Mechanobiological considerations in colorectal stapling: Implications for technology development

Caulk, Alexander W.; Chatterjee, Monideepa; Barr, Samantha J.; Contini, Elizabeth M.

doi:10.1016/j.sopen.2023.04.004

Cited by 4 publications

(2 citation statements)

References 144 publications

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“…Investigations using breaking forces offer the advantage that the results are comparable between different studies [14]. This is of particular relevance for studies investigating intestinal surgery or their endoscopic counterparts [30], because the surgical procedures, irrespective if conducted openly or laparoscopically, would include stapling of the anastomoses [92]. Although bursting pressure has been used to evaluate staplers [65,93] and anastomoses [57,[94][95][96][97][98], this has met criticism [15], because bursting pressures are only comparable within, but not beyond, a single study [14].…”

Section: Discussionmentioning

confidence: 99%

“…Although bursting pressure has been used to evaluate staplers [65,93] and anastomoses [57,[94][95][96][97][98], this has met criticism [15], because bursting pressures are only comparable within, but not beyond, a single study [14]. Consequently, breaking forces have been the standard to evaluate colorectal surgical stapling [37,38,63,92,99,100] but have also been used to investigate hand-sewn anastomoses [4,101,102]. As stapling is the standard for such colorectal anastomoses, endoscopic interventions that should supplement or even replace surgery in cases of intestinal perforation [30], a comparative assessment of the durability of the anastomoses requires using the same technique to evaluate them.…”

Section: Discussionmentioning

confidence: 99%

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Not All Porcine Intestinal Segments Are Equal in Terms of Breaking Force, but None Were Associated to Allometric Parameters

Kratz,

Dauvergne,

Kronberg

et al. 2023

Gastroenterology Insights

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Biomechanics are gaining ground in gastroenterology in the creation of educational models and to describe the necessary forces to perforate hallow organs during endoscopy. We thus investigated the breaking forces of porcine intestinal segments and whether they could be predicted based on body weight or crown–rump length. Based on a priori power-analyses, 10 pigs were included. The breaking forces were determined with a motorized test stand. We found that the breaking forces of intestinal segments were different (H(6) = 33.7, p < 0.0001): Ileal breaking force (x¯ = 24.14 N) was higher than jejunal (x¯ = 14.24 N, p = 0.0082) and colonic (x¯ = 11.33 N, p < 0.0001) breaking force. The latter was also smaller than cecal breaking force (x¯ = 24.6 N, p = 0.0044). Likewise, rectal (x¯ = 23.57 N) breaking force was higher than jejunal (p = 0.0455) and colonic (p = 0.0006) breaking force. Breaking forces were not correlated to body weight or crown–rump length (R < 0.49, p > 0.148). Intestinal segments differ in their breaking forces. The colon had the least resistance to traction forces. It remains to be determined if similar relationships exist in humans in order to validate porcine models for endoscopy and surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Not All Porcine Intestinal Segments Are Equal in Terms of Breaking Force, but None Were Associated to Allometric Parameters

Kratz,

Dauvergne,

Kronberg

et al. 2023

Gastroenterology Insights

View full text Add to dashboard Cite

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Changes in microcirculation of small intestine end-to-end anastomoses in an experimental model

Varga,

Matrai,

Fazekas

et al. 2024

Microvascular Research

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Finite element analysis of soft tissue pressure at different fixation positions of tracheal catheter in oral cavity (Preprint)

