Micro-CT imaging as a method for comparing perfusion in graduated-height and single-height surgical staple lines

Abstract

BackgroundWound healing is a goal for advanced technology in the surgical space to benefit clinical outcomes. Surgical staplers are commonly used in a variety of open and minimally invasive abdominal and thoracic procedures. Assessment of wound healing traits, such as perfusion, has been challenging due to technical limitations. A novel technique that utilizes micro-computed tomography methodology to measure perfusion was designed to compare the micro-perfusion of staple lines between commercial stapler reloads that employ different staple height strategies.Materials and methodsFollowing an Institutional Animal Care and Use Committee-approved protocol, rats were euthanized and immediately heparinized prior to a subtotal gastrectomy with either graduated-height or single-height staples. Rats were then perfused with barium, following which stomachs were removed and immediately fixed in formalin to prevent degradation. Stomachs were then imaged using micro-computed tomography and subsequent analysis was utilized to quantify fluid volume and patent vasculature proximity to staples within the staple line region for each group.ResultsAverage perfusion volume was significantly higher with graduated-height staples (0.33% ± 0.18%) compared to single-height staples (0.16% ± 0.09%, P=0.011). Average vessel-to-staple line distance was not significant but trended lower with graduated-height staples (0.35±0.02 mm) compared to single-height staples (0.36±0.03 mm, P=0.18).DiscussionGraduated-height staples had significantly higher perfusion volume than single-height staples, which likely has a downstream benefit on wound healing and clinical outcomes.ConclusionThis study shows a higher perfusion volume around the staple lines using graduated-height staples as compared to single-height staples and this may contribute to better wound healing in patients.

Gastrointestinal thickness, duration, and leak pressure of six intestinal anastomoses in dogs

“…From these results, the authors believe that the largest TA staple size, green, may be most appropriate for routine intestinal use in dogs, especially when it is considered that the mural wall thickness is doubled when the staple device is placed around and including both luminal walls. This may reduce the dehiscence rate associated with stapled anastomoses by minimizing compromise of the intestinal microvasculature secondary to a fixed staple height 26 . Tearing of the serosa by the blue staple heads immediately after construct assembly was consistently noted in FEESA‐TAB and FEESA‐GIA constructs but not in FEESA‐TAG constructs in this study.…”

Evaluating Performance of Circular Staplers Using Comparative Test Methods for Evidence-Based Surgery

“…Segmentation analysis was performed according to previously published methods. 19 Briefly, vessels and staples were segmented using spectral based filters, which minimize segmentation errors in stapling applications; vessels and staples were each skeletonized using 3D thinning algorithms. A region of interest (ROI) for the staple line was then created as well as a dilated region of interest, which was a single, hollow object including voxels surrounding the staple line but excluding voxels within the staple line ROI (Figure 4).…”

“…Previous published methods for assessing perfusion preclinically have been performed in different models, as well as with different perfusion analysis methods with limited reporting in some cases on test technique, limiting reproducibility and consequently, the capacity to compare stapler performance. 14,19,20…”

Mechanobiological considerations in colorectal stapling: Implications for technology development

“…The ranges of final thicknesses are driven by the “closed height” of the staples after the staples have been delivered to the tissue. Final form of staple delivery differs by manufacturer with some offering 2 vs. 3 rows of staples on either side of the transection line, varied vs. uniform height staples, and 2-D vs. 3-D staple formation [ 6 ].…”