A Novel Articulating Chip-on-Tip Endoscope for Dynamic Middle Ear Surgical Visualization.

OBJECTIVE: To enhance visualization in pediatric Otolaryngology middle ear surgeries and reduce mastoidectomy instances, we introduce a novel Articulating Chip-on-Tip Endoscope (ACoT Endo). METHODS: The ACoT Endo incorporates a cable-driven distal end camera and off-the-shelf Chip-on-Tip camera to improve visualization. We compared its capabilities with standard endoscopes, evaluating its bending capacity (70 ° ± 2 °) and center axis rotation (360 °). To test the overall functionality of this device, a Mock Ear was created to simulate the anatomy of the human ear, and the ACoT Endo's ability to be used in this cavity is compared to a standard 0 ° Karl Storz endoscope through tests with the Mock Ear and respective endoscopes. RESULTS: The ACoT Endo accurately captured surgical details similar to standard endoscopes in the ENT field. Compared to the 0 ° Karl Storz endoscope, the ACoT Endo demonstrated an increased field of view by approximately 69% and captured area by approximately 249%. ACot Endo allowed the surgeon to effortlessly articulate the camera with the rotation of a finger, while an excision tool was inserted in the middle ear, a procedure that is currently extremely difficult with standard endoscopes. CONCLUSION: The ACoT Endo's dynamic viewing angle and Chip-on-Tip camera enable unparalleled surgical visualization within the middle ear using a single endoscope, offering potential benefits in Otolaryngology procedures. SIGNIFICANCE: By reducing the need for invasive mastoidectomies and providing better visualization tools, the ACoT Endo has significant potential to improve outcomes and safety in pediatric middle ear surgeries.

Deep Learning Segmentation of the Right Ventricle in Cardiac MRI: The M&Ms Challenge.

In recent years, several deep learning models have been proposed to accurately quantify and diagnose cardiac pathologies. These automated tools heavily rely on the accurate segmentation of cardiac structures in MRI images. However, segmentation of the right ventricle is challenging due to its highly complex shape and ill-defined borders. Hence, there is a need for new methods to handle such structure's geometrical and textural complexities, notably in the presence of pathologies such as Dilated Right Ventricle, Tricuspid Regurgitation, Arrhythmogenesis, Tetralogy of Fallot, and Inter-atrial Communication. The last MICCAI challenge on right ventricle segmentation was held in 2012 and included only 48 cases from a single clinical center. As part of the 12th Workshop on Statistical Atlases and Computational Models of the Heart (STACOM 2021), the M&Ms-2 challenge was organized to promote the interest of the research community around right ventricle segmentation in multi-disease, multi-view, and multi-center cardiac MRI. Three hundred sixty CMR cases, including short-axis and long-axis 4-chamber views, were collected from three Spanish hospitals using nine different scanners from three different vendors, and included a diverse set of right and left ventricle pathologies. The solutions provided by the participants show that nnU-Net achieved the best results overall. However, multi-view approaches were able to capture additional information, highlighting the need to integrate multiple cardiac diseases, views, scanners, and acquisition protocols to produce reliable automatic cardiac segmentation algorithms.

Local lateral contact governs shear traction of micropatterned surfaces on hydrogel substrates.

Micropatterned surfaces exhibit enhanced shear traction on soft, aqueous tissue-like materials and, thus, have the potential to advance medical technology by improving the anchoring performance of medical devices on tissue. However, the fundamental mechanism underlying the enhanced shear traction is still elusive, as previous studies focused on interactions between micropatterned surfaces and rigid substrates rather than soft substrates. Here, we present a particle tracking method to experimentally measure microscale three-dimensional (3D) deformation of a soft hydrogel in normal and shear contact with arrays of microscale pillars. The measured 3D strain and stress fields reveal that the lateral contact between each individual pillar and the deformed hydrogel substrate governs the shear response. Moreover, by comparing pillars with different cross-sectional geometries, we observe experimental evidence that the shear traction of a pillar on the hydrogel substrate is sensitive to the convex features of its leading edge in the shear direction.

Miniaturized Circuitry for Capacitive Self-Sensing and Closed-Loop Control of Soft Electrostatic Transducers.

