Suture technology is one of the foundations of surgical development, and the emergence of staplers represents a further promotion of surgical development by technological progress. It replaces the vast differences in individual suture techniques with precisely designed and standardized instruments, making it safer than manual suturing. Moreover, mechanized suturing also extends the surgeon's hand. Surgical staplers are a special surgical device used to deliver staples to internal tissues during surgery when cutting, transecting, or creating anastomotic sites. It is widely used in surgical procedures such as gastrointestinal, gynecological, and thoracic surgery.
Choosing the appropriate stapler according to different treatment objects has become extremely important in the current widespread use of laparoscopic surgery. Especially when dealing with blood vessels, a suitable stapler is often an important guarantee for the patient's life and health.
All medical devices have a scope of application when registered. Their instructions must clearly state their indications and scope of application. If they exceed this scope, it will involve violations, "explained Director Yu of the Equipment Department at a tertiary hospital. The specific risks of using instruments beyond the scope may include surgical failure, failure to achieve the performance of the instrument, or other risks to the patient.
Strictly speaking, according to medical device regulations, staplers with Class II registration certificates are not allowed to be used for vascular closure and can only be used for tissue closure. The stapler used for blood vessels must have three types of registration certificates. Choosing the appropriate classification of staplers based on different processing objects has become extremely important in the current widespread use of laparoscopic surgery. Especially when dealing with blood vessels, a suitable stapler is often an important guarantee for the patient's life and health.
Improper firing position of stapler leads to ischemia
Choosing the position of the anvil head can be done according to the physician's habits, either in front, in the center, or behind the closed line; Secondly, it must depend on the specific anatomical situation. In principle, it is required that the position where the anvil head penetrates should be as close as possible to the closure line (even if the closure line is close to the center of the cutting ring), so that the angle between the cutting ring and the closure line on the front and back sides is similar, and small acute angles should be avoided as much as possible, which can increase the chance of anastomotic leakage due to local ischemia. Especially during rectal anastomosis, as the posterior wall of the rectum itself is a potential ischemic area anatomically, the occurrence of acute ischemic areas that exacerbate ischemia can increase the risk of anastomotic leakage.
Bleeding at the anastomotic site or anastomotic site
The design of suturing instruments uses two rows of interlocking staples, which cannot fully nail submucosal blood vessels. In addition to the mechanical design characteristics, other possible reasons include insufficient treatment of anastomotic vessels and/or adipose tissue, thin or thick intestinal walls, sparse staples in some suturing instruments, closure defects caused by non firing staples, and incomplete cutting. Small bleeding after nailing is common and usually does not require treatment, but there are also some bleeding that is more obvious and needs to be treated. For bleeding after closure, suturing or electrocoagulation can be used (such as directly cutting open the closed intestinal tract with electrocoagulation). If using electrocoagulation method, be sure not to touch the suture nail, as the conductivity of the suture nail can cause sheet-like tissue damage. The bleeding caused by cutting open the stapler and stapler mostly occurs after anastomosis.
Intraoperative treatment methods
Stitching with absorbable thread from the mucosal surface is more accurate, but the disadvantage is that it is prone to contamination. However, in low rectal anastomosis, it can only be sutured through the anus from the cavity; Bleeding from other gastrointestinal anastomosis sites can also be sutured from the serosal surface, which can generally achieve hemostasis and is not easily contaminated. If there are mesenteric blood vessels near the anastomotic line, bleeding is likely to occur on the mucosal surface opposite to these areas. At this time, suturing the muscular layer can also achieve hemostasis.
Postoperative treatment methods
Bleeding at the anastomotic site can also occur after surgery, manifested as gastric tube bleeding, rectal bleeding, and accompanied by abdominal and pelvic drainage tube bleeding or gastrointestinal contents, indicating anastomotic defects. Conservative treatment for postoperative bleeding without anastomotic defects is often effective, including systemic use of hemostatic drugs, local infusion of saline and hemostatic drugs, endoscopic spraying of hemostatic drugs, or clamping of bleeding points with hemostatic clips. If there is a defect in the anastomosis, it is recommended to undergo surgery as soon as possible, or to suture the defect through the anus or open the abdomen for treatment. Prevention should be emphasized over treatment.