Automatic Stapling Device Research Articles

Intrapericardial Pulmonary Vein Ligation to Prevent Stump Thrombosis During Left Upper Lobectomy

BackgroundPostoperative cerebral infarction, a serious complication of surgery, is occasionally experienced with pulmonary vein stump thrombosis (PVST), which is frequently observed after left upper lobectomy (LUL). Herein, we prospectively investigated whether PVST could be safely prevented by intrapericardial ligation of the superior pulmonary vein (SPV) to shorten the SPV stump during LUL. MethodsIn a consecutive 21 patients who underwent LUL, we ligated the proximal intrapericardial SPV with 1-0 silk suture and divided the distal hilar SPV by an automatic stapling device. We measured the SPV stump length from the left atrium to the point of ligation and evaluated the presence of PVST on postoperative computed tomography. The procedure time was measured as the time from pericardial treatment initiation to the distal SPV division. Furthermore, the safety of the procedure and postoperative complications were evaluated and compared with those of 76 historical control patients who underwent LUL without intrapericardial SPV ligation. ResultsThe median procedure time was 8.8 minutes, and the median blood loss was 3 g. The median length of the SPV stump after the procedure was 5.0 mm. The 30- and 90-day mortality rates were both 0% for patients who underwent LUL with SPV ligation. None of the patients in the SPV ligation group showed signs of PVST on postoperative contrast-enhanced computed tomography images or had cerebrovascular disease. No significant difference in postoperative complications was observed between the groups. ConclusionsIntrapericardial SPV ligation is safe and has a potential to prevent cerebral infarction after LUL.

Design and Performance Evaluation of a Novel Automatic Stapling Device for Knotless Barbed Suture in Laparoscopic Surgery.

This study developed a novel automatic stapling device for improving the speed and stability of suturing in laparoscopic surgery. The stapling device included 3 components: driver module, actuator module, and transmission module. A negative water leakage test of the in vitro intestinal defect model preliminarily demonstrated the safety of the new automatic stapling device. The suturing time for skin and peritoneal defects through the automatic stapling device was significantly shorter than that through the ordinary needle-holder suture (P < .05). These 2 suture methods had good tissue alignment. The automatic suture showed less inflammatory cell infiltration and lower inflammatory response scores at the tissue incision on days 3 and 7 after surgery compared with the ordinary needle-holder suture, with statistically significant differences (P < .05). In the future, the device needs to be further optimized and the experimental needs to be supplemented to provide some evidence for clinical use. This novel automatic stapling device for knotless barbed suture designed in this study has advantages of shorter suturing time and milder inflammatory responses than the ordinary needle-holder suture, safe and feasible in laparoscopic surgery.

Alternative technique of intrauterine myelomeningocele repair to decrease the incidence of unfavorable maternal and fetal outcomes.

The aim of the study was to determine the effectiveness of an alternative method of open fetal surgery to prevent severe unfavorable prenatal events, both for the mother and the fetus. In this study, the previously published results for a cohort of 46 patients, who had undergone intrauterine myelomeningocele repair (IUMR) at our Center by 2014, constituted the retrospective control group (CG). The MOMS protocol had been applied for hysterotomy, with an automatic uterine stapling device. The study group (SG) n = 57 was assembled during a prospective observation. IUMR was performed using an alternative method of hysterotomy, with the typical opening and closure of the uterus, without automatic stapling device, as described by Moron et al. Additionally, our single-center results were compared with the post-MOMS findings of other centers: CHOP (Children' S HOSPITAL OF PHILADELPHIA: ) and VUMC (Vanderbilt University Medical CENTER: ). No cases of delivery before 30 weeks of gestation (0%, 0/55) were observed in the study group, which is a statistically significant difference (p < 0.05) as compared to controls (15/44). Statistically significantly lower incidence of chorioamniotic separation (5.4% (3/55) vs CHOP 22.9% (22/96), p < 0.001) and contractile activity resulting in preterm labor (16.3% (9/55) vs CHOP 37.5% (36/96), p < 0.05) was found in the study group. Premature rupture of the membranes was statistically significantly less common in the study group as compared to controls, CHOP and VUMC (SG 12.7% (7/55) vs CG 52.2% (24/46), p < 0.001; vs CHOP 32.3% (31/96), p < 0.001; vs VUMC 22% (9/43), p < 0.01, respectively). The presented IUMR method is associated with improved perinatal outcomes, i.e., lower rates of preterm delivery at < 30 weeks of gestation, preterm premature rupture of membranes, and uterine contractility resulting in preterm delivery. That, in turn, results in lower prematurity rates and, consequently, more favorable neonatal outcomes.

