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Obtaining secure stapling of a double stapling anastomosis.
Shinya Nakayama1, Suguru Hasegawa1, Koya Hida1
1Department of Surgery, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, Japan.
The Journal of Surgical Research
|October 4, 2014
Summary
Waiting time during stapler firing improves staple formation in rectal surgery, especially with blue cartridges on thicker tissues. This technique enhances surgical safety by reducing staple malformation.
Area of Science:
- Surgical technology
- Gastrointestinal surgery
Background:
- Anastomotic leakage is a significant risk following rectal surgery.
- Optimizing stapling device performance is crucial for patient safety.
Purpose of the Study:
- To evaluate the impact of waiting time during the firing sequence of endoscopic linear staplers on staple formation.
- To compare staple formation across different waiting times and tissue types.
Main Methods:
- Porcine stomachs (cardiac and pyloric regions) were used with an endoscopic linear stapler (Echelon Flex 60 Endopath) and blue/gold cartridges.
- Three waiting time protocols (0/0, 2/0, 2/2 min) were tested for precompression and interstroke periods.
- Staple shape and formation were analyzed in four sections of the staple line; circular stapler performance was also assessed.
Main Results:
- Waiting time positively influenced optimal staple formation with blue cartridges, particularly in the thicker pyloric region.
- Staple malformation was more frequent in the top portion of the staple line but improved with interstroke waiting time.
- Circular stapler performance was consistently satisfactory and unaffected by waiting time or tissue thickness.
Conclusions:
- Implementing a waiting time during the firing cycle of endoscopic linear staplers enhances optimal staple formation.
- This strategy is particularly beneficial when stapling challenging or thicker tissues, potentially reducing anastomotic complications.
