This article discusses the use of electrosurgery in a porcine model to repair liver injuries using radiofrequency energy. The procedure involves creating controlled injuries and applying bipolar electrosurgery to achieve hemostasis.
Electrosurgery uses targeted radiofrequency - RF - energy to repair sites of injury. To perform electrosurgery, begin by making a midline incision on an anesthetized porcine model to expose the liver.
Use an abrasive force on the Glisson's capsule - a fibrous hepatic covering - to stimulate an injury and induce bleeding from the liver surface. Create lacerations - deep cuts of varying degrees - to facilitate hemorrhagic bleeding. Place an electrosurgery device directly at the injury site on the liver.
This bipolar electrosurgery device utilizes transcollation technology, supplying the RF energy at the injury site using saline flow through two adjacent electrodes. Each electrode has a terminal nozzle that ejects a stream of saline at a constant rate as the device moves. The passage of high-frequency alternating current produces ionic oscillations inside the tissue. This process generates frictional heat, elevating the temperature at the injury site.
A steady flow of saline from the probe provides an even heat distribution through the cut. The heat allows thermal coagulation - a process that denatures the collagen proteins at the cut ends of the vessels. Upon cooling, the collagen strands reform into an entangled mass, sealing the wound and arresting the blood flow. After hemorrhage arrest, the porcine liver can be used for further testing.
When the animal is ready, open the handpiece of an ignited SBRF device prepared according to the manufacturer's specifications, and connect the handpiece to the generator. Then, set the saline flow rate to low and the radio frequency power setting to 160 watts. Establish an adequate exposure of the solid organs of interest, mobilizing other structures, and inserting a retractor as necessary.
Using a #10 scalpel blade, apply an abrasive, back and forth, 1 to 2-millimeter deep, 2-square centimeter area superficial force to the liver capsule, to induce capsular bleeding. Continue to create 1-centimeter deep solid organ lacerations of increasing severity with the scalpel from 5 centimeters to the entire length of the liver tissue.
Then, using a blunt device such as a Kelly clamp, use a stabbing motion to create penetrating injuries of a partial to full thickness. After simulating all of the appropriate experimental injuries, depress the button of the handpiece to initiate the simultaneous flow of 0.9% saline and the delivery of bipolar radiofrequency energy. The saline will boil at the site of application.
Position the tip of the device directly onto the raw of the liver surface to superficial areas of bleeding, or within defects in the liver itself, and apply concurrent suctioning from a standard surgical aspirator as needed, to deliver the heated saline and energy directly to the areas of ongoing hemorrhage. Using a gentle back-and-forth motion, heat the tissues to approximately 100 degrees Celsius. An auditory pop will occur after three to five seconds, signifying that the burn is complete.
Then, move the instrument in an organized manner to the next targeted site, applying precisely directed high-voltage electrocautery in conjunction with the application of the SBRF and suction devices, to obtain hemostasis as necessary. When all of the sites of the hemorrhage have been cauterized, apply the tip of the device across the injured edge of the liver parenchyma to seal the small to medium bile ducts.
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