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Contini, Elizabeth, Marisha L. Godek, Jennifer M. Whiffen y Dwight G. Bronson. "Ex Vivo Pneumostasis Evaluation of a Variable-Height Staple Design". Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 8, n.º 4 (junio de 2013): 284–88. http://dx.doi.org/10.1097/imi.0b013e3182a6912a.
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Objective This study examined the effect of using a variable-height staple construct containing three rows of staples with heights of 3.0, 3.5, and 4.0 mm (staple leg length, medial to lateral) versus standard three-row single-height staplers (with staple heights of either 3.5 or 4.8 mm) for pneumostasis in healthy porcine and canine lung parenchyma to determine whether a single stapler that uses variable staple heights could perform as well as, or better than, existing single-height stapling devices. The work presented here used healthy animal tissues, in lieu of diseased tissue, which is extremely difficult to obtain and quantify. Methods Briefly, fresh explanted porcine and canine trachea-lung blocs were used for all testing. Tissue thicknesses were measured with a custom-design spring-loaded caliper before stapling with control and test articles to ensure that the tissue was of “appropriate” thickness for the stapler size (staple height) selected (per manufacturer's instructions for use). All tissue measurements were comparable across each area of lung tested, and both test and control devices were fired into the same tissue thicknesses. After stapling, the lungs were submerged in water, insufflated, checked for air leaks at four discrete (increasing) pressures, and scored using a predetermined scale. Statistical analysis was performed for n = 26 (3.5-mm staples), n = 29 (4.8-mm staples), and n = 26 or 29 (paired to the standard group) for the variable-height stapler (3.0-, 3.5-, and 4.0-mm staples). Results The results demonstrated that the test article comprising three rows of variable-height staples provided comparable pneumostasis with the standard three-row single-height staplers (with staple heights of either 3.5 or 4.8 mm) under the test conditions described. Conclusions A novel test article containing three rows of staples with heights of 3.0, 3.5, and 4.0 mm (variable-height stapler) showed promising results when compared with standard commercially available single-height staplers, performing as well as or better than the standard single-height staplers. This work demonstrates important first steps to proving equivalent device performance, which might facilitate the use of a variable-height stapler in place of multiple single-height staplers.
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Richtsmeier, William J. "Myotomy Length Determinants in Endoscopic Staple-Assisted Esophagodiverticulostomy for Small Zenker's Diverticula". Annals of Otology, Rhinology & Laryngology 114, n.º 5 (mayo de 2005): 341–46. http://dx.doi.org/10.1177/000348940511400502.
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A small Zenker's pouch is a major challenge for endoscopic staple-assisted esophagodiverticulostomy (ESED). This study tested the stapler dimensions so as to identify limitations they impose on ESED. Combining ESED with additional endoscopic suturing could extend the incision and consequently the myotomy. Zenker's diverticulum residual pouch measurements were performed with a previously reported latex glove model and in patients undergoing surgery. Two stapler designs were compared by measuring the residual pouch length for both the stock and modified staplers. One other stapler model cannot be modified without damaging the mechanism. The Endostitch was used to place an additional suture at the apex of the staple line, allowing cutting between the staples while leaving a closed distal incision. All three staplers suitable for ESED leave a residual pouch of 1.5 cm when unmodified. The modified anvil staplers gave a smaller residual pouch by 4 to 5 mm. An additional septal reduction can be accomplished by suturing the area distal to the staple line and incising the party wall beyond the stapler cut. The absolute amount of residual pouch with an additional myotomy is 3 mm. The combined staple-suture technique has proven relatively safe thus far. To provide a maximally efficient myotomy in a patient with a short pouch, the surgeon needs to be aware of the stapler differences. Modifications of the staplers may decrease the depth of the residual pouch, but may carry an added liability. A minimum residual pouch can be achieved with a combination of stapler and suture techniques, but is more technically demanding than the original ESED description.
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Sturiale, Alessandro, Bernardina Fabiani, Claudia Menconi, Danilo Cafaro, Felipe Celedon Porzio y Gabriele Naldini. "Stapled Surgery for Hemorrhoidal Prolapse: From the Beginning to Modern Times". Reviews on Recent Clinical Trials 16, n.º 1 (15 de febrero de 2021): 39–53. http://dx.doi.org/10.2174/1574887115666200310164519e.
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Introduction: Hemorrhoidal disease is the most common proctologic condition in adults. Among the different surgical procedures, one of the greatest innovations is represented by the stapled hemorrhoidopexy. The history of this technique started with a single stapler use passing through a double stapler technique to resect the adequate amount of prolapse, finally coming to the use of high volume devices. Methods: Nevertheless, each device has its own specific feature, the stapler is basically made up with one or more circular lines of titanium staples whose height may be variable. The procedure is based on different steps: Introduction of the CAD, evaluation of the prolapse, fashioning purse string or parachute suture, the introduction of the stapler head beyond the suture, pull the wires through the window, close the stapler and keep pulled the wires of the suture held together with forceps, fire using two hands, open the stapler and remove it and check the staple line and then check the specimen. One of the latest innovations in stapled surgery is Tissue Selective Therapy. It is a minimally invasive procedure in which there is a partial circular stapled hemorrhoidopexy focused on the prolapsing piles with bridges of normal mucosa left. Results: Several studies have reported that SH is a safe and effective procedure to treat hemorrhoidal prolapse. It is a quicker procedure with a shorter hospital stay and earlier return to work if compared with the conventional treatment. This is due to less postoperative pain, postoperative bleeding, wound complications and constipation. Furthermore, the first generation devices had worse outcomes if compared with those of the new generation stapler that showed lower postoperative complication rates with better anatomical and symptomatic results. Conclusions: Stapled procedure for the treatment of symptomatic hemorrhoidal prolapse represents one of the most important innovations in proctology of the last century bringing with it the new revolutionary concept of the rectal intussusception as a determining factor involved in the natural history of the disease. Stapled hemorrhoidopexy marked an era in which the surgeon may offer the patients a safe, effective treatment with less pain and fast recovery.
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Angotti, Lisa M., Christopher Decker, Brittany Pahwa, Carl Rosati y Todd Beyer. "Internal hernia caused by a free intraperitoneal staple after laparoscopic appendectomy". Case Studies in Surgery 4, n.º 1 (17 de mayo de 2018): 14. http://dx.doi.org/10.5430/css.v4n1p14.
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Background: Laparoscopic appendectomy is the gold standard for treatment of appendicitis. Stapled closure of the appendiceal stump is commonly performed and has several advantages. Few prior cases have demonstrated complications from free staples left within the abdomen after the stapler has been fired.Case report: A 29-year-old female underwent laparoscopic appendectomy for acute uncomplicated appendicitis during which the appendix and mesoappendix were divided using laparoscopic gastrointestinal anastomosis (GIA) staplers. Her initial recovery was uncomplicated. She returned on postoperative day 17 with sharp mid-abdominal pain, obstipation, and emesis. Her abdomen was distended, and she had a mild leukocytosis. Computed tomography (CT) demonstrated twisted loops of dilated small bowel in the right lower quadrant with two transition points, suggestive of internal hernia with closed loop bowel obstruction. Diagnostic laparoscopy was performed through the three prior appendectomy incisions. An adhesion between the Veil of Treves and the mesentery of the ileum caused by a solitary free closed staple, remote from the staple lines, had caused an internal hernia. The hernia was reduced, and the small bowel was noted to have early ischemic discoloration. The adhesion was lysed by removing the staple from both structures. The compromised loops of bowel began to show peristaltic movement and color returned to normal, and the procedure was concluded without resection. She was discharged home the following day.Conclusions: Gastrointestinal staplers are commonly used due to ease of use and low complication rate. It is not uncommon to leave free staples in the abdomen as retrieval can be difficult and time consuming. Our case is only the second in the literature reporting an internal hernia with closed loop bowel obstruction as a complication of retained staples. Choosing the most appropriate size staple load to reduce the number of extra staples, removing free staples, or the use of an endoloop can prevent potentially devastating complications.
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Marcet, Jorge, Andrea Ferrara, David E. Rivadeneira, Jose Erbella y Harry T. Papaconstantinou. "Prospective, Multicenter Randomized Controlled Trial Comparing Two Hemorrhoidopexy Staplers: The HEMOSTASIS Study". International Surgery 103, n.º 3-4 (1 de marzo de 2018): 129–38. http://dx.doi.org/10.9738/intsurg-d-15-00171.1.
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The objective of this study was to compare two hemorrhoidopexy staplers (EEA versus PPH03). Stapled hemorrhoidopexy is a treatment option for patients with symptomatic internal hemorrhoids who have failed more conservative measures. However, staple line bleeding remains common. Recent improvements in stapler design have attempted to reduce intraoperative bleeding and the need for intervention. HEMOSTASIS is a prospective, multicenter, 1:1 randomized controlled trial. Twelve hospital centers in the United States enrolled participants between 18 and 85 years of age with symptomatic grades 2 to 3 internal hemorrhoids. The primary end point was intraoperative bleeding, defined as bleeding requiring intervention (e.g., placement of sutures, cauterization, or ligation to achieve hemostasis). Secondary end points included staple line location, postoperative pain, quality of life, operative time, length of hospital stay, adverse events, and complication rates. On the primary end point, the rates of intraoperative bleeding requiring intervention were 41.0% (32 of 78) with EEA and 70.4% (50 of 71) with PPH (P < 0.001). Treatment for active bleeding was required in 30.8% versus 57.7% (P < 0.001) in the EEA and PPH arms, respectively. There were no significant differences between groups in postoperative pain. Adverse events and perioperative complication rates were generally mild/moderate and were similar between groups: 74.1% (60 of 81) of patients in the EEA group reported at least one adverse event versus 80.9% (55 of 68) in the PPH group (P = 0.32). Intraoperative bleeding occurred less often after stapled hemorrhoidopexy with the EEA stapler compared with the PPH03 stapler. Intervention to achieve hemostasis was required less often with the EEA stapler.
