Authors: Stefanos Demertzis Oligca Beslac Daniel Mettler Daniel Zalokar Taylor Spangler Bernard Hausen Lee Swanstrom
Publish Date: 2015/03/21
Volume: 29, Issue: 12, Pages: 3674-3684
Abstract
Surgical staplers currently all rely on the same staple form—the “B” which necessitates a high delivery profile 12 mm A novel “D” shape staple allows for an extremely low profile of the applicator The acute and longterm efficacy of a Dshaped staple Cardica Redwood City CA USA was compared to conventional Bform staples Covidien Norwalk CN USA in an animal model for intestinal transections and anastomosesJejunojejunal anastomoses JJ were performed via minilaparotomy in a swine model White blue D and Bshaped staples were studied in three groups planned survival 14–84 days Intraoperative assessment included completeness of staple line hemostasis and need for intervention Postoperatively animals were evaluated for complications At the time of sacrifice gross pathological and histological assessments were performedTwentythree animals had 40 anastomoses 23 “D” and 17 “B” staple anastomoses with no intraoperative mortalities One “D” staple application required a manual extension of the cut Acute hemostasis was 100 Group 1 n = 5 compared white staples in JJs D staple n = 5 B staple n = 5 14day survival = 100 Group 2 n = 12 compared white staples in JJs D staple n = 12 B staple n = 6 34day survival = 92 One animal died on day 4 for a nonstaple related cause Group 3 n = 6 compared blue staples in JJs D staple n = 6 B staple n = 6 84 day survival = 84 One animal died on day 18 due to an obstruction at the B staple JJ caused by stricture There were no other bleeding leaks or strictures in any of the groups Gross pathology and histology were unremarkable in all JJsThis study showed no difference in intraoperative performance and the chronic healing response in JJs between D and Bshaped staples Based on these findings the Dshaped staple elicits a normal healing response in jejunostomies and offers the possibility of clinical use of this advance in staple designThe modern surgical stapler is 55 years old this year It evolved from the very first surgical stapler developed in 1908 by Dr Hümer Hültl 1868–1940 which had resemblances of a “B”shaped staple along with staggered rows 11 Ever since medical and most nonmedical staplers have been designed and iterated around the “B”shaped staple Today staplers are used in virtually all surgical disciplines and have become the gold standard for the transection and anastomosis of tissues Surgical staplers are absolutely essential instruments for surgeons worldwide 3Over the past 20 years there have been concentrated efforts by the surgical community to further reduce the invasiveness of their surgical procedures This started with trocarbased laparoscopic and thoracoscopic procedures using cameras and specialized instruments that could be applied through various size access ports More recently surgeons have introduced the concepts of singleport surgery minilaparoscopy or natural orifice translumenal endoscopic surgery NOTES always driven by the desire to reduce the size of the skin incisions and the invasiveness of the procedures 2 9 10 12 15 16As a result the majority of surgical instruments are now available with 5 or 8mm shaft diameters and offer various degrees of articulation This includes standard surgical instruments such as graspers scissors or irrigation and suction devices It also includes more sophisticated instruments such as energybased instruments or clip appliers 14 However in regards to surgical stapling until recently universally applicable instruments have only been available with a 12mm or larger diameter shaft
Keywords: