Intestinal Injury by Heat Conduction from Surgical Sealing Devices

BACKGROUND: There have been no investigations of intestinal injury induced by surgical sealing devices, especially focusing heat conduction from the back of active blades during laparoscopic surgery. OBJECTIVE: This study of damage to the small intestine by heat conduction from the back of active blades both physically and histopathologically was performed to establish safe usage of surgical sealing devices. MATERIALS AND METHOD: We compared seven types of bipolar sealing device and two types of ultrasonic coagulating shear in an animal model simulating laparoscopic surgery. Time-dependent changes in heat conduction from the back of active blades were measured using a direct contact thermometer during intracorporeal activation. Histopathological damage to the small intestine by the back of active blades in laparoscopic surgical application was evaluated. The backs of active blades were activated while attached to the serosa of the small intestine. The depths of histopathological changes were measured to evaluate the thermal effects of surgical sealing devices. RESULTS: Most devices generated temperatures >70°C even on the back of active blades. There were no significant differences in duration for cooling to ≤50°C among these devices. All devices induced histopathological heat damage in the submucosal layer or deeper. CONCLUSIONS: Regardless of type, the backs of active blades of surgical sealing devices conduct high temperatures and can induce heat damage in the small intestine. Surgical sealing devices should not be activated while attached to surrounding tissue or organs in laparoscopic surgery.