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Kathare, Sagar S. y Nandkishor D. Shinde. "A comparative study of skin staples and conventional sutures for abdominal skin wound closures". International Surgery Journal 6, n.º 6 (28 de mayo de 2019): 2168. http://dx.doi.org/10.18203/2349-2902.isj20192387.
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Background: The objectives of the study were to study the operative time, the effect on wound healing, cosmetic results, patients acceptance and total cost with the use of sutures and staples.Methods: The study was conducted on 100 patients who were undergoing elective surgery from January 2016 to July 2017 in our institute. The patients were randomly selected to receive either suture or staple.Results: The study group included 50 patients who underwent wound closure by staplers and 50 patients underwent suturing. The commonest region of the surgical wounds was Mc Burneys site. The time taken for wound closure using staplers showed statistically significance difference over closure with suture, it took the stapler 4 times less duration to perform wound closure. The average cost of using stapler was higher than suturing. The appearance of the scar among the staple group was good in 90% of those who returned for follow-up at 1 month, 10% had average scar. The patients acceptance was better in staple group with less pain during removal as compared to suture group. P-value calculated using students unpaired T-test. P<0.0001 which was highly significant.Conclusions: Staples did not cause excess wound pain and allows saving in time with better cosmetic results.
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Basu, S. "Evaluation of Staple Impressions in the Scanning Electron Microscope". Proceedings, annual meeting, Electron Microscopy Society of America 43 (agosto de 1985): 514–15. http://dx.doi.org/10.1017/s0424820100119399.
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Use of the scanning electron microscope (SEM) for examination of tool marks, paricularly firing pin impressions of semi-automatic pistols, selected shotguns and rifles, is well documented. It was the intent of this investigation to apply SEM to staplers, in order to examine if the impressions on the shoe-ends of staples using a particular stapler possessed persisting defects with repeated tackings, and whether these defects can be used as “individual characteristics” in order to be able to identify the source of a staple on tacked papers from a list of eight staplers of different makes and models (Swingline® 747 and 27, ASCO® 40 and ACE® 102). The effects of pre-existing marks, which are usually existent as parallel striations on staples, and the different forms (100% round, 100% round with sharp points and chisel points) of staples on the resulting impression were examined by using different brands of staples (Swingline® standard No. S.F.-1, Swingline® R. W.-35, Bostitch® standard, and ACE® 2025).
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Sato, Masaaki. "Strategies to improve the accuracy of lung stapling in uniportal and multiportal thoracoscopic sublobar lung resections". European Journal of Cardio-Thoracic Surgery 58, Supplement_1 (12 de marzo de 2020): i108—i110. http://dx.doi.org/10.1093/ejcts/ezaa051.
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Abstract The challenges in video-assisted thoracic surgery for sublobar lung resection include difficulty in tumour localization by palpation and difficulty in determining appropriate resection lines. Virtual-assisted lung mapping (VAL-MAP), a bronchoscopic preoperative multispot lung dye-marking technique, allows for both tumour localization and determination of resection lines. To facilitate stapler-based resection, the AMAGAMI or ‘incomplete grasping’ stapler technique is useful to adjust the alignment of the stapler and resection lines. However, when the lung tissue to be stapled is thick, there is unavoidable uncertainty in the staple line inside the lung. We experimentally demonstrated that up to 1 cm of slippage of lung parenchyma occurs at stapling when the stapled lung tissue is >1 cm thick. VAL-MAP 2.0 is a new generation of VAL-MAP combining multispot dye markings with intrabronchial microcoil placement, allowing for 3-dimensional lung mapping and intraoperative navigation using fluoroscopy. The uncertainty of stapling in the lung parenchyma can be partly overcome by VAL-MAP 2.0.
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Agapov, M. A., V. V. Kakotkin, D. R. Markaryan y T. N. Garmanova. "INTRAOPERATIVE MALFUNCTIONS OF STAPLER DEVICES. THE CURRENT STATE OF THE PROBLEM AND A SERIES OF CLINICAL CASES". Surgical practice, n.º 3 (22 de septiembre de 2022): 5–11. http://dx.doi.org/10.38181/2223-2427-2022-3-5-11.
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The paper presents several medical device reports from our center identified during application of surgical staplers from different manufacturers. The revealed malfunction did not lead to postoperative complications, however, they affected the duration of the operation and the cost of treatment. Failure of the stapler devices during surgery in the absence of proper attention to the staple line can lead to an increase in the frequency of postoperative complications. It remains unclear the problem of «small» malfunctions of stapler devices, which may go unnoticed during surgery, but affect the outcomes of treatment of patients. In order to identify a possible association between these adverse events and postoperative complications, it is necessary to form a state register of events associated with the use of stapler devices.
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Gupta, Paritosh, Dhruv N. Kundra, Amanpriya Khanna, Akanksha Aggarwal y Kanu Kapoor. "Our initial experience of three versus two rows circular stapler devices for stapled hemorrhoidopexy: a single institution review of 224 cases". International Surgery Journal 7, n.º 3 (26 de febrero de 2020): 685. http://dx.doi.org/10.18203/2349-2902.isj20200505.
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Background: Stapled haemorrhoidopexy is a non-excisional approach for haemorrhoids as opposed to conventional open Milligan-Morgan and Ferguson closed haemorrhoidectomy techniques. It repositions the prolapsed haemorrhoid tissue and also causes vascular interruption to the haemorrhoids. This causes faster recovery and lesser post-operative pain.Methods: In authors institute, stapled haemorrhoidopexy was being carried out using two rows proximate PPH circular haemorrhoidal stapler. In February 2018, MIRUS three rows circular stapler was introduced. This is a retrospective observational study carried out at Artemis Hospital, Gurgaon, India. Authors studied records and operative notes of all patients who underwent stapled haemorrhoidopexy between February 2018 and September 2019 and compared key parameters.Results: A total of 224 patients underwent stapled haemorrhoidopexy between February 2018 and September 2019. 116 using MIRUS three rows circular stapler and 108 using two rows proximate PPH circular haemorrhoidal stapler. Most of the studied parameters were comparable with only significant statistical difference seen in higher use of haemostatic sutures in two rows stapler group compared to three rows stapler group. Haemostatic sutures were needed in three row stapler group for 27 patients and in two rows stapler group for 39 patients.Conclusions: Author’s initial experience shows slightly better haemostasis with three rows stapled haemorrhoidopexy with no significant difference in other parameters.
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Laxa, Bernadette U., Kristi L. Harold y Dawn E. Jaroszewski. "Minimally Invasive Esophagectomy". Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 4, n.º 6 (octubre de 2009): 319–25. http://dx.doi.org/10.1097/imi.0b013e3181c4fc8b.
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Objective Minimally invasive esophagectomy (MIE) can be performed a variety of ways using different techniques for the anastomosis. End-to-end anastomosis (EEA) transoral circular staplers have traditionally been used in gastric bypass surgery with good success. An evaluation of the safety and utility of the EEA transoral circular stapler for esophageal anastomoses in MIE is reviewed. Methods A retrospective chart review of all patients who underwent transthoracic MIE with EEA-stapled transoral anastomoses between January 2008 and May 2009 was performed. Patient demographics, indication for esophagectomy, perioperative treatments, intraoperative data, postoperative complications, hospital length of stay, and in-hospital mortality were evaluated. Results Twenty-six consecutive patients underwent MIE with EEA circular-stapled transthoracic anastomoses. Twenty-three were male with a mean age of 64 years (32–88). Indications for esophagectomy included esophageal cancer (24), high-grade dysplasia (1), and refractory stricture (1). Fifteen patients (63%) had neoadjuvant chemotherapy and radiation. There were no conversions to open thoracotomy or laparotomy. Mean operative time was 6.0 hours. Eight patients (31%) suffered postoperative complications; including leak from the gastric conduit staple line requiring operative intervention (1), postoperative bleeding requiring multiple transfusions (1), aspiration pneumonia (1), acute respiratory distress syndrome (1), myocardial infarction (1), chylothorax (1), and anastomotic stricture (2). Median hospital length of stay was 9 days (range 6–43). There were no in-hospital mortalities. Conclusions In our series, the EEA circular stapler seems technically feasible and relatively safe for an intrathoracic anastomosis in MIE.
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Makey, Ian A., Magdy M. El-Sayed Ahmed y Samuel Jacob. "The Radial Stapler Facilitates Lung-Conserving Wedge Resections". Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 15, n.º 5 (13 de agosto de 2020): 463–67. http://dx.doi.org/10.1177/1556984520942370.