wang,

Dong,

et al. 2024

Preprint

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BACKGROUND The primary method of respiratory support for critically ill patients in the ICU is oral tube intubation, which ensures airway patency, increases ventilation volume, and enhances lung function. However, the use of oral tube intubation may lead to Oral Mucosal Pressure Injury (OMPI) due to excessive or prolonged pressure, friction, and shear forces [1]. OMPI can increase patient pain, elevate the risk of infection, impose a financial burden on healthcare, increase staff workload, and even result in medical disputes. Studies indicate that the incidence of OMPI in ICU patients ranges from 2.95% to 49.2%, with different fixation positions and methods of tracheal catheterization influencing its occurrence [2]. While numerous factors contribute to OMPI, including patient-related factors, physiological conditions, the use of specific medications, and nursing-related aspects, there are limited reports addressing the mechanical factors that cause OMPI [3-5]. The International Guidelines for the Clinical Prevention and Treatment of Stress Injuries (2019) suggest that finite element models can be employed to evaluate mechanical factors by assessing stress distribution characteristics within tissue structures and predicting the risk of cellular and tissue damage [6]. This study utilizes a finite element theory contact algorithm to simulate the compression process of oral soft tissue when the tracheal catheter is fixed in various positions within the oral cavity. It aims to analyze the stress distribution characteristics under this action to more accurately evaluate the actual stress state within the oral soft tissue structure, thereby preventing the occurrence of OMPI. OBJECTIVE This study aimed to establish finite element models for different fixation positions of tracheal catheters in the oral cavity to identify the optimal fixation position that minimizes the risk of oral mucosal pressure injury. METHODS CT data of the head and face from healthy male subjects were selected, and a 3D finite element model was created using Mimics 21 and Geomagic Wrap 2021 software. A pressure sensor was utilized to measure the actual pressure exerted by the oral soft tissue on the upper and lower lips, as well as the left and right oral angles of the tracheal catheter. The generated model was imported into Ansys Workbench 21.0 software, where all materials were assigned appropriate values, and boundary conditions were established. Vertical loads of 2.6 N and 3.43 N were applied to the upper and lower lips, while horizontal loads of 1.76 N and 1.82 N were applied to the left and right corners of the mouth, respectively, to observe the stress distribution characteristics of the skin, mucosa, and muscle tissue in four fixation areas. RESULTS The equivalent stress of the skin mucosa was ranked as follows: left oral angle < right oral angle < upper lip < lower lip, with values of [(28.42±0.65) kPa, (30.72±0.98) kPa, (35.20±0.99) kPa, (41.79±0.48) kPa] (P<0.001). The equivalent stress of muscle tissue, from smallest to largest, was: right oral angle < left oral angle < upper lip < lower lip, with values of [(34.35±0.52) kPa, (35.64±1.18) kPa, (43.17±0.58) kPa, (43.17±0.58) kPa]（P<0.001）. The shear stress of the skin mucosa tissue also followed the same order: left oral angle < right oral angle < upper lip < lower lip, with values of [(6.58±0.16) kPa, (7.05±0.32) kPa, (7.70±0.17) kPa, (10.02±0.44) kPa] (P<0.001). The shear stress of muscle tissue increased in the following order: right oral angle < left oral angle < upper lip < lower lip, with values of [(5.69±0.29) kPa, (5.74±0.30) kPa, (8.91±0.55) kPa, (11.96±0.50) kPa] (P<0.001). The equivalent and shear stresses of muscle tissue were significantly higher than those of the skin mucosal tissue across all four fixation positions, with statistical significance (P<0.05). CONCLUSIONS Fixation of the tracheal catheter at the left and right oral corners results in the lowest equivalent and shear stresses, while the lower lip exhibits the highest stresses. It is recommended to minimize the contact time and area of the lower lip during tracheal catheter fixation, and to alternately replace the contact area at the left and right oral corners to prevent oral mucosal pressure injuries.

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Mechanobiological considerations in colorectal stapling: Implications for technology development

Cited by 4 publications

References 144 publications

Not All Porcine Intestinal Segments Are Equal in Terms of Breaking Force, but None Were Associated to Allometric Parameters

Not All Porcine Intestinal Segments Are Equal in Terms of Breaking Force, but None Were Associated to Allometric Parameters

Changes in microcirculation of small intestine end-to-end anastomoses in an experimental model

Finite element analysis of soft tissue pressure at different fixation positions of tracheal catheter in oral cavity (Preprint)

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