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Stapling Flashcards

1
Q

What is the role of a staple in surgery

A

The staple apposes or approximates which means it holds the tissue in proximity until biological healing has occurred and thus formed a perfect union of the tissue

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2
Q

Define biphasic

A

Human tissue is considered biphasic because it displays the characteristics of both solids and liquids

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3
Q

What is the role of collagen in mechanical fusion ?

A

Collagen provides strength to the surgical wound

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4
Q

What key role does the submucosa provide in wound healing?

A

The submucosa provides holding strength to the staple line.

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5
Q

What did our own internal bench testing find when examining the relationship between levels of mucosal capture and staple line leak sites?

A

78% of the time initial leak sites are associated with areas of incomplete mucosal capture ; that the mucosa is 7 x more likely to be captured with echelon GST vs EndoGIA

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6
Q

The 4 main tissue layers of concern with mechanical stapling

A

Muscularis
Mucosa
Submucosa
Serosa

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7
Q

How does viscosity affect compression?

A

Viscosity ( thick water component ) affects how much tissue will compress over time. Surgeon needs to under stand the properties of the tissue in order to select the correct reload.

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8
Q

The Baker paper : The science of stapling leaks?
Published ?
3 pig, buttress and different cartridge effects on S/L

A

2004 Published in Obesity Surgery Grand Rapids MI USA
Leaks 2 causes 1. Mechanical (common)2. Ischaemic (rare)
Undesizing can lead to overcompression Green suggested thick stomach
Buttressing significantly increased staple line strength and should be considered in an attempt to decrease leaks.
Optimal stapling consists of adequate time for compression and creep while not producing excessive tensile stress.

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9
Q

The 3 primary complications of stapling ?

A
  1. Anastomotic leak
  2. Bleeding
  3. Stricture
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10
Q

After firing the proximate ILS curved stapler how many turns of the adjusting knob does it take to open before removal?

A

1/2 to 3/4 turn lefty loosely anti clockwise

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11
Q

Which proximate TX product has 3 rows of staples either side of cut line vs 2

A

TX30V ( Vascular)

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12
Q

The proximate ILS endoscopic curved intralumenal stapler (ECS) offers which features

A

Non glare black shaft
A sealed shaft
A 10cm longer shaft than proximate curved CDH
It does not however offer larger lumen sizes than ECS 21,25,29,33mm

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13
Q

Echelon Flex powered plus

Jaw lengths, 3 shaft lengths, articulation, staple rows, GST reloads closed staple heights?

A

Jaw lengths 45mm & 60mm with 45 degrees of articulation
Shaft lengths compact 280mm, regular 340mm, long 440mm
6 rows of staples 3 either side of cut line
GST reloads with closed staple heights of
Grey 0.75mm white 1.0mm blue 1.5mm gold 1.8mm green 2.0mm and black 2.3mm

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14
Q

Echelon Flex Powered Plus knife jammed and will not return to home position? Trouble shooting protocol

A

Knife reverse button
Remove battery reinsert battery
Knife reverse button
Manual override - device is now non functional

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15
Q

The 3 main changes in the echelon GST system that make it 7 x more likely to fully capture mucosa vs EndoGIA ?

A

GST Atraumatic pocket extensions - better grip and hold during firing
Asymmetrical staple legs and closed bottom cartridge channel - improve trajectory and prevents stapler deflection for consistent staple formation.

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16
Q

What is enhanced system wide compression or multistage compression ?

A
  1. Pre compression when device closed and

2. Focal compesssion when device fired

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17
Q

What are the tissue characteristics that can affect stapling ?

A 
BTCLVM
Biphasic nature
Thickness 
Collagen content 
Layers 
Viscosity 
Movement
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18
Q

What are the challenges for devices in surgical stapling

A

Deflection
Tissue mvt laterally and longitudinally ( milking )
Can cause malformed staples

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19
Q

Echelon Flex controls tissue movement through which 3 mechanisms? and what are the claims around this ?

