This study examines the design and development of a new disposable electric intelligent laparoscopic stapler and its components,addressing issues in existing electric staplers,particularly insufficient power for cutti...This study examines the design and development of a new disposable electric intelligent laparoscopic stapler and its components,addressing issues in existing electric staplers,particularly insufficient power for cutting thick tissue and postoperative complications.Finite element analysis was utilized to model cutting force and tissue thickness,optimizing the device’s cutting performance.The electric intelligent laparoscopic stapler integrates control,drive,transmission,execution,and communication modules,employing intelligent thickness detection and feedback mechanisms to enhance surgical precision and safety.Additionally,a degradable,absorbable hemostatic pad with excellent biocompatibility and an optimal degradation cycle was developed to minimize postoperative complications.The marketing strategy focuses on product diversification,competitive pricing,channel expansion,and technical services to strengthen the product’s presence in the domestic market and support import substitution,enhancing its competitiveness.A risk analysis was conducted to address potential policy,operational,technological,and market risks,with strategies proposed for mitigation.展开更多
AIMTo report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible endoscopy.METHODSFrom November 2014 till December 201517 patients(8 female,9 male,average age 69.8 years)wi...AIMTo report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible endoscopy.METHODSFrom November 2014 till December 201517 patients(8 female,9 male,average age 69.8 years)with a symptomatic Zenker diverticulum(mean size 3.5 cm)were treated by inserting a new 5 mm fully rotatable surgical stapler(MicroCutter30 Xchange,Cardica Inc.)next to an ultrathin flexible endoscope through an overtube.The Patients were under conscious sedation with the head reclined in left position,the stapler placed centrally and pushed forward to the bottom of the diverticulum.The septum was divided by the staple rows under flexible endoscopic control.RESULTSIn eleven patients(64.7%)the stapler successfully divided the septum completely.Mean procedure time was 21 min,medium size of the septum was 2.8 cm(range 1.5 cm to 4 cm).In four patients the septum was shorter than 3 cm,in seven longer than 3 cm.To divide the septum,averagely 1.3 stapler cartridges were used.Two minor bleedings occurred.Major adverse events like perforation or secondary haemorrhage did not occur.After an average time of two days patients were discharged from the hospital.In 6 patients(35.3%)the stapler failed due to a thick septum or insufficient reclination of the head.Follow up endoscopy was performed after an average of two months in 9 patients;4 patients(44.4%)were free of symptoms,5 patients(55.6%)stated an improvement.A relapse of symptoms did not occur.CONCLUSIONFlexible endoscopic Zenker diverticulotomy by using a surgical stapler is a new,safe and efficient treatment modality.A simultaneously tissue opening and occlusion prevents major complications.展开更多
Introduction: Systematic lymphadenectomy and ligation of the feeding artery is extremely important when performing radical resection in colorectal cancer. However, vascular surgery via laparoscopy requires advanced sk...Introduction: Systematic lymphadenectomy and ligation of the feeding artery is extremely important when performing radical resection in colorectal cancer. However, vascular surgery via laparoscopy requires advanced skills and techniques;thus, this procedure needs to be simplified while maintaining quality of the surgery to make it a preferred technique for the surgeons. Methods: There were 49 patients who underwent laparoscopic sigmoidectomy or anterior resection till T2 level for sigmoid colon cancer and recto-sigmoid colon cancer. We analyzed short-term and long-term outcomes between stapling ligation and clipping ligation techniques used in these surgeries. Results: The mean volume of blood loss in the stapling ligation group was 12.8 ± 12.3 ml, which was significantly lower than 41.9 ± 71.2 ml of mean volume of blood loss in the clipping ligation group. There was no significant difference in the mean duration of surgery, the mean number of harvested lymph nodes, morbidity, recurrence, and 5-year relapse free survival rates between the 2 groups. Conclusions: This study demonstrates a surgical technique using staplers for vascular treatment of tumor-feeding arteries as a new technical improvement in laparoscopic colectomy for the treatment of early-stage colon cancer. We found that the described procedure was technically safe, simple, convenient, and oncologically valid.展开更多