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Objective To test whether use of the radial stapler facilitates lung-conserving wedge resections compared to the linear stapler. Methods A video-assisted thoracoscopic simulation lab was established to compare wedge resections performed only with linear staplers to wedge resections performed with the option of a radial stapler. Preserved sheep lungs were used. The target was a 0.5 cm mark on an ovoid surface of the lung equidistant from all edges. Seven fully trained cardiothoracic surgeons participated. They were instructed to obtain at least a 1 cm margin in all directions from the mark. The surgeons were allowed to work from only 2 preassigned ports. Each resected specimen was weighed. The resection margin was the shortest distance measured from the edge of the mark to the staple line. The mass-to-margin ratio was defined as the mass of the specimen divided by the length of the margin. The results were analyzed using a t-test for 2 independent means. Results The 17 radial resections demonstrated a significantly better mass-to-margin ratio (3.31 [SD = 1.19]) compared to the 11 linear resections (4.75 [SD = 1.32], t[26] = 3, P = 0.006). Conclusions In a thoracoscopic simulation, the option of a radial stapler allowed for a better mass-to-margin resection of a small target from a broad surface of the lung than a linear stapler-only option.
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Bernardi, Daniele, Emanuele Asti y Luigi Bonavina. "VS03.08: ANASTOMOTIC TECHNIQUES FOR MINIMALLY INVASIVE TRANSTHORACIC ESOPHAGECTOMY". Diseases of the Esophagus 31, Supplement_1 (1 de septiembre de 2018): 49. http://dx.doi.org/10.1093/dote/doy089.vs03.08.
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Abstract Description Minimally invasive esophagectomy has the potential to reduce the incidence of pulmonary complications and postoperative pain. This video shows two safe and reproducible technical variants for thoracoscopic stapled anastomosis. The patient is placed in a left semi-prone position after induction of anesthesia with a single lumen orotracheal tube. Triportal access and low-pressure pneumothorax (8 mmHg) are used for the procedure. Once circumferential mobilization of the esophagus is completed, intraoperative ultrasonography is performed to identify a previously placed endoscopic metal clip marking the upper tumor level. The esophagus is safely transected above this level. An end-to-side intra-corporeal esophagogastric anastomosis is performed. Technique A. The esophagus is stapled with a 60 mm cartridge (EndoGIA™ Tri-Staple™ purple). The anvil of a 25 mm circular stapler (OrVil™) is inserted transorally and retrieved through a small hole in the esophageal stump. Technique B. The 25 mm anvil is inserted through a transverse esophagotomy with a 7 cm long 2–0 polypropylene suture attached to the sharp tip. The suture is passed from inside to outside of the esophageal lumen. The esophagus is then divided distal to the anvil with an linear stapler. At this point, the anvil is pulled out with a gentle traction close to the stapled line. In both techniques, the circular stapler is introduced into the chest cavity through a mini-thoracotomy at the level of lowermost trocar and a wound retractor (Alexis™) is used. The head of the circular stapler, sealed with a surgical glove cutted at the middle finger, is then introduced into the gastric tube through a small gastrotomy on the lesser curvature. The tip of the gastric tube is perforated close to the greater curvature and engage the esophageal anvil. After checking the doughnut, transection of the remnant gastric tube is completed with a linear stapler and the specimen is retrieved through the mini-thoracotomy. Disclosure All authors have declared no conflicts of interest.
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Hasegawa, Suguru, Shinya Nakayama, Koya Hida, Kenji Kawada y Yoshiharu Sakai. "Effect of Tri-Staple™ Technology and Slow Firing on Secure Stapling Using an Endoscopic Linear Stapler". Digestive Surgery 32, n.º 5 (2015): 353–60. http://dx.doi.org/10.1159/000437216.
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Aim: To evaluate the effect of Tri-staple™ technology and slow firing using the Endo-GIA™ endoscopic linear stapler. Methods: The cardiac and pyloric portions of porcine stomachs were divided using the endoscopic linear stapler with different reload types. A total of 8 min of waiting time was employed during firing in the slow-firing group and no waiting time was employed in the normal-firing group. The shape of the staples was then evaluated. The length of the staple line and serosal laceration was also determined. Results: There was a moderate negative correlation between tissue thickness and secure staple formation. Tri-staple™ reloads (purple, black) offered more secure staple formation compared with Universal green reload. Although slow firing enhanced secure staple formation, its effect was greater when using green reload, compared with Tri-staple™ reloads. Significantly shorter staple line length and longer serosal laceration was observed in the thick tissue. Although the cartridge type did not influence lengths of the staple line or serosal laceration, both were better in the slow-firing group. Conclusions: Tri-staple™ reloads offered more secure staple formation compared with the Universal reload. Although slow firing improved staple line shortening and serosal laceration, its effect on secure stapling was relatively small when using Tri-staple™ reloads.
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Guadagni, Simone, Matteo Palmeri, Matteo Bianchini, Desirée Gianardi, Niccolò Furbetta, Fabrizio Minichilli, Gregorio Di Franco, Annalisa Comandatore, Giulio Di Candio y Luca Morelli. "Ileo-colic intra-corporeal anastomosis during robotic right colectomy: a systematic literature review and meta-analysis of different techniques". International Journal of Colorectal Disease 36, n.º 6 (23 de enero de 2021): 1097–110. http://dx.doi.org/10.1007/s00384-021-03850-9.
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Abstract Purpose Robotic assistance could increase the rate of ileo-colic intra-corporeal anastomosis (ICA) during robotic right colectomy (RRC). However, although robotic ICA can be accomplished with several different technical variants, it is not clear whether some of these technical details should be preferred. An evaluation of the possible advantage of one respect to another would be useful. Methods We conducted a systematic review of literature on technical details of robotic ileo-colic ICA, from which we performed a meta-analysis of clinical outcomes. The extracted data allowed a comparative analysis regarding the outcome of overall complication (OC), bleeding rate (BR) and leakage rate (LR), between (1) mechanical anastomosis with robotic stapler, versus laparoscopic stapler, versus totally hand-sewn anastomosis and (2) closure of enterocolotomy with manual double layer, versus single layer, versus stapled. Results A total of 30 studies including 2066 patients were selected. Globally, the side-to-side, isoperistaltic anastomosis, realized with laparoscopic staplers, and double-layer closure for enterocolotomy, is the most common technique used. According to the meta-analysis, the use of robotic stapler was significantly associated with a reduction of the BR with respect to mechanical anastomosis with laparoscopic stapler or totally hand-sewn anastomosis. None of the other technical aspects significantly influenced the outcomes. Conclusions ICA fashioning during RRC can be accomplished with several technical variants without evidence of a clear superiority of anyone of these techniques. Although the use of robotic staplers could be associated with some benefits, further studies are necessary to draw conclusions.
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Vasaiya, Mehulkumar K., Samir M. Shah, Vikram B. Gohil y Milankumar S. Vaghasia. "A prospective study of 50 cases of laparoscopic intestinal anastomosis by Endo GIA universal loading stapler (green/blue) versus Endo GIA articulating reload with tri staple technology (purple)". International Surgery Journal 7, n.º 11 (23 de octubre de 2020): 3657. http://dx.doi.org/10.18203/2349-2902.isj20204667.
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Background: Intestinal anastomosis is a commonly performed procedure in surgery. Various evolvements have occurred in the field of intestinal anastomosis and recent advancement is the use of stapler in laparoscopic surgeries as a device for Gastrointestinal (GI) anastomosis. Few previous studies evaluating the clinical safety of the 2 laparoscopic linear stapling devices are available.Methods: A prospective comparative study of 50 cases which met the inclusion and exclusion criteria were included in this hospital-based study. They were randomly allocated to two groups, Group A which underwent laparoscopic intestinal anastomosis by Endo GIA tri-staple (purple) stapler and Group B which underwent Endo GIA universal loading unit (blue/green) stapler. Primary outcome was assessed in terms of intra-operative staple line bleeding, operative time and post-operative anastomotic leak.Results: Patients with laparoscopic intestinal anastomosis by Endo GIA tri-staple stapler (purple) have required less operation time as compared to Endo GIA universal loading unit. In Endo GIA universal loading unit (blue/green) 04% patients developed anastomotic leak and 40% patients had intra-operative staple line bleed while with Endo GIA tri-staple no postoperative anastomotic leak was found and 02% patients developed intra-operative staple line bleeding.Conclusions: The result of our study has shown that the Endo GIA reload tri- staple (purple) is superior in terms of having no anastomosis leak, negligent staple line bleeding and less operation time as compared with Endo GIA universal loading unit (blue/green). Thus, laparoscopic intestinal anastomosis by Endo GIA reload tri-staple stapler (purple) technology is more effective and overall more efficient.
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Giffen, Zane, Austin Ezzone y Obi Ekwenna. "Robotic stapler use: Is it safe?–FDA database analysis across multiple surgical specialties". PLOS ONE 16, n.º 6 (24 de junio de 2021): e0253548. http://dx.doi.org/10.1371/journal.pone.0253548.
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Introduction Robotic-assisted techniques are common across many surgical subspecialties. While robotic stapling offers increased surgeon control, there is limited information on surgical complications related to robotic stapler use. Methods We reviewed the FDA’s MAUDE database for adverse events related to robotic stapler use. Results Upon review of the FDA database, the most frequently reported robotic stapler complications were malfunction, failure to form staple line, device fragmentation, and misfire. 31 Clavien-Dindo grade II or higher complications were attributed to stapler use since 2014. Conclusions Further research on prevalence of robotic stapler use is needed to quantity the associated complication rate.
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Rahman, Dr Sharif Mushfaqur, Dr Syed Mahbubul Alom y Dr Gazi Md Salahuddin. "A Comparison between Skin Stapler and Polypropylene Sutures in Closing Laparotomy Wounds: A Study of 100 Cases". SAS Journal of Surgery 8, n.º 8 (25 de agosto de 2022): 562–67. http://dx.doi.org/10.36347/sasjs.2022.v08i08.013.
