The advancement of surgical instruments is also constantly promoting the development of surgical technology. At present, the use of surgical staplers has brought huge benefits to doctors and patients, improved surgical techniques, and improved the quality of life of patients. In the field of surgery, staplers have been comprehensively developed and improved. They not only make surgical operations mechanized, but also improve the safety of surgical operations.
So in actual clinical work, what types of staplers are there? How to choose a stapler? Next, I will take you into the world of commonly used staplers in gastrointestinal surgery.
Development of surgical staplers
At the beginning of the 20th century, foreign experts had already started research on staplers, but the instruments were bulky, time-consuming to load and unload, and too large to be used clinically. With the continuous exploration and improvement of experts, staplers are getting closer and closer to clinical application. The surgical stapler (Auto Suture) that is truly widely used in clinical practice was created and invented by the United States Surgical Company (USSC) in the 1960s. In 1967, the closure stapler (TA) was first introduced, in 1968, the cutting stapler (GIA) was first introduced, and in 1978, the end-to-end stapler (EEA) was first introduced, creating a milestone in the history of modern surgery.
Basic working principle of stapler
The working principle of various staplers and staplers is similar to that of staplers, so they are collectively called STAPLER, which means firing two or three rows of staggered staples into the tissue to cross-stapling the tissue. Various staplers and staplers all strive to achieve "B"-shaped suturing.
The main components of the stapler include the staple drill, stapler brake, stapler magazine, stapler driver, firing handle, positioning needle, knob and marking ruler, etc.
Types and functions of surgical staplers
Cutting and closing device
1. Linear closing device
Provides two rows of staples spaced apart from each other to close the tissue in a linear manner without cutting function. Suitable for thoracic surgery, gastrointestinal surgery, hepatobiliary surgery, such as lung bag, main bronchus, portal vein, pancreatic head and distal rectum surgery, etc.
Laparoscopic linear closing device
The stapler head of most laparoscopic closing devices can change direction, which is more flexible to operate in a narrow surgical space; at the same time, a disposable safety device is provided to avoid secondary firing of the used stapler, ensuring the safety of the operation;
At the same time, the wide front opening of the stapler is convenient for tissue inclusion; this type of stapler has a total of 6 rows of staples, and there are blades in the stapler. While stapling, the blade cuts the tissue from the middle, so that 3 rows of staples on each side complete the functions of suturing and hemostasis;
In addition, there are now electric laparoscopic closing devices, which are more convenient to cut than manual operation.
Note: Before releasing the stapler, remove the excess tissue and the organ to be removed along the edge of the stapler mouth, disinfect the broken end with iodine, and then release and remove the stapler.
Ensure that the anastomosis is free of tension; ensure blood supply to the anastomosis; be sure to select a nail gate with the corresponding nail leg length according to the thickness of the tissue, and push the blade to cut and separate in the middle of the titanium nail line.
2. Linear (straight) cutting closure (GIA)
This stapler can simultaneously drive three rows of cross-arranged staples on both sides of the tissue, and then use a push knife to cut and separate between the sutured tissues on both sides, which is used to cut and suture tissues. It is suitable for thoracic surgery, general surgery, urology, obstetrics and gynecology, such as lobectomy, gastrointestinal anastomosis, etc.
GIA has a larger opening and closing mouth, which helps to adjust the position; many GIA firing button designs can be operated on both sides; at the same time, GIA is generally equipped with nail magazines of different lengths, suitable for different surgical needs.
Notes:
Do not open the device immediately after firing. Keep the device closed for 15-20 seconds to enhance the hemostatic effect.
The firing process should be completed in one go, and the device should be pushed all the way to the bottom without stopping 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 correct use of the semi-locking device requires the tissue to be fired to be flat, without wrinkles or folds.
3. Arc-shaped cutting stapler
It has the characteristics of small size and suitable for pelvic anatomy, and has certain advantages in low rectal cancer anal preservation surgery; cutting and suturing are completed simultaneously; the arc-shaped head end design is easy to insert into the pelvic cavity; replaceable stapler.
Precautions: Ensure that the anastomosis is free of tension. Under the premise of radical cure, moderately resect the proximal colon. When the anastomosis is suspected to have tension, the proximal colon should be fully freed or the splenic flexure of the colon should be loosened;
Choice of anastomotic site: The anastomosis should be made on the dorsal side of the midpoint of the rectal closed edge, and the lower rectal resection of the intestinal wall should contain part of the rectal closed edge. Because the free range of the dorsal side of the rectum is usually larger than the ventral side, and the blood supply is relatively poor. Anastomosis here can reduce the blood-free area on the dorsal side.
After anastomosis, perform anal digital examination to check whether the staples are in a regular circle. Female patients routinely check the posterior wall of the vagina to ensure that there is no anastomotic damage.
It is used for the anastomosis of various cavities. Two rows of circular cross-arranged staples can be driven into the cavity tissue to suture the two layers of cavity tissue together. The built-in circular knife removes excess tissue to form a circular anastomosis to complete the anastomosis of the cavity.
Currently, it is mainly used for end-to-end anastomosis and end-to-side anastomosis of the digestive tract such as the esophagus, stomach, and intestine.
Precautions for surgical staplers in clinical applications:
The application of surgical staplers has brought great convenience to surgical operations. Various staplers are simple, easy to use, safe and reliable as a whole, but improper use can also lead to surgical failure and cause unnecessary trouble.
During the use process, surgeons should master the basic working principles of staplers, be familiar with the structural performance of various types of staplers, master their correct operation methods, and strictly abide by their operating procedures and usage skills.
For example, when using, pay attention to the correct placement of tissues; the operation should be smooth; after firing, check the hemostasis of the incision and the nailing status.
Surgical staplers have many advantages and are now recognized by surgeons. With its introduction, suturing and anastomosis, which were originally difficult to operate manually due to narrow surgical fields, deep locations, have become easier, and the operation time has been greatly shortened, reducing surgical complications.
However, the correct and reasonable use of staplers is the key to successful surgery and the prevention of complications. In order to improve the application level of staplers, surgeons must master the correct use methods to better serve patients.