Linear Cutter Research Articles

Design and performance analysis of soft pneumatic manipulator‐based linear cutter and stem holder for sweet pepper harvesting

AbstractEfficient automation of stem‐cutting processes in agricultural practices is crucial but little‐studied for improving productivity and reducing labor‐intensive tasks. To address this need, we present a customized stem cutter and stem holder designed explicitly for sweet pepper harvesting. The stem cutter comprises a fixed plate and a moving plate with a blade, which moves in a single plane at an upward angle of 30° toward the fixed plate. The movement of the blade is facilitated by a soft bellows pneumatic actuator constructed using silicon rubber material. By applying air pressure from a DC air pump, the actuator extends forward, causing the blade part to make contact with the fixed plate and effectively cut the stem. The stem holder holds the stem securely before cutting. It contains two inflatable manipulators made of soft materials that expand inwards when air‐filled, ensuring that the stem is securely held and readily collected after harvest. Both simulation and experimental results are presented, in which the average cutting time was 2.356 s. We believe that these innovations represent an efficient method for automating the stem‐cutting process in sweet pepper cultivation and thus significantly contribute to the field of agricultural robotics.

Catheter-guided anvil insertion for circular stapler esophagojejunal anastomosis: a novel technique in laparoscopic total gastrectomy

ObjectiveThis study evaluates feasibility, safety, and short-term outcomes of employing the catheter-guided stapler anvil insertion technique for esophagojejunal anastomosis using a circular stapler during laparoscopic total gastrectomy (LTG).Materials and methodsFrom September 2021 to April 2023, the catheter-guided stapler anvil insertion technique was employed in 80 patients undergoing laparoscopic total gastrectomy (LTG) for esophagojejunal anastomosis. A modified D2 dissection, according to the en bloc technique, was performed in the patients. Subsequently, a longitudinal incision, approximately 2 cm in length, was made on the anterior wall of the esophagus, about 2 cm above the tumor. The transection line was pre-marked with blue dye along the esophagus's minor axis, and the tail of the anvil was capped with a 10-cm length of catheter (F14 d4.7 mm). The surgeon secures the head of anvil and carefully inserts it into the esophagus, ensuring that only a 5-cm segment of the catheter remains outside the esophagus. A linear cutter was employed to transect and seal the lower end of the esophagus. Subsequently, esophagojejunostomy was performed under laparoscopic guidance using a circular stapler.ResultsAmong patients undergoing esophagojejunal anastomosis with the new technique, postoperative complications included pneumonia or pleural effusion in 14 patients (17.5%), anastomotic stenosis in 3 patients (3.75%), abdominal infection in 2 patients (2.5%), and intestinal obstruction in 1 patient (1.25%). No instances of anastomotic leakage, anastomotic bleeding, or deaths were recorded. All patients experiencing complications improved with conservative treatment, without the need for secondary surgery.ConclusionThe catheter-guided stapler anvil insertion technique is demonstrated to be a safe and effective method for esophagojejunostomy, potentially reducing the occurrence of anastomotic leakage.

Modified reverse puncture technique for esophagojejunostomy during totally laparoscopic total gastrectomy for gastric cancer

Objective: To evaluate the value of implementing a modified reverse puncture procedure for esophagojejunostomy during totally laparoscopic total gastrectomy. Methods: This was a descriptive case series. Relevant clinical data, including the operative procedure, recovery, and pathological findings of 35 patients with gastric cancer who had undergone esophagojejunostomy with a modified reverse puncture technique during totally laparoscopic total gastrectomy in the Department of Gastrointestinal Surgery, Fujian Provincial Hospital, from June 2022 to January 2023, were prospectively collected and retrospectively analyzed. The age of all patients in the group was (64.9±8.0) years old, with 22 males (62.9%) and a body mass index of (23.2±2.4) kg/m2. The tumors were located in the upper and middle parts of the stomach in 24 cases (68.6%) and in the junction of the esophagus and stomach in 11 cases (31.4%). Important technical aspects of the modified reverse puncture procedure are as follows. (1) Site of the esophageal incision: a transverse incision is made across the right lateral wall of the esophagus at the expected site of esophageal disjunction. (2) Technique for inserting an anvil: after threading a silk thread through the tip of anvil, the end of the thread is knotted and fixed as the traction thread, after which an anvil is inserted into the esophagus through the esophageal incision, leaving the end of the traction line exposed. Next, a 60-mm linear cutter is placed through the right midclavicular trocar to straighten the opened esophagus vertically, after which the rod of the anvil is pulled out of a small incision that has been made in the esophagus by pulling the traction thread, thus completing anvil placement. (3) Jejunal binding: the jejunum on the central bar of the stapler is fastened with silk thread to the stump of the jejunum, and then tied to the output loop of the jejunum with a gauze strip. Results: All 35 surgeries were successful, with no mortality or conversion to laparotomy. The operation time, anvil insertion time, and digestive tract reconstruction time were (232.7±34.4), (8.5±1.4), and (40.5±4.8) minutes, respectively. The intraoperative blood loss was 100 (20-250) mL and the incision was (5.3±0.9) cm long. The upper surgical margin was negative in all patients and the mean distance between the upper and tumor margins was (3.5±1.2) cm. The mean number of lymph nodes dissected per patient was 33.9±7.1. The times to initial ambulation, initial passage of flatus , postoperative fluid intake, and length of postoperative hospital stay were (3.2±1.1), (3.7±1.5), (4.6±2.3), and (9.8±3.2) days, respectively. Postoperative complications occurred in five patients: one case of anastomotic leak, two of anastomotic stenosis, one of pulmonary infection, and one of incomplete intestinal obstruction, all of which were successfully managed conservatively. Conclusion: Esophagojejunostomy using a modified reverse puncture technique during totally laparoscopic total gastrectomy is safe and feasible for gastric cancer, requiring only a small incision and achieving higher upper esophageal resection margins and good postoperative recovery, and therefore warrants further implementation.