Soft robotics is a field of robotic system design characterized by materials and structures that exhibit large-scale deformation, high compliance, and rich multifunctionality. The incorporation of soft and deformable structures endows soft robotic systems with the compliance and resiliency that makes them well adapted for unstructured and dynamic environments. Although actuation mechanisms for soft robots vary widely, soft electrostatic transducers such as dielectric elastomer actuators (DEAs) and hydraulically amplified self-healing electrostatic (HASEL) actuators have demonstrated promise due to their muscle-like performance and capacitive self-sensing capabilities. Despite previous efforts to implement self-sensing in electrostatic transducers by overlaying sinusoidal low-voltage signals, these designs still require sensing high-voltage signals, requiring bulky components that prevent integration with miniature untethered soft robots. We present a circuit design that eliminates the need for any high-voltage sensing components, thereby facilitating the design of simple low cost circuits using off-the-shelf components. Using this circuit, we perform simultaneous sensing and actuation for a range of electrostatic transducers including circular DEAs and HASEL actuators and demonstrate accurate estimated displacements with errors <4%. We further develop this circuit into a compact and portable system that couples high voltage actuation, sensing, and computation as a prototype toward untethered multifunctional soft robotic systems. Finally, we demonstrate the capabilities of our self-sensing design through feedback control of a robotic arm powered by Peano-HASEL actuators.

Enabling Autonomous Colonoscopy Intervention Using a Robotic Endoscope Platform.

OBJECTIVE: Robotic endoscopes have the potential to dramatically improve endoscopy procedures, however current attempts remain limited due to mobility and sensing challenges and have yet to offer the full capabilities of traditional tools. Endoscopic intervention (e.g., biopsy) for robotic systems remains an understudied problem and must be addressed prior to clinical adoption. This paper presents an autonomous intervention technique onboard a Robotic Endoscope Platform (REP) using endoscopy forceps, an auto-feeding mechanism, and positional feedback. METHODS: A workspace model is established for estimating tool position while a Structure from Motion (SfM) approach is used for target-polyp position estimation with the onboard camera and positional sensor. Utilizing this data, a visual system for controlling the REP position and forceps extension is developed and tested within multiple anatomical environments. RESULTS: The workspace model demonstrates accuracy of 5.5% while the target-polyp estimates are within 5 mm of absolute error. This successful experiment requires only 15 seconds once the polyp has been located, with a success rate of 43% using a 1 cm polyp, 67% for a 2 cm polyp, and 81% for a 3 cm polyp. CONCLUSION: Workspace modeling and visual sensing techniques allow for autonomous endoscopic intervention and demonstrate the potential for similar strategies to be used onboard mobile robotic endoscopic devices. SIGNIFICANCE: To the authors' knowledge this is the first attempt at automating the task of colonoscopy intervention onboard a mobile robot. While the REP is not sized for actual procedures, these techniques are translatable to devices suitable for in vivo application.

Patterned enteroscopy balloon design factors influence tissue anchoring.

Balloon-assisted enteroscopy procedures allow visualization and intervention in the small intestine. These balloons anchor an endoscope and/or overtube to the small intestine, allowing endoscopists to plicate the small intestine over the overtube. This procedure can extend examination deeper into the small intestine than the length of the endoscope would allow with direct examination. However, procedures are often prolonged or incomplete due to balloon slippage. Enteroscopy balloons are pressure-limited to ensure patient safety and thus, improving anchoring without increasing pressure is essential. Patterning balloon exteriors with discrete features may enhance anchoring at the tissue-balloon interface. Here, the pattern design space is explored to determine factors that influence tissue anchoring. The anchoring ability of smooth versus balloons with patterned features is investigated by experimentally measuring a peak force required to induce slippage of an inflated balloon inside ex-vivo porcine small intestine. Stiffer materials, low aspect-ratio features, and pattern area/location on the balloons significantly increase peak force compared to smooth silicone balloons. Smooth latex balloons, used for standard enteroscopy, have the lowest peak force. This work demonstrates both a method to pattern curved surfaces and that a balloon with patterned features improves anchoring against a deformable, lubricated tissue interface.

Three-Dimensional Microscale Imaging and Measurement of Soft Material Contact Interfaces under Quasi-Static Normal Indentation and Shear.

