. E. , 2014, “ Tissue Bond Strength as a Function of Applied Fusion Pressure1,” ASME J. Med. Devices, 8(3), p. 030925. [CrossRef]
Cezo, J. D. , Passernig, A. C. , Ferguson, V. L. , Taylor, K. D. , and Rentschler, M. E. , 2014, “ Evaluating Temperature and Duration in Arterial Tissue Fusion to Maximize Bond Strength,” J. Mech. Behav. Biomed. Mater., 30, pp. 41–49. [CrossRef] [PubMed]
Davidson, J. M. , Hill, K. E. , and Alford, J. L. , 1986, “ Davidson 1986 COL Elastin Biosynthesis Developmental Changes in Collagen and Elastin Biosynthesis in the Porcine Aorta,” Dev. Biol., 118(1), pp. 103–111. [CrossRef] [PubMed]

Figures

Grahic Jump Location
Fig. 1

Three-dimensional solid model of the custom loading fixture used in this study (left). Photograph of the fusion device during testing loaded onto the MTS Insight II platform (right).

Grahic Jump Location
Fig. 2

Representative loading curve of a fusion with a prescribed force of 40 N. The points indicate events as follows: (A) onset of tissue compression, (B) PID controller compensates for overshoot, (C) heaters activate; tissue expands briefly, exerting pressure against the heater surfaces in response to the vaporization of tissue water, (D) PID controller compensates for decreased force exerted on the jaws and load cell due to volumetric tissue shrinkage and water loss, and (E) steady-state load achieved.

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Fig. 3

Box plots of the burst pressure data, normalized for vessel thickness, and grouped by apposition force during fusion (170 °C, 3 s duration). Median values are represented by horizontal lines, outliers (i.e., points outside of 1.5 times the interquartile range) are represented by crosses. Sample sizes of 14 per group were used for testing at 10–50 N; eight per group were used for testing at 100–500 N.

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Fig. 4

Mean thermocouple temperature in degree Celsius, plotted as a function of applied load and thermocouple position. Each section of the plot represents one thermocouple position, and each data point represents the mean temperature of five samples measured by that thermocouple at a particular load (defined by the key). All data are presented as mean± SD.

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Fig. 5

Hematoxylin and eosin (H&E) stained samples fused at applied loads of 20 N, 30 N, 40 N, and 100 N at 5× magnification. Note that the media (m) is included in the fusion region at 20 N and 30 N, begins to retract at 40 N, and is entirely absent at 100 N, where the fusion region is composed entirely of adventitia (a). The fusion region is denoted within each panel.

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