a workman must first sharpen his tools if he is to do his work well。 A successful surgery must have good tools, and an endoscopic stapler plays a crucial role in the operation. An endoscopic stapler is a device used in surgery to replace manual suturing, and its working principle is to use titanium nails to separate or anastomose tissues, similar to a stapler.
In laparoscopic surgery, both intestinal resection and intestinal anastomosis are performed using stapling devices, which are similar to those used in open surgery, but the former has a longer handle. For laparoscopic surgery, controlling tissue margin bleeding after anastomosis is technically more difficult.
In order to enhance the hemostatic effect, current technology has added other auxiliary materials to the narrow opening of laparoscopic anastomosis instruments. Auxiliary materials can be biological (such as bovine pericardium) or artificially synthesized.
In a randomized trial involving 34 patients, patients randomly assigned to the enhanced linear stapler group had significantly fewer bleeding points at the stapler suture site compared to those assigned to the non enhanced linear stapler group for all tissue types studied [gastric tissue (0.4 vs 2.5 sites), jejunal tissue (0.1 vs 0.6 sites), mesenteric tissue (0 vs 0.8 sites)]. Although the conventional use of linear staplers for reinforcement has potential advantages in reducing bleeding, it is necessary to consider two factors: the higher cost of the device and the lack of significant benefits in reducing the incidence of gastrointestinal anastomotic leakage.
Using a special laparoscopic vascular stapler to separate large arteries and veins. The vascular stapler usually needs to be inserted into the abdominal cavity through a 12mm abdominal passage hole. The staple chamber of a stapler usually has 6 rows of anastomotic nails, with 3 rows on each side of the separated tissue (Figure 2). In a pig experimental model, the vascular stapler can close blood vessels (with a maximum arterial diameter of 17mm and a maximum venous diameter of 22mm) and increase the anastomotic burst pressure (>310mmHg) to three times the average systolic pressure.
Choosing a suitable stapler with appropriate nail height is crucial. The final height of the staple depends on the stapler, the selected stapler cartridge, and the tissue itself. If the blood vessels can be easily compressed to 0.75-1.0mm and the stapler with a nail height of 2.0-2.5mm in the nail compartment has excellent hemostatic effect on the vast majority of large arteries. The new generation of staplers, such as Echelon and Endo GIA, use a technique called tissue gap control, which ensures that the final fixed nail height remains consistent throughout the entire length of the anastomotic line.
Generally speaking:
For a 2.0mm nail magazine, the final tissue compression should be between 0.75-1.0mm.
For a 2.5mm nail magazine, the final tissue compression should be between 1.0-1.5mm.
For a 3.5mm nail magazine, the final tissue compression should be between 1.5-2.0.
Using too long or too short staples can cause bleeding after the stapler is fixed. Using short nails on thicker tissues that cannot be compressed to the final nail height can result in weak fixation or tissue tearing. On the contrary, if the nail is too long, it cannot fully compress the tissue and can cause bleeding at the suture site of the stapler.
There are several methods to control the hemostasis of residual bleeding at the suture site of the stapler. For most cases, brief electrocoagulation hemostasis of compressed tissue at the free edge of the nail thread is effective. Titanium clips can also be used at the bleeding point of the stapler suture. Suture and ligation at the suture site, as well as the use of local hemostatic agents, are equally effective, which may be the preferred method of hemostasis in gastrointestinal
