![]() ![]() Gastrointestinal anastomotic staplers/skin staplers/linear staplers/circular staplers/curved cutters/articulation linear cutters What does an optimal staple line look like? How many rows are “right”? What should a staple look like when the stapler is deployed? How does the staple shape affect outcomes? To improve surgeons’ understanding of staplers and stapler–tissue interactions with the goal being to optimize the clinical outcome and fill this knowledge gap, a framework is needed within which the existing literature can be reviewed and the available data gathered and made accessible ( Table 1). 1, 3 Many surgeons are not aware of the tissue handling characteristics and limitations of new or reengineered staplers, and thus there is a knowledge gap that can impact the clinical outcome of operations. 2 Of these, technical errors can play a significant role, potentially increasing the risk of bleeding, transfusions, and unplanned proximal diversions, particularly in gastrointestinal procedures. ![]() Although these devices are highly versatile and efficient, there have been well-documented incidences of staple line leaks leading to postoperative complications that often resulted from issues not attributable to ischemia. The surgical stapler is an example of a device that is commonly used during surgical procedures and, at the same time, is in an almost constant state of developmental evolution. Consequently, surgeons may often fall back on their own experience, exercise their own judgment, or rely on anecdotal evidence, which may translate into suboptimal patient outcomes, even if the devices themselves function correctly. In many cases, surgeons may not understand either the scientific/clinical basis for the optimal use of these devices or how to optimally take advantage of unique intricacies inherent to a particular device. Both the ongoing introduction of new devices and continuing technical improvements in existing devices are changing the way surgeons perform traditional tasks and enabling them to develop new surgical techniques with the goal of improving patient outcomes.Īn unintended consequence of these rapid technological advances is the production of a collective “knowledge gap” in surgeons’ understanding of how devices interact with tissue. Technological advances across numerous scientific disciplines have produced many unique surgical devices and instruments that are used during surgery. It is hoped that the framework presented in this review will facilitate this process. Educational programs need to be established to inform and update surgeons on the characteristics of each stapler. The surgeon’s experience, therefore, is a critical factor. ![]() These studies reinforce the universal theme that compression, staple height, tissue thickness, tissue compressibility, and tissue type must all be considered by the surgeon prior to choosing a stapler and cartridge. The correct staple height will vary depending on these tissue-specific properties and the tissue pathology. The thickness of each tissue varies as do the intrinsic biomechanical properties that determine the ideal compressive force and prefiring compression time for each tissue type. It is clear from this review that each tissue type presents unique challenges. Understanding how staplers interact with target tissues is key to improving patient outcomes. This review focuses on published studies that evaluated the creation of stable anastomoses in bariatric, thoracic, and colorectal procedures. The integrity of the staple line, which depends on adequate tissue compression, is the primary factor in creating a stable anastomosis. Surgical staplers, which are continually being developed, are the focus of this piece. The goal of this review is to present a framework for the study of device– tissue interactions and to initiate the process of “filling in” the knowledge gap via the available literature. However, most surgeons are unaware of these attributes and, therefore, new device introduction creates a “knowledge gap” that is potentially dangerous. Each new device has benefits and limitations in regards to tissue interactions that, if known, allow for optimal use. The introduction of both new surgical devices and reengineered existing devices leads to modifications in the way traditional tasks are carried out and allows for the development of new surgical techniques.
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