BACKGROUND The most common causes of outlet obstructive constipation(OOC)are rectocele and internal rectal prolapse.The surgical methods for OOC are diverse and difficult,and the postoperative complications and recurr...BACKGROUND The most common causes of outlet obstructive constipation(OOC)are rectocele and internal rectal prolapse.The surgical methods for OOC are diverse and difficult,and the postoperative complications and recurrence rate are high,which results in both physical and mental pain in patients.With the continuous deepening of the surgeon’s concept of minimally invasive surgery and continuous in-depth research on the mechanism of OOC,the treatment concepts and surgical methods are continuously improved.AIM To determine the efficacy of the TST36 stapler in the treatment of rectocele combined with internal rectal prolapse.METHODS From January 2017 to July 2019,49 female patients with rectocele and internal rectal prolapse who met the inclusion criteria were selected for treatment using the TST36 stapler.RESULTS Forty-five patients were cured,4 patients improved,and the cure rate was 92%.The postoperative obstructed defecation syndrome score,the defecation frequency score,time/straining intensity,and sensation of incomplete evacuation were significantly decreased compared with these parameters before treatment,and the differences were statistically significant(P<0.05).The postoperative anal canal resting pressure and maximum squeeze pressure in patients decreased compared with before treatment,and the differences were statistically significant(P<0.05).The initial and maximum defecation thresholds after surgery were significantly lower than those before treatment,and the differences were statistically significant(P<0.05).The postoperative ratings of rectocele,resting phase,and defecation phase in these patients were significantly decreased compared with those before treatment,and the differences were statistically significant(P<0.05).CONCLUSION The TST36 stapler is safe and effective in treating rectocele combined with internal rectal prolapse and is worth promoting in clinical work.展开更多
BACKGROUND Gastric cancer is the most common cause of cancer-related deaths,and is classified according to its location in the proximal,middle,or distal stomach.Surgical resection is the primary approach for treating ...BACKGROUND Gastric cancer is the most common cause of cancer-related deaths,and is classified according to its location in the proximal,middle,or distal stomach.Surgical resection is the primary approach for treating gastric cancer.This prospective study aimed to determine the best reconstruction method after distal gastrectomy for gastric cancer.AIM To explore the efficacy of different staplers and digestive tract reconstruction(DTR)methods after radical gastrectomy and their influence on prognosis.METHODS Eighty-seven patients who underwent radical gastrectomy for distal gastric cancer at our institution between April 2017 and April 2020 were included in this study,with a follow-up period of 12-26 mo.The patients were assigned to four groups based on the stapler and DTR plan as follows:BillrothⅠ(B-I)reconstruction+linear stapler group(group A,22 cases),B-I reconstruction+circular stapler group(group B,22 cases),Billroth II(B-II)reconstruction+linear stapler group(group C,22 cases),and B-II reconstruction+circular stapler group(group D,21 cases).The pathological parameters,postoperative gastrointestinal function recovery,postoperative complications,and quality of life(QOL)were compared among the four groups.RESULTS No significant differences in the maximum diameter of the gastric tumors,total number of lymph nodes dissected,drainage tube removal time,QLQ(QOL questionnaire)-C30 and QLQ-STO22 scores at 1 year postoperatively,and incidence of complications were observed among the four groups(P>0.05).However,groups A and C(linear stapler)had significantly lower intraoperative blood loss and significantly shorter anastomosis time,operation time,first fluid diet intake time,first exhaust time,and length of postoperative hospital stay(P<0.05)than groups B and D(circular stapler).CONCLUSION Linear staplers offer several advantages for postoperative recovery.B-I and B-II reconstruction methods had similar effects on QOL.The optimal solution can be selected according to individual conditions and postoperative convenience.展开更多
BACKGROUND Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of ...BACKGROUND Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of WOPN represents an important surgical treatment option for selected patients. The da Vinci surgical System has been developed to allow an easy, minimally invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using the da Vinci Xi. CASE SUMMARY A 63-year-old man with an episode of acute necrotizing pancreatitis was referred to our center. Six wk after the acute episode the patient developed a walled massive fluid collection, with an extensive pancreatic necrosis, causing obstruction of the gastrointestinal tract. The patient underwent a robotic transgastric drainage and debridement of the WOPN performed with the da Vinci Xi platform. Firstly, an anterior ideal gastrotomy was carried out, guided by intraoperative ultrasound (US)-scan using the TilePro? function. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was again US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler with vascular cartridge. Debridement and washing of the cavity through the anastomosis were performed. Finally, the anterior gastrotomy was closed and the cholecystectomy was performed. The postoperative course was uneventful and a post-operative computed tomography-scan showed the collapse of the fluid collection. CONCLUSION In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option.展开更多