A
  1. Pre compression
  2. Focal compression
  3. Gripping surface technology
    Leads to unsurpassed staple formation and superior mucosal capture
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20
Q

What are the goals of surgical stapling ?

A
  1. To create a proper staple line
  2. Precise transection
  3. To promote wound healing
  4. Staple legs hit anvil pockets creating properly formed staples
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21
Q

3 key claims from the Roy Real World Evidence study powered echelon vs manual EndoGIA Bariatrics

A

47% reduction in bleeding related complications
21% reduction in OT time
13% reduction in overall hospital costs

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22
Q

What is the role of the mucosa ?

A

To protect the submucosa which is critical for staple line strength

23
Q

What are the characteristics of good mucosal capture and what may incomplete capture lead to?

A

Both mucosa and submucosa captured in staple line
If incomplete capture may lead to bacterial ingrowth, shift from healing response to inflammation response, reduction in staple line integrity.

24
Q

What is the purpose of the curved tip of the echelon flex PVS with advanced placement tip?

A

Enhances visualisation and manoeuvrability while also allowing for blunt dissection

25
What are the specs and claims of echelon flex PVS with APT | Jaw, shaft, articulation, reload, #staple rows
35mm jaw, 320mm shaft, 50 degrees of articulation, 1 reload VASCR35 white with 1.0mm closed staple height 4 staple rows 2 either side of cut line 26 % narrower shaft and anvil 11% greater manual articulation in each direction 83% reduction in distal tip movement on firing
26
Medtronic Tristaple heights, compression and movement principles in summary are ?
Tristaple are multiheight staples ( smallest closest to cut line) Focal compression single stage Encourages movement directs mvt of tissue laterally and distally to reduce tissue thickness and force to fire.
27
The reload colours of Tristaple S-L are ?
Grey Tan Purple Black
28
Once the battery is inserted into echelon flex powered endopath stapler it can be used for x hrs, fully drained at x hrs?
Used for 12hrs | Fully drained at 24hrs
29
Echelon flex powered endopath has what? For full control in the event of power loss and what is the acronym to remember the troubleshooting tips?
``` Manual override for full control Knife reverse Battery out reinsert Knife reverse Manual override bail out - device is now non functional K-B-K-BOMO ```
30
The echelon flex endopath stapler firing trigger must be squeezed how many times for complete firing, how many times to retract knife blade for a total of how many squeezes?
4 for complete firing 1 to retract knife blade Total of 5 squeezes 4,1,5
31
The echelon endopath stapler comes in what shaft lengths?
Compact 280mm Regular 340mm Long 440mm
32
Compared to Endo GIA curved tip reload with TST the echelon flex PVS provides how much more ; 1. Articulation 2. Narrower anvil 3. Thinner shaft 4. Reload choices
1. 11% greater articulation in each direction 50 degrees 2. 26% narrower anvil 7mm vs 9.6mm EndoGIA 3. 26% narrower shaft 9/12mm greater angle of reach in tight intercostal space. 4. No increased reload choice VASCR35 only
33
Which device offers compression that is achieved by the 3 point gap control knife construct that pulls the anvil and the channel into the correct gap to achieve appropriate staple height?
Echelon endopath stapler
34
The approximate articulation angles of the echelon flex endopath stapler are ?
15,30,45 degrees
35
Echelon flex GST system has ———- x less tissue slippage during firing compared to EndoGIA reloads with Tristaple technology
4 x
36
The staple line length for the echelon flex PVS is ?
35mm
37
The reload colours for the Tristaple reloads S-L are ?
Grey - Tan - Purple - Black
38
Medtronics EndoGIA with TST utilises what type of compression and what affect does this have tissue movement during the firing sequence ?
TST utilises focal compression | This promotes tissue movement during the firing sequence
39
Endopath ETS articulating linear cutters are available in which cartridge lengths?
45 mm only 2 models ATS45 & ATS45NK ( no knife )
40
Echelon flex PVS lays how many rows of staples either side of the cut line and what is the reload code?