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Objective: Healing of laparotomy wounds is associated with number of factors. The aim of the study was to compare skin stapler and polypropylene sutures in closing laparotomy wounds. Materials and method: This randomized controlled trial study was conducted at the Department of Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh. The study duration was 6 months, from July 2010 to December 2010. A total of 100 participants were included in the study, divide in two equal groups of 50 participants. The first group received interrupted suture with 2/0 polypropylene. The other group received skin staples. Results: The mean time for closure with suture and staple were 3.7±SD and 22.5±SD cm/min respectively (p- value<0.05). Rate of wound closure was calculated in cm per minute and materials were compared statistically in pairs by t- test. Wounds were closed five times faster with staples then suture (p<0.001). In relation to post-operative infection, 17 (34%) cases developed wound infection in sutured group and 15 (30%) patients in stapled group. Most of the infection occurred in the emergency contaminated cases. There was no significant association between wound infections and method of skin closure (p> 0.05, chi square= 3.15). Conclusions: Staples were well-liked by operators and resulted in substantial and worthwhile savings in time for wound closure.
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Horkoff, Michael, Kieran Purich, Noah Switzer, Shalvin Prasad, Neal Church, Xinzhe Shi, Philip Mitchell, Estifanos Debru, Shahzeer Karmali y Richdeep Gill. "A Shorter Circular Stapler Height at the Gastrojejunostomy during a Roux-En-Y Gastric Bypass Results in Less Strictures and Bleeding Complications". Journal of Obesity 2018 (29 de mayo de 2018): 1–4. http://dx.doi.org/10.1155/2018/6959786.
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The laparoscopic Roux-en-Y gastric bypass (LRYGB) is prone to a number of complications, most notably at the gastrojejunostomy (GJ) staple line. The circular stapler technique is a common method used to create the GJ anastomosis. Although recent studies have shown a decreased rate of anastomotic strictures with shorter stapler heights, the optimal circular stapler height to use remains controversial. We therefore completed a retrospective cohort study within the Alberta Provincial Bariatric Program (APBP) to compare outcomes between the 3.5 mm and 4.8 mm stapler heights. We identified 215 patients who had a LRYGB done between the years 2015 and 2017. 143 patients had the GJ constructed with a 3.5 mm circular stapler height, with the remaining 72 patients having the GJ fashioned with a 4.8 mm stapler height. The rate of anastomotic stricturing was lower in the 3.5 mm stapler group compared to the other cohort (3.5 versus 13.9%, resp., p=0.008). Likewise, the overall rate of bleeding complications was lower in the 3.5 mm stapler group compared to the 4.8 mm group (6.3 versus 15.3%, resp., p=0.04). The rate of anastomotic stricturing and postoperative bleeding is lower with the use of a 3.5 mm circular stapler compared to a 4.8 mm circular stapler when forming the GJ.
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Gaidry, Alicia D., Laurier Tremblay, Don Nakayama y Romeo C. Ignacio. "The History of Surgical Staplers: A Combination of Hungarian, Russian, and American Innovation". American Surgeon 85, n.º 6 (junio de 2019): 563–66. http://dx.doi.org/10.1177/000313481908500617.
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Since their development in 1908, surgical staplers have been used as a method of “mechanical suturing” in efforts to divide hollow viscera and create anastomoses in an efficient and sterile manner. The concept for the surgical stapler was first developed by Humér Hultl, a Hungarian professor and surgeon, and designed by Victor Fischer, a Hungarian businessman and designer of surgical instruments. The design was highly acclaimed; however, it was bulky, cumbersome, and expensive to manufacture. In 1920, Aladár Petz, a student of Hultl, incorporated two innovations to the Fischer-Hultl stapler to create a more lightweight model, which was named the Petz clamp. In 1934, Friedrich of Ulm designed what would be the predecessor to the modern-day linear stapler. In the 1950s, Russian and American staplers began to emerge. Throughout the 1960s, a variety of stapling instruments were developed in the United States, manufactured by the United States Surgical Corporation. In the 1970s, Johnson & Johnson Ethicon brand joined the market. The United States Surgical Corporation was later bought by Tyco Healthcare and became Covidien in 2007. Through the collaboration of Felicien Steichen, Mark Ravitch, and Leon Hirsch, surgical staplers were further modified to incorporate interchangeable cartridges with various designs. With the advent of minimally invasive surgery began production of laparoscopic surgical staplers. Since its inception, the surgical stapler has provided a means to efficiently create safe and effective visceral and vascular anastomoses. The surgical stapler design continues to evolve while still maintaining the basic principles that were implemented in the original design.
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Jahan, K., R. Shrestha, P. Adhikari, M. Tripathi, C. P. Neupane, R. T. Gurung y J. Mally. "A Comparative Study between Staplers and Suture (Silk 2-0) for Skin Closure in Cesarean Sections at Gandaki Medical College Teaching Hospital". Journal of Gandaki Medical College-Nepal 10, n.º 2 (17 de agosto de 2018): 1–5. http://dx.doi.org/10.3126/jgmcn.v10i2.20800.
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Background: Skin closure in the abdominal surgeries is an important factor that affects the prognosis of wound in terms of hospital stay as well as overall outcome of the surgery.Objectives: Cesarean section being the commonly performed operation, choice of suture material has the unexceptional role on it. This study has been performed with an objective to look for the merits and demerits of the skin closure by suture (Silk 2-0) and stapler.Methods: Prospective comparative study conducted among the patients admitted in a Maternity Ward of Gandaki Medical College Teaching Hospital for elective and emergency cesarean section. The comparison has been made in terms of time taken during the skin closure, presence or absence of soakage and wound dehiscence, day of suture removal and pain during the suture removal.Results: The average time taken for skin closure for suture group was found to be 5.46 min (±0.97) and the same for stapler group was found to be 1.22 min (±0.15) respectively. Similarly, the mean day of stitch removal in suture and staples were found to be 6.94 (±1.75) and 7.95 (±1.89) respectively. Surgical site infection (SSI) i.e. soakage was present in eight percent of those in suture group and 20% in stapler group. Wound dehiscence was present in two percent among the suture group and five percent among the stapler group. The severity of pain is more in stapler group than that of suture group during its removal.Conclusions: Our study concluded suture being superior to staplers for skin closure during cesarean section. Though time taken for the closure is less in the stapler group, other factors like wound complications, duration of hospital stay, pain during its removal favored for the suture to be used.J-GMC-N | Volume 11 | Issue 01 | January-June 2018, Page: 1-4
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Mari, Francesco Saverio, Luigi Masoni, Umile Michele Cosenza, Francesco Favi, Giammauro Berardi, Anna Dall'Oglio, Fioralba Pindozzi y Antonio Brescia. "The Use of Bioabsorbable Staple-Line Reinforcement Performing Stapled Hemorrhoidopexy to Decrease the Risk of Postoperative Bleeding". American Surgeon 78, n.º 11 (noviembre de 2012): 1255–60. http://dx.doi.org/10.1177/000313481207801135.
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Postoperative staple-line bleeding after stapled hemorrhoidopexy represents a major issue of this procedure, especially in the day surgery setting. In this study we assess the possible benefit of using circular bioabsorbable staple-line reinforcement to reduce the risk of hemorrhage when performing stapled hemorrhoidopexy in a day surgery setting. Patients with symptomatic II to III grade hemorrhoidal disease were randomly assigned into two groups. In Group A we performed a stapled hemorrhoidopexy using PPH33-03® with Seamguard®, a bioabsorbable staple-line reinforcement; in Group B, we used only a PPH33-03® stapler. We evaluated the intraoperative and postoperative staple-line bleeding and, secondarily, the duration of surgery, need for additional hemostatic stitches, and presence of postoperative complications. One hundred patients were enrolled in the study. Group A patients showed a statistically significant decrease of intraoperative bleeding (4 vs 42% in Group B) and hemostatic stitch placement (5.7 vs 42%) with the consequent reduction in mean operative time, postoperative pain, and tenesmus. There were no differences between the two groups in hemorrhoidal disease control or postoperative late complications. The use of bioabsorbable staple-line reinforcement while performing stapled hemorrhoidopexy may allow improvement of the safety of this procedure, especially in a day surgery setting.
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Chaudhari, Dr Ganesh y Dr Satish Sonawane. "Our Experience of Tie Over bolster and Quilting Sutures Versus Stapler fixation for Split thickness skin graft in post burn neck contracture – A Comparative study". VIMS Health Science Journal 8, n.º 2 (17 de junio de 2021): 58–61. http://dx.doi.org/10.46858/vimshsj.8202.
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Background: Traditional method to fix Split thickness skin graft in post burn neck contracture is Tie over Bolster dressing and Quilting sutures. We used staplers to fix split thickness skin graft. Materials & methods: A comparative study conducted in 30 patients with post burn neck contracture at Dr. Vasantrao Pawar Medical College, Nashik, during January 2015 to December 2020. Time required for fixation of split thickness skin graft, outcome in terms of graft uptake and patients comfort level while removing sutures and stapler recorded. Results: Total 30 Patients were included in our study. Mean time required for Tie over and quilting suture was 10.53 ± 0.88 min, significantly higher than the mean time in stapler fixation 4.87 ± 0.81 min. (p<0.001). Graft take was 95% in stapler and 93% in Tie over and quilting suture. Conclusion: Fixation of Split thickness skin graft with stapler is more rapid, less time consuming also results in decreased surgical and anaesthesia time. More patient friendly while removing staplers with comparable skin graft uptake.
