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Results for “Surgical Stapling”

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PubMed1996

Positive surgical margins with radical prostatectomy: detailed pathological analysis and prognosis.

OBJECTIVES: To examine the extent and location of positive surgical margins and their influence on progression. METHODS: Two hundred fifteen consecutive radical prostatectomy specimens, using 2 to 3-mm step-sections, were reviewed. Particular attention was paid to the location and extent of positive margins. Seventy-three patients (34%) with one or more positive margins were subjected to further detailed analysis. Progression was defined as a serum prostate-specific antigen level greater than 0.1 ng/mL and rising. The mean follow-up period was 23.2 months; median 24 months (range 3 to 40). RESULTS: Margin-positive patients had a significantly higher biopsy tumor grape (P = 0.05) than did margin-negative patients. Capsular preforation was present in 75%, seminal vesicle invasion in 33%, and nodal metastases in 10% of margin-positive patients; in contrast, these tumor characteristics were present in 47%, 8%, and 1% of margin-negative patients, respectively. The extent of involvement of linked margins was focal in 22% and extensive in 66%. An equivocal margin identified as surgical incision into the specimen (due to hemostatic staples, surgical dissection, or retraction) was present in 12%. Seventy-one percent of patients had a positive margin at only one location. Of all 99 positive-margin locations, 40% were apical, 10% anterior, 8% bladder neck, 16% posterolateral, and 25% posterior. Thirty-four percent of margin-positive and 7% of the margin-negative patients demonstrated biochemical progression. Of the 36 patients with a positive margin as their only major risk factor for progression (seminal vesicle and lymph node negative, Gleason score less than 8), 25% have progressed. Progression occurred in 2 of 9 patients with an equivocal positive margin, and 5 of 16 with a single focal-positive margin. A multivariate analysis of margin-positive patients identified tumor volume and grade as the most significant predictors, with the location and extent of the positive margin not significant. CONCLUSIONS: Although more frequent at the prostatic apex, tumor at the inked margin at any location is a risk factor for postoperative biochemical progression.

Adult↗

PubMed1991

Recurrence of colorectal cancer after sutured and stapled large bowel anastomoses.

The purpose of this study was to compare surgical stapling and manual suturing techniques with respect to the incidence of tumour recurrence in patients with colorectal cancer: 294 patients undergoing potentially curative resections for colorectal cancer were randomly allocated to receive sutured (n = 142) or stapled (n = 152) anastomoses. The mean (s.e.m.) incidence of tumour recurrence at the end of 24 months was 29.4(4.4) per cent in the sutured group, compared with 19.1(3.9) per cent in the stapled group (P less than 0.05). The corresponding rates for cancer-specific mortality at 24 months were 22.3(4.1) per cent and 10.9(3.0) per cent respectively (P less than 0.01). A multiple regression analysis revealed that the influence of anastomotic technique on recurrence and mortality rate was independent of tumour stage. These results suggest that in colorectal cancer surgery the use of stapling instruments for anastomotic construction could be associated with a reduction in the incidence of recurrence and mortality rate by as much as 50 per cent.

Aged↗

PubMed2000

Stapled versus hand sewn anastomoses in patients with small bowel injury: a changing perspective.

INTRODUCTION: Recent studies indicate that trauma patients with hollow viscus injuries requiring anastomosis who are managed with stapling have a higher rate of complications than do those in whom a hand-sewn anastomosis is used. We undertook this study to determine whether this finding applied to patients with small bowel trauma at our institution. METHODS: Records of patients with small bowel injuries were retrospectively reviewed. Demographics, severity of injury, injury management, and outcome data were collected. RESULTS: Patients who had their small bowel injuries managed by hand-sewn repair versus resection and stapled anastomosis demonstrated a nonsignificant decrease in overall complication rate (35% vs. 44%) and rate of intra-abdominal complication (10% vs. 18%). Yet the rate of intra-abdominal abscess formation was significantly lower with hand-sewn repair than with resection and stapled anastomosis (4% vs. 13%). However, when hand-sewn primary repairs were excluded from the analysis and injuries that required resection and either stapled or hand-sewn anastomosis were compared, there was a similar overall complication rate (41% vs. 41%) and rate of intra-abdominal complications (17% vs. 21%). CONCLUSION: The rate of intra-abdominal complications did not differ significantly between patients requiring small bowel resection and reanastomosis managed by either a stapled or hand-sewn technique. In our experience, surgical stapling devices appear to be safe for use in repairing traumatic small bowel injury.

Abdominal Injuries↗

PubMed1989

Heart-lung transplantation. Technical modifications that may improve the early outcome.