Accurate prediction of five-axis machining cycle times with deep neural networks using Bi-LSTM

This paper presents a novel machine learning (ML) based approach to predict machining cycle (part program running) times for complex 5-axis machining. Typical 5-axis machining toolpaths consist of short-segmented discrete linear cutter location lines (CL-lines) with simultaneously varying tool center point (TCP) and orientation vectors (ORI). As the 5-axis machine tool NC (numerical control) system tries to interpolate such part programs smoothly, the TCP motion decelerates and accelerates repeatedly causing the actual feedrate to fluctuate. The actual observed (resultant) feedrate can be approximately 30 % lower than the user commanded one. Furthermore, if the toolpath requires the 5-axis machine tool to travel closer to its singular point, or if the workpiece placement on the table is not optimal, actual feedrate is even lowered further. This paper presents two ML-based approaches to accurately predict 5-axis machining toolpaths. The first strategy uses a bidirectional long short-term memory (Bi-LSTM) network to model the machine tool behavior and generates a direct final cycle time estimation for any given part program. This approach only uses the toolpath geometry to predict the cycle time, and for training it only needs the “final” cycle times of similar part programs making it practical on today’s shop floors. The second strategy requires individual CL-line processing times for training. In return, it can provide highly accurate cycle time predictions. Both strategies can capture the interpolation dynamics of 5-axis machine tool NC systems accurately. Simulation studies and experimental validations are conducted on modern 5-axis machine tools with varying workpiece placements and interpolation parameters. Proposed approaches have shown to predict cycle times with 90–95 % accuracy on real-life complex 5-axis machining toolpaths.

Application of endoscopic suturing instrument in laparoscopic gastrojejunostomy

Objective: To investigate the safety and feasibility of using an endoscopic suturing instrument in laparoscopic gastrojejunostomy. Methods: A descriptive case series study was conducted to retrospectively analyze the clinical data of 5 patients with gastric cancer who underwent laparoscopic distal gastrectomy (Billroth II + Braun anastomosis) at Tangdu Hospital, Air Force Medical University from October 2022 to January 2023. The common opening was closed using an endoscopic suturing instrument. The indications were as follows: (1) patients aged between 18 and 80 years; (2) patients with gastric adenocarcinoma; (3) cTNM between I-III; (4) lower-third gastric cancer and radical gastrectomy is recommended; (5) no history of upper abdominal surgery (except for laparoscopic cholecystectomy). The surgery was performed as follows: A side-to-side gastrojejunostomy was performed with endoscopic linear cutter stapler. Then the common opening was closed with endoscopic suturing instrument. During suturing and closing the common opening, a vertical mattress suture was used to completely invert and close the mucosa-to-mucosa and serosa-to-serosa of the gastric and jejunum walls. After the first layer of suture was completed, the seromuscular layer was sutured from top to bottom to embed the common opening of stomach and jejunum. Results: Laparoscopic closure of the common gastrojejunal opening with endoscopic suturing instrument was successfully completed in all 5 patients. The operative time was (308.6±22.6) minutes, while the time of gastrojejunostomy was (15.4±3.1) minutes. The operative blood loss was (34.0±10.8) ml. No intraoperative or postoperative complications occurred in any of the patients. The first passage of gas occurred at (2.6±0.9) days, and the postoperative hospital stay was (7.0±1.9) days. Conclusion: The application of endoscopic suturing instrument in laparoscopic gastrojejunostomy is safe and feasible.