Background: Procedure for prolapse and hemorrhoids (PPH) has emerged as an alternative surgical treatment of symptomatic hemorrhoids. The operative technique along with the device to be used is constantly evolving. Ai...Background: Procedure for prolapse and hemorrhoids (PPH) has emerged as an alternative surgical treatment of symptomatic hemorrhoids. The operative technique along with the device to be used is constantly evolving. Aim: The aim of the present study was to evaluate results of PPH using a modified technique and an innovative circular stapler. Material and Methods: A prospective, comparative study of patients undergoing PPH for symptomatic Grade II and Grade III internal hemorrhoids with either 32 mm or 34 mm stapler diameter (Circular Stapler for Hemorrhoids-CSH 32/34) during a 36 month period (1/1/2012-1/1/2015) was performed. A modified operative technique using two purse string sutures was employed. Patients were evaluated and compared in terms of postoperative complications, operation time, length of hospital stay and time to return to normal activities. Results: A total of 100 patients were included: 50 in the CSH 32 group and 50 in the CSH 34 group. Complication rates were equal for both stapler diameters (32 mm and 34 mm). Serious or life threatening complications were not encountered and need for reintervention was never met. Operation time, length of hospital stay and time to return to normal activities were similar in both groups. Conclusions: Our study suggests that there are no significant differences between the two available diameters of a new-fangled circular stapler, using a modified technique. It seems that progress of hemorrhoidal staplers has led to a step towards the goals of implement and from then on complications of surgical practice could be merely a matter of operative technique.展开更多
Objective: To observe the clinical effect and safety of circumcision stapler in children with phimosis and redundant prepuce. Methods: From July 2013 to July 2017, 40 children were prospectively randomized and assigne...Objective: To observe the clinical effect and safety of circumcision stapler in children with phimosis and redundant prepuce. Methods: From July 2013 to July 2017, 40 children were prospectively randomized and assigned to experiment group (circumcision stapler n = 20) or control group (conventional circumcision, n = 20). Outcomes were operation time, intraoperative blood loss and postoperative complications. Results: There was significant difference between the two groups for operation time (5.35 min vs 30.30 min, P < 0.05) and intraoperative blood loss (2.56 ml vs 10.40 ml, P < 0.05) respectively. Conclusion: Circumcision staplers are superior to conventional circumcision for the advantages of shorter operation time and fewer blood losses.展开更多
For thousands of years, women simply tolerated the distressing symptoms generated by rectovaginal fistulas (RVFs). This is no longer necessary because most RVFs can be surgically corrected via a number of approaches. ...For thousands of years, women simply tolerated the distressing symptoms generated by rectovaginal fistulas (RVFs). This is no longer necessary because most RVFs can be surgically corrected via a number of approaches. Most rectovaginal fistulas are acquired;obstetric injury alone accounts for nearly 88% of the cases. The high fistulas are repaired by abdominal approach, while middle or low fistulas are best approached perineally. There are only few case reports of laparoscopic RVF repair noted in literature till date. Laparoscopic repair of RVF is challenging and requires advanced laparoscopic skill. Laparoscopy is a better alternative in selected cases of RVF and yields faster recovery and good patient compliance. We present a case of high RVF managed laparoscopically by using stapler.展开更多
Introduction: Stapler application for pharyngeal closure after total laryngectomy allows rapid watertight closure. We intend to report the experience of the Portuguese Oncology Institute of Lisbon, Francisco Gentil (I...Introduction: Stapler application for pharyngeal closure after total laryngectomy allows rapid watertight closure. We intend to report the experience of the Portuguese Oncology Institute of Lisbon, Francisco Gentil (IPOLFG). Material and Methods: Retrospective study of patients submitted to total laryngectomy using linear stapler device treated in IPOLFG from 2005 to 2010. Results: 108 patients were studied. The majority of patients were male, aged from 60 to 69 years old, and had smoking and alcohol habits. The average length of hospital stay was 13.1 days. Post-operative complications occurred as follows: wound infection in 6.5%, cervical hematoma in 4.6% and pharyngocutaneous fistula in 11.1% of cases. Conclusions: The mechanical suture of the pharynx in total laryngectomy is a simple and quick method. It does not increase the incidence of post-operative complications. It seems to be a very safe method, as long as its limits regarding the location and extent of tumour are respected.展开更多