After heart-lung transplantation, mortality and morbidity remain related, to a significant degree, to surgical problems such as uncontrollable bleeding, phrenic nerve palsy, and dehiscence of the tracheal anastomosis. The following modifications of the original Stanford technique were designed: (1) Back bleeding from the graft is avoided; (2) dissection of the posterior mediastinum is limited as much as possible, with only the tracheobronchial bifurcation being dissected free; (3) surgical stapling is extensively used to optimize hemostasis; (4) the surgical procedure is kept away from the phrenic and vagus nerves; (5) early corticosteroid therapy is avoided and the tracheal anastomosis may be wrapped with a pedicle of great omentum. These techniques were used in 21 patients. Postoperative bleeding remained minimal and never necessitated reoperation. There was no instance of phrenic nerve palsy. Dehiscence of the tracheal anastomosis occurred in two patients during the initial experience, but in subsequent patients this complication was prevented by adequate improvements (omentoplasty and avoidance of corticosteroids). Our technical modifications may reduce the risk of early surgical complications and thereby improve the early outcome and leave the patient in better condition to face the other hazards of heart-lung transplantation.

Adolescent↗

PubMed2006

Spread of malignant cells in the surgical margin with stapled excision of lung cancer: comparison of aggressive clump and less traumatic jaw closure type staplers.

BACKGROUND: During stapled excision of lung cancer tissue, malignant cells can spread in the surgical margin. Stapling methods can be classified as aggressive clumping (AC) and less traumatic jaw closing (LTJC) types, thus the ratio of malignant margins may differ between stapler types. METHODS: The malignant status of the stapled margin was retrospectively investigated in 112 cases using a cytology technique. Stapler type, maximum tumor diameter, distance from surgical margin, thoracotomy type, and tumor location were used as variables. In addition, clinical results of excision cases were assessed. RESULTS: The ratio of malignant margins was 22/54 (41 %) in the AC group and 11/58 (19 %) in the LTJC group ( P = 0.01). Multivariate analysis revealed that the stapling method and tumor location were an independently significant factor. Surgical margin recurrence occurred only in 4 (57 %) of 7 cases with malignant margin. CONCLUSIONS: The AC type method showed a greater potential to spread malignant cells, thus there seems to be a higher possibility of regional relapse with that technique.

Aged↗

PubMed1990

Absorbable staples in continent ileal urinary pouch.

Continent ileal urinary reservoirs were created in dogs to study absorbable surgical staples. Within each pouch, certain controlled observations were possible. The staples and chemically similar polyglactin absorbable sutures caused almost identical tissue reactions. The staples outlasted the sutures, probably because of greater size. Inverted and everted staple closures worked equally well. It appears feasible to consider clinical urinary diversion with absorbable staples, a time-saving method.

Animals↗

PubMed1991

Vaginal cuff closure at abdominal hysterectomy: comparing sutures with absorbable staples.

To compare two methods of vaginal cuff closure during abdominal hysterectomy, 60 patients were randomized to one of two cuff-closure methods. The vaginal cuff was closed with three interrupted 0-Dexon sutures in 30 and with absorbable staples in 30. Both groups were similar with respect to age, gravidity, parity, preoperative indication, hemoglobin, and hematocrit. The operative technique and quantity of irrigation used was standardized. Operative blood loss was calculated by the weight method and an unactivated, medium flat Jackson-Pratt drain was left in place for collecting postoperative cuff cultures at 24 and 48 hours. The mean operative times in the suture group (97.4 minutes) and staple group (93.4 minutes) were not significantly different (P greater than .05). Cuff-closure time was more rapid (P = .0001) in the staple group (5.8 minutes) than in the suture group (9.3 minutes). Intraoperative cultures were positive in eight of 30 suture patients (26.7%) and eight of 30 staple patients (26.7%). Postoperative cultures at either 24 or 48 hours were positive in four women (13.3%) in the suture group and six (20%) in the staple group. Febrile morbidity occurred in six (20%) in each group. Three staple and two suture subjects developed a vaginal cuff abscess or hematoma, one of whom was readmitted to the hospital for intravenous antibiotics and draining of the vaginal cuff abscess. The presence of a positive vaginal cuff culture did not predict clinical outcome. Based on these observations and the increased cost of the stapling device, we conclude that there is no significant clinical advantage of surgical staples over traditional sutures for vaginal cuff closure at abdominal hysterectomy.

Adult↗

PubMed1991

A simplified technique for continent urinary diversion: an all-stapled colonic reservoir.