NC直線加減速処理によるマシニングセンタの直線補間工具経路の運動誤差推定

From the machining center (MC) user’s point of view, the authors propose a practical approach to estimate the trajectory error of a linear interpolation cutter path produced by the linear acceleration/deceleration (Acc/Dec) processing for a target MC in this paper. Firstly, a simple and convenient motion model is established for describing the behavior of the servo axes corresponding to the linear Acc/Dec procession of a linear segment, which can be applied to any linear segment regardless of length. Based on the model and a linearity assumption on the dynamics of servo system, a simulation method is developed to precisely calculate the cutter path trajectory in detail together with the servo axis speed from the motion parameters commanded in NC program. The algorithm not only has a very simple structure but also demonstrates high efficiency in actual calculation. In order to confirm the effect of the approach, verification experiments have been performed on the target MC, in which specially designed cutter paths were inspected by a cross grid measuring device with high resolution in non-contact state. These measured trajectories are compared and discussed with the ones simulated under the same motion parameters, from different perspectives. The examination results sufficiently demonstrate the effectiveness of the proposed model and simulation method. Therefore, as a useful tool, the approach provides a potential application possibility, i.e. beforehand estimating the influence of the NC Acc/Dec processing on cutter path accuracy or judging the motion conditions for the machining purpose without performing an actual machining with the target MC.

MP25-19 COMPARISON OF COMPLICATIONS, OPERATING TIME AND COSTS IN DOUBLE-LAYERED HAND-SEWN VS. MECHANICAL STAPLED ILEO-ILEAL ANASTOMOSIS DURING RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 May 2022MP25-19 COMPARISON OF COMPLICATIONS, OPERATING TIME AND COSTS IN DOUBLE-LAYERED HAND-SEWN VS. MECHANICAL STAPLED ILEO-ILEAL ANASTOMOSIS DURING RADICAL CYSTECTOMY Gabriele Tulone, Nicola Pavan, Sofia Giannone, Giuseppe Alario, Alberto Abrate, Mirko Pinelli, Piero Mannone, Francesco Claps, Davide Baiamonte, Rosa Giaimo, Marco Vella, Carlo Pavone, Vincenzo Ficarra, and Alchiede Simonato Gabriele TuloneGabriele Tulone More articles by this author , Nicola PavanNicola Pavan More articles by this author , Sofia GiannoneSofia Giannone More articles by this author , Giuseppe AlarioGiuseppe Alario More articles by this author , Alberto AbrateAlberto Abrate More articles by this author , Mirko PinelliMirko Pinelli More articles by this author , Piero MannonePiero Mannone More articles by this author , Francesco ClapsFrancesco Claps More articles by this author , Davide BaiamonteDavide Baiamonte More articles by this author , Rosa GiaimoRosa Giaimo More articles by this author , Marco VellaMarco Vella More articles by this author , Carlo PavoneCarlo Pavone More articles by this author , Vincenzo FicarraVincenzo Ficarra More articles by this author , and Alchiede SimonatoAlchiede Simonato More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002568.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Intestinal anastomosis during radical cystectomy (RC), can be performed by hand suturing or by a mechanical suturing machine. The purpose of the study is to compare complications, timing and costs of the intestinal anastomosis techniques. METHODS: A multi-institutional cohort of 195 patients who underwent RC, performed by expert surgeons, from 2016 to 2021, were retrospectively analyzed. 100 (51.3%) double-layered hand-sewn intestinal anastomosis (HS-IA) with 2 Vicryl 3.0 and 2 Vicryl 4.0 stitches were performed. 95 (48.7%) mechanical stapled intestinal anastomosis (MS-IA) were conducted with a mechanical stapler (disposable Ethicon 75mm Linear Cutter from Johnson and Johnson) and 1 refill. RESULTS: Of the 195 procedures, 100 patients underwent HS-IA and 95 underwent MS-IA. The median age was 71 years (IQR 65-77 years). Charlson comorbidity index and ASA score were higher in the MS-IA group. 29 (29%) patients of the HS-IA group reported early postoperative complications and in 34 (36%) patients were documented in the MS-IA group (p<0.001). In the MS-IA group, 20 (21.1%) patients presented major complications according to Clavien Dindo, while only 6 patients (6%) had complications in the HS-IA group (p=0.03). In HS-IA group ileo-ileal anastomosis dehiscence occurred in 1 patient (1%); 1 patient (1%) had intestinal mechanical obstruction and 2 (2%) patients ileus in postoperative period. In the MS-IA group in 2 patients (2.1%) bowel perforation occurred, and intestinal obstruction in 2 patients was also reported. There is not a statistically difference in time to flatus and defecation, 2 days (IQR 2-3 days) vs 3 days (IQR 2-3 days) and 5 days (4-6 days) vs 5 days (4-6 days) respectively in the two groups. The median operating time for the hand-sewn anastomosis was 16.4 min (range 15.0-17.4 min), compared to 20.0 min (range 20.0 -20.0 min) p<0.001 for the mechanical suturing machine. The costs of the double-layered hand-sewn for a single patient is 5 €, against 350.00 € for a disposable mechanical stapler and one refill. CONCLUSIONS: Both HS-IA and MS-IA are safe and feasible without postoperative course differences but the HS-IA is less expensive and can reduce the operating time of the ileo-ileal anastomosis during RC. Additionally, MS-IA is reinforced with supplementary stitches and despite this, the risk of anastomosis dehiscence is not completely cancelled. Concluding, the HS-IA anastomosis is an important cost-saving approach compared to the stapled alternative. Source of Funding: No © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e436 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gabriele Tulone More articles by this author Nicola Pavan More articles by this author Sofia Giannone More articles by this author Giuseppe Alario More articles by this author Alberto Abrate More articles by this author Mirko Pinelli More articles by this author Piero Mannone More articles by this author Francesco Claps More articles by this author Davide Baiamonte More articles by this author Rosa Giaimo More articles by this author Marco Vella More articles by this author Carlo Pavone More articles by this author Vincenzo Ficarra More articles by this author Alchiede Simonato More articles by this author Expand All Advertisement PDF DownloadLoading ...

