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Martín-Arévalo J, Pla-Martí V, Huntley D, García-Botello S, Pérez-Santiago L, Izquierdo-Moreno A, Garzón-Hernández LP, Garcés-Albir M, Espí-Macías A, Moro-Valdezate D. Two-row, three-row or powered circular stapler, which to choose when performing colorectal anastomosis? A systematic review and meta-analysis. Int J Colorectal Dis 2024; 39:51. [PMID: 38607585 PMCID: PMC11014877 DOI: 10.1007/s00384-024-04625-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Three types of circular staplers can be used to perform a colorectal anastomosis: two-row (MCS), three-row (TRCS) and powered (PCS) devices. The objective of this meta-analysis has been to provide the existing evidence on which of these circular staplers would have a lower risk of presenting a leak (AL) and/or anastomotic bleeding (AB). METHODS An in-depth search was carried out in the electronic bibliographic databases Embase, PubMed and SCOPUS. Observational studies were included, since randomized clinical trials comparing circular staplers were not found. RESULTS In the case of AL, seven studies met the inclusion criteria in the PCS group and four in the TRCS group. In the case of AB, only four studies could be included in the analysis in the PCS group. The AL OR reported for PCS was 0.402 (95%-confidence interval (95%-CI): 0.266-0.608) and for AB: 0.2 (95% CI: 0.08-0.52). The OR obtained for AL in TRCS was 0.446 (95%-CI: 0.217 to 0.916). Risk difference for AL in PCS was - 0.06 (95% CI: - 0.07 to - 0.04) and in TRCS was - 0.04 (95%-CI: - 0.08 to - 0.01). Subgroup analysis did not report significant differences between groups. On the other hand, the AB OR obtained for PCS was 0.2 (95% CI: 0.08-0.52). In this case, no significant differences were observed in subgroup analysis. CONCLUSION PCS presented a significantly lower risk of leakage and anastomotic bleeding while TRCS only demonstrated a risk reduction in AL. Risk difference of AL was superior in the PCS than in TRCS.
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Affiliation(s)
- José Martín-Arévalo
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain.
- Department of Surgery, University of Valencia, Valencia, Spain.
| | - Vicente Pla-Martí
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| | - Dixie Huntley
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
| | - Stephanie García-Botello
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| | - Leticia Pérez-Santiago
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
| | - A Izquierdo-Moreno
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Instituto Valenciano de Oncología, Valencia, Spain
| | - L P Garzón-Hernández
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
| | - M Garcés-Albir
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
- Department of Anatomy, University of Valencia, Valencia, Spain
| | - A Espí-Macías
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| | - David Moro-Valdezate
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
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2
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Ohki A, Takagi T, Kojima Y, Tsurumi M, Hashimoto Y, Takeuchi H, Kamma H, Sakamoto Y, Sunami E, Abe N. Intragastric free cancer cells may be attached to automatic staplers during anastomosis in patients with gastric cancer. World J Surg Oncol 2024; 22:9. [PMID: 38172834 PMCID: PMC10765920 DOI: 10.1186/s12957-023-03285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Automatic staplers are often used to reconstruct the digestive tract during surgeries for gastric cancer. Intragastric free cancer cells adhering to automatic staplers may come in contact with the laparoscopic port area and progress to port site recurrence. This study aimed to investigate the presence/absence of cancer cells adhering to automatic staplers during gastric cancer surgery using cytological examinations. We further determined the positive predictive clinicopathological factors and clinical implications of free cancer cells attached to automatic staplers. METHODS This study included 101 patients who underwent distal gastrectomy for gastric cancer. Automatic staplers used for anastomosis in gastric cancer surgeries were shaken in 150 ml of saline solution to collect the attached cells. Papanicolaou stains were performed. We tested the correlation between cancer-cell positivity and clinicopathological factors to identify risk factors arising from the presence of attached cancer cells to the staplers. RESULTS Based on the cytology, cancer cells were detected in 7 of 101 (6.9%) stapler washing fluid samples. Univariate analysis revealed that circular staplers, type 1 tumors, and positive lymph nodes were significantly associated with higher detection of free cancer cells adhering to staplers. No significant differences in other factors were detected. Of the seven cases with positive cytology, one developed anastomotic recurrence. CONCLUSIONS Exfoliated cancer cells adhered to the automatic staplers used for anastomoses in 6.9% of the staplers used for distal gastrectomies in patients with gastric cancer. Staplers used for gastric cancer surgeries should be handled carefully.
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Affiliation(s)
- Atsuko Ohki
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Taisuke Takagi
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yohei Kojima
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Masanao Tsurumi
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yoshikazu Hashimoto
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hirohisa Takeuchi
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hiroshi Kamma
- Nasu Institute of Medical Sciences, 2-5 Daikokuchou, Nasushiobara, Tochigi, 325-0046, Japan
| | - Yoshihiro Sakamoto
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Eiji Sunami
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Nobutsugu Abe
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
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3
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Manfredelli S, Rebmann E, Romain B. Comment on: Use of circular staplers for the creation of abdominal apertures for end colostomies: phase I study. Br J Surg 2024; 111:znad364. [PMID: 37931156 DOI: 10.1093/bjs/znad364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/27/2023] [Accepted: 09/01/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Simone Manfredelli
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Emeline Rebmann
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Benoit Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
- Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental et Appliquée à la Cancérologie, Strasbourg, France
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4
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Murphy EK, Devaraj H, Eschbach M, Knapp R, Holden B, Halter RJ. Development of an Electrical Impedance Tomography Coupled Surgical Stapler for Tissue Characterization. IEEE Trans Biomed Eng 2024; 71:97-105. [PMID: 37440379 DOI: 10.1109/tbme.2023.3292541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
OBJECTIVE This study explores the feasibility of coupling Electrical Impedance Tomography (EIT) to a standard-of-care laparoscopic surgical stapler, stapler+EIT, with the long-term goal of enabling intraoperative tissue differentiation for tumor margin detection. METHODS Two custom printed-circuit-board-based electrode arrays with 60 and 8 electrodes, respectively, matching the stapler geometry, served as the jaws of an electrode-integrated surrogate stapler+EIT device. The device was evaluated through a series of simulations and bench-top imaging experiments of agar-gel phantoms and bovine tissue samples to evaluate the technique and determine optimal imaging parameters. RESULTS Electrodes localized to only one jaw (the 60-electrode side) of the stapler outperformed a dual-jaw distribution of electrodes. Using this one-sided electrode array, reconstructions achieved an Area-Under-the-Curve (AUC) ≥ 0.94 for inclusions with conductivity contrasts of ≥30% for any size considered on measured agar-gel tests, and an AUC of 0.80 for bovine tissue samples. CONCLUSION A stapler+EIT algorithm has been tuned and evaluated on challenging phantom tests and demonstrated to produce accurate reconstructions. SIGNIFICANCE This work is an important step in the development of a surgical stapler+EIT technique for margin assessment.
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Thomaidis T, Xiang AY, Lyros O, Athanasiadis I, Kallimanis G, Papaioannou D, Zhou PH. Endoscopic removal of an extraluminal gastrointestinal stromal tumor recurrence located on the surgical stapler line at gastroesophageal junction. Endoscopy 2023; 55:E896-E897. [PMID: 37442181 PMCID: PMC10344628 DOI: 10.1055/a-2113-9985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Affiliation(s)
- Thomas Thomaidis
- Second Department of Gastroenterology, Hygeia Hospital, Athens, Greece
- First Medical Department, Johannes-Gutenberg University of Mainz, Mainz, Germany
| | - Anyi Y. Xiang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Orestis Lyros
- First Department of General Surgery, Hygeia Hospital, Athens, Greece
| | | | - George Kallimanis
- Second Department of Gastroenterology, Hygeia Hospital, Athens, Greece
| | | | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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Adams ED, Zaghiyan KN, Fleshner PR. End-to-end stapled technique for Kono-S anastomosis. Tech Coloproctol 2023; 27:1383-1386. [PMID: 37284973 PMCID: PMC10638207 DOI: 10.1007/s10151-023-02802-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/07/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE Our aim was to develop a Kono-S anastomotic technique using surgical staplers. METHODS Two patients underwent stapled Kono-S anastomosis, one via abdominal and one transanal approach. RESULTS The approach for an abdominal and transanal stapled Kono-S anastomosis is detailed. CONCLUSION The Kono-S anastomosis can be safely configured using common surgical staplers.