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Chaudhari, Dr Ganesh y Dr Satish Sonawane. "Our Experience of Tie Over bolster and Quilting Sutures Versus Stapler fixation for Split thickness skin graft in post burn neck contracture – A Comparative study". VIMS Health Science Journal 8, n.º 2 (17 de junio de 2021): 58–61. http://dx.doi.org/10.46858/vimshsj.8202.
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Background: Traditional method to fix Split thickness skin graft in post burn neck contracture is Tie over Bolster dressing and Quilting sutures. We used staplers to fix split thickness skin graft. Materials & methods: A comparative study conducted in 30 patients with post burn neck contracture at Dr. Vasantrao Pawar Medical College, Nashik, during January 2015 to December 2020. Time required for fixation of split thickness skin graft, outcome in terms of graft uptake and patients comfort level while removing sutures and stapler recorded. Results: Total 30 Patients were included in our study. Mean time required for Tie over and quilting suture was 10.53 ± 0.88 min, significantly higher than the mean time in stapler fixation 4.87 ± 0.81 min. (p<0.001). Graft take was 95% in stapler and 93% in Tie over and quilting suture. Conclusion: Fixation of Split thickness skin graft with stapler is more rapid, less time consuming also results in decreased surgical and anaesthesia time. More patient friendly while removing staplers with comparable skin graft uptake.
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Müller, Dolores T., Benjamin Babic, Veronika Herbst, Florian Gebauer, Hans Schlößer, Lars Schiffmann, Seung-Hun Chon, Wolfgang Schröder, Christiane J. Bruns y Hans F. Fuchs. "Does Circular Stapler Size in Surgical Management of Esophageal Cancer Affect Anastomotic Leak Rate? 4-Year Experience of a European High-Volume Center". Cancers 12, n.º 11 (22 de noviembre de 2020): 3474. http://dx.doi.org/10.3390/cancers12113474.
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Anastomotic leak is one of the most severe postoperative complications and is therefore considered a benchmark for the quality of surgery for esophageal cancer. There is substantial debate on which anastomotic technique is the best for patients undergoing Ivor Lewis esophagectomy. Our standardized technique is a circular stapled anastomosis with either a 25 or 28 mm anvil. The aim of this study was to retrospectively analyze whether the stapler diameter had an impact on postoperative anastomotic leak rates during a 4-year time frame from 2016 to 2020. A total of 632 patients (open, hybrid, and totally minimally invasive esophagectomy) met the inclusion criteria. A total of 214 patients underwent an anastomosis with a 25 mm stapler vs. 418 patients with a 28 mm stapler. Anastomotic leak rates were 15.4% vs. 10.8%, respectively (p = 0.0925). Stapler size should be chosen according to the individual anatomical situation of the patient. Stapler size may be of higher relevance in patients undergoing totally minimally invasive reconstruction.
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Makanyengo, Samwel Okoth y Dhan Thiruchelvam. "Literature Review on the Incidence of Primary Stapler Malfunction". Surgical Innovation 27, n.º 2 (19 de diciembre de 2019): 229–34. http://dx.doi.org/10.1177/1553350619889274.
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Background. Surgical stapling devices are known for their reliability and convenience. A letter to health care professionals published by the US Food and Drug Administration in March 2019 highlighted the increasing number of adverse events associated with surgical staplers. Driven by a case of stapler malfunction during an elective laparoscopic sleeve gastrectomy, we performed a literature review to investigate the incidence of primary stapler malfunction. We also discuss the common types and an approach to its management. Methods. PubMed, MEDLINE, and EMBASE databases were searched for articles discussing surgical stapler malfunction. Twelve studies were selected that described the incidence and/or consequences of primary stapler malfunction. A narrative synthesis was performed. Results. From observational studies, the incidence ranged from 0.022% to 2.3%. A prospective survey reported that 86% of laparoscopic surgeons either had personal experience with or knew of surgeons who experienced stapler malfunction, implying a higher incidence. Underreporting has been an issue as manufacturers can get exemptions from public reporting. Significantly, higher malfunctions have been reported after exemptions were lifted. The most common types of stapler malfunction are stapler misfire and stapler locking. Major morbidity and mortality have been reported. Conclusion. Surgeons are increasingly reliant on technological innovations. Stapling failure occurs and it is imperative to be aware of this. Given the high volume of stapler use, a high percentage of surgeons are likely to encounter this problem in their career. It is important to have an approach to the prevention and management of this potentially catastrophic complication.
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Varghese, Fobin, Jose Gamalial y John S. Kurien. "Skin stapler versus sutures in abdominal wound closure". International Surgery Journal 4, n.º 9 (24 de agosto de 2017): 3062. http://dx.doi.org/10.18203/2349-2902.isj20173888.
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Background: Wound closure is as important as any other action performed by the surgeon. Apart from the need for producing a healthy and strong scar, it is the surgeon’s responsibility to ensure its aesthetically pleasing physical appearance. Skin staples are an alternative to regular sutures in offering this advantage. The present study has helped to highlight the benefits of skin stapler.Methods: Out of the 120 participants, 60 underwent skin closure with Stainless steel skin staples and the remaining 60 with non-absorbable Polyamide mattress sutures randomly. They all received one mandatory dose of pre-operative parenteral antibiotic 1 hour prior to the incision. On the 3rd postoperative day, the wound was evaluated for inflammation, infection and wound gape. Participants were re-evaluated for infection/gape/inflammation during follow-up on 7th day. The wounds were evaluated at 1 months follow up which were rated for cosmesis by Visual Analogue Score. The data was coded and entered in Microsoft excel and then analysed using statistical software SSPS.Results: Study population consisted of 79 males (65.8%) and 41 females (34.2%). Mean age of the study population was 49.35 with an SD 16.739. Wound infection was found to be higher in stapler group (30%) when compared to conventional suture group (11.7%)which was found to be statistically significant with chi-square value 6.114 and p value 0.013. Mean time for closure was significantly shorter in stapler group 4.55 minutes, when compared to suture group (11.22 minutes). Better cosmetic outcome was observed in conventional suture group.Conclusions: Preventing wound infection, especially in abdominal wounds, is of importance as it may lead to wound gaping. Incidence of post-operative wound infection was more with skin staples. Cosmesis is essential and important aspect in this day and age. A cosmetic scar not only gives satisfaction to the patient but also mental ease to the surgeon. Conventional sutures provided better cosmetic result when compared with skin staplers.
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Narang, Rahul, Sudhir Kalaskar, Hoong-Yin Chong, Rama Ganga, Giovanna da Silva, Steven Wexner y Eric G. Weiss. "Tu1529 Stapled Loop Ileostomy Closure: Does Stapler Length Matter?" Gastroenterology 144, n.º 5 (mayo de 2013): S—1120. http://dx.doi.org/10.1016/s0016-5085(13)64176-1.
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Shaikh, Shiraz, Zameer Hussain Laghari, Qamber Ali Laghari, Aisha Memon, Sahrish . y Arif Hussain. "Outcome on Surgical Site Infections for the Closure of Abdominal Incisions in General Surgery". Pakistan Journal of Medical and Health Sciences 16, n.º 3 (31 de marzo de 2022): 414–16. http://dx.doi.org/10.53350/pjmhs22163414.
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Objective: To determine the frequency of surgical site infections according to the closure of abdominal incisions (skin staplers versus suture stitches) in General Surgery at Liaquat University of Medical and Health Sciences (LUMHS). Material and Method: This cross-section comparative study was conducted at the Department of General Surgery at LUMHS. The study was conducted for one year from January 2021 to December 2021. All the patients aged more than 12 years, both genders and who had undergone abdominal surgeries were included. Patients were divided into two groups group A and group B as per closure of the abdominal incisions. Patients in group A underwent staplers wound closure and patients in group B underwent wound closure by suture stitches. Patients were assessed for postoperative surgical site infection during hospital stay. All the data were collected via self-made study proforma. SPSS version 26 was used for the purpose of data analysis. Stratification with respect to the effect modifiers was done and a p-value < 0.05 was taken as significant. Results: In this study, a total of 41 cases were comparatively studied regarding surgical site infections as to the type of wound closure. The average age of the stapler’s patients’ group was 36.70+6.22 years and the average age of the suture patients’ group was 42.47+5.09 years. Males were most common in both groups without a significant difference (p-929), while average duration of closure was significantly lower in stapler group as compared to suture group (p-0.001). Of all, 12 cases had wound infection, particularly as 4 cases had infection grade I, 5 cases had grade II infection and 2 cases had grade III infection. Although frequency of surgical site infection was statistically insignificant (p-0.223). Conclusion: The wound closure skin stapler’s method was observed to be effective in terms of short duration, while the frequency of surgical site infection was higher in stapler closure but statistically insignificant as per both techniques. Keywords: Wound infection, stapler, suture, effectiveness
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Al-Khudari, Samer, Eric Succar, Robert Standring, Helmi Khadra, Tamer Ghanem y Glendon M. Gardner. "Delayed Failure after Endoscopic Staple Repair of an Anterior Spine Surgery Related Pharyngeal Diverticulum". Case Reports in Medicine 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/281547.
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We present a rare complication of endoscopic staple repair of a pharyngeal diverticulum related to prior anterior cervical spine surgery. A 70-year-old male developed a symptomatic pharyngeal diverticulum 2 years after an anterior cervical fusion that was repaired via endoscopic stapler-assisted diverticulectomy. He initially had improvement of his symptoms after the stapler-assisted approach. Three years later, the patient presented with dysphagia and was found to have erosion of the cervical hardware into the pharyngeal lumen at the site of the prior repair. We present the first reported case of late hardware erosion into a pharyngeal diverticulum after endoscopic stapler repair.
