Christen Salyer1, Anthony Spuzzillo2, Devin Wakefield2, Dina Gomaa2, Jonathan Thompson2,3, Michael Goodman4,5. 1. Division of Research, Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. 2. Section of General Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA. 3. Standard Bariatrics, Inc., Cincinnati, OH, USA. 4. Section of General Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA. michael.goodman@uc.edu. 5. Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, ML 0558, USA. michael.goodman@uc.edu.
Abstract
BACKGROUND: Optimal stapler selection during laparoscopic sleeve gastrectomy requires careful balance between tissue compression, hemostasis, and mechanical integrity. Junctions along a staple line can further increase the risks of technical or mechanical staple line failures. The aim of this study was to compare two commonly utilized laparoscopic linear gastrointestinal staplers (Ethicon, Medtronic) with a novel linear stapler (Titan) designed to perform a sleeve gastrectomy with a single stapler firing. METHODS: Excised gastric remnants from laparoscopic sleeve gastrectomy were utilized and tissue thickness was measured from fundus to antrum. An optimized experimental staple line was then created. The greater curve remnant was insufflated to determine the staple line burst pressure and location. The doubly stapled (clinical and experimental) gastric specimen underwent staple analysis for junctional location, malformation, and height. RESULTS: The Titan stapler withstood a significantly higher burst pressure than both Ethicon and Medtronic linear cutting staplers. While the Medtronic and Ethicon staplers had a similar percentage of staples in junctions, the Titan stapler has no junctions. In considering the formation of all staples outside of junctions, the Medtronic and Titan staplers had no difference in percentage of malformed staples, while the Ethicon stapler had a significantly higher percentage. Additionally, there were no differences in mismatch between staple height and tissue thickness between experimental groups. CONCLUSIONS: The Titan stapler conveys the mechanical benefits of higher burst pressure with the advantage of single load functionality. This single staple load eliminates staple line junctions without sacrificing the integrity of staple formation.
BACKGROUND: Optimal stapler selection during laparoscopic sleeve gastrectomy requires careful balance between tissue compression, hemostasis, and mechanical integrity. Junctions along a staple line can further increase the risks of technical or mechanical staple line failures. The aim of this study was to compare two commonly utilized laparoscopic linear gastrointestinal staplers (Ethicon, Medtronic) with a novel linear stapler (Titan) designed to perform a sleeve gastrectomy with a single stapler firing. METHODS: Excised gastric remnants from laparoscopic sleeve gastrectomy were utilized and tissue thickness was measured from fundus to antrum. An optimized experimental staple line was then created. The greater curve remnant was insufflated to determine the staple line burst pressure and location. The doubly stapled (clinical and experimental) gastric specimen underwent staple analysis for junctional location, malformation, and height. RESULTS: The Titan stapler withstood a significantly higher burst pressure than both Ethicon and Medtronic linear cutting staplers. While the Medtronic and Ethicon staplers had a similar percentage of staples in junctions, the Titan stapler has no junctions. In considering the formation of all staples outside of junctions, the Medtronic and Titan staplers had no difference in percentage of malformed staples, while the Ethicon stapler had a significantly higher percentage. Additionally, there were no differences in mismatch between staple height and tissue thickness between experimental groups. CONCLUSIONS: The Titan stapler conveys the mechanical benefits of higher burst pressure with the advantage of single load functionality. This single staple load eliminates staple line junctions without sacrificing the integrity of staple formation.
Authors: Piotr Major; Michał Wysocki; Michał Pędziwiatr; Magdalena Pisarska; Piotr Małczak; Mateusz Wierdak; Marcin Dembiński; Marcin Migaczewski; Mateusz Rubinkiewicz; Andrzej Budzyński Journal: Wideochir Inne Tech Maloinwazyjne Date: 2017-09-26 Impact factor: 1.195
Authors: Christen E Salyer; Jonathan Thompson; Aaron Hoffman; Matthew D Burstein; Paul Enochs; Brad M Watkins; Joshua Kuethe; Michael D Goodman Journal: Surg Endosc Date: 2022-01-26 Impact factor: 3.453