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Affiliation(s)
- E D Adams
- Department of General Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, North Tower, Suite 8215, Los Angeles, CA, 90048, USA.
| | - K N Zaghiyan
- Department of General Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, North Tower, Suite 8215, Los Angeles, CA, 90048, USA
- Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - P R Fleshner
- Department of General Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, North Tower, Suite 8215, Los Angeles, CA, 90048, USA
- Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
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7
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Strassner H, Caulk A, Reher N, Petrescu S, Vasanji A. Evaluating Performance of Circular Staplers Using Comparative Test Methods for Evidence-Based Surgery. Surg Innov 2023; 30:576-585. [PMID: 37029908 DOI: 10.1177/15533506231166447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
BACKGROUND Circular stapler anastomosis is a common surgical procedure. Despite technological advancements, anastomotic leak remains a postoperative concern. Assessment of new technologies is impeded by variations in test methods and analysis, precluding outcome reproducibility and direct comparisons of results across studies. The development of robust and reproducible preclinical test methods is critical to accelerating stapling technology advancements. METHODOLOGY Leak pressure, staple line perfusion and security, and device removal force were quantified for triple-row (Tri-staple EEA, TriEEA) and double-row staplers (Echelon Circular Powered, ECP). Leak and perfusion testing were performed in vivo. Device removal force and staple line security testing were performed with synthetic medium using an Instron. Data were analyzed using unpaired student's t-test or Kruskal-Wallis test, with statistical significance defined as P < .05. RESULTS Leak pressure was 73% higher in TriEEA vs ECP (P = .016). TriEEA staple line failure force was lower than ECP at 40 and 50 mmHg (P = .001 and P = .023, respectively). Perfusion to the staple line was higher (148%) for TriEEA than for ECP (P = .003) and the force required to remove the device from its stapled anastomosis was 78% lower for TriEEA than for ECP (P < .001). DISCUSSION/CONCLUSIONS This report addresses a primary limitation in stapling research by presenting novel methodologies which enhance clinical relevance and provide sufficient detail for reproduction by independent investigators. These methods are applied to a comparison between triple-row and double-row staplers to demonstrate utility of new test methods in assessing key technology design features.
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Affiliation(s)
| | | | - Nicholas Reher
- Surgical Innovations, Medtronic plc, North Haven, CT, USA
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8
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Vijgen GHEJ. Surgical stapler. Br J Surg 2023; 110:1125-1127. [PMID: 36609641 DOI: 10.1093/bjs/znac451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Guy H E J Vijgen
- Department of Surgery, Laurentius Hospital, Roermond, the Netherlands
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9
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Alverdy JC. Biologically inspired gastrointestinal stapler design: "Getting to Zero" complications. Am J Surg 2023; 226:48-52. [PMID: 36775790 PMCID: PMC10293041 DOI: 10.1016/j.amjsurg.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/15/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023]
Abstract
As next generation stapling devices enter the marketplace with robotic adaptations, tri-staple technology, preloaded reinforcement materials, etc., in this perspective piece we assert that a "refresh" in our understanding of the mechanisms of action of these devices is needed. While much attention has been paid to explain the mechanical features of one device versus another, it seems that little to no attention is being paid to understand how an intestinal anastomosis responds biologically to the variations in their use and design. Here we will review various aspects of gastrointestinal stapling in the context of emerging technology in the field and expose the gaps in knowledge that exist regarding the effect of gastrointestinal stapling on the biology of healing.
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Affiliation(s)
- John C Alverdy
- University of Chicago, 5841 S Maryland MC 6090, Chicago, Illinois, 60637, USA.
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10
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Izzo P, De Intinis C, Di Pumpo F, Sibio S, Basso L, Crocetti D, Gabriele R, Polistena A, Pisanelli MC, Izzo L, Izzo S. Sutures in general surgery. New materials and advice. Ann Ital Chir 2023; 94:649-653. [PMID: 38131379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The suture thread used in digestive surgery must have several characteristics, including resistance to tension until the anastomosis coalescence, rapid absorption to avoid complications, biocompatibility and ease of handling. The preference is for monofilament polymers as they offer greater guarantees in biliary-digestive anastomoses. Suturing with synthetic polymers and mechanical devices such as staplers are the most suitable techniques. It is believed that staplers may become the gold standard technique in robotic surgery based on their experience and experimental data. In general, the goal is to use materials that minimize the risk of post-operative complications and offer maximum reliability in the anastomosis. KEY WORD: Suture material, Stapler.
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11
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Koike S, Eguchi T, Matsuoka S, Takeda T, Miura K, Shimizu K, Hamanaka K. Impact of counterclockwise rotation of the right middle lobe following right upper lobectomy. Interact Cardiovasc Thorac Surg 2022; 34:1062-1070. [PMID: 34922347 PMCID: PMC9159427 DOI: 10.1093/icvts/ivab356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/02/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Following right upper lobectomy, the right middle lobe may shift towards the apex and rotate in a counterclockwise direction with respect to the hilum. This study aimed to investigate the incidence and clinical impact of middle lobe rotation in patients undergoing right upper lobectomy. METHODS From January 2014 to November 2018, 82 patients underwent right upper lobectomy at our institution for lung cancer using a surgical stapler to divide the minor fissure. Postoperative computed tomography scans evaluated the counterclockwise rotation of the middle lobe, in which the staple lines placed on the minor fissure were in contact with the major fissure of the right lower lobe (120° counterclockwise rotation). Clinicoradiological factors were evaluated and compared between patients with and without middle lobe rotation. We also reviewed surgical videos in patients with middle lobe rotation to evaluate the position of the middle lobe at the end of surgery. RESULTS Nine patients had a middle lobe rotation (11%), where 1 patient required surgical derotation. Patients with middle lobe rotation were significantly associated with more frequent right middle lobe atelectasis and severe postoperative complications compared with those without rotation. A surgical video review detected potential middle lobe rotation at the end of the surgery. CONCLUSIONS Middle lobe rotation without torsion following right upper lobectomy is not rare, and it is associated with adverse postoperative courses. Careful positioning of the right middle lobe at the end of surgery is warranted to improve postoperative outcomes.
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Affiliation(s)
- Sachie Koike
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Takashi Eguchi
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Shunichiro Matsuoka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Tetsu Takeda
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Kentaro Miura
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Kazutoshi Hamanaka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Nagano, Japan
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12
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Bonnet B, Tabiai I, Rakovich G, Gosselin FP, Villemure I. Air leaks: Stapling affects porcine lungs biomechanics. J Mech Behav Biomed Mater 2021; 125:104883. [PMID: 34678619 DOI: 10.1016/j.jmbbm.2021.104883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/28/2021] [Accepted: 10/02/2021] [Indexed: 11/19/2022]
Abstract
During thoracic operations, surgical staplers resect cancerous tumors and seal the spared lung. However, post-operative air leaks are undesirable clinical consequences: staple legs wound lung tissue. Subsequent to this trauma, air leaks from lung tissue into the pleural space. This affects the lung's physiology and patients' recovery. The objective is to biomechanically and visually characterize porcine lung tissue with and without staples in order to gain knowledge on air leakage following pulmonary resection. Therefore, a syringe pump filled with air inflates and deflates eleven porcine lungs cyclically without exceeding 10 cmH2O of pressure. Cameras capture stereo-images of the deformed lung surface at regular intervals while a microcontroller simultaneously records the alveolar pressure and the volume of air pumped. The raw images are then used to compute tri-dimensional displacements and strains with the Digital Image Correlation method (DIC). Air bubbles originated at staple holes of inner row from exposed porcine lung tissue due to torn pleural on costal surface. Compared during inflation, left upper or lower lobe resections have similar compliance (slope of the pressure vs volume curve), which are 9% lower than healthy lung compliance. However, lower lobes statistically burst at lower pressures than upper lobes (p-value<0.046) in ex vivo conditions confirming previous clinical in vivo studies. In parallel, the lung deformed mostly in the vicinity of staple holes and presented maximum shear strain near the observed leak location. To conclude, a novel technique DIC provided concrete evidence of the post-operative air leaks biomechanics. Further studies could investigate causal relationships between the mechanical parameters and the development of an air leak.
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Affiliation(s)
- Bénédicte Bonnet
- Department of Mechanical Engineering, Polytechnique Montréal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada.
| | - Ilyass Tabiai
- Department of Mechanical Engineering, Polytechnique Montréal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada.
| | - George Rakovich
- Department of Thoracic Surgery, University of Montréal, 2900 Boulevard Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.
| | - Frédérick P Gosselin
- Department of Mechanical Engineering, Polytechnique Montréal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada.
| | - Isabelle Villemure
- Department of Mechanical Engineering, Polytechnique Montréal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada.
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13
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Mun J, Park SJ, Yim GW, Chang SJ, Kim H. Solution to prevent tumor spillage in minimally invasive radical hysterectomy using the endoscopic stapler for treating early-stage cervical cancer: Surgical technique with video. J Gynecol Obstet Hum Reprod 2021; 50:102211. [PMID: 34481135 DOI: 10.1016/j.jogoh.2021.102211] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022]
Abstract
Gynecologic oncologists had originally preferred minimally invasive surgery (MIS) over laparotomic surgery for patients with early-stage cervical cancer until the Laparoscopic Approach to Cervical Cancer (LACC) trial reported a worse prognosis and more loco-regional recurrence in patients treated with MIS. Although some controversy remains, experts suggested that tumor cell spillage and aggravation may have been caused by intra-corporeal colpotomy, usage of uterine elevators, maintenance of Trendelenburg position, and tumor irritation by capnoperitoneum during surgery. Thus, we introduce a surgical procedure with some steps added to the conventional MIS radical hysterectomy for preventing tumor spillage during the surgery, which is currently being evaluated in terms of safety and efficacy through a prospective, multicenter, single-arm, phase II study, entitled "Safety of laparoscopic or robotic radical surgery using endoscopic stapler for inhibiting tumor spillage of cervical neoplasms (SOLUTION trial: NCT04370496)".