Novel laparoscopic cornual resection of interstitial pregnancy using the Endo GIA™ Universal Stapler (Medtronic): A series of 12 cases

The maternal mortality of interstitial pregnancy is five times greater than that of other ectopic gestations due to potential haemorrhage. Minimal access surgical techniques usually comprise cornual resection and cornuostomy, requiring laparoscopic suturing skills. To describe a case series using a laparoscopic automatic stapling device with reloadable cartridges to resect the cornu, enabling surgeons less familiar with intracorporeal suturing to avoid laparotomy when managing interstitial pregnancy. Twelve cases of laparoscopic cornual resections for interstitial pregnancies with the Endo GIA™ Universal Stapler (Medtronic) were collected prospectively over eight years. Outcome measures include human chorionic gonadotropin beta subunit (hβCG) levels, successful laparoscopic completion, estimated blood loss, intra-and post-operative complications and length of stay. Median age and gestation at surgery were 31years (range: 20-44) and eight weeks (range: 5-12), respectively. All involved live interstitial gestations, and 4/12 cases had significant haemoperitoneum at laparoscopy. The median blood loss was 300mL (range 100-3500), and five women had blood loss >500mL. The median serum hβCG level was 6429IU/L (range: 1800-58690), and the median ectopic size was 4cm (range 2-6). All cases were completed laparoscopically with no intra- or post-operative complications, although two women required blood transfusions. Median length of stay was 40h. Further pregnancies could only be followed in 2/12 cases due to the migratory nature of our local population. We describe a case series of 12 laparoscopic cornual resections for interstitial pregnancies using Endo GIA™ Universal Stapler, which simultaneously staples and transects the tissues, thus minimising the need for laparoscopic intracorporeal suturing.

Use of an automatic stapling device during castration to prevent (re)occurrence of inguinal hernia in horses with large vaginal rings

Use of an automatic stapling device during castration to prevent (re)occurrence of inguinal hernia in horses with large vaginal rings

Preservation of Pubovesical Fascia During Robotic Radical Prostatectomy

Introduction: One potential complication of radical prostatectomy is urinary incontinence. The acceptance of robotic surgery for prostate cancer has been accompanied by an evolution of robotic techniques. Recently, the importance of anatomic structures supporting the urethra and bladder neck in maintaining continence has been appreciated. The purpose of this video is to demonstrate a novel technique designed to improve continence by preserving the anterior support and the pubovesical fascia during robotic prostatectomy. Materials and Methods: The pubovesical fascia sparing approach involves a more medial incision on the endopelvic fascia when compared to the traditional method. This spares the puboprostatic ligaments, pubovesical fascia, and the arcus tendineus support structures. An automatic stapling device used for dorsal vein transection also serves to secure the urethra anteriorly against the pubic symphysis. Results: This video demonstrates a novel technique designed to preserve the support of the urethra and bladder neck. A stapling device is used to anchor the urethra to the puboprostatic ligaments, which are, in turn, left with a broad attachment to the arcus tendineus levator ani and the pubovesical fascia. This maintains the natural support of the urethra and bladder neck. The patient demonstrated in this video had total continence with no leakage at 3 weeks follow-up. Conclusions: Preservation of urethral and bladder neck support may contribute to post-prostatectomy continence. Although prospective, randomized trials will be required to validate this technique, it has the potential to improve the patient's quality of life after prostatectomy. No competing financial interests exist. Runtime of video: 4 mins 42 secs

Laparoscopic distal gastrectomy with intracorporeal handsewn Billroth-I anastomosis (ICHSA)