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Mohammed, Serbin, Kavitha Jayanthi Balachandran, S. Vineed y Meer M. Chisthi. "Stapled versus open haemorrhoidectomy: a prospective study". International Surgery Journal 7, n.º 11 (23 de octubre de 2020): 3740. http://dx.doi.org/10.18203/2349-2902.isj20204682.
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Background: In this era of staplers and advanced techniques in surgery Milligan Morgan technique of open haemorrhoidectomy is still considered as gold standard procedure for symptomatic haemorrhoids. Stapler haemorrhoidectomy, even though it is practiced in many centres has not become common due to various factors. The present study was done to compare the efficacy, safety and advantages, if any, of the stapled haemorrhoidectomy to open procedure.Methods: This prospective study was performed in the department of general surgery, Government medical college, Thiruvananthapuram, Kerala over a period of 12 months from March 2015 to March 2016. Symptomatic patients with grade 3 and4 haemorrhoids were selected for the study. The patients were randomized into two equal groups of 20 each. Group A underwent conventional open haemorrhoidectomy and group B, stapled haemorrhoidectomy.Results: Mean operative time period for group A was 39.25 ±5.5 minutes and group B was 26.75±4.7 minutes. There was significant difference in the pain score between these procedures on first 3 post-operative days. There was also significant difference in group A and group B which was 6.55±1.099 and 3.55±0.759 days respectively for mean hospital stay and 9.90±1.651 and 5.70±0.865 days respectively for return to normal work.Conclusions: Stapler haemorrhoidectomy is associated with lower pain scores postoperatively and shorter duration of hospital stay with early return to work when compared to conventional open haemorrhoidectomy.
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Lao, Yong Hua, Yue Shan Huang, Wei Rong Li y Ying Jun Wang. "Structure Optimization on FEM Biomechanical Model of Bioabsorable Pure Magnesium Skin Staple". Advanced Materials Research 1049-1050 (octubre de 2014): 511–14. http://dx.doi.org/10.4028/www.scientific.net/amr.1049-1050.511.
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Skin Stapler is an alternative instrument, which makes surgy easily and quickly and owns fine-looking effect without scars after the wound healed, to traditional surgical suture for the wound skin sewing. Magnesium recently is considered to develop medical implants because of its beneficial biocompatibility and bioabsorability. Due its less mechanical strength than traditional 316L stainless steel used in common staple, this paper try to optimize the structure of pure magnesium skin staple by FEM models and simulation as so to assure its biomechanical safty. Using ADINA software, two staples with different pre-bended shoulders and the traditional staple without shoulder are modeling to analyze its stress and plastical strain during structural deformation under load. The results, not only of pure magnesium models but also of 316L stainless steel models, showed that the shoulders optimization on staple structure has important role in its mechanical performance. The research increases the possibility of bioabsorable magnesium material application on medical skin staple.
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Subhedar, Preeti D., Sameer H. Patel, Peter J. Kneuertz, Shishir K. Maithel, Charles A. Staley, Juan M. Sarmiento, John R. Galloway y David A. Kooby. "Risk Factors for Pancreatic Fistula after Stapled Gland Transection". American Surgeon 77, n.º 8 (agosto de 2011): 965–70. http://dx.doi.org/10.1177/000313481107700811.
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The objective of this study was to identify risk factors for pancreatic fistula (PF) after stapled transection in distal pancreatectomy (DP). Patients undergoing DP using a stapler for transection between 2005 and 2009 were identified from a pancreatic resection database. Variables examined included patient and tumor characteristics, staple size, and the use of mesh reinforcement. Univariate and multivariate regression analyses were performed to identify risk factors for postoperative PF. One hundred forty-nine had stapled transection, and of these, 25 (17%) had mesh reinforcement. The overall morbidity and mortality rates were 28 per cent and less than 1 per cent; 34 (23%) were diabetic. The rate of clinically significant PF was 14 per cent. On univariate analysis, diabetes ( P = 0.04), a firm pancreas ( P = 0.03), use of mesh staple line reinforcement ( P = 0.02), use of a 4.1-mm staple cartridge ( P = 0.01), and blood loss greater than 100 mL ( P = 0.01) were associated with higher pancreatic fistula rates. On multivariate analysis, only the presence of diabetes (OR, 4.17; 95% CI, 1.1-15.3; P = 0.03) and the use of a 4.1-mm cartridge (OR, 8.57; 95% CI, 1.2-60.2; P = 0.03) were independently associated with pancreatic fistula formation. Stapled pancreatic transection provides an acceptable PF rate after DP. Diabetes and staple size influence PF rates. In our experience, use of mesh staple line reinforcement did not reduce the incidence of PF after stapled transection.
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ALKAN, Murat, Kamuran TUTUŞ, Selcan TÜRKER ÇOLAK, Ender FAKIOĞLU, Şeref Selçuk KILIÇ, Onder OZDEN y Recep TUNCER. "Comparison of stapler and hand-sewn roux en Y jejunal anastomosis in children". Cukurova Medical Journal 47, n.º 4 (28 de diciembre de 2022): 1424–30. http://dx.doi.org/10.17826/cumj.1091286.
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outcomes of stapled and hand-sewn Roux-en-Y intestinal anastomoses in childhood.
Materials and Methods: At a university hospital, the records of the children who underwent roux-en-Y anastomosis between December 2007 and December 2014 were reviewed. The data were compared according to the roux-en-Y anastomosis technique used (stapled versus hand-sewn).
Results: A total of 52 patients had undergone roux-en-Y anastomosis. All had biliary atresia or choledochal cyst. Thirty-one of the patients were diagnosed with biliary atresia and 21 with choledochal cysts. Staple anastomosis technique was used in 16 of the patients with biliary atresia and 9 of the patients with choledochal cyst. Both in biliary atresia and choledochal cyst cases; operations with stapled anastomosis were significantly shorter than the ones with hand-sewn anastomosis. Among the biliary atresia cases, post-operative oral feeding was initiated significantly earlier in the stapled group, with its lower risks of post-operative cholangitis and longer hospital stay than 7 days.
Conclusion: This is the first study in children, confirming the time-saving advantage of stapled anastomosis over hand-sewn, during roux-en-Y anastomosis for biliary atresia and choledochal cyst; along with the safety of stapler use, including the neonates. Stapled anastomosis yields lower complication rates, faster function gain with earlier feeding and hospital discharge.
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Patel, Dr Shaishav V., Dr Kalpit R. Suthar, Dr Dhruv N. Shah, Dr Hitesh Kumar Tourani, Dr Ashwin P. Godbole y Dr Yuvrajsinh Rathod. "A Comparative Study of Stapler Versus Handsewn Gastrointestinal Anastomosis". BJKines National Journal of Basic & Applied Sciences 14, n.º 1 (10 de junio de 2022): 28–32. http://dx.doi.org/10.56018/bjkines2022064.
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Background: In gastro intestinal surgery after resection of bowel loops, anastomosis of the bowel loops is the central part. Stapler technique, commonly used by many of the surgeons is more useful than the hand sewn anastomosis for safety, easy accessibility, duration of procedure, efficiency. This study compares the hand sewn anastomosis with stapler Anastomosis. The purpose of the presentation is to compare the feasibility and outcome of stapler and hand sewn anastomosis in gastro intestinal surgeries. Material & Method: This study was conducted in the department of surgery of our hospital between the groups of hand sewn and stapler anastomosis gastro intestinal surgeries conducted by open technique in period from January 2021 to September 2021. Results: Various parameters like operative time, hospital stay, and post op day of starting oral diet, post op day of appearance of bowel sound, anastomotic leak, time taken to return to work and mortality were compared. Conclusion: Results of this study were comparable to many studies done previously which showed there was not much significant difference in post op outcomes after hand sewn or stapled technique of gastrointestinal anastomosis. Key-words: Anastomosis, stapler, handsewn
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Maciver, A., M. McCall, D. Mihalicz, D. Al-Adra, R. Pawlick y A. M. J. Shapiro. "The Use of Bovine Pericardial Buttress on Linear Stapler Fails to Reduce Pancreatic Fistula Incidence in a Porcine Pancreatic Transection Model". HPB Surgery 2011 (25 de octubre de 2011): 1–6. http://dx.doi.org/10.1155/2011/624060.
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We investigate the effectiveness of buttressing the surgical stapler to reduce postoperative pancreatic fistulae in a porcine model. As a pilot study, pigs (n=6) underwent laparoscopic distal pancreatectomy using a standard stapler. Daily drain output and lipase were measured postoperative day 5 and 14. In a second study, pancreatic transection was performed to occlude the proximal and distal duct at the pancreatic neck using a standard stapler (n=6), or stapler with bovine pericardial strip buttress (n=6). Results. In pilot study, 3/6 animals had drain lipase greater than 3x serum on day 14. In the second series, drain volumes were not significantly different between buttressed and control groups on day 5 (55.3 ± 31.6 and 29.3 ± 14.2 cc, resp.), nor on day 14 (9.5 ± 4.2 cc and 2.5 ± 0.8 cc, resp., P=0.13). Drain lipase was not statistically significant on day 5 (3,166 ± 1,433 and 6,063 ± 1,872 U/L, resp., P=0.25) or day 14 (924 ± 541 and 360 ± 250 U/L). By definition, 3/6 developed pancreatic fistula; only one (control) demonstrating a contained collection arising from the staple line. Conclusion. Buttressed stapler failed to protect against pancreatic fistula in this rigorous surgical model.