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Affiliation(s)
- Jaehee Mun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Soo Jin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Ga Won Yim
- Department of Obstetrics and Gynecology, Donnguk University College of Medicine, Goyang 10326, Republic of Korea
| | - Suk-Joon Chang
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Ajou University, School of Medicine, Suwon 16499, Republic of Korea
| | - HeeSeung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
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14
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Molnár F T, Zsoldos P, Oláh A. [ Surgical staplers: definitions and functions]. Magy Seb 2021; 74:14-21. [PMID: 33729992 DOI: 10.1556/1046.74.2021.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
Definition and systemic review of the different surgical staplers are offered in a comprehensive manner. Improved efficacy in tender decisions, better understanding and usage of clear categories are the main targets of the present overview.
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Affiliation(s)
- Tamás Molnár F
- 1 Petz Aladár Egyetemi Oktató Kórház, Általános Sebészet, Mellkassebészeti részleg, 9024 Győr, Vasvári Pál út 2
- 2 PTE ÁOK Műveleti Medicina Tanszék, Pécs
| | - Péter Zsoldos
- 1 Petz Aladár Egyetemi Oktató Kórház, Általános Sebészet, Mellkassebészeti részleg, 9024 Győr, Vasvári Pál út 2
| | - Attila Oláh
- 1 Petz Aladár Egyetemi Oktató Kórház, Általános Sebészet, Mellkassebészeti részleg, 9024 Győr, Vasvári Pál út 2
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15
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Fortin SP, Johnston SS, Chaudhuri R, Fryrear R, Roy S. Incidence, predictors, and economic burden of circular anastomotic complications in left-sided colorectal reconstructions involving manual circular staplers. J Med Econ 2021; 24:255-265. [PMID: 33576292 DOI: 10.1080/13696998.2021.1880749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
STUDY AIM Manual circular staplers are widely used in colorectal surgery; however, limited literature exists examining complications related to circular anastomoses when such devices are used. The present study evaluated the incidence, predictors, and economic burden of circular anastomotic complications in left-sided colorectal reconstructions involving manual circular staplers. MATERIALS AND METHODS Patients aged ≥18 years who underwent hemicolectomy, low anterior resection, or sigmoidectomy between 1 October 2016 and 31 December 2018 were identified from the Premier Healthcare Database. Manual circular stapler use was identified from hospital administrative billing records. Circular anastomotic complications were defined as a composite endpoint of multiple circular stapler use (proxy for stapler failure) or other circular anastomotic complications (anastomotic leak, bleeding, device/surgical complications, infection, and transfusion). Multivariable analyses were used to model the associations between circular anastomotic complications and total hospital costs, length of stay, operating room time, and 30-, 60-, and 90-day readmission rates. RESULTS A total of 13,167 patients met the study criteria, of whom 2,984 (22.7%) had circular anastomotic complications. Predictors of circular anastomotic complications included age, procedure type, provider region, and select patient comorbidities. As compared with those who did not, patients who suffered circular anastomotic complications had significantly higher adjusted total hospital costs ($26,924 vs. $18,748; p < .0001), length of stay (7.79 vs. 4.99 days; p < .0001), operating room time (280 vs. 239 min; p < .0001), non-home discharge status (9.63% vs. 4.61%; p < .0001), and all-cause readmission at 30 days (12.2% vs. 8.7%; p < .0001), 60 days (16.0% vs. 11.6%; p < .0001), and 90 days (18.5% vs. 13.4%; p < .0001). LIMITATIONS The present study is limited by the observational nature and potential for measurement error that is inherent to administrative healthcare databases. CONCLUSIONS In this analysis of patients undergoing left-sided colorectal reconstructions involving a manual circular stapler, circular anastomotic complications were associated with adverse economic consequences.
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Affiliation(s)
- Stephen P Fortin
- Medical Devices - Epidemiology, Johnson & Johnson Co., New Brunswick, NJ, USA
| | - Stephen S Johnston
- Medical Devices - Epidemiology, Johnson & Johnson Co., New Brunswick, NJ, USA
| | | | - Raymond Fryrear
- Preclinical, Clinical, Medical Centre, Ethicon Inc., Cincinnati, OH, USA
| | - Sanjoy Roy
- Franchise Health Economics and Market Access, Ethicon Inc., Cincinnati, OH, USA
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16
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Amersi FF, Wright B, Silberman AW. Use of the End to End Anastomotic Stapler From Above for Difficult Pelvic Surgery for Distal Rectal Disease. Am Surg 2020; 87:1313-1315. [PMID: 33342264 DOI: 10.1177/0003134820971626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Transabdominal utilization (TAU) of the end to end anastomotic (EEA) stapler in low anterior resection (LAR) for rectal cancer is an excellent alternative to the most widely performed techhnique. METHODS We performed a retrospective analysis of a prospectively maintained database which obtained data on 104 patients with rectal disease who underwent EEA-assisted LAR with TAU. Records of all patients were used to evaluate demographics, complications, tumor location, margin status, postoperative complications, clinical sphincter function, adjuvant or neoadjuvant treatment, disease stage, and survival. RESULTS Of the 104 patients, 48% were women with a mean age of 64 years (range 34-85 years). The average tumor location was 8 cm above the dentate line, and the mean tumor distance from the distal margin was 1.9 cm. All distal margins in cases for patients with rectal cancer were negative. Hospital length of stay averaged 8.7 days (6-15 days). There were no anastomotic complications (leaks, bleeding, or obstruction), and there were no leaks at the separate colotomy site. All patients have had normal postoperative sphincter function. CONCLUSION Transabdominal utilization of the EEA stapler in LAR for colorectal carcinoma is an alternative to the conventional approach and may be advantageous in avoidance of the lithotomy position with potential nerve injury, risk of deep venous thrombosis, and stapler-induced sphincter trauma.
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Affiliation(s)
- Farin F Amersi
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Byron Wright
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Allan W Silberman
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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17
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Kajmolli A, McGuirk M, Gachabayov M, Bergamaschi R, Latifi R. Evolution of the Circular Stapler in Rectal Cancer Surgery. Surg Technol Int 2020; 37:99-101. [PMID: 33245140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The circular stapler has played a critical role in fashioning colorectal anastomoses following low anterior resection for rectal cancer. One of the greatest benefits of the circular stapler has been the feasibility of constructing ultra-low anastomoses, thereby decreasing permanent colostomy rates. A notable US innovation to the original design was the addition of disposable cartridges of various sizes, which greatly decreased assembly time and made the instrument more versatile. Another important modification was the ability to detach the anvil from the stapler shaft. This markedly simplified the construction of anastomoses by negating the need for a double purse-string and avoiding an open rectal stump. An additional modification to facilitate transanal stapler extraction was the tilted-top anvil, which flipped parallel to the shaft once the stapler was fired. The circular stapler continues to evolve while maintaining the basic elements of Hültl's brilliant concept from over a century ago.
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Affiliation(s)
| | | | | | | | - Rifat Latifi
- Westchester Medical Center, Valhalla, NY,New York Medical College, School of Medicine, Valhalla, NY
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18
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Bi L, Deng X, Meng X, Yang X, Wei M, Wu Q, Ren M, Wang Z. Ligating the rectum with cable tie facilitates rectum transection in laparoscopic anterior resection of rectal cancer. Langenbecks Arch Surg 2020; 405:233-239. [PMID: 32266529 DOI: 10.1007/s00423-020-01863-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 03/03/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Proper transection of the distal rectum is important for reconstruction of bowel continuity in rectal cancer surgery. In this study, we introduced a modified technique for ligation of the distal rectum, and investigated its safety and efficiency to facilitate the rectum transection. METHODS After complete mobilization and transection of the mesorectum, a cable tie was carefully positioned distal to the tumor, followed by washout and transecting the rectum with a linear stapler. From September 2017 to June 2018, consecutive 67 mid-low rectal cancer patients with laparoscopic anterior resection underwent this technique. Clinical data of these patients, including number of firings, pathological and operative variables, and postoperative outcomes, were compared with those of 132 consecutive patients who underwent traditional surgery from January 2016 to August 2017. RESULTS Compared with the traditional method, cable tie ligation significantly reduced the number of firings (1.1 ± 0.32 vs. 1.3 ± 0.52, p < 0.001). A very high ratio of one firing transection of rectum was observed in the cable tie group (94.0% vs. 68.9%, p < 0.001), even in patients with tumor at or below the peritoneal reflection (90.2% vs. 54.4%, p < 0.001), in male patients (95.5% vs. 65.8%, p < 0.001), and in obese patients (93.8% vs. 64.9%, p = 0.005). The mean distal margin was longer in the cable tie group (3.19 ± 1.77 cm vs. 2.54 ± 1.36 cm, p = 0.005), with no positive distal margin observed. The operation time, quality of mesorectum, and morbidity between two groups were comparable. Two leaks (3.0%) in the cable tie group were observed, similar to 3.8% in the control. CONCLUSIONS Ligation of the rectum with a cable tie reduces the number of cartridges, and increases the rate of one stapler firing for rectal transection, even in those difficult cases like male, overweight, and low rectal cancer patients. It is also useful for occlusion of the rectum before washout. It is safe, feasible, and worthwhile for popularization. TRIAL REGISTRATION Registered at ClinicalTrial.gov, number NCT03570684.
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Affiliation(s)
- Liang Bi
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangbing Deng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xia Meng
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xuyang Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Minyang Ren
- Department of Gastrointestinal Surgery, Nanchong Central Hospital, Nanchong, Sichuan, China.