EP.FRI.988Life threatening recurrent bleeding gastric fundus Dieulafoy lesion: A case report

Abstract Introduction Dieulafoy lesion is a rare but significant cause of upper gastrointestinal tract (GIT) bleeding. Over 75% of Dieulafoy lesions are located in the stomach and they tend to be responsible for recurrent upper GIT bleeding. Endoscopic therapy is the first line intervention to achieve haemostasis. Patient A 49-year old normally fit man known to have a gastric Dieulafoy lesion since 2008 presented with a history of collapse on the street and significant melaena. He was tachycardic, with a heart rate of 116, and hypotensive, blood pressure 109/68 mmHg on admission. He had significant upper GIT bleeding from the gastric fundus Dieulafoy lesion in April 2008, requiring a massive blood transfusion. At the time, the attempted endoscopic therapy was unsuccessful, resulting in an emergency surgery and under-running of the bleeding vessels. For the recent admission, he underwent an urgent therapeutic oesophagogastroduodenoscopy, with 3 endoscopic clips applied, but this failed to maintain haemostasis. Four units of packed red cell were transfused and he was transferred immediately to the operating theatre. He underwent an emergency laparotomy, adhesiolysis, gastrostomy and wedge resection of the bleeding gastric fundus Dieulafoy lesion using a linear cutter 75mm stapler. He had an uneventful post-operative recovery and was discharged home on day four after surgery. The histology of the wedged gastric specimen confirmed an area of gastric mucosa ulceration with a network of mixed dilated, thin and thick-walled tortuous vessels in the adjacent submucosal layer. The histologic features are consistent with a bleeding gastric Dieulafoy lesion.

P06.10 Low-Cost Video-Assisted Thoracic Surgery (VATS) Lobectomy Versus Regular VATS Lobectomy: A Propensity-Matched Study

The modern video-assisted thoracoscopic surgery (VATS) lobectomy demands disposable consumable endoscopic linear cutter and stapler devices for anastamosis. These pieces are associated with additional high medical costs which makes the procedure less affordable by patients. Here we have developed a new knotting method,“twining high-tension knot” to seal and cut off the bronchus and vessels instead of endoscopic staplers that can omit the use of these expensive pieces，we call it “Low-cost VATS lobectomy”.The purpose of this study is to compared the safety and cost of low-cost VATS lobectomy and regular VATS lobectomy.

Use of hem-o-lok clips for laparoscopic appendectomy in children: retrospective analysis and comparison to ligature loop and endoscopic surgical stapler.

