Downloaded 402 times
More Related Content
Similar to Staplers in Surgery
Staplers in Surgery
- 1. STAPLERS IN SURGERY By:Dr.B.Vinod Dept.of General surgery, Gandhi medical college and hospital, Hyderabad, Telangana.
- 2. ● The principlesfor gently treating living tissue were established more than 100 years ago by Dr. William Halsted. ● Those principles haven’t changed. However, with the evolution of surgery, techniques of interacting with tissue have become more complex.
- 3. Halsted’s Principles ofAnastomosis • No tissue tension • Good hemostasis • Obliteration of dead space • Gentle handling of tissue • Adequate blood supply • Adequate lumen
- 4. HISTORY OF SURGICALSTAPLERS 1880s Reports of first stapler by Dr Henroz- everted bowel anastomosis in dogs. 1908 Professor Humer Hultl with Victor Fischer created a stapler with emphasis of following principles- Tissue compression B-shaped configuration of closed staples Placement of staples in double staggered rows Use of fine wire as the staple material. But it was heavy and its assembly was difficult and time-consuming
- 5. 1980 The dawn ofminimally invasive procedures (MIP). Surgeons request laparoscopic adaptation of Transecting Linear Cutter (TLC) device 1989 Titanium replaces stainless steel as the key component for staples
- 6. Properties of Tissue ●Living tissue mainly consists of solid and fluid (biphasic nature) ● Tissue thickness changes when external force is applied, then tissue also has properties to return to the original shape over time (viscoelastic nature) ● Based on biphasic and viscoelastic nature, we have to consider… when using staplers ○ Thickness ○ Compressibility ○ Property variability
- 7. Materials for staplers Stainlesssteel Pure Titanium Titanium Alloy*
- 8. Tissue Dynamics inAction: Stapling Tissue Living tissue compressed to adequate thickness for stapling. Living tissue before compression. Energy is stored in the staple as compression is maintained
- 9. Two types ofcompression Closing Lever Forward Backward 25% Stronger Focal Compression (V-shape) Cam Tube Compression (Parallel)
- 10. Pre-Compression Pre-compression is necessary for goodstaple formation
- 11. firing Compression Over Time Holdingcompression before firing: Prepares the tissue to be fired upon Reduces stress on the tissue prior to firing Minimizes tissue flow Optimizes staple formation No Pre-Compression Pre-Compression
- 12.
- 13. 0 0.29 0.41 0.49 0.50 0 0.1 0.2 0.3 0.4 0.5 0.6 0 510 15 20 25 Tissue thickness reduction (mm) over time (s) after jaw closure Tissuethicknessinmm Time in seconds 15 to 20 seconds gives an optimal thickness
- 14. Tissue thickness varieswidely throughout the body from organ to organ. Even within each organ, tissue thickness ranges greatly.1 Diagram of the stomach indicating the locations of measurements* (n=50) measurements at each location *Mean measurement (maximum measurement) Tissue Dynamics
- 15. Tissue thickness ina given organ varies location by location
- 16.
- 17. EES Linear CutterCartridge with 3D Staples 3D Staple The Staple & Cartridge Configuration Appropriate staple formation is a combination of the instrument and cartridge interaction with living tissue. Staple Retainer Staples Staple Drivers Cartridge body 3D Staple Linear Cutter Cartridge with 3D Staples 3D Staple B-Form Staple
- 18. The Staple FormationContinuum
- 19.
- 20.