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
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19
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Atallah S, Kural S, Banda N, Banda A, Bawaney F, Cabral F, Neychev V, Patel C, Larach S. Initial clinical experience with a powered circular stapler for colorectal anastomosis. Tech Coloproctol 2020; 24:479-486. [PMID: 32193667 DOI: 10.1007/s10151-020-02162-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 02/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Echelon circular™ powered stapler (ECP stapler) obviates the need for manual firing of conventional circular staplers during the construction of a colorectal anastomosis, but has not been evaluated clinically. The aim of this study was to perform a clinical evaluation of this stapler. METHODS A retrospective review of the initial clinical experience of a single surgeon using the ECP stapler for left-sided colorectal anastomosis construction during elective colorectal resections for benign and malignant disease was conducted by analyzing results from a prospectively maintained study database. Additionally, four attending colorectal and/or general surgeons who had performed ≥ 5 colorectal operations with the ECP stapler were invited to complete an anonymous online survey to subjectively assess the user experience with the device. Statistical analysis was conducted using Microsoft Excel Version 15.33. RESULTS Seventeen patients underwent left-sided anastomotic reconstruction using the ECP stapler. All donuts (proximal and distal) were intact. Anastomotic integrity was evaluated using the air-leak test utilizing flexible video sigmoidoscopy. No leaks were observed, although one patient (5.9%) developed a postoperative pelvic abscess. The anonymous survey was completed by all four surgeons. Subjective evaluation of the ECP stapler suggests that the overall stapling quality, overall device ease-of-use, and the overall perception of anastomotic quality as above average when compared to manual 'end-to-end anastomosis' (EEA) stapling devices. CONCLUSIONS In an initial clinical evaluation of the ECP stapler, the safety and ease-of-use of the device appears to be satisfactory. Powered stapling and the design of '3D stapling' may provide advantages over manual systems, and may improve the construction quality of left-sided colorectal anastomosis.
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Affiliation(s)
- S Atallah
- University of Central Florida, College of Medicine, Orlando, FL, USA.
- HCA North Florida Division, Winter Park, FL, 32792, USA.
| | - S Kural
- Uludag University, Bursa, Turkey
| | - N Banda
- University of Central Florida, College of Medicine, Orlando, FL, USA
| | - A Banda
- University of Central Florida, College of Medicine, Orlando, FL, USA
| | - F Bawaney
- University of Central Florida, College of Medicine, Orlando, FL, USA
| | - F Cabral
- Instituto Português de Oncologia, Lisbon, Portugal
| | - V Neychev
- University of Central Florida, College of Medicine, Orlando, FL, USA
- HCA North Florida Division, Winter Park, FL, 32792, USA
| | - C Patel
- University of Central Florida, College of Medicine, Orlando, FL, USA
- HCA North Florida Division, Winter Park, FL, 32792, USA
| | - S Larach
- University of Central Florida, College of Medicine, Orlando, FL, USA
- HCA North Florida Division, Winter Park, FL, 32792, USA
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20
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Tokuhara T, Nakata E, Tenjo T, Kawai I, Kondo K, Hatabe S. Modified delta-shaped gastroduodenostomy consisting of linear stapling and single-layer suturing with the operator positioned between the patient's legs: A technique preventing intraoperative duodenal injury and postoperative anastomotic stenosis. PLoS One 2020; 15:e0230113. [PMID: 32142547 PMCID: PMC7059953 DOI: 10.1371/journal.pone.0230113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background The drawback of the delta-shaped gastroduodenostomy (DSG) in totally laparoscopic distal gastrectomy (TLDG) is the presence of intraoperative duodenal injury and postoperative anastomotic stenosis, which can occur due to a relatively short duodenal bulb diameter. Materials and methods From June 2013 to June 2019, 35 patients with gastric cancer underwent TLDG with a modified DSG consisting of linear stapling and single-layer hand suturing in our institution. All anastomotic procedures were performed by the right hand of the operator positioned between the patient’s legs. Linear stapling of the posterior walls of the remnant stomach and duodenum without creating a gap was performed using a 45-mm linear stapler, considering the prevention of intraoperative duodenal injury. The stapler entry hole was closed using a single-layer full-thickness hand suturing technique with knotted sutures and a knotless barbed suture. We described the clinical data and outcomes in the present retrospective patient series. Results No intraoperative duodenal injury occurred in any of the 35 patients. The median staple length at linear stapling of the posterior walls of the remnant stomach and duodenum was 41.7 ± 4.2 (30–45) mm, and 2 patients (5.7%) had a staple length of 30 mm. There were no incidences of postoperative anastomotic stenosis. Conclusions We suggest that a modified DSG consisting of linear stapling and single-layer hand suturing performed by an operator positioned between the patient’s legs can be one option for B-Ⅰ reconstruction following TLDG because it can aid in preventing both intraoperative duodenal injury and postoperative anastomotic stenosis.
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Affiliation(s)
- Takaya Tokuhara
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka, Japan
| | - Eiji Nakata
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka, Japan
| | - Toshiyuki Tenjo
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka, Japan
| | - Isao Kawai
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka, Japan
| | - Keisaku Kondo
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka, Japan
| | - Shigeru Hatabe
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka, Japan
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21
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Molina GA, Aguayo WG, Rojas CL. Inclusion of a Clip Inside the Cartridge and Failure of the Stapler When Performing a Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 30:2836-2839. [PMID: 32048153 DOI: 10.1007/s11695-020-04458-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The growth of the surgical industry and the development of surgical techniques have allowed us to achieve better results for patients. Laparoscopic staplers are a crucial tool in laparoscopic surgery, and despite their proven safety and efficiency, they have been associated with technical and mechanical failures on rare occasions. Adequate knowledge of the surgical instruments is critical to accomplishing optimal results and to adequately treating these rare malfunctions and their consequences. We present a case of a surgical stapler malfunction due to a titanium clip during laparoscopic sleeve gastrectomy. This mechanical failure produced a complication that was adequately resolved, and the patient completely recovered. Our brief communication shows that errors during sleeve gastrectomy can occur, and that precise surgical skills along with a close follow-up are crucial to improve the patient outcome when these rare complications arise.
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22
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Park SY, Kim DJ, Mo Nam C, Park G, Byun G, Park H, Choi JH. Clinical and economic benefits associated with the use of powered and tissue-specific endoscopic staplers among the patients undergoing thoracoscopic lobectomy for lung cancer. J Med Econ 2019; 22:1274-1280. [PMID: 31210074 DOI: 10.1080/13696998.2019.1634081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Thoracoscopic lobectomy for lung cancer is a complex procedure where endoscopic staplers play a critical role in transecting the lung parenchyme, vasculature, and bronchus. This retrospective study was performed to investigate the economic benefits of powered and tissue-specific endoscopic staplers such as gripping surface technology (GST) and powered vascular stapler (PVS) compared to standard staplers.Methods: Two hundred and seventy-five patients who received a thoracoscopic lobectomy between 2008 and 2016 were included. Group 1 (n = 117) consisted of patients who received the operation with manual endoscopic staplers, whereas Group 2 (n = 158) consisted of patients who received the operation with GST and PVS.Results: Patient demographics and clinical characteristics were comparable, except smoking history, pulmonary function, and pleural adhesion. All patients received the operation successfully without mortalities and broncho-pleural fistula. Operation time and blood loss were higher in Group 1. Pleurodesis was performed less in Group 2 than in Group 1 (18.0% vs 3.8%, p < 0.0001). Group 2 had statistically significant lower adjusted hospital costs (Korean Won, 14,610,162 ± 4,386,628 vs 12,876,111 ± 5,010,878, p < 0.0001), lower adjusted hemostasis related costs (198,996 ± 110,253 vs 175,291 ± 191,003, p = 0.0101); lower cartridge related adjusted costs (1,105,091 ± 489,838 vs 839,011 ± 307,894, p < 0.0001) compared to Group 1. As well, Group 2 showed ∼12% lower adjusted total hospital costs compared to Group 1. Multivariable analysis revealed that Group 1 was related to increased hospital costs.Conclusions: This study showed that thoracoscopic lobectomy with powered and tissue-specific endoscopic staplers were associated with better clinical outcomes and reduced adjusted hospital costs when compared in Korean real-world settings.