Background:Pancreatic fistula after distal pancreatectomy is a common and potentially lethal complication.The optimal closure method for the pancreatic remnant during minimally invasive distal pancreatectomy(MDP)remai...Background:Pancreatic fistula after distal pancreatectomy is a common and potentially lethal complication.The optimal closure method for the pancreatic remnant during minimally invasive distal pancreatectomy(MDP)remains unclear.Methods:Data of consecutive patients who underwent MDP in our institution between July 2018 and June 2021 were collected.The outcomes of MDP with stapler and hand-sewn closure were compared.The primary outcome was clinically relevant postoperative pancreatic fistula(CR-POPF)per the International Study Group of Pancreatic Surgery definition.Results:Of the 384 patients(stapler closure,339;hand-sewn closure,45)enrolled,249 developed CR-POPF(grades B and C:242 and 7 patients,respectively).The rates of grade B and grade C POPF in the stapler group were similar to the corresponding rates in the hand-sewn group(64.6%and 1.5%vs 51.1%and 4.4%,P=.078 and P=.223,respectively).No differences between the stapler and hand-sewn groups were observed regarding the median operation time(207 vs 222 minutes,P=.139),incidence of major complications(16.5%vs 20.0%,P=.559),and mortality(0.2%vs 0%,P=1.000).The independent risk factors of CR-POPF were abdominal abscess,prolonged operation time,and transection site(P=.004,.006,and.001,respectively).Conclusion:The incidence and severity of CR-POPF by stapler closure of the pancreatic stump were comparable to those associated with hand-sewn closure in MDP in this retrospective cohort.Randomized controlled trials are needed to verify this finding.展开更多
BACKGROUND The rising incidence of laryngeal cancer has led to an increasing number of total laryngectomy procedures.While voice prostheses have significantly improved post-laryngectomy rehabilitation,the risk of sali...BACKGROUND The rising incidence of laryngeal cancer has led to an increasing number of total laryngectomy procedures.While voice prostheses have significantly improved post-laryngectomy rehabilitation,the risk of salivary fistula remains a major complication.This study aims to compare the stapler and hand-sewn techniques for esophageal closure and evaluate their impact on fistula formation.AIM To compare stapler-assisted and hand-sewn esophageal closure techniques after laryngectomy regarding their impact on salivary fistula formation.METHODS A total of 52 patients(44 men,8 women),aged 43 to 77 years,underwent total laryngectomy.Esophageal reconstruction was performed using either a stapler(29 patients)or a hand-sewn technique(23 patients).A surgical stapler TA was used for esophageal closure in the stapler group.Patients were clinically monitored for fistula formation during the first 7 days postoperatively and again two weeks after discharge using fiberoptic examination.RESULTS A total of 22 salivary fistulas were recorded:17(77.3%)occurred following the hand-sewn technique,while 5(22.7%)developed in the stapler group.Addi-tionally,preoperative radiotherapy was identified as a statistically significant risk factor for fistula formation.No technical complications related to the stapler device were observed.CONCLUSION Although hand-sewn closure is commonly used after total laryngectomy,stapler-assisted closure shows lower fistula rates and is a viable esophageal reconstruction alternative.展开更多
文摘This study examines the design and development of a new disposable electric intelligent laparoscopic stapler and its components,addressing issues in existing electric staplers,particularly insufficient power for cutting thick tissue and postoperative complications.Finite element analysis was utilized to model cutting force and tissue thickness,optimizing the device’s cutting performance.The electric intelligent laparoscopic stapler integrates control,drive,transmission,execution,and communication modules,employing intelligent thickness detection and feedback mechanisms to enhance surgical precision and safety.Additionally,a degradable,absorbable hemostatic pad with excellent biocompatibility and an optimal degradation cycle was developed to minimize postoperative complications.The marketing strategy focuses on product diversification,competitive pricing,channel expansion,and technical services to strengthen the product’s presence in the domestic market and support import substitution,enhancing its competitiveness.A risk analysis was conducted to address potential policy,operational,technological,and market risks,with strategies proposed for mitigation.
