Basic principles of suturing in the use of the Endoscopic Linear Cutter Stapler.
01. Ensure good alignment of the sutured wound or wounds: suturing should be performed in layers, according to the anatomical level of the tissue, so that the tissue levels are tightly packed, do not involve or sew into other tissues, do not leave residual cavities, and prevent fluid accumulation, blood accumulation and infection. The margin distance and needle spacing of the suture must be uniform and consistent.
02. Pay attention to the tension of the suture: the tightness of the ligature suture should be such that the edges of the incision are closely connected, and should not be too tight.
03. The selection of sutures and suture needles should be appropriate.
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2. Specification of sutures in the Endoscopic Linear Cutter Stapler
The specification of the suture is indicated by a number. The specification indicates the diameter of the suture, and the larger the number, the thicker the suture. For example, a size 4 thread is thicker than a size 1 thread, and the tensile strength is also greater. Generally, there are 1 to 10 threads, and below 0, the more 0s, the smaller the diameter and the lower the tensile strength.
The tensile strength of a suture knot is the amount of force (expressed in pounds) it can withstand before it breaks. The tensile strength of the tissue in question is a prerequisite for the surgeon's choice of suture type and tensile strength. It is generally accepted that the tensile strength of a suture does not need to exceed the tensile strength of the tissue, but should be at least as strong as the normal tissue it is being sutured to.
Suture material
The following materials are currently used in the Endoscopic Linear Cutter Stapler procedure.
(1) Silk thread: widely used, inexpensive and strong, easy to use, still occupies most of the surgical suture market, but the absorption cycle is more than 1 year and is non-absorbable.
(2) Sheep intestine thread: Sheep intestine thread is the traditional absorbable surgical suture, which has been gradually replaced due to its inherent insurmountable defects.
(3) Polyethyleneglycolate (PGA) and polyethyleneglycolate propyleneglycolate (PGLA) absorbable sutures: due to their good biocompatibility and secure fixation, they are used more and more widely in clinical practice.
(4) Single-fiber and multi-fiber sutures: Single-fiber sutures encounter less resistance when crossing tissues and avoid bacterial adhesion on them, which are suitable for vascular surgery or contaminated wound closure. Single fiber sutures are easy to knot, but are less strong and can break if the suture folds or curls during the ligation process.
2. Endoscopic Linear Cutter Stapler
Types of suture needles.
1. According to the cross-sectional shape of the needle tip: round needles; angled needles (sharp, mostly used for suturing skin); round body angled needles; spade needles (mainly used for ophthalmic surgery); blunt needles.
2. According to the curvature of the needle: 12 arc; 318 arc (mostly used for suture skin); 5/8 arc; straight needle; 14 arc (mostly used for ophthalmic surgery)
3. Master the correct way to hold the needle of Endoscopic Linear Cutter Stapler
(1) Using the Endoscopic Linear Cutter Stapler method
The bite of the needle holder of the Endoscopic Linear Cutter Stapler should match the size of the suture needle. The contact point between the needle holder and the suture needle should be located at the wide oval of the body of the suture needle, equivalent to 1/3 to 1/2 of the length of the suture needle, so that the contact area between the needle holder and the suture needle is maximized, which is conducive to the needle holder's stable control of the suture needle and avoids suture needle shaking and twisting during tissue suturing. The needle should be positioned in such a way that the needle holder and the needle are in maximum contact to facilitate stable control of the suture needle and to avoid suture needle shaking and twisting during tissue closure. The needle and the needle holder should be perpendicular to each other, and the needle holder should not over-clamp the needle during suturing; the needle holder should only hold the needle until it is initially engaged.
(2) Mastering the correct way to hold the needle holder
Place the thumb and ring finger in the ring of the needle holder and place the index finger on the needle holder for a stable grip, or hold the entire needle holder in the palm of the hand for increased dexterity.