Understanding the contact and friction between soft materials is vital to a wide variety of engineering applications including soft sealants and medical devices such as catheters and stents. Although the mechanisms of friction between stiff materials have been extensively studied, the mechanisms of friction between soft materials are much less understood. Time-dependent material responses, large deformations, and fluid layers at the contact interface, common in soft materials, pose new challenges toward understanding the friction between soft materials. This article aims to characterize the three-dimensional (3D) contact interfaces in soft materials under large deformations and complex contact conditions. Specifically, we introduce a microindentation and visualization (MIV) system capable of investigating soft material contact interfaces with combined normal and shear loading. When combined with a laser scanning confocal microscope, the MIV system enables the acquisition of 3D image stacks of the deformed substrate and the indenter under fixed normal and shear displacements. The 3D imaging data allows us to quantify the 3D contact profiles and correlate them with the applied normal and shear displacements. Using a spherical indenter and a hydrogel substrate as a model system, we demonstrate that the MIV system and the associated analysis techniques accurately measure the contact area under combined normal and shear loading. Although the limited speed of confocal scanning implies that this method is most suitable for quasi-static loading conditions, potential methods to increase the imaging speed and the corresponding trade-off in image resolution are discussed. The method presented here will be useful for the future investigation of soft material contact and friction involving complex surface geometries.

Energy-Based Tissue Fusion for Sutureless Closure: Applications, Mechanisms, and Potential for Functional Recovery.

As minimally invasive surgical techniques progress, the demand for efficient, reliable methods for vascular ligation and tissue closure becomes pronounced. The surgical advantages of energy-based vessel sealing exceed those of traditional, compression-based ligatures in procedures sensitive to duration, foreign bodies, and recovery time alike. Although the use of energy-based devices to seal or transect vasculature and connective tissue bundles is widespread, the breadth of heating strategies and energy dosimetry used across devices underscores an uncertainty as to the molecular nature of the sealing mechanism and induced tissue effect. Furthermore, energy-based techniques exhibit promise for the closure and functional repair of soft and connective tissues in the nervous, enteral, and dermal tissue domains. A constitutive theory of molecular bonding forces that arise in response to supraphysiological temperatures is required in order to optimize and progress the use of energy-based tissue fusion. While rapid tissue bonding has been suggested to arise from dehydration, dipole interactions, molecular cross-links, or the coagulation of cellular proteins, long-term functional tissue repair across fusion boundaries requires that the reaction to thermal damage be tailored to catalyze the onset of biological healing and remodeling. In this review, we compile and contrast findings from published thermal fusion research in an effort to encourage a molecular approach to characterization of the prevalent and promising energy-based tissue bond.

Positioning Performance of Power and Manual Drivers in Posterior Spinal Fusion Procedures.

This work presents an analysis and comparison of the efficacy of two methods for pedicle screw placement during posterior spinal fusion surgery. A total of 100 screws (64 manual and 36 power driven), all placed utilizing a surgical navigation system, were analyzed and compared. Final screw placement was compared to initial surgical plans using the navigation system, and the final screw locations were analyzed on the basis of angular deviation from these planned trajectories as well as screw translation within a critical reference plane. The power driver was found to insignificantly decrease the resulting angular deviation of these pedicle screws with a mean deviation of 3.35 degrees compared to 3.44 degrees with the manual driver (p = 0.853). Conversely, the power driver was found to increase the translational distance in the critical region, with mean deviations of 2.45 mm for the power driver compared to 1.54 mm with the manual driver. The increase in translational deviation was significant (p = 0.002) indicating that there may be some loss in performance from the adoption of the power driver.

Characterizing Adhesion between a Micropatterned Surface and a Soft Synthetic Tissue.

The work of adhesion and work of separation are characteristic properties of a contact interface that describe the amount of energy per unit area required to adhere or separate two contacting substrates, respectively. In this work, the authors present experimental and data analysis procedures that allow the contact interface between a soft synthetic tissue and a smooth or micropatterned poly(dimethylsiloxane) (PDMS) substrate to be characterized in terms of these characteristic parameters. Because of physical geometry limitations, the experimental contact geometry chosen for this study differs from conventional test geometries. Therefore, the authors used finite element modeling to develop correction factors specific to the experimental contact geometry used in this work. A work of adhesion was directly extracted from experimental data while the work of separation was estimated on the basis of experimental results. These values are compared to other theoretical calculations for validation. The results of this work indicate that the micropatterned PDMS substrate significantly decreases both the work of adhesion and work of separation as compared to a smooth PDMS substrate when in contact with a soft synthetic tissue substrate.