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Gao, Yang, Fang Xiong, Xiaozhe Xia, Pengjuan Gu, Qinghong Wang, Aiping Wu, Huan Zhan, Wendong Chen y Zhaoxin Qian. "Clinical outcomes of powered and manual staplers in video-assisted thoracic surgery lobectomy for lung cancer". Journal of Comparative Effectiveness Research 10, n.º 13 (septiembre de 2021): 1011–19. http://dx.doi.org/10.2217/cer-2021-0060.
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Methods: This retrospective cohort study identified patients who underwent video-assisted thoracic surgery (VATS) lobectomy for lung cancer from January 2016 to December 2018 in a Chinese tertiary general hospital. The electronic hospital medical records associated with the VATS lobectomy for lung cancer were the data sources. Results: Based on the analysis of 433 patients with the utilization of staplers in their VATS lobectomy for lung cancer, using powered stapler was associated with significantly shorter operation time and postsurgery hospital stay length than using the manual stapler in the multivariable generalized linear regression analyses with the adjustment of patient characteristics. However, no other significant differences were observed for other clinical outcomes between the two staplers.
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SHIEKH, SAJID, FAKHAR HAMEED, MUHAMMAD KHALID NASEEM MIRZA y Muhammad Afzal. "STAPLER HAEMORRHOIDECTOMY". Professional Medical Journal 13, n.º 01 (6 de marzo de 2006): 113–18. http://dx.doi.org/10.29309/tpmj/2006.13.01.5070.
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Objectives: To demonstrate advantages of staplerhaemorrhoidectomy and its applicability to all patients who require surgical treatment of haemorrhoids. Design: CaseDescriptive Study. Place & Duration of study: Allied/DHQ Hospitals, Faisalabad. (February 2004 – July 2005).Patients & methods: A total of 20 patients having grade III or IV haemorrhoids were included in the study. After adetailed GIT history, patients were subjected to standard stapler haemorrhoidectomy under regional anaesthesia.Patients were asked to record the postoperative pain intensity according to visual analogue score ranging from (0-10)on daily basis and the drugs required for pain control noticed. Patients were followed at weekly intervals for one month.Main outcome measures were postoperative pain, bleeding, sepsis, urinary retention, continence, relief of preoperativesymptoms, operation time, hospital stay & recovery time. Results: Pain was the most common postoperativecomplication affecting 18 patients (90 %age).There was significant reduction in postoperative pain except for onepatient in which pain was severe (VAS=8) due to technical error. Two patients developed urinary retention on the dayof surgery. Postoperative bleeding was not observed in any of the patients. Pelvic sepsis & incontinence was not foundin any patient. Preoperative symptoms were resolved in majority of the cases (80%age) with marked improvement inthe rest(20 %age). The mean operative time was 17 minutes & mean hospital stay 1.3 days. Most patients were backto their work after 11 post operative day. Conclusions: th Stapler Haemorrhoidectomy is a simple, quick & safeprocedure that gives benefit in terms of reducing the postoperative complications namely pain & its sequelae with earlyreturn to activity. The vast majority of patients currently undergoing conventional surgical haemorrhoidectomy wouldbe suitable for stapler approach, however the long term benefits need to be evaluated.
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Varghese, Bipin T. "Stapler Laryngectomy". International Journal of Phonosurgery & Laryngology 3, n.º 1 (2013): 10–11. http://dx.doi.org/10.5005/jp-journals-10023-1050.
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ABSTRACT Closed stapling of the pharynx after careful separation of the laryngeal frame work from the adjacent pharynx is a viable option in total laryngectomy for endolaryngeal cancers. Author describes his experience and improvization that ensures success in stapler laryngectomy. How to cite this article Varghese BT. Stapler Laryngectomy. Int J Phonosurg Laryngol 2013;3(1):10-11.
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Ommer, A. y R. Schneider. "Stapler-Hämorrhoidopexie". coloproctology 42, n.º 2 (19 de noviembre de 2019): 204–10. http://dx.doi.org/10.1007/s00053-019-00416-w.
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Gracias, Vicente, Paul Truche, David Blitzer, Erin Scott y Joseph Hanna. "Acute Care Surgeon: Use of the Endo GIA Stapler for Cystic Duct Ligation in Emergent Cholecystectomy". Panamerican Journal of Trauma, Critical Care & Emergency Surgery 6, n.º 1 (2017): 44–48. http://dx.doi.org/10.5005/jp-journals-10030-1171.
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ABSTRACT Introduction Endo GIA stapler use is a method to ligate cystic ducts during laparoscopic cholecystectomy in the elective and emergent setting. Its use has not been widely described in the acute care surgery (ACS) setting. Our study aims to determine factors predicting Endo GIA use by acute care surgeons and evaluate when applied its safety and efficacy in emergent cholecystectomy. Additionally, we investigate the use of Endo GIA stapler with respect to conversion to open surgery, reduction in postoperative morbidity, and impact on length of stay in an ACS setting. Materials and methods A retrospective chart review was conducted for laparoscopic cholecystectomy performed by ACS in a public university training hospital over 1 year. Variables associated with Endo GIA stapler use were identified through multivariate logistic regression and subsequently, assessed after optimizing the model to control for confounding effects. Results Of the 118 laparoscopic cholecystectomies performed, the Endo GIA Stapler was used for cystic duct ligation in 20 cases. Surgeons’ dictated reason for stapler use included dilated cystic duct (45%), short cystic duct remnant (15%), inadequate room for clip ligation and division (10%), and nonspecific (45%). Patient demographic variables for Endo GIA stapled and clipped groups were not significantly different. Logistic regression revealed a significantly higher likelihood of Endo GIA stapler use in patients with comorbid biliary duct disease, preoperative endoscopic retrograde cholangiopancreatography (ERCP), and a trend towards significance in patients with previous emergency department (ED) visits. There was no significant difference in conversion to open surgery, postoperative morbidity, and postoperative length of stay. Conclusion Comorbid biliary duct disease, previous ED visits, and preoperative ERCP are predictive of patients requiring use of the Endo GIA stapler for cystic duct ligation during emergent cholecystectomy. The use of Endo GIA stapler by Acute Care Surgeons is safe and effective. How to cite this article Truche P, Blitzer D, Scott E, Hanna J, Gracias V, Peck G. Acute Care Surgeon: Use of the Endo GIA Stapler for Cystic Duct Ligation in Emergent Cholecystectomy. Panam J Trauma Crit Care Emerg Surg 2017;6(1):44-48.
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Lacitignola, Luca, Alberto Crovace, Giuseppe Passantino y Francesco Staffieri. "Ex-Vivo Evaluation of “First Tip Closing” Radiofrequency Vessel Sealing Devices for Swine Small Intestinal Transection". Veterinary Sciences 9, n.º 8 (19 de agosto de 2022): 445. http://dx.doi.org/10.3390/vetsci9080445.
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This study compared burst pressure (BP), number of activations, and histological assessment of ex vivo swine small intestine loops transected by stapler, a single fulcrum radiofrequency vessel sealing (RFVS) device, and the newly-developed jaws RFVS. Fifty (n = 50) 20 cm long jejunal loops were randomly assigned to be transected with RFVS devices and linear stapler (Caiman5, Caiman Maryland, Caiman12, Ligasure Atlas, and Stapler group as control respectively). Caiman5, Caiman12 and stapler required only one activation to complete the sealing. The mean BP in Caiman5 and Caiman Maryland groups were significantly lower (p < 0.05) than the S group as control and the other RFVS devices studied. RFVS Caiman12 and Ligasure Atlas produced mean BP values that were close to the Control and did not differ between them. The lumen was totally closed in the Caiman12 and Ligasure Atlas groups. The findings of this investigation were promising; we discovered that Caiman12 and Ligasure Atlas produce comparable mechanical capabilities as well as stapled intestinal closure, however Caiman12 need a single activation to complete the transection.
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Edwin Conner, W., Allen B. Jetmore y John W. Heryer. "Circular stapled rectal stricturoplasty with the proximate® intraluminal stapler". Diseases of the Colon & Rectum 38, n.º 6 (junio de 1995): 660–63. http://dx.doi.org/10.1007/bf02054130.
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Rabha, Pinky, Shradha Srinivas y K. Bhuyan. "Closure of skin in surgical wounds with skin stapler and conventional sutures: a comparative study". International Surgery Journal 9, n.º 1 (28 de diciembre de 2021): 66. http://dx.doi.org/10.18203/2349-2902.isj20215132.
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Background: Application of suture is the technique of choice for apposition of skin edges in surgical wounds. The same procedure performed with application of staplers is faster and produce better cosmetic outcomes. A comparative study between conventional suture and stapler closure of skin in abdominal surgical wounds was undertaken to study the merits and demerits of the techniques. The aim was to study the time required for closure of surgical wounds, aesthetic outcome, post-operative complications and patient’s compliance.Methods: This was a single centre, prospective, observational study, conducted upon 100 patients undergoing abdominal surgeries. 50 patients were selected for skin closure of surgical wounds with stapler and the other 50 patients for closure with conventional nylon sutures. Data were collected for time required for closure of skin, aesthetic outcome, post-operative complications and patient’s compliance for both the groups for comparison. Data were analysed using student t test for comparison and chi square test of significance. Results: There was significant better results in stapler group in terms of cosmetic outcome (96% vs 88%, p<0.001), time taken during closure (60 vs 219 seconds, p<0.001) and patient’s compliance VAS of 1.44 vs 4.58 p<0.001).Conclusions: Closure of skin with stapler is a faster method. Patient’s compliance with stapler closure is better. It produces cosmetically acceptable scar and less discomfort or pain during its removal.