There are multiple techniques used for laparoscopic appendectomy (LA): ligature loop (LL), surgical stapler (SS) (Endopath Ets-Flex-Endoscopic Articulating Linear Cutter 33 mm Standard Ref Atb 35. Ethicon, Somerville, New Jersey, US), and hem-o-lok clips (HOL) (Weck Closure System. Triangle Park, NC, USA). The application of the LL usually demands dexterity and training, whilst using HOL may be more advantageous due to its simplicity in terms of application and its low cost in contrast with the SS. The objective of this study is to determine safety and efficacy of the different devices that can be used in the surgical procedure. From June 2016 to December 2019, 253 consecutive children aged to 1 to 18 years were retrospectively reviewed. They were divided into three groups depending on the device used to secure the appendix: (I) in the first group, the base of the appendix was secured by double LL, (II) in the second group the base of the appendix was secured with SS, and (III) in the third group the base of the appendix was secured with two non-absorbable HOL. The data collected includes age, gender, operative time, device used to ligate the base of the appendix, previous tests (blood analysis, imaging), antibiotic prophylaxis administered, length of hospital stay, intraoperative and postoperative complications, shoulder pain and histological study of the specimen. There were 253 patients that underwent laparoscopic appendectomy during the study time, with a mean age of 10.3±4.1 in the LL group, 9.4±2.7 in the SS group and 10.4±3.3 in the HOL group, P=0.165. Distribution by gender was 77.8% for males in the LL group, 65.2% in the SS group and 61.3% in the HOL group, P=0.559. The mean surgical time with IQR in brackets was 60.0 (10.0) minutes (min), in the first group in which the base of the appendix was secured with LL, in the second group in which the base of the appendix was secured with SS 60.0 (15.0) min and finally in the third in which the base of the appendix was secured with HOL 40.0 (30.0) min, P<0.001. HOL clips have a significantly lower cost than their analogues. Specifically, 5 HOL clips have a cost of EUR 26.75, while three LL have a cost of EUR 53.70 and a single SS has a cost of EUR 276.58. Postoperative complications were found in 14.3% of the LL group, 9.8% in the SS group and 4.6% in the HOL group, P=0.137. Efficacy and safety in controlling the base of appendix were the same in all groups. The HOL are safe and reduce surgical costs during laparoscopic appendectomy in children.

Surgical advances in the management of placenta accreta spectrum: establishing new expectations for operative blood loss

Objective To evaluate whether the implementation of our surgical approach, referred to in the text as Linear Cutter Vessel Sealing System (LCVSS) technique, will improve perioperative outcomes in patients with placenta accreta spectrum (PAS), specifically by reducing blood loss and blood transfusion rates at the time of cesarean hysterectomy (C-HYST). The LCVSS technique integrates the following: (1) hysterotomy performed using the Linear Cutter, (2) no placental manipulation, (3) cauterization of anatomically prominent vascular anastomosis using the handheld vessel sealing system, and (4) completion of bladder dissection until the cervico-vaginal junction before ligation and division of uterine arteries. Materials and methods This is a retrospective cohort study that analyzed perioperative outcomes in patients undergoing C-HYST for PAS at a tertiary care center from 1 July 2014 to 1 December 2019. Comparisons were performed between cases managed with the use of the LCVSS technique (designated as LCVSS cohort) and those managed without the use of the LCVSS technique (designated as no technique cohort). The primary outcomes were cumulative blood loss (CBL) and total perioperative blood transfusion of ≥4 and ≥6 units of PRBCs. The secondary outcomes were intra- and postoperative complications. Continuous and categorical variables were compared according to the sample size and distribution. Binary logistic regression analysis was performed to predict confounders for blood transfusion of ≥4 units of PRBCs. Results A total of 69 prenatally diagnosed PAS cases underwent C-HYST at the time of delivery. Forty-four cases that were performed using the LCVSS technique comprised the LCVSS cohort. The remaining 25 were marked as no technique cohort. CBL was significantly lower in the LCVSS cohort (1124 ml [300–4100] vs 3500 ml [650–10600]; p < .001). The rate of urinary tract injuries was similar (16%). The rate of postoperative complications and reoperation for intra-abdominal bleeding were lower but not significantly different in LCVSS cohort (9 vs 20% and 0 vs 8%, p = .26 and p = .12, respectively). There were no differences in neonatal outcomes. Conclusion Implementation of this advanced surgical approach for PAS management resulted in reduced blood loss and blood transfusion rates in comparison with no technique cohort.

