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While the humble surgical stapler may not seem as impressive as the high-definition scopes and towers and other flashy pieces of equipment in your general surgery suite, advances in surgical stapling technology have actually played a huge role in making outpatient abdominal surgery safer, quicker and less invasive than it was even 5 years ago. Let's examine some of these recent developments in surgical stapling devices.
1. Smaller profile. Stapling devices nearly as small as the diameter of a pen give surgeons access to hard-to-reach, almost hidden areas of the abdomen that are very difficult to reach using the open technique. For example, the upper portion of the stomach is well hidden by the left lobe of the liver, the spleen and the diaphragm — all sensitive areas that you want to avoid. Smaller laparoscopes and stapling devices let you maneuver precisely to the surgical site without harming these critical structures.
2. Articulating tips. Laparoscopic instruments with flexible, articulating tips are revolutionizing the way we do minimally invasive abdominal surgery. The newest generation of surgical staplers can be angled in different directions around critical structures by as much as 45 degrees. This feature is very useful in certain types of procedures, particularly those in the pelvis, colon and stomach areas, where you're maneuvering close to vital organs.
3. Multiple suture rows. Many staplers currently on the market can create 3 rows of suture, creating a stronger seal for thicker tissue that can reduce the risk of gapping or breakage along the staple line, which can cause infection.
4. Staple-line reinforcement. Some of the newer stapling systems for laparoscopic surgery feature a pre-loaded thin strip of material that looks almost like cellophane along the staple line. This extra layer helps to buttress and strengthen the staple line to create a better, stronger seal with a reduced risk of bleeding and leaking. These reinforcement strips are getting thinner, stronger and easier to handle with each new generation of surgical staplers.
5. Staples in all shapes and sizes. As the applications and techniques of surgical stapling systems grow and vary, so do the options for the size and thickness of the staples themselves. The thicker the tissue, the thicker the staple you'll need to create an effective seal, while thinner, more delicate tissue will require smaller profile staples. Be aware that there is no one-size-fits-all approach and that your surgeons will need to have staples of different sizes, lengths and thicknesses available to them depending on the type of procedure to ensure a successful outcome.
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Reusable Stapling Devices on the Rise |
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Most manual surgical staplers are entirely disposable, but there's been a shift toward more reusable or semi-reusable endo-mechanicals, including staplers. When determining whether to purchase reusable or disposable stapling devices for your facility, you'll need to consider both the functionality of the device and the requirements for proper cleaning, sterilization and handling of any reusable parts. Disposable staplers still rule the roost at Pinnacle Health System in Harrisburg, Pa., where Luciano DiMarco, DO, FACOS, practices general surgery. "We use all disposable, because we feel that it's safer for the patient. You're getting a fresh blade and fresh equipment every time." He feels that disposables remove the question of whether the device was sterilized appropriately and still works properly. But some advancements in stapling technology require more robust, complex mechanical parts that wouldn't make sense as disposables, notes Sang W. Lee, MD, FACS, FASCRS, associate professor of colon and rectal surgery at Weill-Cornell Medical College in New York, N.Y. "If a reusable device allows you to do things that a disposable doesn't, it's worthwhile," he says, citing the example of computer-driven, powered stapling devices that let users better roticulate and flex the end, as well as more reliably close the stapler around tissue, than a disposable manual stapler would. The powered, computerized part of the device is made from durable materials that stand up well to today's advanced sterilization methods, says Dr. Lee. "As devices become more complex, with more mechanical parts, those parts have to be reusable. And we have a very reliable way to sterilize even the most complex instruments." — Irene Tsikitas |
Still evolving
Advances in surgical stapling technologies have helped to open up a whole new range of possibilities for laparoscopic abdominal surgery. We can now do pretty much any abdominal case laparoscopically. For example, during open bowel surgery, surgeons used to literally open the bowel and expose its contents, which required irrigation and subjected the patient to a higher risk of infection. Now, through a small laparoscopic incision, we can use a staple device to divide and seal the bowel without ever exposing its contents to the rest of the abdomen, a technique that has significantly reduced infection rates associated with this type of surgery.
It's important to recognize that this technology hasn't reached its apex yet. Surgical stapling devices are ever-changing and ever improving to enhance and complement minimally invasive techniques, so it's definitely worth looking into new stapling systems as they come onto the market.
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