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23 February 2011 Hyperthermic tissue sealing devices: a proposed histopathologic protocol for standardizing the evaluation of thermally sealed vessels
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Hyperthermic tissue sealing devices are advancing modern laparoscopy and other minimally invasive surgical approaches. Histopathologic evaluation of thermally sealed vessels can provide important information on their associated tissue effects and reactions. However, a standardized systematic approach has not been historically used in the literature. This paper proposes a histologic approach for the analysis of thermally sealed vessels and their basis of hemostasis, including thermal tissue changes, healing, and thrombosis. Histologic evaluation during the first week (Days 3-7) can assess the seal's primary tissue properties. These parameters include the thermal seal's length, architecture, tissue layers involved, adventitial collagen denaturation length, entrapped vapor or blood pockets, tissue homogenization and thermal tissue injury zones. While the architectural features can be assessed in Day 0-3 specimens, the latter thermal injury zones are essentially not assessable in Day 0-3 specimens. Day 14 specimens can provide information on the early healing response to the sealed vessel. Day 30 and longer specimens can be used to evaluate the seal's healing reactions. Assessment of the healing response should include seal site inflammation, granulation tissue, necrosis resorption, fibroproliferative scar healing, and thrombus organization. In order to accurately evaluate these parameters, careful specimen orientation, embedding and multiple histologic sections across the entire seal width are required. When appropriate in vivo post-treatment times are used, thermal vessel seals can be evaluated with routine light microscopy and common histologic staining methods.
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Ryan H. Livengood, Jeffrey A. Vos, and James E. Coad "Hyperthermic tissue sealing devices: a proposed histopathologic protocol for standardizing the evaluation of thermally sealed vessels", Proc. SPIE 7901, Energy-based Treatment of Tissue and Assessment VI, 79010Y (23 February 2011);

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