Profiling surgical staplers: effect of staple height, buttress, and overlap on staple line failure

A novel approach to assess minimally invasive surgical device failure utilizing adverse event outcome severity and design complexity.

“…Endoscopic staplers deploy either purely mechanical or powered mechanisms to simultaneously staple and transect target tissue during the firing sequence. Stapling occurs as individual straight metal staples are released from the cartridge, travel through the compressed tissue, and typically bent into a "B" shape upon contact with a hard anvil pocket on the opposite side (Mery, Shafi et al 2008). …”

“…The successful creation of an anastomosis from an optimal staple line can be achieved by applying the proper size cartridge and corresponding staple height based on the tissue's thickness and mechanical properties. Performance of endoscopic staplers relies on an optimal compression force that allows for proper tissue approximation, yet spares tissue from shearing or injury (Mery, Shafi et al 2008). …”

“…Performance of endoscopic staplers relies on an optimal compression force that allows for proper tissue approximation, yet spares tissue from shearing or injury (Mery, Shafi et al 2008). Mery et al profiled endoscopic staplers through a series of leak pressure tests and found staple height was an important determinant of leak pressure, overlap did not affect leak pressure, and buttressing improved all types of staple lines (Mery, Shafi et al 2008). Buttressing refers to thin sheets that are placed on one or both sides of the target tissue in attempt to supply additional support and hemostasis (Mery, Shafi et al 2008).…”

“…Mery et al profiled endoscopic staplers through a series of leak pressure tests and found staple height was an important determinant of leak pressure, overlap did not affect leak pressure, and buttressing improved all types of staple lines (Mery, Shafi et al 2008). Buttressing refers to thin sheets that are placed on one or both sides of the target tissue in attempt to supply additional support and hemostasis (Mery, Shafi et al 2008). Less bleeding from staple lines has been associated with buttressing, yet it can cause visualization issues and interference with repeated staple firing (Angrisani, Lorenzo et al 2004).…”

“…Overlapping staple lines has been shown to attribute to adverse event outcomes and can result in dulling of the blade and incomplete staple lines accompanied by a difficulty in firing (Mery, Shafi et al 2008). Though, certain procedures call for overlapping staple lines in order to complete a transection, such as the creation of a gastric pouch during gastric bypass.…”