Towards autonomous motion control in minimally invasive robotic surgery.

INTRODUCTION: While autonomous surgical robotic systems exist primarily at the research level, recently these systems have made a strong push into clinical settings. The autonomous or semi-autonomous control of surgical robotic platforms may offer significant improvements to a diverse field of surgical procedures, allowing for high precision, intelligent manipulation of these systems and opening the door to advanced minimally invasive surgical procedures not currently possible. AREAS COVERED: This review highlights those experimental systems currently under development with a focus on in vivo modeling and control strategies designed specifically for the complex and dynamic surgical environment. Expert review: Novel methods for state estimation, system modeling and disturbance rejection, as applied to these devices, continues to improve the performance of these important surgical tools. Procedures such as Natural Orifice Transluminal Endoscopic Surgery and Laparo-Endoscopic Single Site surgery, as well as more conventional procedures such as Colonoscopy, serve to benefit tremendously from the development of these automated robotic systems, enabling surgeons to minimize tissue damage and shorten procedure times while avoiding the consequences of laparotomy.

Strength and Persistence of Energy-Based Vessel Seals Rely on Tissue Water and Glycosaminoglycan Content.

Vessel ligation using energy-based surgical devices is steadily replacing conventional closure methods during minimally invasive and open procedures. In exploring the molecular nature of thermally-induced tissue bonds, novel applications for surgical resection and repair may be revealed. This work presents an analysis of the influence of unbound water and hydrophilic glycosaminoglycans on the formation and resilience of vascular seals via: (a) changes in pre-fusion tissue hydration, (b) the enzymatic digestion of glycosaminoglycans (GAGs) prior to fusion and (c) the rehydration of vascular seals following fusion. An 11% increase in pre-fusion unbound water led to an 84% rise in vascular seal strength. The digestion of GAGs prior to fusion led to increases of up to 82% in seal strength, while the rehydration of native and GAG-digested vascular seals decreased strengths by 41 and 44%, respectively. The effects of increased unbound water content prior to fusion combined with the effects of seal rehydration after fusion suggest that the heat-induced displacement of tissue water is a major contributor to tissue adhesion during energy-based vessel sealing. The effects of pre-fusion GAG-digestion on seal integrity indicate that GAGs are inhibitory to the bond formation process during thermal ligation. GAG digestion may allow for increased water transport and protein interaction during the fusion process, leading to the formation of stronger bonds. These findings provide insight into the physiochemical nature of the fusion bond, its potential for optimization in vascular closure and its application to novel strategies for vascular resection and repair.

A Novel Parameter for Predicting Arterial Fusion and Cutting in Finite Element Models.

Current efforts to evaluate the performance of laparoscopic arterial fusion devices are limited to costly, time consuming, empirical studies. Thus, a finite element (FE) model, with the ability to predict device performance would improve device design and reduce development time and costs. This study introduces a model of the heat transfer through an artery during electrosurgical procedures that accounts for changes in thermal material properties due to water loss and temperature. Experiments then were conducted by applying a known heat and pressure to carefully sectioned pieces of porcine splenic arteries and measuring cut completeness. From this data, equations were developed to predict at which temperature and pressure arterial tissue is cut. These results were then incorporated into a fully coupled thermomechanical FE model with the ability to predict whole artery cutting. An additional experiment, performed to examine the accuracy of the model, showed that the model predicted complete artery cut results correctly in 28 of 32 tests. The predictive ability of this FE model opens a gateway to more advanced electrosurgical fusion devices and modeling techniques of electrosurgical procedures by allowing for faster, cheaper and more comprehensive device design.

Intestinal Manometry Force Sensor for Robotic Capsule Endoscopy: An Acute, Multipatient In vivo Animal and Human Study.