文摘AIMTo report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible endoscopy.METHODSFrom November 2014 till December 201517 patients(8 female,9 male,average age 69.8 years)with a symptomatic Zenker diverticulum(mean size 3.5 cm)were treated by inserting a new 5 mm fully rotatable surgical stapler(MicroCutter30 Xchange,Cardica Inc.)next to an ultrathin flexible endoscope through an overtube.The Patients were under conscious sedation with the head reclined in left position,the stapler placed centrally and pushed forward to the bottom of the diverticulum.The septum was divided by the staple rows under flexible endoscopic control.RESULTSIn eleven patients(64.7%)the stapler successfully divided the septum completely.Mean procedure time was 21 min,medium size of the septum was 2.8 cm(range 1.5 cm to 4 cm).In four patients the septum was shorter than 3 cm,in seven longer than 3 cm.To divide the septum,averagely 1.3 stapler cartridges were used.Two minor bleedings occurred.Major adverse events like perforation or secondary haemorrhage did not occur.After an average time of two days patients were discharged from the hospital.In 6 patients(35.3%)the stapler failed due to a thick septum or insufficient reclination of the head.Follow up endoscopy was performed after an average of two months in 9 patients;4 patients(44.4%)were free of symptoms,5 patients(55.6%)stated an improvement.A relapse of symptoms did not occur.CONCLUSIONFlexible endoscopic Zenker diverticulotomy by using a surgical stapler is a new,safe and efficient treatment modality.A simultaneously tissue opening and occlusion prevents major complications.
文摘Introduction: Systematic lymphadenectomy and ligation of the feeding artery is extremely important when performing radical resection in colorectal cancer. However, vascular surgery via laparoscopy requires advanced skills and techniques;thus, this procedure needs to be simplified while maintaining quality of the surgery to make it a preferred technique for the surgeons. Methods: There were 49 patients who underwent laparoscopic sigmoidectomy or anterior resection till T2 level for sigmoid colon cancer and recto-sigmoid colon cancer. We analyzed short-term and long-term outcomes between stapling ligation and clipping ligation techniques used in these surgeries. Results: The mean volume of blood loss in the stapling ligation group was 12.8 ± 12.3 ml, which was significantly lower than 41.9 ± 71.2 ml of mean volume of blood loss in the clipping ligation group. There was no significant difference in the mean duration of surgery, the mean number of harvested lymph nodes, morbidity, recurrence, and 5-year relapse free survival rates between the 2 groups. Conclusions: This study demonstrates a surgical technique using staplers for vascular treatment of tumor-feeding arteries as a new technical improvement in laparoscopic colectomy for the treatment of early-stage colon cancer. We found that the described procedure was technically safe, simple, convenient, and oncologically valid.
基金The Natural Science Foundation of Liaoning Province,No.20170540840.
文摘BACKGROUND The most common causes of outlet obstructive constipation(OOC)are rectocele and internal rectal prolapse.The surgical methods for OOC are diverse and difficult,and the postoperative complications and recurrence rate are high,which results in both physical and mental pain in patients.With the continuous deepening of the surgeon’s concept of minimally invasive surgery and continuous in-depth research on the mechanism of OOC,the treatment concepts and surgical methods are continuously improved.AIM To determine the efficacy of the TST36 stapler in the treatment of rectocele combined with internal rectal prolapse.METHODS From January 2017 to July 2019,49 female patients with rectocele and internal rectal prolapse who met the inclusion criteria were selected for treatment using the TST36 stapler.RESULTS Forty-five patients were cured,4 patients improved,and the cure rate was 92%.The postoperative obstructed defecation syndrome score,the defecation frequency score,time/straining intensity,and sensation of incomplete evacuation were significantly decreased compared with these parameters before treatment,and the differences were statistically significant(P<0.05).The postoperative anal canal resting pressure and maximum squeeze pressure in patients decreased compared with before treatment,and the differences were statistically significant(P<0.05).The initial and maximum defecation thresholds after surgery were significantly lower than those before treatment,and the differences were statistically significant(P<0.05).The postoperative ratings of rectocele,resting phase,and defecation phase in these patients were significantly decreased compared with those before treatment,and the differences were statistically significant(P<0.05).CONCLUSION The TST36 stapler is safe and effective in treating rectocele combined with internal rectal prolapse and is worth promoting in clinical work.