Laparoscopic Radical Hysterectomy with Enclosed Colpotomy Using Surgical Stapler for Early-Stage Cervical Cancer

Study Objective To report the application of Ethicon Endo-Surgery re-usable linear cutter (Ethicon endocutter) in vaginal closure without usage of uterine manipulator to prevent tumor spillage in laparoscopic radical hysterectomy for early-stage cervical cancer. Design A step-by-step explanation of the procedures using a video. Setting Hospital for women's health teaching and research. Patients or Participants This is a 41-year-old woman with clinical stage IBI cervical squamous cell cancer. Interventions After the contraindication was removed, laparoscopic type C radical hysterectomy with pelvic lymph node dissection and ovarian transposition were performed, the surgery was finished without usage of uterine manipulator. The patient signed an informed consent that allows us to use her clinical data. Measurements and Main Results In this method, after completion of the radical hysterectomy procedures, an Ethicon endocutter was placed into abdominal cavity through a 12-mm trocar. The uterus was elevated with fixed sutures on the uterus. Then, the stapler was placed. Before the surgical stapler was fired to close the vagina, we should checked that no other unintended structure was included in the jaws of the stapler. After being fired, the stapler places 2 triple-staggered rows of titanium staples and simultaneously knife blade cuts between them. Once the vagina has been divided, the stapler was released. The upper part of the vaginal cuff was excised and checked by pathology as a surgical margin, and the uterus was removed through the vagina. Finally, the vaginal cuff was closed with absorbable barbed sutures. Conclusion Vaginal closure with Ethicon endocutter before colpotomy is a useful and effective procedure to block vaginal cuff and prevent tumor spillage during laparoscopic radical hysterectomy of cervical cancer.

Effect of different pancreatic stump closure techniques after distal pancreatectomy on frequency and severity of acute postoperative pancreatitis

Objective: to study the effect of different pancreatic stump closure techniques and diameter of the main pancreatic duct on frequency and severity of acute postoperative pancreatitis after distal pancreatectomy. Material and Methods. Distal pancreatectomy was performed on 126 patients with neoplasms of body and/or tail of the pancreas. Patients were distributed among four groups based upon the pancreatic stump closure technique applied after distal pancreatectomy: group 1 (control) included the patients with isolated suturing of the main pancreatic duct in the pancreatic stump with its subsequent sealing by the gastrocolic omentum or hemostatic sponge; group 2 patients underwent isolated suturing of the main pancreatic duct in the pancreatic stump with its subsequent sealing with 2-octyl cyanoacrylate biological glue; group 3 patients had their pancreatic stump closure performed with endoscopic linear cutter stapler; group 4 was composed of the patients with external transduodenal transnasal drainage of enlarged (D&gt;3 mm) main pancreatic duct in the pancreatic stump. Results. The occurrence of acute postoperative pancreatitis in the control group amounted to 45.8%, while, in groups 2, 3 and 4, the frequencies were 44.4, 9.7 and 15.0(%), correspondingly. Besides, the control group was characterized by declined occurrence of the moderately severe form of acute postoperative pancreatitis. Use of endoscopic linear cutter stapler and external transduodenal transnasal drainage of the enlarged main pancreatic duct caused lower acute postoperative pancreatitis frequency in the patients with main pancreatic duct in their pancreatic stumps below 5 mm in diameter. Conclusion. Use of proposed pancreatic stump closure techniques after distal pancreatectomy resulted in lower frequencies of occurrence and severity of acute postoperative pancreatitis.

A Novel Surgical Technique for Placenta Accreta Spectrum: Comparisons of Intra- and Post-operative Outcomes [01N

INTRODUCTION: A novel surgical technique to reduce blood loss during cesarean hysterectomy (Chyst) for placenta accreta spectrum disorder (PAS) was previously described (LC-VSS: hysterotomy using linear cutter and dissection of the bladder using vessel sealing system before clamping uterine arteries). We hypothesized that LC-VSS reduces intra- and post-operative complications. METHODS: After IRB approval, PAS cases from 2014 to 2019 were reviewed. Gravid hysterectomy, interval hysterectomy and focal resection were excluded. Data collected includes patient demographics, estimated blood loss (EBL), number of intra-operative blood products, massive transfusion, organ injuries and post-operative complications (intensive care unit (ICU) admission, re-laparotomy, hospital stay). Chyst without using LC-VSS was marked as control. Impact of LC-VSS was analyzed using univariate analysis. Predictors for transfusion of more than 4 packed red blood cells (PRBCs) were assessed using regression analysis including pathology (accreta-increta vs percreta), surgical technique and urgency. RESULTS: Of 59 cases, LC-VSS was used in 39 cases (66%). EBL was significantly lower in LC-VSS cases compared to controls (1200 vs 3330 ml, P=.0001) as well as the number of PRBCs and fresh frozen plasma transfused (0 vs. 4, P&lt;.0001, and 0 vs 2, P=.0007, respectively). The number of massive transfusions was lower in LC-VSS cases (1 vs. 7, P=.002). Need for re-laparotomy was lower in LC-VSS patients (0 vs. 20%, P=.01). Median hospital stay was similar between groups. LC-VSS was the only predictor of blood transfusion less than 4 units of PRBCs (P=.004). CONCLUSION: Use of this novel surgical technique (LC-VSS) during Chyst for PAS improves intra- and post-operative outcomes.