- 22. Modern Stapler Types ●Linear staplers ● Linear cutting ● Circular staplers ● Curved cutter ● Skin
- 23. LINEAR STAPLERS ● Closeinternal organs prior to transection ● Close the common opening or enterotomy after the creation of an anastomosis ● Biopsy or wedge resection of the lung and closing of the bronchus and to close pulmonary vessels prior to their division
- 24. LINEAR CUTTER STAPLERS ●Open linear cutter Without selectable height With selectable heights. ● Endoscopic linear cutter Endoscopic Articulating linear Powered Articulating Endoscopic linear cutter
- 26. Features Benefits 6 Row3D Staple Technology • Optimizes tissue compression & provides superior hemostasis Selectable Staple Height • Allows surgeon to choose close staple height without changing reload Proximal Preload Support • Consistent staple formation without fork deflection Two-sided Firing •Ambidextrous use of instrument Intermediate Locking Position • Allows repositioning of tissue Safety Lockout Mechanism • Prevents firing if there is no cartridge or fired cartridge Non-slip grip surface • Tighter & stronger grip
- 27. Without selectable heightWith selectable height 4 rows of B formation 6 rows of 3D technology No selectable height Selectable height One sided firing Two sided firing No gripping surface Gripping surface Preloaded and total 8 firings No preloaded,total 12 firings
- 28. DEVICE CUT LINESTAPLE LINE RELOAD COLOR CLOSED STAPLE HEIGHT ROWS OF STAPLES NTLC55 58 61 Black 1.5 mm 6 1.8 mm 6 2 mm 6 NTLC75 78 81 Black 1.5 mm 6 1.8 mm 6 2 mm 6
- 29.
- 30.
- 31.
- 32. Top features ● Enhancedsystem wise compression Pre compression: Management of tissue before firing 3 point gap control:Ensures alignment and calibration throughout the staple line for consistent staple formation and haemostasis. Precision machined anvil:Removes exudative fluid and prepare for proper staple formation
- 33. ● Stroke firingsystem:Distributes for evenly ● Articulating joint:For lateral access ● Manual Override:In surgeons control in event of power loss ● Anvil jaw release ● Knife reverse switch:Discontinue firing and reverse the knife ● Battery pack:Should be preinstalled before use
- 34.
- 35.
- 36. ● Curved andStraight intraluminal staplers are anastomotic staplers available in four sizes to permit proper matching of instrument to diameter of the lumen. 21 mm 25 mm 29 mm 33 mm
- 37. Number of Reloads/Firings Single–fire instrument and single-patient use
- 38. Uses ● End toend anastomosis e.g. colorectal anastomosis in LAR ● End to side anastomosis e.g. illeocolostomy after right hemicolectomy ● Side to side anastomosis e.g. side to side gastrojejunostomy after billroth II gastrectomy ● Rapid creation of pyloroplasty
- 39. Curved Cutter Staplers ●Curvilinear cutting staplers (contour stapler) transabdominal proctectomy very-low- anterior resection of the rectum
- 40. Features & Benefits ●Simultaneous stapling and cutting Innovative device delivers four curvilinear rows of staples with a single cut between- eliminating two procedure steps: the need for a bowel clamp and scalpel ● Unique curved head design Delivers lower pelvic access with enhanced visibility; it also allows placement of a 40 mm staple line in the width of 30 mm space
- 41. Ease of placement Confirmsto the natural anatomy of the pelvis Lower pelvic access For the narrow pelvis , the CONTOUR exceeds the access of 30 mm linear stapler Reloadable cartridges A single device for up to six firings in a single procedure
- 42.
- 43.
- 48. Anastomotic leaks ● Mechanical/tissue causes –Seen in first two days following surgery. More commonly seen. ● Ischemic causes – ischemic leaks happens 5 to 7 days post operatively
- 49. Advantages of staplingdevices ● Less tissue handling and less tissue tension ● Less trauma ● Time saving ● Better haemostasis ● Available for MIS.
- 50. Contraindications ● If circularhead greater diameter than lumen diameter ● Tissue in tension ● Different lumen diameter
- 51. Types of staplersbased on usage. ● Reusable staplers with disposable catridges. ● Disposable catridges.
- 52. ● The useof stapling does not guarantee the successful outcome of a surgical procedure. ● Effective and safe use of mechanical stapling devices depends upon good basic surgical technique, including clean, atraumatic dissection, careful hemostasis, attention to tissue condition and blood supply, and creation of tension-free anastomoses. "If you wouldn't sew it, don't staple it,” A maxim that is worth remembering. Respect for living tissue lives at the heart of what we do.
- 53.
Editor's Notes
- #45 hkjdflasdigsua