文摘BACKGROUND Gastric cancer is the most common cause of cancer-related deaths,and is classified according to its location in the proximal,middle,or distal stomach.Surgical resection is the primary approach for treating gastric cancer.This prospective study aimed to determine the best reconstruction method after distal gastrectomy for gastric cancer.AIM To explore the efficacy of different staplers and digestive tract reconstruction(DTR)methods after radical gastrectomy and their influence on prognosis.METHODS Eighty-seven patients who underwent radical gastrectomy for distal gastric cancer at our institution between April 2017 and April 2020 were included in this study,with a follow-up period of 12-26 mo.The patients were assigned to four groups based on the stapler and DTR plan as follows:BillrothⅠ(B-I)reconstruction+linear stapler group(group A,22 cases),B-I reconstruction+circular stapler group(group B,22 cases),Billroth II(B-II)reconstruction+linear stapler group(group C,22 cases),and B-II reconstruction+circular stapler group(group D,21 cases).The pathological parameters,postoperative gastrointestinal function recovery,postoperative complications,and quality of life(QOL)were compared among the four groups.RESULTS No significant differences in the maximum diameter of the gastric tumors,total number of lymph nodes dissected,drainage tube removal time,QLQ(QOL questionnaire)-C30 and QLQ-STO22 scores at 1 year postoperatively,and incidence of complications were observed among the four groups(P>0.05).However,groups A and C(linear stapler)had significantly lower intraoperative blood loss and significantly shorter anastomosis time,operation time,first fluid diet intake time,first exhaust time,and length of postoperative hospital stay(P<0.05)than groups B and D(circular stapler).CONCLUSION Linear staplers offer several advantages for postoperative recovery.B-I and B-II reconstruction methods had similar effects on QOL.The optimal solution can be selected according to individual conditions and postoperative convenience.
文摘BACKGROUND Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of WOPN represents an important surgical treatment option for selected patients. The da Vinci surgical System has been developed to allow an easy, minimally invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using the da Vinci Xi. CASE SUMMARY A 63-year-old man with an episode of acute necrotizing pancreatitis was referred to our center. Six wk after the acute episode the patient developed a walled massive fluid collection, with an extensive pancreatic necrosis, causing obstruction of the gastrointestinal tract. The patient underwent a robotic transgastric drainage and debridement of the WOPN performed with the da Vinci Xi platform. Firstly, an anterior ideal gastrotomy was carried out, guided by intraoperative ultrasound (US)-scan using the TilePro? function. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was again US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler with vascular cartridge. Debridement and washing of the cavity through the anastomosis were performed. Finally, the anterior gastrotomy was closed and the cholecystectomy was performed. The postoperative course was uneventful and a post-operative computed tomography-scan showed the collapse of the fluid collection. CONCLUSION In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option.
文摘Background: Procedure for prolapse and hemorrhoids (PPH) has emerged as an alternative surgical treatment of symptomatic hemorrhoids. The operative technique along with the device to be used is constantly evolving. Aim: The aim of the present study was to evaluate results of PPH using a modified technique and an innovative circular stapler. Material and Methods: A prospective, comparative study of patients undergoing PPH for symptomatic Grade II and Grade III internal hemorrhoids with either 32 mm or 34 mm stapler diameter (Circular Stapler for Hemorrhoids-CSH 32/34) during a 36 month period (1/1/2012-1/1/2015) was performed. A modified operative technique using two purse string sutures was employed. Patients were evaluated and compared in terms of postoperative complications, operation time, length of hospital stay and time to return to normal activities. Results: A total of 100 patients were included: 50 in the CSH 32 group and 50 in the CSH 34 group. Complication rates were equal for both stapler diameters (32 mm and 34 mm). Serious or life threatening complications were not encountered and need for reintervention was never met. Operation time, length of hospital stay and time to return to normal activities were similar in both groups. Conclusions: Our study suggests that there are no significant differences between the two available diameters of a new-fangled circular stapler, using a modified technique. It seems that progress of hemorrhoidal staplers has led to a step towards the goals of implement and from then on complications of surgical practice could be merely a matter of operative technique.
文摘Objective: To observe the clinical effect and safety of circumcision stapler in children with phimosis and redundant prepuce. Methods: From July 2013 to July 2017, 40 children were prospectively randomized and assigned to experiment group (circumcision stapler n = 20) or control group (conventional circumcision, n = 20). Outcomes were operation time, intraoperative blood loss and postoperative complications. Results: There was significant difference between the two groups for operation time (5.35 min vs 30.30 min, P < 0.05) and intraoperative blood loss (2.56 ml vs 10.40 ml, P < 0.05) respectively. Conclusion: Circumcision staplers are superior to conventional circumcision for the advantages of shorter operation time and fewer blood losses.
