Background: Advanced bipolar radiofrequency (RF) energy-based devices are increasingly used for non-vascular tissue sealing, transection and anastomosis. Although the potential to further develop this technology is clear, the limitations of commercially available devices are poorly understood. This systematic review examines the current utilisation of advanced bipolar RF fusion technology for non-vascular applications in thoracic and abdominal tissues and organs.
Methods: Medline, Embase, Web of Science and Cochrane library databases were searched. Studies examining the non-vascular application of advanced bipolar RF technology in the abdomen and thorax were assessed. Measurement of seal sufficiency and the extent of tissue injury induced by bipolar RF energy application were the main outcomes of interest.
Results: Forty-six animal and human studies conducted in and ex vivo across a range of tissue types, met the inclusion criteria. The diversity of study protocols together with the heterogeneity of their outcomes prevented pooled analysis. However, the experimental animal studies assessed suggest that bipolar RF fusion devices are capable of effectively sealing most tissue types with the notable exception of large caliber bronchi (>4 mm) and bile ducts, where the rate of seal failure was unacceptably high. Human studies were additionally found to predominantly use bipolar RF technology as a means of parenchymal and ductal occlusion. A similar trend was seen amongst animal studies with only a handful of papers examining bipolar RF energy use for (bowel) anastomosis.
Conclusion: Bipolar RF fusion devices are capable of safely sealing a variety of thoracic and anterior abdominal tissues with an injury and leakage profile comparable to established technologies. Although thermal monitoring is increasingly sophisticated and multimodal, consistent real time tracking of a multitude of parameters is necessary in order to expand RF fusion technology utilisation to complete an array of tasks such as vessel ligation, ductal obliteration and anastomosis in the open and laparoscopic environments.