GOAL: Development of a new medical device class generally termed robotic capsule endoscopes (RCE) is currently being pursued by multiple research groups. These maneuverable devices will allow minimally invasive diagnosis and treatment of intestinal pathologies. While the intraluminal pressures related to the migrating motor complex (MMC) are well understood, no previous study has measured the active contact forces exerted by the human small bowel wall on a solid, or near solid bolus such as an RCE. Understanding and quantifying the active contact force are critical for the advancement of RCE technology. METHODS: In this study, the authors develop a novel manometric contact force sensor for human studies and validate the feasibility of the design, sterilization method, and minimally invasive surgical procedure in a multianimal study, followed by a multihuman study. RESULTS: Four porcine tests of the sensor were conducted. The mean porcine myenteric contact force measured using the new sensor is 1.20 ± 0.08 N·cm-1. The mean myenteric contact force recorded for all five human test subjects is 0.18 ± 0.33 N·cm-1. CONCLUSION: This study demonstrates the feasibility of operating an MMC force sensor in a live human with a minimally invasive surgical technique and presents force data necessary for RCE design. SIGNIFICANCE: This study represents the first known myenteric contact force measurements on a solid bolus in the human small intestine.

A new 3-dimensional method for measuring precision in surgical navigation and methods to optimize navigation accuracy.

PURPOSE: Description of a novel method for evaluation of pedicle screws in 3 dimensions utilizing O-arm(®) and StealthStation(®) navigation; identifying sources of error, and pearls for more precise screw placement. METHODS: O-arm and StealthStation navigation were utilized to place pedicle screws. Initial and final O-arm scans were performed, and the projected pedicle probe track, projected pedicle screw track, and final screw position were saved for evaluation. They were compared to evaluate the precision of the system as well as overall accuracy of final screw placement. RESULTS: Thoracolumbar deformity patients were analyzed, with 153 of 158 screws in adequate position. Only 5 screws were malpositioned, requiring replacement or removal. All 5 were breached laterally and no neurologic or other complications were noted in any of these patients. This resulted in 97 % accuracy using the navigation system, and no neurological injuries or deficits. The average distance of the screw tip and angle of separation for the predicted path versus the final pedicle screw position were analyzed for precision. The mean screw tip distance from the projected tip was 6.43 mm, with a standard deviation of 3.49 mm when utilizing a navigated probe alone and 5.92 mm with a standard deviation of 3.50 mm using a navigated probe and navigated screwdriver (p = 0.23). Mean angle differences were 4.02° and 3.09° respectively (p < 0.01), with standard deviations of 2.63° and 2.12°. CONCLUSIONS: This new technique evaluating precision of screw placement in 3 dimensions improves the ability to define screw placement. Pedicle screw position at final imaging showed the use of StealthStation navigation to be accurate and safe. As this is a preliminary evaluation, we have identified several factors affecting the precision of pedicle screw final position relative to that predicted with navigation.

Bond Strength of Thermally Fused Vascular Tissue Varies With Apposition Force.

Surgical tissue fusion devices ligate blood vessels using thermal energy and coaptation pressure, while the molecular mechanisms underlying tissue fusion remain unclear. This study characterizes the influence of apposition force during fusion on bond strength, tissue temperature, and seal morphology. Porcine splenic arteries were thermally fused at varying apposition forces (10-500 N). Maximum bond strengths were attained at 40 N of apposition force. Bonds formed between 10 and 50 N contained laminated medial layers; those formed above 50 N contained only adventitia. These findings suggest that commercial fusion devices operate at greater than optimal apposition forces, and that constituents of the tunica media may alter the adhesive mechanics of the fusion mechanism.

Tissue storage ex vivo significantly increases vascular fusion bursting pressure.

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.

Soft material adhesion characterization for in vivo locomotion of robotic capsule endoscopes: Experimental and modeling results.