Gastric volvulus with perforation 1 year after total pancreatectomy: a case report

BackgroundBecause of its rare indication and relatively simple reconstruction procedure (only choledochojejunostomy and gastrojejunostomy) compared to those for pancreatoduodenectomy, the technical tips and pitfalls of total pancreatectomy are rarely discussed. Herein, we discuss a rare case of gastric volvulus 1 year after total pancreatectomy and provide advice to prevent such cases.Case presentationA 66-year-old woman underwent total pancreatectomy with splenectomy for mixed-type intraductal papillary mucinous neoplasm of the pancreas. Choledochojejunostomy (retro-colic route) and gastrojejunostomy (ante-colic route, Billroth II method) were performed for reconstruction. The final diagnosis was mixed-type intraductal papillary mucinous adenoma of the pancreas without malignant neoplasm. She had no clinical symptoms, such as abdominal pain and fever, during postoperative follow-up. However, at 1 year postoperatively, she complained of abdominal pain. Contrast-enhanced abdominal computed tomography showed volvulus and perforation of the stomach. Emergent surgery was performed. The stomach fornix was located on the right side and was partly perforated. We resected the perforation site with a linear cutter® (New Type Linear Cutter, Ethicon, USA) and released the gastric volvulus. Moreover, we fixed the stomach to the left abdominal wall using non-absorbable thread. The cause of the perforation was clinically and pathologically unclear. Her serum albumin and cholinesterase levels temporarily decreased postoperatively, but gradually increased. A recurrence of volvulus-related symptoms has not been observed.ConclusionsAfter total pancreatectomy with splenectomy, although the stomach is connected with the jejunum, it is typically fixed only by the pedicle of the left gastric artery and vein. In the present case, this anatomical change may have been a cause of the gastric volvulus. Thus, it might be better to fix the remnant stomach in total pancreatectomy with splenectomy.

Clinical prospects for laparoscopic stoma closure of a temporary loop ileostomy: Initial experience and report.

IntroductionIn closure of a stoma, the small working space and adhesions hinder a precise surgical procedure, compared with conventional approaches to digestive surgery. The aim of this prospective study was to introduce a new technique of laparoscopic stoma closure (LASC).Materials and surgical techniquesAfter starting with three trocars, it is a priority to dissect around the arising ileum; a linear stapler is precisely inserted in both orifices of the loop stoma and applied two times, extracorporeally. Ultimately, both the oral and anal sides of the loop ileum are cut and closed using a linear cutter stapler in a delta‐shaped manner just under the abdominal wall, intracorporeally. Eventually, the arising stoma is removed using an intra‐abdominal and cutaneous approach.DiscussionLASC for patients with a temporary loop ileostomy is safe and feasible. More data and experience will be required to verify the benefits of this new technique.

Stapled versus handsewn methods for ileocolic anastomoses

This is the first systematic review specifically investigating ileocolic anastomosis. To compare outcomes of ileocolic anastomoses performed using stapling and handsewn techniques. The hypothesis tested was that the stapling technique is associated with fewer complications. MEDLINE, EMBASE, Cochrane Colorectal Cancer Group specialised register SR-COLOCA, and Cochrane Library were searched for randomised controlled trials comparing the use of a linear cutter stapler with any type of suturing technique for ileocolic anastomoses in adults from 1970 to 2005. Selection criteria were randomised controlled trials comparing the use of linear cutter stapler (isoperistaltic side to side or functional end to end) with any type of suturing technique in adults. Regarding data collection and analysis, eligible studies were selected and their methodological quality assessed. Sub-group analyses for cancer and inflammatory bowel disease as indication for ileocolic anastomoses were performed. Six trials (including one unpublished) with 955 ileocolic participants were included. The three largest trials had adequate allocation concealment. Stapled anastomosis was associated with significantly fewer anastomotic leaks compared with the handsewn technique (S = 5/357, HS = 36/598, OR 0.34 [0.14, 0.82] p = 0.02). For the sub-group of 825 cancer patients in four studies, stapled anastomosis led to significantly fewer anastomotic leaks (S = 4/300, HS = 35/525, OR 0.28 [0.10, 0.75] p = 0.01). There were very less Crohn's disease patients to perform a sub-group analysis. All other outcomes showed no significant difference. Stapled functional end-to-end ileocolic anastomosis is associated with fewer leaks than handsewn anastomosis.

