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Shestakov AL, Tadzhibova IM, Cherepanin AI, Bezaltynnykh AA, Shakhbanov ME. MECHANICAL ESOPHAGEAL ANASTOMOSES. SURGICAL PRACTICE 2020. [DOI: 10.38181/2223-2427-2020-3-29-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article gives an overview of mechanical esophageal anastomosis. The results of the esophageal anastomoses formation by using circular and linear stitching devices (staplers) by Russian and foreign authors are presented in chronological order. The faults of staplers, complications associated with them are described. The importance of the problem related to the choice of anastomotic technique to reduce the risks of specific complications such as leakage and stricture of esophageal anastomosis was remarked by authors. The advantages and disadvantages of the currently known esophageal anastomotic methods have been analyzed. It was noted that mechanical side-to-side anastomoses are associated with low frequency of leakage, stricture, postoperative mortality, that’s why they have become preferable, especially in the mini-invasive reconstructive surgery. The authors concluded that the question about the feasibility of mechanical esophageal anastomoses formation is not answered, the evaluation of the properties of modern staplers and the search for the best esophageal anastomotic method are relevant for modern surgery.
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Affiliation(s)
| | | | - A. I. Cherepanin
- Federal State Institution «Federal Clinical Center of High Medical Technologies of the Federal Medical and Biological Agency»
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Chen M, Cao J, Huang D, Zhang B, Pan L, Zhang Z, Wang Z, Ye Y, Xiu D, Li D, Cai X. End-to-end intestinal anastomosis using a novel biodegradable stent for laparoscopic colonic surgery: a multicenter study. Surg Today 2019; 49:1003-1012. [PMID: 31256255 DOI: 10.1007/s00595-019-01841-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/02/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Our animal studies have demonstrated the safety and feasibility of end-to-end intestinal anastomosis using a stent for laparoscopic colonic surgery. Therefore, we designed a non-inferiority trial to investigate the outcomes of stent anastomosis (SA) vs. those of conventional hand-sewn anastomosis (CA). METHODS A multicenter randomized controlled trial was conducted between December, 2016 and April, 2018. The primary outcome was the healing condition of the anastomoses, evaluated by endoscopy 6 months postoperatively. The secondary outcomes were the anastomotic completion time, anastomotic leak, intestinal obstruction, peritoneal effusion, and bleeding. Quality of life (QOL) was evaluated by questionnaires. RESULTS The subjects of this study were 60 patients, randomly divided into a SA group (n = 30) and a CA group (n = 30). There were no differences in anastomotic healing conditions (P = 1.00). The stent procedure was associated with a significantly shorter anastomosis time than the hand-sewn anastomosis (13.517 ± 4.281 vs. 20.333 ± 2.998 min, respectively; P < 0.001). There were no significant differences in anastomotic leakage, intestinal obstruction, peritoneal effusion, or bleeding between the groups. Questionnaires revealed almost no discrepancy between baseline QOL scores and those assessed 2, 4, 8, 12, and 24 weeks postoperatively in either group. CONCLUSIONS Intestinal anastomosis with a stent is a non-inferior strategy for laparoscopic colonic surgery, which requires less time for the anastomosis.
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Affiliation(s)
- Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
- Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, 310016, China
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Diyu Huang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Bin Zhang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Long Pan
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100032, China
| | - Zhenjun Wang
- Department of Anorectal Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yingjiang Ye
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, 100032, China
| | - Dianrong Xiu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100089, China
| | - Dechuan Li
- Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, 310011, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China.
- Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, 310016, China.
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Gaidry AD, Tremblay L, Nakayama D, Ignacio RC. The History of Surgical Staplers: A Combination of Hungarian, Russian, and American Innovation. Am Surg 2019. [DOI: 10.1177/000313481908500617] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since their development in 1908, surgical staplers have been used as a method of “mechanical suturing” in efforts to divide hollow viscera and create anastomoses in an efficient and sterile manner. The concept for the surgical stapler was first developed by Humér Hultl, a Hungarian professor and surgeon, and designed by Victor Fischer, a Hungarian businessman and designer of surgical instruments. The design was highly acclaimed; however, it was bulky, cumbersome, and expensive to manufacture. In 1920, Aladár Petz, a student of Hultl, incorporated two innovations to the Fischer-Hultl stapler to create a more lightweight model, which was named the Petz clamp. In 1934, Friedrich of Ulm designed what would be the predecessor to the modern-day linear stapler. In the 1950s, Russian and American staplers began to emerge. Throughout the 1960s, a variety of stapling instruments were developed in the United States, manufactured by the United States Surgical Corporation. In the 1970s, Johnson & Johnson Ethicon brand joined the market. The United States Surgical Corporation was later bought by Tyco Healthcare and became Covidien in 2007. Through the collaboration of Felicien Steichen, Mark Ravitch, and Leon Hirsch, surgical staplers were further modified to incorporate interchangeable cartridges with various designs. With the advent of minimally invasive surgery began production of laparoscopic surgical staplers. Since its inception, the surgical stapler has provided a means to efficiently create safe and effective visceral and vascular anastomoses. The surgical stapler design continues to evolve while still maintaining the basic principles that were implemented in the original design.
