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Tissue storage ex vivo significantly increases vascular fusion bursting pressure

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Abstract

Introduction

Harvested biological tissue is a common medium for surgical device assessment in a laboratory setting; this study aims to differentiate between surgical device performance in the clinical and laboratory environments prior to and following tissue storage. Vascular tissue fusion devices are sensitive to tissue-device temperature gradients, tissue pre-stretch in vivo and tissue water content, each of which can vary during tissue storage. In this study, we compare the results of tissue fusion prior to and following storage using a standardized bursting pressure protocol.

Methods

Epigastric veins from seven porcine models were subject to identical bursting pressure protocols after fusion. One half of each vein was fused in vivo, harvested and immediately analyzed for burst pressure; the remainder was stored (0.9% Phosphate Buffered Saline, 24h, 4 °C) and then analyzed ex vivo. Histological slides were prepared for qualitative analysis of in versus ex vivo fusions.

Results

Bursting pressures of vessels fused ex vivo (514.7 ± 187.0 mmHg) were significantly greater than those of vessels fused in vivo (310 ± 127.7 mmHg, p = 2.06 E-10). Histological imaging of venous axial cross-sections indicated the lamination of adventitia and media layers ex vivo, whereas in vivo samples consisted only of adventitia.

Conclusion

These findings suggest that the fusion of porcine venous tissue ex vivo may overestimate the clinical performance of fusion devices. Prior work has indicated that increased tissue hydration and the lamination of tissue layers both positively affect arterial fusion bursting pressures. The bursting pressure increase observed herein may therefore be due to storage-induced alterations in tissue composition and mechanics of the fusion interface. While harvested tissue provides an accessible medium for comparative study, the fusion of vascular tissue in vivo may avoid storage-induced biomechanical alterations and is likely a better indicator of fusion device performance in a clinical setting.

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Acknowledgments

The authors would like to thank Nicholas Anderson, Kelli Barnes, Dave Stafford, Roberto del Cid, ConMed Electrosurgery, Premier Labs, PreClinical Research Services, Inc., and the University of Colorado Denver Anschutz Medical Campus Large Animal Operating Room staff. This publication is funded by grant support from ConMed Electrosurgery Corporation, Centennial, CO, to the University of Colorado at Boulder.

Disclosures

Drs. Rentschler, Ferguson, Cezo, and Eric Kramer receive materials, supplies, and travel funding under the ConMed Corporation grant. Dr. Taylor is the Vice President of research and development at ConMed Corporation. Dr. Schoen has no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

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

    James D. Cezo, Eric A. Kramer, Virginia L. Ferguson & Mark E. Rentschler

  2. Department of Surgery, University of Colorado at Denver, 12631 E 14th Ave, Aurora, CO, 80045, USA

    Jonathan A. Schoen

  3. ConMed Electrosurgery, Centennial, Toronto, ON, USA

    Kenneth D. Taylor

Authors
  1. James D. Cezo
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  2. Eric A. Kramer
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  3. Jonathan A. Schoen
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  4. Virginia L. Ferguson
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  5. Kenneth D. Taylor
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  6. Mark E. Rentschler
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Correspondence to Eric A. Kramer.

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Cezo, J.D., Kramer, E.A., Schoen, J.A. et al. Tissue storage ex vivo significantly increases vascular fusion bursting pressure. Surg Endosc 29, 1999–2005 (2015). https://doi.org/10.1007/s00464-014-3900-4

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  • DOI: https://doi.org/10.1007/s00464-014-3900-4

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