The number of cases of laparoscopic surgery has been increasing. Lymph node dissection has been standardized, and the enlarged view provided by laparoscopes allows for the procedure to be performed successfully entirely within the abdominal cavity, but many cases of reconstruction using the Billroth-I method are performed under direct vision through a small incision. In this study, by placing an anchor thread on a suture line on the lesser curvature of the stomach, we simplified the procedure for handsewn anastomosis and safely performed gastroduodenal anastomosis at low cost to obtain good results. From January 2009 to December 2010, we performed handsewn gastroduodenal anastomosis in 18 cases. After performing lymph node dissection, the duodenum and the stomach were separated using an automatic stapling device. Anchor sutures were placed on the suture line of the lesser curvature of the stomach. First, the seromuscular layer of the stomach and the seromuscular layer of the duodenum were sutured by performing interrupted suturing using an extracorporeal knot-tying method. With the stomach and the duodenum in a fixed state, the anastomosis area was opened. The thread of the anchor suture was pulled toward the abdominal wall, and then all layers of the stomach and the duodenum at the posterior wall were continuously sutured. Similarly, for the anterior wall, all layers were continuously sutured from the lesser curvature toward the greater curvature. We performed this anastomotic procedure in 18 patients with early gastric carcinoma. The mean time required for the anastomosis was 64.6 ± 17.1 min, and the estimated blood loss was 53.1 ± 91 g. All operations were curative, and the mean number of retrieved lymph node was 27.1 ± 10.8. A nasogastric tube was removed on the first or second day. An upper gastrointestinal series performed on postoperative days 5-6 showed no anastomotic leakage and normal transit. Oral intake was started on days 6-7. Postoperative complications included one case of a ruptured suture, but this was resolved through a conservative approach. There was no mortality. Postoperative endoscopy revealed that the anastomosis area was extremely soft, and no abnormalities were observed. Moreover, the only costs related to the anastomosis were for the thread and needles, and although more time was required compared with mechanical anastomosis, the cost was extremely low. We performed gastroduodenal anastomosis under a total laparoscopic approach by handsewn. This method is economical, because it does not require the use of machinery for anastomosis, and the duodenal stump is short. We believe that this method, which can be performed in a similar manner even for obese patients, can be used as a standard method of anastomosis.

STUDY OF SKIN STAPLES AND CONVENTIONAL SUTURE FOR ABDOMINAL SKIN WOUND CLOSURE

Introduction: The use of automatic stapling device for skin closure has become more popular due to its minimum disadvantages as compared to conventional suturing. Hence, this study was undertaken to compare the time required for abdominal skin closure and pain during suture removal, between skin staplers and conventional suture. Materials and Methods: The study includes 100 patients with age group of 45yrs-75yrs undergoing elective surgery, of which 50 patients underwent wound closure by staplers (Group-I) and 50 patients underwent closure using prolene suturing (Group-II), during June 2009 to June 2011 at Basaweshwar Teaching and General Hospital, Gulbarga. Patients were randomly selected for conventional suture and skin staple. Time duration for wound closure was recorded and pain scoring was given during suture removal, between both groups. Results and conclusion: In our study duration of wound closure was statistically significant (P<0.001) with staplers requiring lesser time than conventional prolene sutures, we also found that pain during suture removal between both groups was statistically significant (P<0.001). We believe the advantages of speed and convenience of skin staples outweigh the extra cost, provided the disposable instruments are reused until empty.

Use of circular stapling gun with peranal insertion of anorectal purse-string suture for construction of very low colorectal or colo-anal anastomoses

A technique is described for construction of the colorectal or colo-anal anastomosis in low rectal resection by using an automatic circular stapling device and inserting the anorectal purse-string suture peranally from below. This method was employed in 4 patients resulting in complete healing in 3 cases and a moderate leak in 1, which, however, eventually healed satisfactorily.

Postoperative Adhesion Formation After Laparoscopic Uterine Horn Resection in a Porcine Model: Comparison of Five Instruments

