Tissue Tension Is an Important Factor to Avoid Urinary and Sexual Dysfunction After Rectal Surgery

Akihiro Kondo, MD, Yuji Nishizawa, PhD, Takayuki Fujii, MD, Masao Fujiwara, PhD, Yasuyuki Suzuki, PhD. Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University.

INTRODUCTION Recently, high precision nerve-sparing has become possible with minute anatomical recognition in laparoscopic rectal surgery. However, it has been considered that thermal damage of the nerve tissue caused by the energy device (ED) can lead to postoperative urinary and sexual dysfunction in many cases. We studied the relation between the tissue tension, which has been considered technically important in rectal surgery, and thermal diffusion to the peripheral tissue through the use of ED.

MATERIALS AND METHODS We excised the mesentery of pigs with three types of ED including an electric scalpel (ES), LCS and a bipolar sealing system (BSS) at three levels of tissue tension (0, 300, 600g). The excision time for each ED was measured and the area reaching a temperature above 70ºC was monitored using thermography. The correlations between the tissue tension and the thermal diffusion area were studied.

RESULTS The excision time inversely correlated strongly with the tissue tension for all EDs (ES: r=0.718, LCS: r=0.949, BSS: r=0.843). Furthermore, the tissue tension inversely correlated strongly with the thermal diffusion area in ES (r=0.718) and BSS (r=0.869).

CONCLUSION This study shows the potential that thermal damage is avoided with adequate tissue tension in particular in ES and BSS.

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