Optical, thermal, and electrical monitoring of radio-frequency tissue modification.

Radio-frequency (rf) tissue fusion involves the sealing of tissue between two electrodes delivering rf currents. Applications include small bowel fusion following anastomosis. The mechanism of adhesion is poorly understood, but one hypothesis is that rf modification is correlated to thermal damage and dehydration. A multimodal monitoring system capable of acquiring tissue temperature, electrical impedance, and optical transmittance at 1325-nm wavelength during rf delivery by a modified Ligasure fusion tool is presented. Measurements carried out on single layers of ex vivo porcine small bowel tissue heated at approximately 500-kHz frequency are correlated with observation of water evaporation and histological studies on full seals. It is shown that the induced current generates a rapid quasilinear rise of temperature until the boiling point of water, that changes in tissue transmittance occur before impedance control is possible, and that a decrease in transmission occurs at typical denaturation temperatures. Experimental results are compared with a biophysical model for tissue temperature and a rate equation model for thermal damage.

Real-time optical monitoring of radio-frequency tissue fusion by continuous wave transmission spectroscopy.

Radio-frequency (RF) tissue fusion is a novel method of tissue approximation that can seal tissue without the need for sutures or staples, based on the combined effects of heat and pressure on the apposed tissue surfaces. RF delivery must be controlled and optimized to obtain a reproducible, reliable seal. We use real-time optical measurements to improve understanding of the tissue modifications induced by RF fusion. The main macroscopic transformations are thermal denaturation and dehydration. Light propagation in tissue is a function of both and therefore should provide interesting insight into the dynamic of occurring phenomena. Quantification by continuous wave technique has proven challenging. We proposed an algorithm based on the measurement of the absolute transmittance of the tissue, making use of the modified Beer-Lambert law. The experimental method and the data algorithm are demonstrated by RF fusion of porcine small bowel. The proposed optical measurement modality is well adapted to modern surgical instrumentation used for minimally invasive procedures.