To evaluate the postoperative adhesion formation caused by instruments used in gynecologic laparoscopic surgery and to determine the optimal instruments to use to reduce adhesions. Seventeen juvenile pigs underwent laparoscopic bilateral resection of the uterine horns under general anesthesia and pneumoperitoneum. The laparoscopic procedures were carried out using monopolar electrocautery (ME) (n = 8), an electrothermal bipolar vessel sealer (EBVS) (n = 6), an ultrasonically activated scalpel (UAS) (n = 6), a loop-type ligature (LTL) with a steel scalpel for severing the tissues (n = 6), and an automatic stapling device (ASD) (n = 8). Second- look laparotomy was performed 14 days postoperatively, and the degree of postoperative adhesions was scored from 0 to 6. The mean and range of adhesion scores were 0.00 with EBVS, 0.13 (range, 0-1) with ASD, 0.33 (range, 0-2) with LTL, 1.17 (range, 0-3) with UAS, and 3.13 (range, 2-6) with ME. We found a statistically significant difference in the extent of postoperative adhesion formation associated with these 5 instruments (P < 0.001, Kruskal-Wallis test). Adhesion formation increased in the order EBVS < ASD < LTL < UAS < ME. Our study strongly suggests that surgical instruments can be selected to reduce postoperative adhesion formation, a particular concern in women of reproductive age.

Resistance to pressure of the stump after mechanical stapling or manual suture. An experimental study on sheep main bronchus

In a previous experimental study on 60 freshly slaughtered pig trachea, a statistically significant better resistance to pressure was found after mechanical stapling compared to hand suture. The objective of this study was to determine the resistance to pressure of a bronchial stump depending upon the closure technique (manual vs. mechanical) used in sheep 14 days after pneumonectomy. Pneumonectomy was performed on 30 sheep, which were alternatively closed either by a double-layer running suture at 90 degrees to the cartilaginous rings or with an automatic stapling device. Exactly 14 days after pneumonectomy, the animals were sacrificed and the trachea with the bronchial stump was retrieved. Sutures were placed under pressure until air leakage was observed. The air-leakage pressure was recorded digitally. In both groups, there was no evidence of a bronchopleural fistula. As in the previous experimental study, mean values of air-leakage pressure revealed a large standard deviation in both groups (min. 0.16-max. 1.15 bar). Unlike the results in the first experiment there was no statistically significant difference between the two groups. After 14 days, when a bronchial stump is considered to be healed, the resistance to pressure of a mechanical suture is equal to that of the manual suture.

胸腔鏡下マイクロウェーブ凝固法を用いた自然気胸治療の経験

We performed microwave coagulation to repair the cut pleural surface for a resected lung experimentally, as an alternative method for spontaneous pneumothorax. We found that the pleura was accumulated by microwave coagulation, but not burned. A water sealing test was used to confirm the repair of the ruptured site of the pleura.Materials and methods : Seven cases of pneumothorax had been admitted for dyspnea. Thoracoscopic microwave coagulation therapy was performed by inserting a throcar of 2 mm in diameter. Using microwave tissue coagulation at the power of 35 W for 30 second, one or more pulmonary bullae of the apex was coagulated thoracoscopically.Results : We evaluated the serum C-reactive protein between the patients who received microwave coagulation and those treated with the popular automatic stapling device method. The microwave coagulation therapy group showed less C-reactive protein than automatic stapling device group.Conclusion : Microwave coagulation therapy could be an alternative method to automatic stapling devices for small sized bullae of pneumothorax.

A Comparison of Bronchial Closure With the Aid of Staples or Suture: An Experimental Study on Pig Tracheae

The objective of this study was to determine the resistance to pressure of a bronchial stump depending upon the closure technique. For the experimental study, 30 pig tracheae were alternatively closed either by a double-layer running suture at 90° to the cartilaginous rings or with an automatic stapling device. Sutures were placed under pressure until air leakage was observed. The air leakage pressure was digitally recorded. A statistically significant difference existed between the two groups. The mechanical suture proved more resistant to pressure (p= .011). Thus, under ideal conditions, the resistance to pressure of a mechnical suture is equal to, if not better than, that of the manual suture.

Thoracoscopic Bilateral Wedge Resections of the Lung in a Child with Hepatoblastoma

We report a 3-year-old boy with hepatoblastoma in whom thoracoscopy was used successfully to perform wedge resections of both lungs at the same time. The boy did well postoperatively, and chemotherapy was restarted on the fifth postoperative day. One-lung ventilation was maintained during the surgery by blocking the main bronchus with a Fogarty catheter. Although an automatic linear stapling device was useful in performing the wedge resections, we stress the importance of developing devices and instruments suitable for endoscopic surgery in children.

