A prospective, randomized, experimental study to investigate the peritoneal adhesion formation of noncontact argon plasma coagulation in a rat model

Abstract

Objective: To investigate the peritoneal adhesion formation of two pulsed noncontact argon plasma coagulation (APC) modes in a rat model.

Design: Prospective, randomized, controlled, and blinded study.

Setting: Laboratory facilities of a university department of obstetrics and gynecology.

Animal(s): Ten female Wistar rats.

Intervention(s): Bilateral lesions were created on the abdominal wall with low and high APC energy in a standard fashion. After 10 days the rats were killed to evaluate the peritoneal trauma sites.

Main outcome measure(s): Adhesion incidence, quantity, and quality were scored 10 days after surgery and studied by histopathologic analysis.

Result(s): The area of coagulation was 30 ± 8.4 mm(2) in the case of high APC energy and 12 ± 5.6 mm(2) (low APC energy). Macroscopic thermal damage of the peritoneum is significantly higher when applying high APC energy. Adhesions due to APC with high energy occurred in 64% and with low energy in 6% of cases. High energy results mainly in dense adhesions. The lesions in the high-energy group showed intense granulation tissue formation with centrally located myocyte necrosis with intense neutrophilic inflammation.

Conclusion(s): This study describes for the first time that different noncontact APC energy settings induce peritoneal adhesions in a reproducible rat model. Higher energy produced significantly deeper tissue defects and adhesions of higher grade. A plasma coagulation system that develops fewer adhesions can be achieved by lower temperature and a more homogeneous application and if the application area desiccates more slowly.