A simple continent colonic reservoir was constructed in its entirety with the aid of surgical stapling techniques in 17 men and 10 women. In 5 men an orthotopic pouch was created and in the rest a continent stoma was designed. Detubularization of the entire colonic segment assures a low pressure system with disruption of directional peristaltic activity. The ureters are implanted by simply burying them in a mucosal furrow. Operative time required for the creation of the reservoir (excluding time for cystectomy) has ranged between 70 and 140 minutes (mean 95.4 minutes). With a followup of 9 to 60 months (mean 22.8 months) continence has been achieved in all but 1 patient with no ureteral reflux or obstruction. Urodynamically the pouch has achieved a large capacity (mean 750 cc) with low filling pressures (8.1 cm. water) because of technical ease of construction together with a shortened operative time due to the stapling techniques. This form of bladder replacement offers an option for select patients in whom continent urinary diversion is contemplated.

Adult↗

PubMed1989

Anastomotic narrowing after esophagogastrectomy with the EEA stapling device.

We studied a series of 176 patients undergoing esophageal resection with the aid of the EEA surgical stapling device (Auto Suture U.K. Limited, Great Britain) during a period of 7 1/2 years. A total of 160 patients (91%) were operated on for malignant disease. Operative death occurred in 15 patients (8.5%), and there were three anastomotic leaks (1.7%). The prevalence of dysphagia caused by both benign and malignant strictures after esophageal resection in which the EEA stapler was used was 17.4%. The rate of benign anastomotic narrowing in discharged patients was 12.5%. Anastomotic stricture resulting from recurrent tumor caused dysphagia in 6.2% of the patients undergoing resection for malignant disease. The highest rate of benign anastomotic narrowing occurred in patients who had undergone esophageal resection for benign, nondilatable strictures. In these patients, the prevalence of benign anastomotic narrowing was 37.5%, compared with 9.6% in the patients undergoing resection for malignant disease (p less than 0.001). An additional trend was noted: The smaller the stapling head used to construct the anastomosis, the higher the prevalence of benign anastomotic narrowing; however, a statistically significant difference could not be documented. Ninety-five percent of patients with benign anastomotic narrowings complained of dysphagia within the first 6 months after the operation; 79% of these patients required two or fewer dilatations to relieve the dysphagia. Dysphagia after esophageal resection with the aid of EEA stapler occurred in just over one of six patients. The usual cause of the dysphagia was benign anastomotic narrowing, which responds well to dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗

PubMed1990

Staple gun in the surgery of hypopharyngeal diverticula.

There have been many approaches advocated over the years for the surgical management of hypopharyngeal diverticulum, and this is a reflection of the absence of an ideal method both in terms of the surgical technique and of the frequency and severity of complications. Further experience with the use of the surgical staple gun is presented together with a discussion of its use in comparison with other operative methods. The ease and speed of the technique combined with a negligible complication rate suggest that it is a viable method for the management of large diverticula.

Aged↗

PubMedDate not supplied

Experimental large colon resection at the cecocolic ligament in the horse.

Ten normal horses had approximately 95% of the length of the large colon resected with a side-to-side anastomosis between right ventral and right dorsal colon performed with surgical stapling equipment. Four horses died shortly after surgery of colitis (1 horse) or failure of the TA 90 transection staple line (3 horses). Another horse died 4 months after surgery from disseminated streptococcal infection but had recovered well from the colon resection. Five horses survived long term (18 months) with no clinical evidence of adverse effects of the resection. Surviving horses had weight loss and soft fecal consistency for 3 to 12 weeks after surgery but returned to preoperative values within 12 months. At a second surgery 1 year later (5 horses) or at necropsy 4 months later (1 horse), fibrous omental adhesions were present over the transection staple line in four horses and over the anastomotic staple line in two horses. Omental adhesions to the everted staple line were moderate but not associated with any clinical sequellae. An incisional hernia was present in one horse. The anastomotic stomata measured between 8 and 9 cm, which was 60% of the size of the original surgically created stomata. Failure of the transection staple line occurred in the first three of five horses in which the procedure was attempted due to improper configuration of the staples or crushing of the tissue between the staples. Experience corrected this complication.

Anastomosis, Surgical↗

PubMed1978

Complication with mechanical stapling device in creation of ileoconduit.

Of 296 patients with pelvic malignancy and ileal urinary conduits, urinary tract calculi developed in 14. Calculi which ordinarily require surgical intervention because of their size may pass spontaneously in patients with ileoconduits because of the presence of a chronically dilated colllecting system and the surgical elimination of three of the four sites of stone impaction (pelvic brim, ureterovesical junction, and ureteral orifice). In 1 patient multiple calculi developed around the surgical staples used to create the proximal end of the ileal conduit. We recommend that autosuture with stapling devices not be used to create the proximal end of an ileal urinary conduit.

Carcinoma↗

PubMed1991

Suturing or stapling in gastrointestinal surgery: a prospective randomized study. West of Scotland and Highland Anastomosis Study Group.

