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Archives of Gynecology and Obstetrics (2018) 297:961–967
https://doi.org/10.1007/s00404-018-4661-4
GENERAL GYNECOLOGY
A prospective randomized experimental study to investigate
the peritoneal adhesion formation after waterjet injection and argon
plasma coagulation (HybridAPC) in a rat model
Bernhard Kraemer
1
· Marcus Scharpf
2
· Simon Keckstein
1
· Julia Dippon
1
· Christos Tsaousidis
1
·
Kristin Brunecker
3
· Markus Dominik Enderle
3
· Alexander Neugebauer
3
· Daniela Nuessle
3
· Falko Fend
2
·
Sara Brucker
1
· Florin‑Andrei Taran
1
· Stefan Kommoss
1
· Ralf Rothmund
1
Received: 10 October 2017 / Accepted: 9 January 2018 / Published online: 23 January 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract
Background This prospective, randomized, controlled, single-blinded study investigates the peritoneal adhesion formation
of HybridAPC (waterjet elevation of the peritoneum with subsequent argon plasma coagulation) versus only waterjet (eleva-
tion with the same instrument, but without subsequent argon plasma coagulation) in a rat model (24 female Wistar rats).
Materials and methods Bilateral lesions were created on the abdominal wall with HybridAPC on one sidewall and waterjet
elevation on the other sidewall of the peritoneum in a standard fashion. After 10 days, the rats were euthanized to evaluate
the peritoneal trauma sites.
Main outcome measure(s) Adhesion incidence, quantity, and quality were scored 10 days postoperatively and studied
histopathologically.
Result(s) Incidence of adhesion formation was 2.3% for HybridAPC; no adhesions occurred for peritoneal elevation with
saline (p = 1.00). Histologic evaluation revealed no acute inflammation in both groups. An overall moderate degree of
granulation tissue formation and myonecrosis was observed in the HybridAPC group, whereas no chronic inflammation and
myonecrosis occurred after elevation without thermal ablation (p < 0.0001).
Conclusion(s) This study investigates the effect of waterjet elevation of the peritoneum with and without subsequent thermal
ablation on adhesion formation in a rat model for the first time. Peritoneal waterjet elevation with saline does not provide
any risk of adhesion formation. Thermal coagulation with APC after waterjet elevation of the peritoneum creates advanta-
geous peritoneal conditions due to a permanent moist tissue surface and the cooling effect of the injected solution, resulting
in no significant difference in adhesion formation compared to peritoneal elevation without thermal ablation. HybridAPC
can thus be regarded as a beneficial coagulation method with only minor adhesion formation due to positive tissue effects
of the combined waterjet.
Keywords Adhesions · Argon plasma coagulation (APC) · HybridAPC · Saline · Rat model · Thermal · Damage · Waterjet
Introduction
Peritoneal adhesions are a common and often unavoidable
complication of laparoscopic or conventional surgery pos-
ing serious risks to the patient and causing postoperative
adhesion-related problems such as chronic abdominal pain,
Contents of this manuscript have been presented as posters/
abstracts at the following meetings: 61. Kongress der DGGG,
2016. 25th ESGE Congress, 2016. 12. Endometriosekongress
deutschsprachiger Länder, 2017. XXV. Akademische Tagung
deutschsprachiger Hochschullehrer 2017 (accepted as poster).
* Bernhard Kraemer
Bernhard.Kraemer@med.uni-tuebingen.de
1
Department of Obstetrics and Gynecology, University
of Tuebingen, Calwerstr. 7, 72076 Tübingen, Germany
2
Department of Pathology, University of Tuebingen,
Liebermeisterstr. 8, 72076 Tübingen, Germany
3
Erbe Elektromedizin GmbH, Waldhoernlestr. 17,
72072 Tübingen, Germany
@Phil_Robichaud
@deepthiw
@JoseServera