2 rows of staples either side of the cut line | Code of reload VASCR35
41
The contour curved cutter stapler allows placement of a ——cut line in a 30mm space and it comes in 2 codes 2 stapled rows with what closed staple heights?
40mm cut in a 30mm space for low pelvic access CS40B standard tissue 1.5mm closed staple height CS40G thick tissue 2.0mm closed staple height
42
NTLC comes in what sizes, allows surgeons to choose what size closed staple heights and what is unique about the staple utilises / how many rows?
55 and 75mm Blue 1.5mm Gold 1.8mm Green 2.0mm 6 rows of 3D staples
43
What is the single continuous membrane that lines the walls of the abdominal cavity and the viscera of the abdominal cavity like a continuous sheet?
The peritoneum
44
The proximate TX is a ............ Has one model that fires 3 x rows of staggered titanium staples? Comes preloaded for a total of x firings Features & Benefits ?
``` reloadable linear stapler TX30V Reloadable linear stapler 8 firings max Features & Benefits one handed operation - ease of use Intermediate locking position - facilitates proper placement Parallel jaw closure - consistent staple formation Models TX30V, TX30B, TX30G, TX60B, TX60G ```
45
How do linear staplers work in regards to compression, design and where they are used ?
User regulates compression based on tactile feedback from device and tissue Compression achieved by rotating screw design that drives linear motion/force in the anvil and cartridge Used for anastomosing organs and tissues
46
How do linear cutters work in terms of compression and design?
Simultaneously transect and close tissue by stapling on either side of a cut line. Compression generated from a central pin ( fulcrum point ) Upon firing the cam mechanism is engaged which aligns the anvil and cartridge channels while pivoting around the central pin. This creates incremental fork compression to the working end of the device without fork deviation.
47
What is an Endocutter and what does it do?
It’s an endoscopic linear cutter for use in MIP and it cuts between lines of staples to simultaneously transect and resect tissue
48
Circular staplers compression, design, types of anastomosis?
Compression - user regulates based on tactile feedback from the device and tissue. Compression achieved by rotating screw design that drives linear motion/ force in the anvil and cartridge. Closed staple height is controlled by surgeon. Have a circular knife blade that cuts off tissue excess during staple release and creation of circular anastomosis. Types of anastomosis - end to end, end to side, side to side
49
Curved cutters create their compression how ? And what are they designed and used for ?
Compression is achieved by a trigger lever design that drives linear force in the anvil and cartridge. Have a knife blade, staple and cut tissue in a curved line. Designed with a unique curved head for increased visibility and optimal use in narrow spaces.
50
The proximate TLC linear cutter comes in what configurations and delivers how many staggered rows of staples either side of the cut line ?
Comes in 55 (3) 75 (3) 100 (2) 55mm ( reloads White Blue Green) 75mm Blue Gold Green 100mm Blue Green
51
The NTLC linear cutter comes in what configurations and staple heights, max firings plus F and B ?
Comes in 55 75 mm models Blue, gold and green selectable staple height Max 12 firings 6 row 3D surgical staple technology optimises tissue compression and provides superior haemostasis 2 sided firing ambidextrous use Spring loaded intermediate locking mechanism allows easier 1 handed tissue manipulation
52
Contour curved cutter has what special features and comes in what product codes, how many stapled rows ?
Unique curved head design provides a 40mm cut in a 30mm space allowing for lower pelvic access as in LAR Larger jaw aperture facilitates manoeuvrability and mobility along the colon Models CS40B CS40G
53
Explain 3 point gap control ?
3 point gap control ensures a uniform distance between the anvil and cartridge surfaces before firing. This is achieved by 3 seperate points of alignment as the c shaped knife blade travels proximal to distal.
54
Explain system wide compression?
The precision machined anvil delivers system wide compression to exude fluids from tissue and prepare the tissue for a uniform staple line.

Ethicon Material (7 decks)

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