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Affiliation(s)
- Alicia D. Gaidry
- Department of General Surgery, Naval Medical Center San Diego, San Diego, California and
| | - Laurier Tremblay
- Department of General Surgery, Naval Medical Center San Diego, San Diego, California and
| | - Don Nakayama
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Romeo C. Ignacio
- Department of General Surgery, Naval Medical Center San Diego, San Diego, California and
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Paulo D, Semonche A, Choudhry O, Al-Mufti F, Prestigiacomo CJ, Roychowdhury S, Nanda A, Gupta G. History of Hemostasis in Neurosurgery. World Neurosurg 2018; 124:S1878-8750(18)32837-7. [PMID: 30579020 DOI: 10.1016/j.wneu.2018.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 12/01/2018] [Accepted: 12/03/2018] [Indexed: 11/17/2022]
Abstract
Control of bleeding in the confined area of the skull is imperative for successful neurosurgery and the prevention of devastating complications such as postoperative hemorrhage. This paper reviews the historical evolution of methods to achieve successful hemostasis in neurosurgery from the early1800s to today. The major categories of hemostatic agents (mechanical, chemical and thermal) are delineated and discussed in chronological order. The significance of this article is in its detailed history of the kinds of hemostatic methods that have evolved with our accumulating medical and surgical knowledge, which may inform future innovations and improvements.
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Affiliation(s)
- Danika Paulo
- Rutgers Robert Wood Johnson Medical School, Department of Neurosurgery, Clinical Academic Building Suite 2100, 125 Paterson St, New Brunswick, NJ 08901, United States
| | - Alexa Semonche
- Rutgers Robert Wood Johnson Medical School, Department of Neurosurgery, Clinical Academic Building Suite 2100, 125 Paterson St, New Brunswick, NJ 08901, United States
| | - Osamah Choudhry
- New York University, Department of Neurological Surgery, 550 1st Avenue, Skirball, Suite 8R, New York, NY 10016, United States
| | - Fawaz Al-Mufti
- University Hospital, Department of Neurology, 90 Bergen Street, Suite 5200, Newark, NJ 07101, United States
| | - Charles J Prestigiacomo
- Rutgers New Jersey Medical School, Department of Neurosurgery, Doctor's Office Center 90 Bergen Street, Newark, NJ 07101, United States
| | - Sudipta Roychowdhury
- Robert Wood Johnson University Hospital, Department of Radiology, Medical Education Building Suite #04, 1 Robert Wood Johnson Pl, New Brunswick, NJ 08901, United States
| | - Anil Nanda
- Robert Wood Johnson Medical School, Department of Neurosurgery, Clinical Academic Building Suite 2100, 125 Paterson St, New Brunswick, NJ 08901, United States
| | - Gaurav Gupta
- Robert Wood Johnson Medical School, Department of Neurosurgery, Clinical Academic Building Suite 2100, 125 Paterson St, New Brunswick, NJ 08901, United States.
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Beyond the "B": a new concept of the surgical staple enabling miniature staplers. Surg Endosc 2015; 29:3674-84. [PMID: 25795379 PMCID: PMC4648953 DOI: 10.1007/s00464-015-4125-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/18/2015] [Indexed: 12/16/2022]
Abstract
Background Surgical staplers currently all rely on the same staple form—the “B” which necessitates a high delivery profile (12 mm). A novel “D” shape staple allows for an extremely low profile of the applicator. The acute and long-term efficacy of a D-shaped staple (Cardica, Redwood City, CA, USA) was compared to conventional B-form staples (Covidien, Norwalk, CN, USA) in an animal model for intestinal transections and anastomoses. Methods Jejunojejunal anastomoses (JJ) were performed via mini-laparotomy in a swine model. White & blue D- and B-shaped staples were studied in three groups (planned survival 14–84 days). Intraoperative assessment included completeness of staple line, hemostasis, and need for intervention. Postoperatively, animals were evaluated for complications. At the time of sacrifice, gross pathological and histological assessments were performed. Results Twenty-three animals had 40 anastomoses (23 “D” and 17 “B” staple anastomoses) with no intraoperative mortalities. One “D” staple application required a manual extension of the cut. Acute hemostasis was 100 %. Group 1 (n = 5) compared white staples in JJs (D staple n = 5; B staple n = 5; 14-day survival = 100 %). Group 2 (n = 12) compared white staples in JJs (D staple n = 12; B staple n = 6; 34-day survival = 92 %). One animal died on day 4 for a non-staple related cause. Group 3 (n = 6) compared blue staples in JJs (D staple n = 6; B staple n = 6; 84 day survival = 84 %). One animal died on day 18 due to an obstruction at the B staple JJ caused by stricture. There were no other bleeding, leaks or strictures in any of the groups. Gross pathology and histology were unremarkable in all JJs. Conclusions This study showed no difference in intraoperative performance and the chronic healing response in JJs between D- and B-shaped staples. Based on these findings, the D-shaped staple elicits a normal healing response in jejunostomies and offers the possibility of clinical use of this advance in staple design.
