Powered Stapling Platforms in Laparoscopic Liver Resection
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 5
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
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- EP ID EP571752
- DOI 10.26717/BJSTR.2017.01.000416
- Views 161
- Downloads 0
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