Investigation of flow fields during the electrochemical machining of variable-section pit arrays

Variable-section pit arrays play an important role on the linear cutter staplers, which are used for surgical suturing. Although numerous methods can be employed to generate pits on the surface of a workpiece, it remains a challenge to form variable-section pit arrays on the surfaces of thin-walled workpieces with high precision and efficiency. Thus, this paper proposes a method for the electrochemical machining of variable-section pit arrays using a radial internal fluid supply. By using simulations and experiments to investigate the flow fields of the electrolyte, it was found that electrolyte supplied by internal electrodes enhanced the accuracy and consistency of the pit profiles. The influence of the electrolyte pressure, pulse current, and feeding speed on the pit profiles of machined variable-section pit arrays was analyzed. To fabricate the designed pit (length = 1750 ± 20 μm, width = 1000 ± 20 μm, and depth = 400 ± 10 μm), the machining parameters were optimized. Using these optimized parameters (electrolyte pressure = 0.5 MPa, pulse current = 35 A, feeding speed = 0.42 mm min−1), ten rows of variable-section pit arrays were generated on a 17-4PH stainless steel plate with a thickness of 1 mm. The resulting length, width, and depth (mean ± SD) were 1750.56 ± 0.55 μm, 999.62 ± 0.63 μm, and 396.71 ± 0.53 μm, respectively, demonstrating the high precision and efficiency of the proposed method.

A novel approach to reduce blood loss in patients with placenta accreta spectrum disorder

Objective Cesarean hysterectomy for the treatment of placenta accreta spectrum (PAS) disorders has the potential to be associated with significant blood loss, massive transfusion, and operative morbidity. Two major contributors to blood loss are the hysterotomy and the bladder dissection. We introduce a new surgical technique and hypothesize that developing the hysterotomy with a linear cutter and mobilization of the bladder using a vessel sealing system (VSS) before clamping uterine arteries will lead to a total reduction in blood loss and transfusion rates. Materials and methods This was a case series, which presents clinical outcomes according to our described surgical technique. The following surgical outcomes were collected: operation time (minutes), estimated blood loss (EBL), intraoperative complications, need for reoperation before discharge, and transfusion rates. Our surgical technique utilizes a linear cutter to create a bloodless hysterotomy and a VSS to dissect the vesicouterine tissue. The VSS cauterizes and transects the small vesicouterine and placental-vesical vascular anastomoses that are prone to bleeding. Once the bladder is mobilized below the level of the cervix, the uterine arteries are ligated to complete the key components of the hysterectomy. Results Of the 23 cases, the median EBL was 1500 cubic centimeters and patients received a median of 1 unit of packed red blood cells. Eleven of the 23 cases did not require any blood transfusion and no patients required massive transfusion. The EBL did not differ between procedures that were performed emergently versus scheduled and it also did not differ between patients that had placenta increta versus placenta percreta, as diagnosed by histopathology. Conclusion Use of a linear cutter and closure of the lower anastomosis with VSS prior to clamping uterine artery during cesarean hysterectomy can significantly reduce blood loss and transfusion rates. This technique is applicable in emergent and nonemergent settings as well as for the most challenging procedures complicated by placenta percreta.

End Track Following Control Method for Multi-axis Machining of Linear Cutting Tools

In the process of linear tool multi-axis machining, it is prone to local interference, resulting in poor curvature matching of the machining end trajectory, tool path tracking control performance is not good, based on critical tool axis vector decomposition, a linear tool end path following control method for multi-axis machining is proposed. The tool axis spatial distribution model of complex curved surface channel parts is constructed, and the local interference suppression is carried out by using two-dimensional feasible pendulum tool domain analysis method. The curve and surface are the critical elements on the multi-axis machining interference surface of linear cutter. The intersection curve equation between the pendulum cutter plane and the surface to be processed is constructed, and the optimal tool parameter selection is realized by using the discrete characteristic point distribution of the surface of the critical cutter axis. Combined with the critical tool axis vector decomposition method, the end trajectory following control of linear tool multiaxial machining is realized. The simulation results show that the output stability of the end track following control of linear tool multiaxial machining is good by using this method. The precision and efficiency of multi-axis machining are improved significantly.