Powered Stapling Platforms in Laparoscopic Liver Resection

Abstract

Introduction: The most recent innovation in laparoscopic surgery has been the introduction of powered stapler platforms. These systems were designed to standardize staple formation, by minimizing tissue dissection and controlling tissue compression and staple formation. Methods: Retrospective cohort analysis compared laparoscopic powered E-beam stapler platform to a laparoscopic non-powered I-beam stapler. The analysis was performed using a robust 2:1 control group study. Statistical analysis was performed using STATA. Results: Forty-three powered cantilever E-beam stapler resection cases were compared to 86 cases of non-powered I-beam stapler resections. Both cohorts were equally matched for demographics, extent of liver disease, tumor size and type of resection. The non-powered I-beam group did have a higher ASA score (2.8 vs. 2.6; p<0.037). Staple usage, blood loss, and complication rates were equivalent. Operative time was significantly shorter in the powered stapler group (136 vs. 157 hrs; p=0.026) realizing accumulative 90-day global cost savings of $8,248.89 per case (p=0.012). Conclusion: Laparoscopic powered E-beam stapler platforms appear to be safe and efficacious with equivalent performance and complication profiles compared to non-powered I-beam platforms. Powered stapling platforms also appear to minimize parenchymal injury reducing operative time further decreasing disposable and global costs. Hepatic resection is a technique driven procedure that has evolved over the last half century. Initial experiences in the mid seventies relied on crushing and clamping of the liver parenchyma and its vascular bundles. This technique was often variable and imprecise resulting in significant intraoperative blood loss and postoperative morbidity and mortality [1-3]. Over the next several decades, significant improvements in the understanding of hepatic anatomy, the use of liver anesthetic and surgical techniques, as well as improved instrumentation dramatically reduced operative mortality from 25% down to nearly 2% [4-6]. The most recent technical innovation in hepatic resection has been the introduction of the laparoscopic approach. The greatest challenge in this procedure has been the hemostatic and effective transection of liver parenchyma [7-9]. The initial descriptions of laparoscopic liver resection were premised on replicating traditional open surgical techniques utilizing a laparoscopic approach including crush, clamp and clip and CUSA dissection [10-12]. During this time an alternative open approach was introduced by Büchler and reported a large series of hepatic resections employing endovascular staplers to transect the liver parenchyma [13,14]. This technique was quickly adopted in the performance of laparoscopic liver resection. Stapler division is now routinely achieved through the use of linear endo staplers employing a hybrid cantilever mechanism with a E-beam construction cutting blade for parenchymal division. Disposable staples are deployed though several size cartridges with a variety of staple heights corresponding to the thickness of the intended tissue. As the endostapler is engaged into the liver, the parenchyma is compressed and the staples interlaced with the critical structures. The E-beam then compresses the staples to form a locking secure B-shaped form.

Authors and Affiliations

Max Shapiro, Michael Darden, David Sigmon, Emad Kandil, Chris Ducoin, Adam Hauch, Geoffrey Parker, Joseph F Buell

Keywords

Related Articles

Assessing Changes in Cognitive Function and Quality of Life associated with Exercise in Individuals with Parkinson’s Disease and their Caregivers

The purpose of this study was to examine the effects of a community-based, multi-modal exercise program on cognitive functioning and quality of life in individuals with Parkinson’s disease and their caregivers. Assessmen...

Microfilled Epoxy-Composites, Capable of Thermo- Hardening and Thermo-Plasticization After Hard Heating (200-300ОC) - For “in-Field\Offroad” Use in Bio-, Agro-, Medservice

The work is devoted to the study of a new type of composites for the manufacture of special details, parts, tools or adhesive repair in the field. We have developed epoxy compounds that preserve or increase strength and...

Towards an Evolutionary Psychological Perspective on a Taxonomic Model of Individual Differences Correlating with the Five-Factor Model

This preview comprises a short introduction on our novel theory for an evolutionary psychological motivation-based, categorized explanation of individual differences. Based on our findings we constructed an evolutionary...

The Importance of the Nurse’s Role in the Management of Complex Diabetic Outpatients: It is the Time to Manage Patient’s Multidimensions

Diabetes is a significant chronic disease, 424.9 million people worldwide are estimated to have diabetes in 2017,and this number is expected to increase to 628.6 million by 2045[1]. More and more patients with diabetes a...

Molecular Conformation Correlation to Activity Against Herpes Simplex Virus of (E)-5-(2-Bromovinyl)-2’-Deoxycytidine and 5-Methoxymethyl-2’-Deoxycytidine Analogs: Short-Review

Analogs of (E)-5-(2-bromovinyl)-2’-deoxycytidine (BrVdCyd) (1) and 5-methoxymethyl-2’-deoxycytidine, MMdCyd (2) by substitution at N4 were synthesized to impart resistance against deamination. The anti HSV-1 activity and...

Download PDF file
  • EP ID EP571752
  • DOI 10.26717/BJSTR.2017.01.000416
  • Views 182
  • Downloads 0

How To Cite

Max Shapiro, Michael Darden, David Sigmon, Emad Kandil, Chris Ducoin, Adam Hauch, Geoffrey Parker, Joseph F Buell (2017). Powered Stapling Platforms in Laparoscopic Liver Resection. Biomedical Journal of Scientific & Technical Research (BJSTR), 1(5), 1271-1274. https://europub.co.uk/articles/-A-571752