The objective of this work is to validate an experimental method and nondimensional model for characterizing the normal adhesive response between a polyvinyl chloride based synthetic biological tissue substrate and a flat, cylindrical probe with a smooth polydimethylsiloxane (PDMS) surface. The adhesion response is a critical mobility design parameter of a Robotic Capsule Endoscope (RCE) using PDMS treads to provide mobility to travel through the gastrointestinal tract for diagnostic purposes. Three RCE design characteristics were chosen as input parameters for the normal adhesion testing: pre-load, dwell time and separation rate. These parameters relate to the RCE׳s cross sectional dimension, tread length, and tread speed, respectively. An inscribed central composite design (CCD) prescribed 34 different parameter configurations to be tested. The experimental adhesion response curves were nondimensionalized by the maximum stress and total displacement values for each test configuration and a mean nondimensional curve was defined with a maximum relative error of 5.6%. A mathematical model describing the adhesion behavior as a function of the maximum stress and total displacement was developed and verified. A nonlinear regression analysis was done on the maximum stress and total displacement parameters and equations were defined as a function of the RCE design parameters. The nondimensional adhesion model is able to predict the adhesion curve response of any test configuration with a mean R(2) value of 0.995. Eight additional CCD studies were performed to obtain a qualitative understanding of the impact of tread contact area and synthetic material substrate stiffness on the adhesion response. These results suggest that the nondimensionalization technique for analyzing the adhesion data is sufficient for all values of probe radius and substrate stiffness within the bounds tested. This method can now be used for RCE tread design optimization given a set of environmental conditions for device operation.

Biocompatibility and tissue integration of a novel shape memory surgical mesh for ventral hernia: in vivo animal studies.

Approximately 400,000 ventral hernia repair surgeries are performed each year in the United States. Many of these procedures are performed using laparoscopic minimally invasive techniques and employ the use of surgical mesh. The use of surgical mesh has been shown to reduce recurrence rates compared to standard suture repairs. The placement of surgical mesh in a ventral hernia repair procedure can be challenging, and may even complicate the procedure. Others have attempted to provide commercial solutions to the problems of mesh placement, but these have not been well accepted by the clinical community. In this article, two versions of shape memory polymer (SMP)-modified surgical mesh, and unmodified surgical mesh, were compared by performing laparoscopic manipulation in an acute porcine model. Also, SMP-integrated polyester surgical meshes were implanted in four rats for 30-33 days to evaluate chronic biocompatibility and capacity for tissue integration. Porcine results show that the modified mesh provides a controlled, temperature-activated, automated deployment when compared to an unmodified mesh. In rats, results indicate that implanted SMP-modified meshes exhibit exceptional biocompatibility and excellent integration with surrounding tissue with no noticeable differences from the unmodified counterpart. This article provides further evidence that an SMP-modified surgical mesh promises reduction in surgical placement time and that such a mesh is not substantially different from unmodified meshes in chronic biocompatibility.

Evaluating temperature and duration in arterial tissue fusion to maximize bond strength.

Tissue fusion is a growing area of medical research that enables mechanical closure of tissues without the need of foreign bodies such as sutures or staples. Utilizing heat and pressure applied for a specified time, a bond can be formed between adjacent tissues. The success or failure of tissue fusion is contingent upon the strength of the bond it creates between opposing tissues, yet little characterization has been done to measure the strength of this interface as a function of the input parameters, such as heat and pressure. Previous studies have examined the strength of tissue fusion using clinically relevant outcomes such as bursting pressure or tearing strength, but none have explored metrics more appropriate for determining the mechanics of the actual bond such as peel or shear strengths. The goal of this study is to establish methodology for T-peel and lap shear testing of fused tissues and measure the fusion bonding strength as a function of temperature and time using the ConMed Altrus(®) laparoscopic thermal fusion device. Across five temperatures (120, 140, 150, 160, 170°C) and four time durations (500, 1000, 1800, 3000ms) the mean peeling strength, ultimate shear strength, and bursting pressure of fused porcine splenic arteries were measured. The shear strength increased with increasing temperature and time with an ultimate shear strength at 160°C and 3000ms equal to 290 ± 99Pa. No trend was observed between the input parameters of time and applied temperature and the mean peeling force, although there were significant differences between groups. The bursting pressure increased significantly with increasing durations, but no trend was noted between temperature and bursting pressure. The shear strength data suggest there is some physical or chemical reaction which occurs in the tissue between 120°C and 150°C which provides a stronger bond. The shear and peel results also reveal that the fusion bond undergoes brittle failure. This study suggests that the tissue fusion bond is maximized at temperatures over 150°C and at a time of 3000ms using the ConMed Altrus(®) and that input parameters can be tuned to optimize the strength of the bonded region.