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Surgical stapling instruments have been used successfully in gastrointestinal anastomosis. A surgical technique using the staples to close a loop colostomy in gynecologic oncology patients is presented. The procedure shortens operating time and results in an enlarged anastomotic site, thus minimizing the possibility of obstruction at the site.
This study describes the use of staplers during surgical treatment performed in emergency from January 1980 to December 1991. For the different, possible operations, some technical notes are examined and results reported. The advantages and risks related to the use of these devices are analysed.
Surgical staplers are complex mechanical devices that require skill and experience to operate. In several cases in which a stapler failed--and may have led to patient injury--staff reported having difficulties with the device before the actual failure. Unfortunately, surgical staff was undeterred by the warning signs and continued to use the device. In some cases, this decision led to patient injuries. In this Guidance Article, we advise users on how to deal with stapler failures. In particular, we focus on those that are preventable--instances in which staplers warn of the impending failure.
We investigated the use of an automatic surgical stapler for ligation of the atrial appendage in sheep, and then applied this technique in patients. Fourteen adult sheep underwent ligation of the left atrial appendage using a surgical stapler with a rotating head and either absorbable or stainless steel staples. In 4 sheep, killed after two hours, no hemorrhage or intraatrial thrombus was observed acutely. Ten sheep were allowed to recover for 90 to 100 days, twice the expected absorption time of absorbable staples. There was complete obliteration of the left atrial appendage without evidence of intraatrial thrombus or staple migration. The absorbable staples were completely reabsorbed. We subsequently used this technique in 5 patients undergoing mitral valve procedures. There were no complications, and adequate obliteration of the atrial appendage was achieved.
Contrary to the popular belief that the stapling machine is a relatively recent technical innovation, surgical staplers have been in general use since as early as the first decade of the century. The first surgical stapler was invented in 1908, and the two people who were responsible for this invention were Victor Fischer and Hümér Hültl.
The potential for reducing the number of gynecologic oncology patients left with a permanent colostomy may be achieved by the use of the end-to-end anastomosis (EEA) automatic surgical stapler. This instrument allows a rectocolonic anastomosis at a very low level (below the levator muscles), which is very difficult and poorly performed by hand-suture techniques. This report presents the author's experience with 6 patients in whom a low rectocolonic anastomosis was performed with the EEA surgical stapler.
A technique for making an end colostomy and a Brooke's ileostomy using the surgical stapler is described. The resulting stoma is geometrically perfect. No complication or wound infection occurred in a series of 26 stomas observed for up to ten months. The cost of the cartridge may be considered recovered if this technique decreases the operating time by 13 minutes.
The Authors dissert on some technical details for a correct use of staplers in colorectal surgery. Surgical skill and technology assure always better results, nevertheless the experience and knowledge of the single surgeon must be a guide for further research.
BACKGROUND AND AIM: Over the past decade the use of surgical staplers has resulted in a substantial change in both elective and emergency surgery for gastrointestinal pathologies. A large number of studies have now affirmed the safety, reliability, simplicity, rapidity and usefulness of these instruments. They offer many advantages, above all the possibility of shortening operating times and thus reducing morbidity and mortality, especially in emergency surgery. METHODS: The authors describe their experience in treating 68 cases of emergency intestinal resection from 1980 to 1997 which were treated with the help of automatic staplers. Twenty-three cases of hemicolectomy (right and left) were performed; 17 sigmoid resections for diverticulitis; 15 gastric sections using Billroth II; 7 Meckel's diverticuli; 6 total gastrectomies. GEA 50 and 75 staplers were used for the intestine, TA 50, 90, 90 Plus and Roticulator, Circular staplers for esophagus, stomach and rectum. Patients were predominantly male: 40 males and 25 females with a ratio of 2:1. RESULTS: Complications included a fistula caused by dehiscence of the esophagojejunal anastomosis which lead to death in 30 days; 3 cases of hemorrhage of the gastroenteric anastomosis which regressed with medical therapy. CONCLUSIONS: In conclusion, mechanical staplers have led to considerable savings in time and a reduced number of postoperative complications.
We describe a technique for refashioning an aneurysmatic arterio-venous fistula by using the multifire GIA 60 surgical stapler. After obtaining proximal and distal control of the aneurysmatic vein each aneurysmal segment of the anterior wall of the vein is excised by applying the GIA 60 stapler. The layer of the staple-line is re-enforced with one layer of 6/0 prolene continuous suture. After completion of the procedure, the size of the vein is reduced by approximately 50%. The AVFs were successfully re-used for dialysis within four weeks postoperatively.
An aim of this study was to establish a simple method for the construction of a Pavlov pouch that is free of fistula formation between the main part of the stomach and the pouch, yet preserves maximal vagal innervation. The Pavlov pouch (vagally innervated gastric pouch) was constructed from the greater curvature of the gastric corpus at the level of the splenic hilus in four dogs. The plane between the mucosal and seromuscular layers was dissected bluntly along the medial margin of the pouch. A surgical stapler was introduced into the space between the mucosal and seromuscular layers, and the pouch was completely separated from the main part of the stomach enterically at the mucosal level but remained connected via the seromuscular layers. All dogs survived the operation and lost minimal weight; fistulas were not found between the remnant stomach and the pouch at necropsy 6 to 8 weeks later. Gastric acid secretion for 30 to 90 min after insulin-induced hypoglycemia, which increases vagal tone, was significantly increased compared to that before insulin injection, confirming preservation of vagal innervation to the pouch. Our technique to create a Pavlov pouch is superior to the methods reported previously because of its simplicity, lower prevalence of fistula formation, and reliable preservation of vagal innervation to the pouch.
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The staple closure of the bronchus, like the manual technique, depends on some essential prerequisites: vascular supply, the length and thickness of the bronchial stump, the resection line, the type of stapler and the size of staples used. GIA 55 or 90 instruments allow safe and simple closure of lung parenchyma. Familiarity with the stapling technique is essential for success.
55 out of 62 patients being operated of esophageal carcinoma underwent gastric tube by stapling technique at the Department of General and Abdominal Surgery, Hospitals and Clinics, Johannes Gutenberg University, Mainz. In 32 cases the intrathoric anastomosis had been performed by using the circular stapling instrument. One patient (3.2%) out of two (6.3%) showing suture dehiscencies died consequently to this complication. A stenosis of the intrathoric anastomosis developed in 11 patients. The stapling technique convinced as a surgically simple and safe method of restructing the nutrition passage after esophageal resection.
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For almost two centuries, surgeons have been using mechanical devices to join tissue. One of the most successful methods is that of stapling, which has become very common in more recent times. The range of staplers consists of five established stapler categories (circular, linear, linear cutting, ligating and skin staplers), along with recent variations which lend themselves to minimally invasive surgery. Within each category, several commercial models are available, many of which have their own unique features. The procedures which are enhanced by these instruments are many and varied. Applications have been further expanded and improved by the instrument design developments seen in recent years. This review attempts to present a rationalized overview of the array of stapling instruments, with relevant procedures. The authors believe that surgical stapling may be greatly enhanced by further research and development, taking the instrument designs and procedures further into the realm of minimally invasive surgery.