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Affiliation(s)
- Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Goeun Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Goeun Byun
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - HyeJin Park
- HEMA, Johnson & Johnson Medical Korea, Seoul, Republic of Korea
| | - Ji Heon Choi
- HEMA, Johnson & Johnson Medical Korea, Seoul, Republic of Korea
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23
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Nekliudov NA, Tsarkov PV, Tulina IA. Uni-center, patient-blinded, randomized, 12-month, parallel group, noninferiority study to compare outcomes of 3-row vs 2-row circular staplers for colorectal anastomosis formation after low anterior resection for rectal cancer. Medicine (Baltimore) 2019; 98:e15978. [PMID: 31192938 PMCID: PMC6587660 DOI: 10.1097/md.0000000000015978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Colorectal anastomotic leakage (AL) is one of the most serious complications in rectal cancer surgery due to its negative impact on the overall as well as cancer-specific survival. Two-row stapling technique has become standard in low anterior resections (LARs), but has neither alleviated the morbidity, nor reduced the incidence of AL. This is the 1st study that aims to compare the success rate of new 3-row circular staplers compared to that of conventional 2-row staplers in a prospective, randomized clinical trial. METHODS The THREESTAPLER trial (Clinical Trials NCT03910699) is a prospective, noninferiority, 2-armed, parallel-group, patient and outcomes assessor blinded study with a 1:1 allocation ratio. Colorectal anastomosis will be formed using Ethicon 29 mm Curved Intraluminal Stapler (CDH29A) in the active comparator group, and using Mirus Disposable Circular Stapler 3 Row 29 (MCS-29R3) in the experimental group. The hypothesis states that the incidence of AL in the 3-row stapler group is at least not higher than in the 2-row stapler group. Assuming there is a difference in success rate of 12% and noninferiority margin Δ = 5%, 154 patients will be required to achieve statistical significance. An interim analysis will be performed after recruitment of 20 patients per group to assess safety profile of 3-row circular staplers. The primary endpoint is the rate of AL, documented by imaging studies, assessed with Pearson Chi-squared test and Fisher exact test. The secondary outcomes include severity of AL (A, B, or C), anastomotic bleeding, postoperative complication rate graded with the Clavien-Dindo classification, reintervention rate, stapler dysfunction rate, complications of defunctioning stoma, overall and cancer-specific quality of life, assessed with short form (36) and quality-of-life questionnaire core 30 questionnaires, respectively, fecal incontinence assessed with Cleveland clinic incontinence score form, and manifestation of LAR syndrome. All patients will be monitored for 12 months following the LAR. DISCUSSION This is the 1st prospective randomized trial to assess the safety profile of 3-row staplers for colorectal anastomosis after LAR for rectal cancer. It may provide evidence of feasibility of 3-row circular staplers in LAR with respect to short-term and long-term patient outcomes. TRIAL REGISTRATION NCT03910699 on 10 April 2019.
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Affiliation(s)
- Nikita A. Nekliudov
- Sechenov Biomedical Science and Technology Park, Sechenov First Moscow State Medical University
| | - Petr V. Tsarkov
- Department of Surgery, Faculty of Preventive Medicine, Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Inna A. Tulina
- Department of Surgery, Faculty of Preventive Medicine, Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russian Federation
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24
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Sahay SJ, Lykoudis PM, Al Midani A, Haswell A, Rahman SH. Vascular Stapler for Transection of Pancreatic Parenchyma in Laparoscopic Distal Pancreatectomy. Am Surg 2019; 85:e275-e276. [PMID: 31267911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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25
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Liao T, Deng L, Yao X, Ouyang M. Comparison of the safety and efficacy between linear stapler and circular stapler in totally laparoscopic total gastrectomy: protocol for a systematic review and meta-analysis. BMJ Open 2019; 9:e028216. [PMID: 31147368 PMCID: PMC6549737 DOI: 10.1136/bmjopen-2018-028216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Total gastrectomy is often recommended for upper body gastric cancer, and totally laparoscopic total gastrectomy (TLTG) is deemed to be a promising surgical method with the well-known advantages such as less invasion and fast recovery. However, the anastomosis between oesophagus and jejunum is the difficulty of TLTG. Although staplers have promoted the development of TLTG, the choice of suitable staplers to complete oesophagojejunostomy is controversial and unclear. Therefore, a higher level of research evidence is needed to compare the two types of staplers in terms of safety and efficacy for oesophagojejunostomy in TLTG among patients with gastric cancer. METHODS AND ANALYSIS PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang Databases will be comprehensively searched from January 1990 to July 2019. All eligible randomised controlled trials (RCTs), non-RCTs or observational studies comparing the two types of staplers will be included. A meta-analysis will be performed using Review Manager V.5.3 software to compare the safety and efficacy of linear and circular staplers for oesophagojejunostomy in TLTG. The primary outcomes are anastomotic leakage, anastomotic stricture, anastomotic haemorrhage. The secondary outcomes include time to first instance of passing gas after surgery, first feeding time, total operation time, reconstruction time, estimated blood loss. The heterogeneity of this study will be assessed by p values and I2 statistic. Subgroup analyses and sensitivity analyses will be used to explore and explain the heterogeneity. The risk of bias will be assessed using the Cochrane tool or the Newcastle-Ottawa Quality Assessment Scale. ETHICS AND DISSEMINATION Ethical approval will not be required because this proposed systematic review and meta-analysis is based on previously published data, which does not include intervention data on patients. The findings of this study will be submitted to a peer-reviewed journal and will be presented at a relevant congress. PROSPERO REGISTRATION NUMBER CRD42018111680.
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Affiliation(s)
- Tianyou Liao
- Gastrointestinal Surgery, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde Foshan), Foshan, China
| | - Leilei Deng
- Graduate School, Guangdong Medical University, Zhanjiang, China
| | - Xueqing Yao
- Department of General Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Manzhao Ouyang
- Gastrointestinal Surgery, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde Foshan), Foshan, China
- Department of General Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
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26
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Zhou P, Wang YL, Liu Q, Li JS. Fallback technique with circular stapler prevents anastomotic obstruction after esophagectomy: A case report of surgical approach. Medicine (Baltimore) 2019; 98:e13571. [PMID: 30813121 PMCID: PMC6408128 DOI: 10.1097/md.0000000000013571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE While performing esophago-ileal anastomosis after esophagectomy with circular staplers, the mucosal folds of the ileum can complicate stapling and lead to obstruction, especially when the diameter of the circular stapler is equal or greater than that of the small bowel lumen. PATIENT CONCERNS A 53-year-old man, presented with complaints of difficulty in swallowing for 2 weeks. Fifteen years previously, he had undergone partial gastrectomy for gastric ulcers. DIAGNOSIS The endoscopy showed that there was a large ulcer in the middle-third of the esophagus, about 28 to 32 cm from the incisors. Biopsy of the ulcer confirmed esophageal squamous cell carcinoma. INTERVENTIONS We performed an esophageal replacement using the right colon with circular staplers, but anastomotic site occurred due to stacking of the mucosa ahead of the stapler. To revise the anastomosis, we inserted the stapler 2 to 3 cm farther into the lumen than the intended site of anastomosis, and then pulled it back and rotated the stapler to complete the anastomosis. Consequently, the obstruction was corrected. OUTCOMES With nearly 16 months' follow-up duration until now, the patient has no difficulty swallowing and has twice received chemotherapy, and returned to his normal life relatively. LESSONS In the event of potential anastomotic obstruction due to accumulated mucosa, the stapler fallback technique can be successfully used achieve patent anastomosis.
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Affiliation(s)
| | - Ya-Li Wang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yoshida Y, Iwasaki A. [Automatic Linear Stapler]. Kyobu Geka 2018; 71:868-874. [PMID: 30310041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The automatic linear stapler becomes the necessary device in today's chest surgery. These made simple and uniform suture techniques possible, but it is important to fully understand the usage and characteristics of automatic linear stapler for safe stapling. In this paper, we focus on the currently used stapler and describe its mechanism and its characteristics.
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Affiliation(s)
- Yasuhiro Yoshida
- Department of Surgery, Faculty of Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan
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Wada AM, Hashiba K, Otoch JP, Brasil H, Marson FP, Cassab J, Abdalla R, Artifon ELA. FULL-THICKNESS ENDOSCOPIC GASTRIC RESECTION USING A STAPLER AND GASTROSTOMY: A FEASIBILITY STUDY. Arq Bras Cir Dig 2018; 31:e1386. [PMID: 30133678 PMCID: PMC6097028 DOI: 10.1590/0102-672020180001e1386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is currently the most frequently performed bariatric procedure in Turkey. The goal of weight reduction surgery is not only to decrease excess weight, but also to improve obesity related comorbidities and quality of life (QoL). AIM To evaluate the impact of LSG on patient quality of life, weight loss, and comorbidities associated with morbid obesity according to the updated BAROS criteria. METHODS Eleven hundred thirty-eight adult patients were undergone to LSG by our bariatric surgery team between January 2013 and January 2016. A questionnaire (The Bariatric Analysis and Reporting Outcome System - BAROS) was published on social media. The data on postoperative complications were collected from hospital database. RESULTS Number of respondants was 562 (49.4%). Six of 1138 patients(0.5%) had leakage. All patients who had leakage were respondants. The overall complication rate was 7.7%. After a mean period of 7.4±5.3 months(1-30), mean excess weight loss was 71.3±27.1% (10.2-155.4). The respondants reported 772 comorbidities. Of these, 162 (30%) were improved, and 420 (54.4%) were resolved. The mean scores for QoL were significantly increased after LSG (range, p<0.05 to <0.001). Of the 562 patients, 26 (4.6%) were classified as failures; 86 (15.3%) fair; 196 (34.9%) good; 144 (25.6%) very good, and 110 (19.6%) excellent results according to the updated BAROS scoring system. CONCLUSION LSG is a highly effective bariatric procedure in the manner of weight control, improvement in comorbidities and increasing of QoL in short- and mid-term.