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Khmelevskaya, I., M. Soutorine, S. Prokoskin y E. Ryklina. "Creation of Superelastic Functional Properties in a Ti-50.7%Ni Wire for the Stapler Suturing of Blood Vessels". Advances in Science and Technology 76 (octubre de 2010): 253–58. http://dx.doi.org/10.4028/www.scientific.net/ast.76.253.
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The technique of aorta-coronary shunting offered by Dr. M. Soutorine by means of the original stapler developed by "Endogene" allows suturing blood vessels by superelastic Тi-Ni staples on «working heart» (without heart switching-off). The material for staples is a 0.30 and 0.315 mm diam. wire which was studied by DSC, shape recovery and mechanical tests. Thermomechanical treatment (TMT) comprised warm drawing, low- temperature (LTMT) by cold drawing with 25-30% strain in the last pass and following post-deformation annealing (PDA). LTMT leads to increasing of yield stress in comparison with warm drawing. Treatment of wire under LTMT+PDA allows obtaining the highest characteristics of functional properties of the wire. The difference between “dislocation” and “transformation” yield stresses Δ=900 MPa. Critical stress of superelastic recovery after TMT on the average is 1.5-2 times higher in comparison with warm drawing. The maximum completely recoverable strain r,1max=6.5%. The maximum obtained force value of staples is РrSE=6.5 Н. The shape recovery rate of staples was 85-97 % that provided its functionality. Storage in the stapler in straightened condition within 1 month does not worse the staples.
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Da Silva Pinto, Danielle, Anna Clara Moraes Paro, Daniel Yuji Tanaka, Ana Carla Oliveira Johnen, Pedro Guimenti Ribeiro de Lima, Izabella Dias Muniz de Andrade, Amanda Regina de Souza Marini, Henrique Perobelli Schleinstein y João Kleber de Gentile. "Pneumoperitoneum, retropneumoperitoneum and pneumomediastinum after stapled hemorrhoidopexy". Brazilian Journal of Case Reports 2, n.º 4 (28 de septiembre de 2022): 33–40. http://dx.doi.org/10.52600/2763-583x.bjcr.2022.2.4.33-40.
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There are several surgical techniques for the treatment of hemorrhoidal disease, the most used currently being stapled hemorrhoidopexy. Complications of this procedure are rare, although they may occur. The aim of this study is to report the clinical case of a patient with severe complication of rectal perforation after stapled hemorrhoidopexy. A 44-year-old man who presented anal pain in his postoperative period of hemorrhoid with urgent computed tomography evidencing rectal perforation with pneumoperitoneum, retropneumo-peritoneum and pneumomediastinum. Rectal perforation is a specific complication of surgery using stapler. One of the serious consequences is pneumoperitoneum, whose air leaked through the rupture of the rectal wall can reach the mediastinum, causing pneumomediastinum. These complications can be avoided by taking care of the triggering of the stapler device, in addition to post-surgical evaluation, such as rectal exploration before discharge.
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Van Daele, Douglas J. "Conservative Management of Stapler Failure in Zenker's Endoscopic Diverticulotomy". Annals of Otology, Rhinology & Laryngology 114, n.º 12 (diciembre de 2005): 946–48. http://dx.doi.org/10.1177/000348940511401210.
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The endoscopic stapler has achieved widespread use in the management of Zenker's diverticulum owing to its ease of use and safety. However, complications associated with its use can and do occur. This study details the treatment course of 2 patients who underwent an endoscopic stapler approach to their Zenker's diverticulum complicated by the stapler's not sealing the mucosal edges. Although the patients' hospital stays were extended as a result, they suffered no long-term morbidity as a result of the complication.
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Pawar, Arjun A., Mohan A. Joshi, Meenakshi Gadhire, Raghav Shotriya, Bankat Phad y Jaskaran Singh. "Prospective randomized comparative study of skin adhesive glue (2- methyl -2- cyanopropionate or cyanoacrylate) versus conventional skin suturing by suture material/skin stapler in clean surgical cases". International Surgery Journal 5, n.º 1 (26 de diciembre de 2017): 168. http://dx.doi.org/10.18203/2349-2902.isj20175889.
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Background: To compare cosmetic appearance of skin closure wound by three methods -sutures, staples and skin adhesive glue. Traditional skin closure using sutures causes more pain, infection, needs its removal, time consuming and leaves behind bad scar. Nowadays, good cosmetic appearance of operated site is appealing among patients. Surgeons are looking for faster, comfortable and cosmetically best technique for skin closure. Newer techniques need to be evaluated which are better than suture and staples. 2-octylcyanoacrylate is easier to use, flexible, water resistant, pain free sealed skin closure without its need for removal and has better cosmesis.Methods: This study is conducted from July 2010 to April 2013 in 90 patients at LTMG Hospital. Wounds of clean surgeries closed with suture material, skin staples and skin adhesive glue were studied in 30 patients each. Patients were randomized using standardized methods. Patients followed up over period of 28 days and their scars were assessed according to the modified Hollander cosmesis scale(MHCS) and cosmetic visual analogue scale(VAS). Patient allotment was done using random number table.Results: Mean MHCS score for skin adhesive group on day 7 was 4.83 which was significantly more than 3.90for suture and 3.97 for stapler. Mean VAS score for skin adhesive group on day 7 was 67.67 which was significantly more than 61.67 for suture and stapler each. Mean MHCS and VAS score for skin adhesive group on day 7, 14 and 28 were significantly more than suture and stapler groups.Conclusions: Octylcyanoacrylate can be used for skin closure in clean elective surgeries with better cosmetic outcome as compared to staples and sutures.
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Nagy, Attila, Tamas Kovacs y Zoltan Lóderer. "Experiences with PPH gun stapled ileo or coloanal anastomoses after ultralow rectal resections and proctocolectomies with J pouch reconstructions". Acta chirurgica Iugoslavica 53, n.º 2 (2006): 61–63. http://dx.doi.org/10.2298/aci0602061n.
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A new method of stapled ileo and coloanal anastomosis with PPH gun (Johnson and Johnson USA) is presented. On 47 totalcolectomised FAP and UC patients and 9 low rectal benign or clinically T1 or T2N0 rectal tumor resection there was only 5 radiologically proven anastomotic leakage without serious septic complications. The anal sphincter function after 6 month of the ileoanal anastomosis remained good in 33/39 and acceptable in 6 cases, if the sphincter function was intact praeoperatively. There was no worsening of the moderate praeoperatively observed insufficiency. After the ultra low rectal resections all patients kept the normal anal shpincter function. The procedure seems to be as good as the double stapler method, but there remained no remnant mucosal ring between the anastomsois and the dentate line. An additional advantage of the method, that only one stapler was consumed per patient compared to the two one at the double stapler technique.
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Cruz, José Vinicius, Francisco Sergio P. Regadas, Sthela Maria Murad-Regadas, Lusmar Veras Rodrigues, Fernando Benicio, Rogério Leal, César G. Carvalho et al. "TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler): a prospective multicenter trial". Arquivos de Gastroenterologia 48, n.º 1 (marzo de 2011): 3–7. http://dx.doi.org/10.1590/s0004-28032011000100002.
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CONTEXT: Since anorectocele is usually associated with mucosa prolapse and/or rectal intussusceptions, it was developed a stapled surgical technique using one circular stapler. OBJECTIVE: To report the results of Transanal Repair of Rectocele and Rectal Mucosectomy with one Circular Stapler (TRREMS procedure) in the treatment of anorectocele with mucosa prolapse in a prospective multicenter trial. METHODS: It was conducted by 14 surgeons and included 75 female patients, mean aged 49.6 years, with symptoms of obstructed defecation due to grade 2 (26.7%) and grade 3 (73.3%) anorectocele associated with mucosa prolapse and/or rectal intussusception (52.0%) and an average validated Wexner constipation score of 16. All patients were evaluated by a proctological examination, cinedefecography, anal manometry and colonic transit time. The TRREMS procedure consists of the manual removal of the rectocele wall with circumferential rectal mucosectomy performed with a circular stapler. The mean follow-up time was 21 months. RESULTS: All patients presented obstructed defecation and they persisted with symptoms despite conservative treatment. The mean operative time was 42 minutes. In 13 (17.3%) patients, bleeding from the stapled line required hemostatic suture. Stapling was incomplete in 2 (2.6%). Forty-nine patients (65.3%) required 1 hospitalization day, the remainder (34.7%) 2 days. Postoperatively, 3 (4.0%) patients complained of persistent rectal pain and 7 (9.3%) developed stricture on the stapled suture subsequently treated by stricturectomy under anesthesia (n = 1), endoscopic stricturectomy with hot biopsy forceps (n = 3) and digital dilatation (n = 3). Postoperative cinedefecography showed residual grade I anorectoceles in 8 (10.6%). The mean Wexner constipation score decreased significantly from 16 to 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). CONCLUSION: Current trial results suggest that TRREMS procedure is a safe and effective technique for the treatment of anorectocele associated with mucosa prolapse. The stapling technique is low-cost as requires the use of a single circular stapler.