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Raoof M, Aloia TA, Vauthey JN, Curley SA. Morbidity and mortality in 1,174 patients undergoing hepatic parenchymal transection using a stapler device. Ann Surg Oncol 2014; 21:995-1001. [PMID: 24248530 DOI: 10.1245/s10434-013-3331-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Transection of liver parenchyma using staplers is now commonly performed. Large studies are needed to assess the usefulness of the technique as well as perioperative outcomes. METHODS This is a retrospective study of a prospectively maintained database. A total of 1,174 patients undergoing liver resections in routine surgical practice, using a stapler device at MD Anderson Cancer Center between January 1, 1994 and November 10, 2011 were evaluated. RESULTS There were 900 major resections (3 segments or more) (77 %) and 274 minor resections (<3 segments or wedge resections) (23 %). A vast majority, 1,133 (96.5 %), were indicated for an underlying malignancy (24 % primary liver or gall bladder and 72.5 % metastatic) compared with benign disease, 41 (3.5 %), with the most common indication being metastatic colorectal cancer 584 (49.7 %). Of the total 1,174 patients 128 (10.9 %) had a prior liver resection. Median OR time and blood loss was 206 min and 300 mL, respectively, with 11 % of patients requiring transfusion in the perioperative or postoperative period. Overall morbidity and mortality rate was 14 and 3.2 %, respectively, with a median hospital stay of 7 days (interquartile range [IQR], 4 days). Multivariate logistic regression demonstrated blood loss and extent of liver resection to be independent predictors of adverse outcome. A total of 13 instances (1.1 %) of misfired staplers were noted and were associated with higher blood loss (p < 0.001) and mortality (15 vs. 3.1 %, p = 0.013). CONCLUSIONS Use of stapler device for hepatic resection is safe and effective, but rare instances of a misfired stapler device are associated with an adverse outcome.
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Affiliation(s)
- Mustafa Raoof
- Department of Surgery, University of Arizona Health Science Center, Tucson, AZ, USA
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Abstract
This review gives an overview of the esophageal anastomosis. The history, various techniques and substitution organs, their advantages and disadvantages, healing mechanism, complications, and actual trend of this essential part of esophageal surgery are described. The history of the esophageal anastomosis extending from the first anastomosis in 1901 to today has undergone more than one century. In the early days, the success rate of the anastomosis was extremely low. As the technology progressed, the anastomosis got significant achievement. Various anastomotic techniques are currently being used. However, controversies exist on the choice of anastomotic method concerning the success rate, postoperative complication and quality of life. How to choose the method, no one can give the best answer. We searched the manuscripts about the esophageal anastomoses in recent years and studied the controversy questions about the anastomosis. Performing an esophageal anastomosis is a technical matter, and suture healing is independent of the patient's biologic situation. Every anastomosis technique has its own merit, but the outcomes were different if it was performed by different surgeons, and we also found that the complication rate of the anastomosis was mainly associated with the surgeons. So the surgeons should learn from their previous experience and others to avoid technical errors.
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Affiliation(s)
- Y Yuan
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Zachariah SK. Reverse Transrectal Stapling Technique Using the EEA Stapler: An Alternative Approach in Difficult Reversal of Hartmann's Procedure. J Surg Tech Case Rep 2011; 2:70-2. [PMID: 22091338 PMCID: PMC3214281 DOI: 10.4103/2006-8808.73618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The introduction of circular end-to-end stapling devices (CEEA OR EEA stapler) into colorectal surgery have revolutionised anastomotic techniques. The EEA stapler is generally regarded as an instrument that is safe, reliable, and simple to operate. Despite it’s popularity, very little information is available regarding the technical difficulties encountered during surgery. The routine technique to perform an end-to-end circular colonic anastomosis is to introduce the instrument distally through the anus (transrectal/transanal approach) and attach it to the anvil which is purse stringed at the distal end of the proximal bowel to be anastomosed. Two cases of reversal of Hartmann’s procedure for perforated diverticulitis are described in the present study, where difficulty was experienced while using the EEA stapler in the routine method. Hence, an alternative reverse technique which was used is presented.
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Abstract
Stapling devices have been clinically applied to connect blood vessels. The early application of these staplers in cardiovascular surgery, including coronary bypass surgery, was encouraging. With further refinement of suture material, however, vascular staplers became impractical and soon fell into oblivion. With advancement in robotic surgery, these devices might become valuable tools once again. Herein early experience with vascular circular stapling devices is reviewed.
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Affiliation(s)
- Igor E Konstantinov
- Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
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