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Affiliation(s)
| | - Kiyoshi Hashiba
- Sírio Libanês Institute for Teaching and Research, São Paulo, SP, Brazil
| | | | - Horus Brasil
- Sírio Libanês Institute for Teaching and Research, São Paulo, SP, Brazil
| | - Fernando P Marson
- Sírio Libanês Institute for Teaching and Research, São Paulo, SP, Brazil
| | - Jorge Cassab
- Sírio Libanês Institute for Teaching and Research, São Paulo, SP, Brazil
| | - Ricardo Abdalla
- Sírio Libanês Institute for Teaching and Research, São Paulo, SP, Brazil
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Bove A, Palone G, Panaccio P, Esposito L, Curci F, Di Martino G, Bongarzoni G. Stapled Transanal Rectal Resection Procedure with Two Different Devices: Comparative Results. Am Surg 2018; 84:e242-e244. [PMID: 30401026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
In an attempt to elucidate if and when there is a place for abdominoperineal excision in rectal cancer, we have evaluated survival, risk of local recurrence and functional results of alternative procedures. There seems to be no difference in survival rate after intended curative surgery for rectal cancer between rectal excision and sphincter-saving resection. This is also true with respect to risk of local recurrence, except in patients with poorly differentiated Dukes’ C tumours, where the risk of significant distal intramural spread is increased. Functional results are satisfactory after low anterior resection with colorectal anastomosis, whereas coloanal anastomosis is followed by less satisfactory results especially in elderly patients. In these patients rectal excision with a permanent colostomy is probably preferable.
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Affiliation(s)
- J Christiansen
- Department of Surgery D, Glostrup Hospital, Copenhagen, Denmark
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Gong CS, Kim BS, Kim HS. Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience. World J Gastroenterol 2017; 23:8553-8561. [PMID: 29358863 PMCID: PMC5752715 DOI: 10.3748/wjg.v23.i48.8553] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/14/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the safety and efficacy of totally laparoscopic total gastrectomy (TLTG) with esophagojejunostomy using a linear stapler compared with laparoscopic-assisted total gastrectomy (LATG) using a circular stapler in gastric cancer patients.
METHODS We retrospectively reviewed 687 patients who underwent laparoscopic total gastrectomy for gastric cancer at a single institution from August 2008 to August 2014. The patients were divided into two groups according to the type of operation: 421 patients underwent TLTG and 266 underwent LATG. Clinicopathologic characteristics and surgical outcomes in the two groups were compared and analyzed.
RESULTS The TLTG group had higher mean ages at the time of operation (57.78 ± 11.20 years and 55.69 ± 11.96 years, P = 0.020) and more histories of abdominal surgery (20.2% and 12.4%, P = 0.008) compared with the LATG group. Surgical outcomes such as intraoperative and postoperative transfusions, combined operations, pain scores and administration of analgesics, and complications were similar between the two groups. However, compared with the LATG group, the TLTG group required a shorter operation time (149 min vs 170 min, P < 0.001), had lower postoperative hematocrit change (3.49% vs 4.04%, P = 0.002), less intraoperative events (3.1% vs 10.2%, P < 0.001), less intraoperative anastomosis events (2.4% vs 7.1%, P = 0.003), faster postoperative recovery such as median time to first flatus (3.30 d vs 3.60 d, P < 0.001), faster median commencement of soft diet (4.30 d vs 4.60 d, P < 0.001) and shorter length of postoperative hospital stay (6.75 d vs 7.02 d, P = 0.005).
CONCLUSION The intracorporeal method for reconstruction of esophagojejunostomy using a linear stapler may be considered a feasible procedure comparing with extracorporeal anastomosis using circular stapler because TLTG is simpler and more straightforward than LATG. Therefore, TLTG can be recommended as an appropriate procedure for gastric cancer.
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Affiliation(s)
- Chung Sik Gong
- Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Byung Sik Kim
- Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Hee Sung Kim
- Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
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Liu Y, Li JJ, Zu P, Liu HX, Yu ZW, Ren Y. Two-step method for creating a gastric tube during laparoscopic-thoracoscopic Ivor-Lewis esophagectomy. World J Gastroenterol 2017; 23:8035-8043. [PMID: 29259379 PMCID: PMC5725298 DOI: 10.3748/wjg.v23.i45.8035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/15/2017] [Accepted: 09/05/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To introduce a two-step method for creating a gastric tube during laparoscopic-thoracoscopic Ivor-Lewis esophagectomy and assess its clinical application.
METHODS One hundred and twenty-two patients with middle or lower esophageal cancer who underwent laparoscopic-thoracoscopic Ivor-Lewis esophagectomy at Liaoning Cancer Hospital and Institute from March 2014 to March 2016 were included in this study, and divided into two groups based on the procedure used for creating a gastric tube. One group used a two-step method for creating a gastric tube, and the other group used the conventional method. The two groups were compared regarding the operating time, surgical complications, and number of stapler cartridges used.
RESULTS The mean operating time was significantly shorter in the two-step method group than in the conventional method group [238 (179-293) min vs 272 (189-347) min, P < 0.01]. No postoperative death occurred in either group. There was no significant difference in the rate of complications [14 (21.9%) vs 13 (22.4%), P = 0.55] or mean number of stapler cartridges used [5 (4-6) vs 5.2 (5-6), P = 0.007] between the two groups.
CONCLUSION The two-step method for creating a gastric tube during laparoscopic-thoracoscopic Ivor-Lewis esophagectomy has the advantages of simple operation, minimal damage to the tubular stomach, and reduced use of stapler cartridges.
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Affiliation(s)
- Yu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Ji-Jia Li
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Peng Zu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Hong-Xu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Zhan-Wu Yu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Yi Ren
- Department of Thoracic Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
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Grotenhuis BA, Nonner J, de Graaf EJR, Doornebosch PG. Implementation of a New High-Volume Circular Stapler in Stapled Anopexy for Hemorrhoidal Disease: Is Patient's Short-Term Outcome Affected by a Higher Volume of Resected Tissue? Dig Surg 2017; 35:406-410. [PMID: 29131098 DOI: 10.1159/000480355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/08/2017] [Indexed: 12/10/2022]
Abstract
BACKGROUND Stapled anopexy is a safe technique for the treatment of hemorrhoids but carries a higher risk of recurrence, which might be caused due to the limited volume of resected tissue. In this study, we investigated the introduction of a high-volume circular stapling device; in particular whether an increased amount of resected tissue could affect patients' short-term postoperative outcome. METHODS Between 2011 and 2015, stapled anopexy was performed for hemorrhoids and/or anal prolapse in 141 patients (n = 25 conventional PPH-3©-stapler versus n = 116 high-volume CHEX©-stapler). In this prospectively collected dataset, operation details and short-term postoperative outcome were compared. RESULTS With the high-volume stapler, a significantly higher amount of tissue was resected: 9.8 g (range 6.2-11.4) vs. 6.4 g (range 4.9-8.8) with the conventional stapler, p < 0.01. Postoperative short-term outcome did not differ in terms of readmission and complication rates. In all 5 patients who underwent a redo operation for residual hemorrhoids or prolapse, the high-volume stapler was used in the primary operation. CONCLUSION A high-volume stapling device for stapled anopexy was introduced safely with a significantly higher amount of resected tissue without a worse short-term outcome. However, it remains unclear whether higher stapling volumes may lead to improved long-term outcome with less reinterventions.
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Ali MAQ, Al-Harthy SO. Successful Treatment of Zenker's Diverticulum by Endoscopic Staple-Assisted Diverticulotomy in a 75-year Saudi Female. J Coll Physicians Surg Pak 2017; 27:645-647. [PMID: 29056128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Abstract
Zenker's diverticulum (hypopharyngeal pouch) is a rare medical entity caused by herniation of esophageal mucosa and submucosa through an anatomical defect between the layers of the inferior constrictor muscle. It is believed that this occurs mainly due to incoordination between the stages of swallowing and timely opening of the cricopharyngeus. It usually affects the elderly and patients usually present with dysphagia, regurgitation of food, halitosis and aspiration. We describe one case of Zenker's diverticulum in a 75-year Saudi female whom we successfully managed in Ear Nose Throat (ENT) department, North West Armed Forces Hospital, Tabuk, Saudi Arabia by endoscopic staple-assisted diverticulotomy resulting in successful division of the intervening septum between the diverticulum and the esophagus. This technique was well-tolerated by the patient with early return to oral feeding and shorter hospital stay. Endoscopic staple-assisted diverticulotomy is a relatively safer technique of dealing with this problem as compared to the traditional open procedure causing more morbidity, and we advocate its use to reduce patient morbidity in selected cases.
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Affiliation(s)
| | - Sultan O Al-Harthy
- Department of ENT, North West Armed Forces Hospital, Tabuk, Saudi Arabia
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Abstract
The GIA Radial Reload is a surgical stapler with a curved cut line that is perpendicular to the direction of instrument insertion. We used the GIA Radial Reload in three cases of single-port thoracoscopic lung wedge resection. The operations were performed through a 3.0-4.5-cm incision. For the first stapler, we selected the GIA Radial Reload. The orientation of this device's cut line enabled us to easily cut the lung behind the lesion during single-port thoracoscopic surgery.
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Affiliation(s)
- Atsushi Sano
- Department of Thoracic Surgery, Chigasaki Municipal Hospital, Honson 5-15-1, Chigasaki, Kanagawa, 253-0042, Japan.
| | - Takuma Yotsumoto
- Department of Thoracic Surgery, Chigasaki Municipal Hospital, Honson 5-15-1, Chigasaki, Kanagawa, 253-0042, Japan
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Wilmsen J, Baumbach R, Stüker D, Weingart V, Neser F, Gölder SK, Pfundstein C, Nötzel EC, Rösch T, Faiss S. New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum: A case series. World J Gastroenterol 2017; 23:3084-3091. [PMID: 28533665 PMCID: PMC5423045 DOI: 10.3748/wjg.v23.i17.3084] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/20/2017] [Accepted: 03/21/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible endoscopy.
