In the history of surgical development, the invention of surgical staplers is a milestone. It not only transforms wound suturing from manual to mechanized, simplifies surgical operations, significantly shortens surgical time, and significantly reduces the chances of intraoperative tissue damage, bleeding, and infection, but also makes some previously impossible surgical operations possible, thus bringing great benefits to doctors and patients. So in actual clinical work, what types of staplers are there? How to choose a stapler? Today, let's learn about gastrointestinal staplers.
History of endoscope staplers
In the early days of surgery, when closing tissue layers or performing anastomosis, surgeons had no choice but to use sutures. It was not until the early 20th century that a Hungarian surgeon, Hultl Humer, developed a medical stapler similar to the working principle of a stapler in 1908 and completed the first mechanized surgery in medical history. The invention of the stapler greatly reduced the time it took doctors to suture wounds, so Hultl was hailed as the "father of surgical staplers."
To date, there are many types of staplers, which are divided into two types according to their working principles: press-fit and staple-fit. According to the shape of the stapler, it can be divided into linear cutting staplers, circular cutting staplers, arc-shaped cutting staplers, etc.
1. Linear Stapler
Principle: Place the tissue between the stapler and the stapler anvil, place the positioning needle, set the appropriate thickness according to the tissue thickness scale, turn the firing handle, and the stapler driver will implant two rows of staggered staples into the tissue and bend them into a "B" shape. Before releasing the stapler, remove the excess tissue and the organ to be removed along the edge of the stapler's mouth. After disinfecting the stump with iodine, release and remove the stapler.
Product Features: Although this stapler has only one function, it is widely used. It is mainly used for closing the stumps of bronchus, esophagus, stomach, duodenum, intestine, blood vessels, etc.
Precautions: 1. Different models can be selected according to different tissues, but it should be noted that this type of stapler does not have a cutting function. 2. Before each firing, make sure that the positioning needle has entered the positioning hole correctly. Incorrect positioning of the positioning needle may cause incomplete formation of the staples and affect the closing effect. 3. Do not open the safety before confirming the firing. 4. When firing, hold the firing handle tightly to the bottom. Incomplete firing may lead to incomplete formation of staples, affecting the closure effect.
2. Circular Stapler
For this type of stapler, it can be further divided into circular tube-type (digestive tract) stapler and (anorectal) stapler according to the application situation.
1. Circular tube-type (digestive tract) stapler
Principle: Use double rows of alternating circular staplers for anastomosis. While cutting, the staplers pass through the two layers of tube wall tissue and are blocked by the stapler seat and bent into a "B" shape. The cutting and anastomosis are completed in one go.
Precautions: The intestinal end to be anastomosed should be fully freed and stripped for at least 2cm; the stapler should be withdrawn gently, and the cut tissue should be checked to see if it is a complete ring; the purse string suture needle distance should not exceed 0.5cm, and the margin should be 2-3mm. Excessive tissue is easy to be embedded in the anastomosis, hindering the anastomosis, and be careful not to miss the mucosa.
2. Circular (anorectal) stapler
This type can be divided into: stapler PPH (hemorrhoidal circumferential resection and anastomosis) and TST (open-loop minimally invasive hemorrhoidal stapler). PPH surgical principle: Use a special circular stapler to insert into the rectum through the anus, circularly remove the mucosa and submucosal tissue of the intestinal wall at the lower end of the rectum, and perform anastomosis while removing, so that the prolapsed anal cushion is lifted up, the normal anatomical position of the anal cushion is restored, and the arterial blood branch supplying the hemorrhoids is cut off, so as to achieve the purpose of radical cure. TST surgery follows the formation mechanism of human hemorrhoids. The specific difference between the two is that TST is a selective stapler, which is a new technology developed on the basis of PPH surgery. TST uses a special anorectal scope to form different open-loop windows, uses anastomotic probes to lock hemorrhoids, and adjusts the resection range of hemorrhoidal mucosa according to the size and amount of hemorrhoids, protecting the normal function of the anus to the maximum extent.
3. Linear Cutter
Principle and application: This stapler can simultaneously drive two rows of cross-arranged staples on both sides of the tissue, and then use a push knife to cut and separate the tissues that have been sutured on both sides. At present, this stapler is widely used in clinical practice for side-to-side anastomosis of the stomach and jejunum, side-to-side intestinal anastomosis, tube-type stomach production, incomplete lung rupture, partial lung resection and other surgeries.
Precautions: Do not open the instrument immediately after firing, and keep the instrument in a closed state for 15-20 seconds to enhance the hemostatic effect. The firing process is done in one go, and it should be pushed to the bottom. There should be no pause during firing; the tissue to be fired should be placed within the scale line (pay special attention to the tail end of the tissue) to avoid invalid operation; the semi-locking device should be used correctly, and the tissue to be fired should be flat, without wrinkles and folds.
During surgery, sometimes not only one type of stapler is used, but two or more than a dozen different types of staplers may be used for surgery. Our company produces various types of staplers and meets the needs of multiple departments. Interested parties are welcome to learn more.