USE OF SURGICAL STAPLING DEVICE IN EXCISION OF PHARYNGEAL DIVERTICULUM

Pharyngeal diverticulum (Zenker's diverticulum, hypopharyngeal pouch) is an outpouching of pharyngeal mucosa through a triangular area of weakness between the lower oblique fibres of the inferior constrictor muscle and cricopharyngeus called Killian's dehiscence. Prescribed treatment in large pouches is excision of the diverticulum with or without cricopharyngeal myotomy. Experience of closure of the oesophageal defect with an automatic stapling device is presented in nine cases of pharyngeal diverticula. Previous reports describing this technique have included substantial delays in the resumption of oral intake and prolonged hospitalization. It is shown that these delays are unnecessary.

Laparoscopic oophorectomy: Comparative study of ligatures, bipolar coagulation, and automatic stapling devices

We assessed laparoscopic oophorectomy using three techniques.From January 1989 to October 1991, 65 patients underwent laparoscopic oophorectomy using three techniques: bipolar coagulation, pretied ligature placement, and automatic stapling devices. The patients were aged 18-57 years and had the indications of pain, ovarian endometriosis, adhesions, unilateral blocked tubes, breast cancer, and recurrent benign ovarian cysts. The primary method of adnexal removal involved the automatic stapling device in 17, bipolar coagulation in 30, and pretied ligatures in 18.Total anesthesia time ranged from 45-123 minutes, with means of 77 minutes for pretied ligatures, 84 minutes for bipolar coagulation, and 84 minutes for automatic stapling devices. Sixty-two patients were discharged within 23 hours, two stayed two nights, and one stayed three nights. Rectus muscle bleeding and hematoma formation were the only complications in this series.All three methods of laparoscopic oophorectomy are effective, with similar operative times and uniformly good results for the patients.

Injuries Associated with the Use of a Linear Stapler During Operative Laparoscopy: Review of Diagnosis, Management, and Prevention

We report 7 recent examples of intraoperative and postoperative complications and injuries resulting from the use of an automatic stapling device during operative laparoscopy. The cases were collected throughout the United States and represent a cross-section of common complications. This report should alert surgeons to the possibilities of ureteral, bladder, and bowel injuries, postoperative bleeding, and instrument malfunctions. In addition, precautions and techniques to prevent and resolve complications are discussed. (J GYNECOL SURG 9:145, 1993)

Automatic Stapling Devices in the Surgical Treatment of Esophageal Diverticula

Experience is presented of 18 patients in whom surgical treatment of esophageal diverticulum included use of an automatic stapling device. Ten diverticula were pharyngoesophageal, three mid-esophageal and five epiphrenic. One-stage diverticulectomy with myotomy was performed in all cases. Postoperative follow-up was 6-66 months. The results were excellent, without early or late complications or recurrence.

The role of inflammation in bronchial stump healing.

The roles of inflammatory response and closure technique in the development of bronchopleural fistula were evaluated. Canine bronchial stumps closed with 3-0 silk and studied 14 days later were characterized by a dense inflammatory infiltrate. Stumps closed with 3-0 chromic catgut suture showed a moderate inflammatory response with disintegration of suture material. However, stumps closed with the automatic stapling device (TA-30) showed the best healing and a minimal degree of inflammation. These findings correlated well with leakage pressures. The average leakage pressure for the silk closed stumps was 139.44 mm Hg plus or minus 78.9 SD. This was significantly lower (P less than 0.02) than the average leakage pressure for staple closed stumps (251.25 mm Hg plus or minus 82.9 SD). It is concluded that the minimal amount of inflammation following staple closure will be associated with improved bronchial stump healing and a lower incidence of bronchopleural fistula.

The use of an automatic stapling device for closure of surgical wounds.

A sterile prepackaged disposable applicator for metal skin clips has been used in 72 patients with a variety of standard incisions in the neck, thorax, abdomen, and limbs. The applicator has been found to be simple to use after very little experience. Its outstanding advantage is that it furnishes a significantly more rapid method of closing wounds than the use of interrupted skin sutures. There have been no problems with wound healing, and patients have found no significant discomfort either with having the clips in place or with their removal. There are a few minor points of technique to learn in the use of clips and their removal, but these have been rapidly learnt without any problem by the members of our surgical and nursing staffs.