METHODS From November 2014 till December 2015 17 patients (8 female, 9 male, average age 69.8 years) with a symptomatic Zenker diverticulum (mean size 3.5 cm) were treated by inserting a new 5 mm fully rotatable surgical stapler (MicroCutter30 Xchange, Cardica Inc.) next to an ultrathin flexible endoscope through an overtube. The Patients were under conscious sedation with the head reclined in left position, the stapler placed centrally and pushed forward to the bottom of the diverticulum. The septum was divided by the staple rows under flexible endoscopic control.
RESULTS In eleven patients (64.7%) the stapler successfully divided the septum completely. Mean procedure time was 21 min, medium size of the septum was 2.8 cm (range 1.5 cm to 4 cm). In four patients the septum was shorter than 3 cm, in seven longer than 3 cm. To divide the septum, averagely 1.3 stapler cartridges were used. Two minor bleedings occurred. Major adverse events like perforation or secondary haemorrhage did not occur. After an average time of two days patients were discharged from the hospital. In 6 patients (35.3%) the stapler failed due to a thick septum or insufficient reclination of the head. Follow up endoscopy was performed after an average of two months in 9 patients; 4 patients (44.4%) were free of symptoms, 5 patients (55.6%) stated an improvement. A relapse of symptoms did not occur.
CONCLUSION Flexible endoscopic Zenker diverticulotomy by using a surgical stapler is a new, safe and efficient treatment modality. A simultaneously tissue opening and occlusion prevents major complications.
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Pérez Lara FJ, Ferrer Berges A, Oliva Muñoz H. Endoluminal stapler prototype for rectal transection. Tech Coloproctol 2017; 21:389-391. [PMID: 28444526 DOI: 10.1007/s10151-017-1607-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 10/02/2016] [Indexed: 11/29/2022]
Affiliation(s)
- F J Pérez Lara
- Digestive Surgery Department, Antequera Hospital, Avda. Peta Muñoz Roas sn, 29200, Antequera, Málaga, Spain.
| | - A Ferrer Berges
- P. Surgery Service, Malaga Universitary Hospital, Malaga, Spain
| | - H Oliva Muñoz
- Digestive Surgery Department, Antequera Hospital, Avda. Peta Muñoz Roas sn, 29200, Antequera, Málaga, Spain
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Abstract
BACKGROUND Staple line and anastomotic leakages are life-threatening complications after bariatric surgery. Upper gastrointestinal (GI) tract X-ray examination with oral administration of a water-soluble contrast agent can be used to detect leaks. The aim of this study was to evaluate the impact of routine upper GI tract fluoroscopy after primary bariatric surgery. METHODS Between January 2009 and December 2014 a total of 658 bariatric interventions were carried out of which 442 were primary bariatric operations. Included in this single center study were 307 sleeve gastrectomies and 135 Roux-en-Y gastric bypasses. Up to December 2012 upper GI tract fluoroscopy was performed routinely between the first and third postoperative days and the detection of leakages was evaluated. RESULTS In the investigation period 8 leakages (2.6 %) after sleeve gastrectomy, 1 anastomotic leakage in gastrojejunostomy and 1 in jejunojejunostomy after Roux-en-Y gastric bypass occurred. All patients developed clinical symptoms, such as abdominal pain, tachycardia or fever. In one case the leakage was detected by upper GI fluoroscopy and in nine cases radiological findings were unremarkable. No leakages were detected in asymptomatic patients. CONCLUSION Routine upper GI fluoroscopy is not recommended for uneventful postoperative courses after primary bariatric surgery.
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Affiliation(s)
- D Gärtner
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.
| | - A Ernst
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - K Fedtke
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - J Jenkner
- Klinik für Gefäß- und Thoraxchirurgie, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - A Schöttler
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - P Reimer
- Institut für diagnostische und interventionelle Radiologie, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - M Blüher
- Klinik und Poliklinik für Endokrinologie und Nephrologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - M R Schön
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
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Ichter ZA, Voeller L, Rivas H, Khoury H, Azagury D, Morton JM. Buttressing of the EEA stapler during gastrojejunal anastomosis decreases rate of bleeding-related complications for laparoscopic gastric bypass. Surg Obes Relat Dis 2017; 13:802-806. [PMID: 28325504 DOI: 10.1016/j.soard.2017.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/15/2016] [Accepted: 01/01/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery is a well-tolerated and effective treatment for severe obesity. Newer surgical techniques and equipment have improved safety standards surrounding bariatric surgery. In particular, buttressing of the staple line in sleeve gastrectomy has decreased rates of clinically significant postoperative bleeding. The present study investigates the effectiveness of buttressing the circular stapled anastomosis during laparoscopic Roux-en-Y gastric bypass (LRYGB). SETTING Academic, accredited hospital. METHODS A total of 253 patients undergoing LRYGB at a single academic institution were included in this retrospective study between 2014 and 2015. Buttressing material was used in 125 of these cases. Demographic information was collected from both groups preoperatively. Surgical characteristics were also obtained analyzed using unpaired t or χ2 tests. RESULTS Patients in both buttressing and nonbuttressing groups were on average 46 years old and predominantly female (79.2% versus 74.2% female, respectively), with a body mass index of approximately 48 kg/m2. Postoperative weight loss did not significantly differ between groups at any time point (buttressing versus nonbuttressing percentage of excess weight loss: 39.5% versus 41.5% at 3 mo, P = .3860; 56.4% versus 56.7% at 6 mo, P = .9341). There were no significant differences for operating time, length of stay, readmissions, or reoperations. Complications due to strictures were found to be lower for the buttressing group (0% buttressing versus 2.3% nonbuttressing, P = .0851). Specific rates of bleeding-related complications were significantly lower for the group in which buttressing was used (0% buttressing versus 3.1% nonbuttressing, P = .0463). CONCLUSION Buttressing of the gastrojejunal anastomosis during LRYGB significantly reduces bleeding-related complications and increases tolerability of the procedure.
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Affiliation(s)
- Zachary A Ichter
- Section of Bariatric and Minimally Invasive Surgery, Stanford University Hospital and Clinics, Stanford, California
| | - Lindsay Voeller
- Section of Bariatric and Minimally Invasive Surgery, Stanford University Hospital and Clinics, Stanford, California
| | - Homero Rivas
- Section of Bariatric and Minimally Invasive Surgery, Stanford University Hospital and Clinics, Stanford, California
| | - Habib Khoury
- Section of Bariatric and Minimally Invasive Surgery, Stanford University Hospital and Clinics, Stanford, California
| | - Dan Azagury
- Section of Bariatric and Minimally Invasive Surgery, Stanford University Hospital and Clinics, Stanford, California
| | - John M Morton
- Section of Bariatric and Minimally Invasive Surgery, Stanford University Hospital and Clinics, Stanford, California.
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Fegelman E, Knippenberg S, Schwiers M, Stefanidis D, Gersin KS, Scott JD, Fernandez AZ. Evaluation of a Powered Stapler System with Gripping Surface Technology on Surgical Interventions Required During Laparoscopic Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A 2016; 27:489-494. [PMID: 27991838 PMCID: PMC5421590 DOI: 10.1089/lap.2016.0513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Transection of gastric tissue during laparoscopic sleeve gastrectomy (LSG) can be challenging. Reinforcing the staple line may decrease the incidence of issues requiring intervention. Methods: The objective of this study was to compare the number of intraoperative surgical interventions for a surgical stapler and reload system with Gripping Surface Technology (GST) to standard reloads in patients who underwent LSG. Patients who underwent elective LSG were enrolled. The study was conducted in two stages. For Stage 1, procedures were performed using a powered stapler and standard reloads. For Stage 2, a reload system with GST was used. The primary endpoint was surgical interventions for bleeding and/or staple line issues during transection of the greater curvature of the stomach. Propensity score matching was applied to create two groups similar in baseline characteristics and risk factors. Results: A total of 111 subjects were enrolled across four centers. Propensity-matched procedures were completed with the standard (n = 38) or GST reloads (n = 38). The mean number of interventions in the standard group was 1.9 (1.29) versus 1.1 (1.45) in the GST group. Nonparametric comparisons were statistically significant, indicating a reduction in the distribution of interventions for GST subjects (P = .0036 for matched pair data). Tissue slippage during transection was low for both groups. Intraoperative leak testing was negative in all procedures, and no procedures were converted to open. Conclusions: Use of the GST stapling system reduces the need for staple line interventions in LSG. Both stapling systems had an acceptable safety profile.
