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

Abstract

To investigate the peritoneal adhesion formation of two pulsed noncontact argon plasma coagulation (APC) modes in a rat model. Prospective, randomized, controlled, and blinded study. Laboratory facilities of a university department of obstetrics and gynecology. Ten female Wistar rats. 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. Adhesion incidence, quantity, and quality were scored 10 days after surgery and studied by histopathologic analysis. 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. 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.