文摘For thousands of years, women simply tolerated the distressing symptoms generated by rectovaginal fistulas (RVFs). This is no longer necessary because most RVFs can be surgically corrected via a number of approaches. Most rectovaginal fistulas are acquired;obstetric injury alone accounts for nearly 88% of the cases. The high fistulas are repaired by abdominal approach, while middle or low fistulas are best approached perineally. There are only few case reports of laparoscopic RVF repair noted in literature till date. Laparoscopic repair of RVF is challenging and requires advanced laparoscopic skill. Laparoscopy is a better alternative in selected cases of RVF and yields faster recovery and good patient compliance. We present a case of high RVF managed laparoscopically by using stapler.
文摘Introduction: Stapler application for pharyngeal closure after total laryngectomy allows rapid watertight closure. We intend to report the experience of the Portuguese Oncology Institute of Lisbon, Francisco Gentil (IPOLFG). Material and Methods: Retrospective study of patients submitted to total laryngectomy using linear stapler device treated in IPOLFG from 2005 to 2010. Results: 108 patients were studied. The majority of patients were male, aged from 60 to 69 years old, and had smoking and alcohol habits. The average length of hospital stay was 13.1 days. Post-operative complications occurred as follows: wound infection in 6.5%, cervical hematoma in 4.6% and pharyngocutaneous fistula in 11.1% of cases. Conclusions: The mechanical suture of the pharynx in total laryngectomy is a simple and quick method. It does not increase the incidence of post-operative complications. It seems to be a very safe method, as long as its limits regarding the location and extent of tumour are respected.
基金supported by the National Key Research and Development Program(No.2019YFC1316000)the National Natural Science Foundation of China(No.82071748,No.82188102)the Innovation Center for the Study of Pancreatic Diseases,Zhejiang Province(ICSPD-ZJ).
文摘Background:Pancreatic fistula after distal pancreatectomy is a common and potentially lethal complication.The optimal closure method for the pancreatic remnant during minimally invasive distal pancreatectomy(MDP)remains unclear.Methods:Data of consecutive patients who underwent MDP in our institution between July 2018 and June 2021 were collected.The outcomes of MDP with stapler and hand-sewn closure were compared.The primary outcome was clinically relevant postoperative pancreatic fistula(CR-POPF)per the International Study Group of Pancreatic Surgery definition.Results:Of the 384 patients(stapler closure,339;hand-sewn closure,45)enrolled,249 developed CR-POPF(grades B and C:242 and 7 patients,respectively).The rates of grade B and grade C POPF in the stapler group were similar to the corresponding rates in the hand-sewn group(64.6%and 1.5%vs 51.1%and 4.4%,P=.078 and P=.223,respectively).No differences between the stapler and hand-sewn groups were observed regarding the median operation time(207 vs 222 minutes,P=.139),incidence of major complications(16.5%vs 20.0%,P=.559),and mortality(0.2%vs 0%,P=1.000).The independent risk factors of CR-POPF were abdominal abscess,prolonged operation time,and transection site(P=.004,.006,and.001,respectively).Conclusion:The incidence and severity of CR-POPF by stapler closure of the pancreatic stump were comparable to those associated with hand-sewn closure in MDP in this retrospective cohort.Randomized controlled trials are needed to verify this finding.
文摘BACKGROUND The rising incidence of laryngeal cancer has led to an increasing number of total laryngectomy procedures.While voice prostheses have significantly improved post-laryngectomy rehabilitation,the risk of salivary fistula remains a major complication.This study aims to compare the stapler and hand-sewn techniques for esophageal closure and evaluate their impact on fistula formation.AIM To compare stapler-assisted and hand-sewn esophageal closure techniques after laryngectomy regarding their impact on salivary fistula formation.METHODS A total of 52 patients(44 men,8 women),aged 43 to 77 years,underwent total laryngectomy.Esophageal reconstruction was performed using either a stapler(29 patients)or a hand-sewn technique(23 patients).A surgical stapler TA was used for esophageal closure in the stapler group.Patients were clinically monitored for fistula formation during the first 7 days postoperatively and again two weeks after discharge using fiberoptic examination.RESULTS A total of 22 salivary fistulas were recorded:17(77.3%)occurred following the hand-sewn technique,while 5(22.7%)developed in the stapler group.Addi-tionally,preoperative radiotherapy was identified as a statistically significant risk factor for fistula formation.No technical complications related to the stapler device were observed.CONCLUSION Although hand-sewn closure is commonly used after total laryngectomy,stapler-assisted closure shows lower fistula rates and is a viable esophageal reconstruction alternative.