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Affiliation(s)
| | | | | | - Dimitrios Stefanidis
- Division of Bariatric Surgery, Department of Surgery, Carolinas Healthcare System, Charlotte, North Carolina
| | - Keith S. Gersin
- Division of Bariatric Surgery, Department of Surgery, Carolinas Healthcare System, Charlotte, North Carolina
| | - John D. Scott
- Division of Bariatric and Metabolic Surgery, Greenville Health System, University of South Carolina School of Medicine—Greenville, Greenville, South Carolina
| | - Adolfo Z. Fernandez
- Department of General Surgery, Wake Forest University School of Medicine, Winston Salem, North Carolina
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Kimura M, Terashita Y. Profiling Surgical Staplers: How to Increase the Strength of Anastomoses between the Edematous and Normal Intestine. Am Surg 2016; 82:e333-e335. [PMID: 28234160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Masahiro Kimura
- Department of Surgery, Nagoya City East Medical Center, Nagoya, Japan
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Abstract
Stapling is a popular method for stump closure in distal pancreatectomy (DP). However, research on which cartridges are suitable for different pancreatic thickness is lacking. To identify the optimal stapler cartridge choice in DP according to pancreatic thickness.From November 2011 to April 2015, data were prospectively collected from 217 consecutive patients who underwent DP with 3-layer endoscopic staple closure in Seoul National University Hospital, Korea. Postoperative pancreatic fistula (POPF) was graded according to International Study Group on Pancreatic Fistula definitions. Staplers were grouped based on closed length (CL) (Group I: CL ≤ 1.5 mm, II: 1.5 mm < CL < 2 mm, III: CL ≥ 2 mm). Compression ratio (CR) was defined as pancreas thickness/CL. Distribution of pancreatic thickness was used to find the cut-off point of thickness which predicts POPF according to stapler groups.POPF developed in 130 (59.9%) patients (Grade A; n = 86 [66.1%], B; n = 44 [33.8%]). The numbers in each stapler group were 46, 101, and 70, respectively. Mean thickness was higher in POPF cases (15.2 mm vs 13.5 mm, P = 0.002). High body mass index (P = 0.003), thick pancreas (P = 0.011), and high CR (P = 0.024) were independent risk factors for POPF in multivariate analysis. Pancreatic thickness was grouped into <12 mm, 12 to 17 mm, and >17 mm. With pancreatic thickness <12 mm, the POPF rate was lowest with Group II (I: 50%, II: 27.6%, III: 69.2%, P = 0.035).The optimal stapler cartridges with pancreatic thickness <12 mm were those in Group II (Gold, CL: 1.8 mm). There was no suitable cartridge for thicker pancreases. Further studies are necessary to reduce POPF in thick pancreases.
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Affiliation(s)
- Hongbeom Kim
- Department of Surgery and Cancer Research Institute, College of Medicine, Seoul National University
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, College of Medicine, Seoul National University
- Correspondence: Jin-Young Jang, Department of Surgery, College of Medicine, Seoul National University Hospital, Seoul National University, 28, Yeongeondong, Jongno-gu, Seoul 110-744, Korea (e-mail: )
| | - Donghee Son
- Department of Mathematics and Statistics, Sejong University, Seoul, Korea
| | - Seungyeoun Lee
- Department of Mathematics and Statistics, Sejong University, Seoul, Korea
| | - Youngmin Han
- Department of Surgery and Cancer Research Institute, College of Medicine, Seoul National University
| | - Yong Chan Shin
- Department of Surgery and Cancer Research Institute, College of Medicine, Seoul National University
| | - Jae Ri Kim
- Department of Surgery and Cancer Research Institute, College of Medicine, Seoul National University
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, College of Medicine, Seoul National University
| | - Sun-Whe Kim
- Department of Surgery and Cancer Research Institute, College of Medicine, Seoul National University
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Boyko VV, Ivanova YV, Vasilyev DV, Shafer YV, Mushenko EV. [[Treatment and prophylaxis of complications of the sternotomy access in thoracic operations].]. Klin Khir 2016:35-39. [PMID: 28661602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Literature data and own experience of the treatment complications, occurring after tho- racic operations, using sternotomy access, were presented. Special attention was drawn to postoperative sternomediastinitis - most frequent infectious complication. Measures for the sternomediastinitis prophylaxis, methods of its diagnosis and treat- ment were presented.
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Grubnik VV, Kovahichuk AL, Malinovskiy AV, Barannikov KV. Possibilities of laparoscopic gastric resection for gastrointestinal stromal tumors. Klin Khir 2016:5-7. [PMID: 28661595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Possibilities of laparoscopic technologies application while surgical excision of gas- trointestinal stromal tumors (GIST) were analyzed. In 2000 - 2015 yrs in the clinic 28 patients were operated on for gastric GIST. In 10 of them laparoscopic gastric resec- tion with tumor (in 3 - the tumor excision in borders of nonaffected tissues, in 4 - gas- tric fundus resection or stapler resection of a great curvature together with tumor, in 3 - transgastric excision of the tumor, using staplers) surgery was done. The disease recurrence in 2-5 yrs follow-up was absent. Laparoscopic operations has advantage over open interventions while preserving oncological radicalism.
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45
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46
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Macina S, Mandolfino F, Frascio M, Casaccia M, Stabilini C, Fornaro R, Testa T. Stapled Mesh Reinforcement Technique (SMART) to Prevent Parastomal Hernias: Our Initial Experience and Review of the Literature. Surg Technol Int 2016; 28:153-157. [PMID: 27175811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Parastomal hernia is one of the most common stoma related complication, with the correlated risk of incarceration, obstruction, and strangulation. The incidence is high (30-50%) and depends on the length of follow up. Different surgical options for repairing are defective with a 25-70% failure and recurrence rate. Prevention of parastomal hernia with mesh reinforcement seems to be effective. Three available trials are recruiting patients: Prism (with matrix porcine prothesis), Prevent (with preperitoneal polypropylene mesh), and the stapled polypropylene mesh stoma reinforcement technique (SMART). We performed the SMART procedure in six patients undergoing definitive colostomy. Our cases show that the procedure is rapid (duration range 15-20 minutes), cost effective (500 euro), and safe (in our experience, there are no post-surgical complications that are procedure-related). A long term follow-up and a higher number of patients will give us confirmation of the initial hopeful results.
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Affiliation(s)
| | | | - Marco Frascio
- Department of General Surgery, IRCCS San Martino Hospital, Genoa, Italy
| | - Marco Casaccia
- Department of General Surgery, IRCCS San Martino Hospital, Genoa, Italy
| | - Cesare Stabilini
- Department of General Surgery, IRCCS San Martino Hospital, Genoa, Italy
| | - Rosario Fornaro
- Department of General Surgery, IRCCS San Martino Hospital, Genoa, Italy
| | - Tommaso Testa
- Department of General Surgery, IRCCS San Martino Hospital, Genoa, Italy
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48
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ElSaegh MM, Petsa A, Dunning J. Lung Biopsies with the Curved Radial Reload™ Stapler. Surg Technol Int 2016; 28:211-213. [PMID: 27175809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE We describe our experience at the James Cook University Hospital (UK) in using the curved Radial Reload™ (RR) stapler (Medtronic, Dublin, Ireland) for lung wedge resections, which is an endoscopic stapler used mainly in endoscopic general surgery. MATERIALS AND METHODS A single center experience (James Cook University Hospital) for patients who had superficial or deep video-assisted thoracoscopic surgery (VATS) lung wedge resection, using the curved RR stapler. RESULTS Seven patients had superficial or deep VATS lung biopsies-their ages ranged from 38 to 75 years, with a median length of hospital stay of two days (one to six days), and a mean length of hospital stay of 2.5 days. No complications were encountered. CONCLUSION The curved RR stapler is effective in several situations and allows fewer firing of staplers. Our experience would suggest that they are as haemostatic and pneumostatic as the straight staplers and can be used effectively in both superficial and deep lung biopsies.
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Affiliation(s)
- Mohamed Moneer ElSaegh
- Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Afroditi Petsa
- Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Joel Dunning
- Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, United Kingdom
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Kawaguchi T, Yasukawa M, Kawai N, Tojo T. [Application of Curved Stapler for Pulmonary Wedge Resection]. Kyobu Geka 2016; 69:317-320. [PMID: 27210260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
End stapler is one of the indispensable devices for pulmonary resections. Various surgical staplers are now available and appropriate types are selected to dissect pulmonary parenchyma, vessel, or bronchus. In this study, we retrospectively reviewed the patients who received pulmonary wedge resections using newly released curved stapler (Endo GIA Radial Reload with Tri-Staple technology). Between April 2013 and October 2014, 10 lesions from the 9 patients were resected using the curved staplers. The reasons for the application of the staplers were pleuro-pulmonary adhesion in 3 lesions and centrally location in 7 lesions. There was no intraoperative complication. After the operations, temporary residual lobe congestion caused by the pulmonary vein stenosis was developed in 1 patient.
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Affiliation(s)
- Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Japan
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Moore AM, Chen DC. Articulating and Reloadable Fixation Devices for Hernia Repair. Surg Technol Int 2016; 28:133-138. [PMID: 27175807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
There have been a variety of absorbable and permanent tacks, tack deployment systems, and fasteners developed for the fixation of mesh during laparoscopic ventral hernia repair. The manufacturer recommendation for all systems is for perpendicular deployment of these tacks into the tissue. Achieving this optimal angle with previously developed deployment systems is often challenging and can lead to tack failure, mesh migration, and recurrence, or may require the placement of additional ports. Additionally, current tack deployment systems lack the ability to reload, leading to increased cost when entire systems must be opened each time a reload is necessary. This article presents products designed to addresses both of these problems. These deployment instruments incorporate an articulating shaft or a hinge mechanism allowing for improved access to different parts of the abdominal cavity and delivering perpendicular placement of tacks with fewer port sites. Devices with the option of reloadable fixation decrease costs and reduce waste.
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Affiliation(s)
- Alexandra M Moore
- Department of General Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA
| | - David C Chen
- Department of General Surgery, Lichtenstein Amid Clinic at UCLA, University of California Los Angeles, CA
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