Surgical disposable staplers and staples are medical devices that can be used in place of sutures. They allow faster closure of large wounds or incisions and are less painful for the patient than sutures. They can also be used to close wounds in areas where the skin is close to the bone and for procedures that remove organs or reattach parts of internal organs.
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They are useful in minimally invasive surgery because they require only a narrow opening to quickly cut and seal tissue and blood vessels. Skin sutures are used externally to close the skin under high tension, for example on the skull or body trunk.
Common materials used for staples in surgery include stainless steel and titanium. These are strong metals and tend to cause little or no problems for patients during surgical procedures.
However, plastic staples are often used for people who are allergic to metals or to reduce scar tissue. Staples made of plastic or metal do not dissolve like many sutures, so extra care must be taken to prevent infection.
Staples made from polypropylene and polyethyleneglycol are intended to be reabsorbed by the body. They are often used in cosmetic surgery because, like plastic staples, they reduce scarring.
Surgical staplers work by compressing tissue, joining two pieces of tissue with interlocking B-shaped surgical staples, and, in some models, cutting away excess tissue to create a clean closure of the surgical wound.
There are several designs for different types of surgery, most of which are classified as linear or circular. Linear staplers are used to attach tissue or remove organs during minimally invasive surgery. Disposable circular staplers are commonly used for procedures involving the digestive tract from the throat to the colon.
When using a disposable linear stapler, the surgeon uses a handle on one end to close the "jaws" of the other end of the suture on the tissue.
The circular stapler fires two interlocking rows of staples from a circular cassette. This circular layout allows the anastomosis to connect two sections or another tubular structure after a portion of the intestine has been removed. The staples allow the tissue to be sandwiched between the staples to form a ring or doughnut. The built-in blade then cuts away the overlying tissue and seals the new connection.
The surgeon observes the closed wound for approximately 30 seconds to ensure that the tissue has been properly squeezed together and to confirm that there is no bleeding.
Surgical staplers are used in gastrointestinal surgeries across the country. In fact, they have been in use for over half a century. However, over 92,000 of them have been recalled recently due to documented evidence of their causing significant injuries and death.
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Injuries linked to surgical staplers include internal organ damage, uncontrolled internal bleeding, and infection, all potentially life-threatening.
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It’s clear that the use of surgical staples can present dangers to patients. The U.S. Food and Drug Administration (FDA)’s Manufacturer and User Facility Device Experience (MAUDE) data indicates that over 41,000 adverse event (AE) reports were received between and the end of March . In it, there are 32,000 reports of surgical staplers malfunctioning, and 9,000 serious injuries to patients caused by surgical staplers. Over 350 fatalities have been reported.
Even more disturbingly, those reports don’t include more than 56,000 reports submitted to the FDA in the same time frame. These reports only became public knowledge when Kaiser Health News reported on their existence.
As a result of the Kaiser Health News report, the FDA announced that it will be reviewing surgical stapler safety.
Surgical staplers are used to close incisions and wounds, rather than sutures.
However, malfunctions, improper use, and defects in the design have apparently caused numerous patients to suffer injuries and complications after surgery. These can be long-term, permanent, or even require additional surgery and ongoing treatment to rectify.
Injuries associated with surgical staples include:
The AEs indicate that the most frequent malfunctions are:
Affected patients and their loved ones (if a patient has died) do have recourse. If you suffered an injury or complication due to issues with surgical staples, you can seek compensation for damages from the manufacturers via a legal claim.
Surgical staplers are manufactured by Ethicon (a division of Johnson & Johnson), 3M Corporation, Covidien, Stryker Medical, Tyco Medical Group, and U.S. Surgical.
Possible compensation for damages include:
Questions about whether you are eligible to file a surgical stapler lawsuit? If you or a loved one has been injured or suffered complications from the use of surgical staples, by any manufacturer, call Chaffin Luhana today. We are experienced in product liability law as it applies to surgical staples, and are dedicated to fighting for the rights of patients who have been victimized by defective medical products.
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