Application of the LigaSure (TM) tissue sealing system to intestinal resection. Experimental and clinical trial

Aim: To evaluate the efficacy and safety of applying the Liga sure system (approved for vessel sealing) to intestine sealing procedures. Methods: fifteen NewZealand rabbits underwent laparotomic intestinal resection of the cecum (7 animals, group 1) or small intestine (8 animals, group 2), sealing the stumps by applying precisely controlled electrothermal energy and physical pressure in an experimental setting. The tightness of these seals was tested immediately after completing the surgical procedure and subsequently an autopsic investigation. The effectiveness of the sealing action was also assessed on biological samples of human duodenum and appendix. All seal zones were the object of histopathological study with a view to assessing the effect of applying the system to human and animal tissues. Results: all the stumps appeared to be sealed immediately after the application of the instrument. Postoperatively, 28 rabbit intestine stumps were effectively investigated: 10 (belonging to the first experimental group) were found still open and 18 (belonging to the second group) were sealed. The effectiveness of the seal was progressively optimised by adjusting the technique adopted in using the instrument. The area of the seal has the appearance of a homogeneous eosinophilic band with a few necrobiotic cells. An inflammatory process develops with a stroll reaction and the formation of connective tissue indistinguishable from the manual sutures. Already after 12 days, the area of the seal was no longer identifiable. Conclusions: the application seems to be effective, though further experimental studies are needed to validate the effectiveness and safety of the Ligature system in sealing the intestine.