A prospective randomized study of 1004 patients is reported, comparing surgical stapling and manual suturing techniques in the construction of gastrointestinal anastomoses. The incidence of clinical leaks was similar between the two groups (sutured 3.2 per cent, stapled 4.7 per cent; P = 0.22), while for radiological leaks the incidence was significantly higher in the sutured group (12.2 per cent versus 4.1 per cent, P less than 0.05). Stapling instruments afforded significantly quicker anastomoses, mean(s.e.m.) 28.1(0.7) versus 14.3(0.5) min (P less than 0.001), and quicker operations, 115.5(2.4) versus 103.8(2.2) min (P less than 0.001). The two groups were found to be comparable in other respects such as operative mortality, requirements for blood transfusion, incidence of infective complications, recovery of gastrointestinal function and postoperative hospital stay.

Aged↗

PubMed1989

The use of the Roticulator TA device as a protractor and technical aid in performing double-stapled anastomosis of the colon and rectum.

The use of the Roticulator TA instrument has been proposed to facilitate the passage of the EEA stapling device. It has been said that we are out of the stage of amazement and into the age of refinement with surgical stapling procedures. We are hopeful that this small refinement will further simplify the double-stapled anastomosis of the colon and rectum.

Anastomosis, Surgical↗

PubMed1978

Construction of pancreaticocystogastrostomy using an automatic stapling device.

The difficulties in employing standard techniques in the management of pancreatic pseudocysts led to the development and evaluation of a new approach. The advent of surgical stapling instruments has allowed the anastomotic procedures to be done in a more expeditious manner. For that reason, it was decided to treat pancreatic pseudocysts in two patients by constructing a pancreaticocystogastrostomy with the use of an automatic stapling instrument. The performance of the technique and the uneventful postoperative course encourages its continued use in cysts that are adjacent to the posterior gastric wall.

Adult↗

PubMedDate not supplied

Stapleless laparoscopic assisted radical cystectomy with ileal neobladder in a male and with ileal loop in a female: initial report from Brazil.

INTRODUCTION: Here, we report our initial experience with laparoscopic assisted radical cystectomy without the use of surgical staples. CASES REPORT: A 70 year old male and a 55 year old female were diagnosed to have T2G3 transitional cell carcinoma of the bladder with negative metastatic work-out. Both patients were scheduled and agreed to a laparoscopic assisted radical cystectomy. In both cases, urinary diversion (orthotopic ileal Studer neobladder in the male and ileal conduit in the female) was performed extracorporeally following radical cystectomy. In both cases control of the bladder vascular pedicle was accomplished with a combination of metallic and hem-o-lock clips. The total surgical time was 6.5 hours in both cases. Estimated intra-operative blood loss was 500 cc and 350 cc respectively, however both patients required postoperative blood transfusions. No intraoperative complications occurred. In both cases, pathology revealed negative surgical margins. CONCLUSIONS: Extracorporeal creation of urinary diversion decrease the overall operative time. Laparoscopic pelvic lymphadenectomy can be performed following the extended template. The use of surgical clips instead of vascular Endo-GIA titanium staples to control the bladder vascular pedicles is feasible and safe in selected patients, thus reducing intraoperative surgical costs. Considerable experience with laparoscopic radical prostatectomy is necessary before one attempts laparoscopic radical cystectomy.

Aged↗

PubMedDate not supplied

Use of disposable stapler in operative cystogastrostomy for pancreatic pseudocyst.

Surgical stapling techniques are widely used in gastrointestinal surgery. These procedures are excellent in convenience and safety. We describe here a new practical application of the surgical disposable stapler, Auto Suture Premium Plus CEEA 34 circular stapler, for the operative drainage of a large symptomatic pancreatic pseudocyst. A 68 year-old man underwent an operative cystogastrostomy using this instrument. His post-operative recovery was uneventful. He is free from symptoms, and abdominal tomography shows complete disappearance of the cystic cavity. We believe that this is the first clinical paper that reports on the stapled cystogastrostomy. This instrument is very useful for creating a stapled cystogastrostomy, similar to one created in the standard open approach.

Aged↗

PubMed1993

VATS wedge resection of the lung using the neodymium:yttrium-aluminum garnet laser.

Many thoracic surgical procedures previously performed using open thoracotomy techniques can now be accomplished using video-assisted thoracic surgical approaches. This has primarily resulted from improvements in both the video and surgical instrumentation and the development of an effective endoscopic surgical stapling device. Laser technology that has been adapted for use in endoscopic surgery has been extended to video-assisted thoracic surgical applications for the resection of pulmonary nodules difficult to manage with the endoscopic stapler alone. We present our experience with the neodymium:yttrium-aluminum garnet laser as either a primary resective tool or as an adjunct to the endoscopic stapler in 67 consecutive patients who underwent video-assisted thoracic surgical wedge resection of the lung.

Female↗