Effect of the thickness and nonlinear elasticity of tissue on the success of surgical stapling for laparoscopic liver resection

Tsukune, Mariko; Kobayashi, Yo; Otsuka, Yuichiro; Maeda, Testuya; Yamazaki, Nozomu; Watanabe, H.; Ando, Takeshi; Kaneko, Hironori; Fujie, Masakatsu G.

doi:10.1109/embc.2014.6943602

Cited by 3 publications

(4 citation statements)

References 9 publications

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“…22 Other factors affecting stapler use are tissue thickness and stiffness; stapling failure has been found to increase with increasing tissue thickness, and it has been suggested that tissue thickness has a greater effect on stapler success compare with tissue stiffness. 27,28 We report similar findings in this study; the right division lobes were assessed to be too challenging for stapler resection in all cadavers due to anatomic location as well as increased lobe thickness. In cadavers >15 kg, all liver lobes were considered too thick for staple resection, with most attempted resections resulting in incomplete closure of the stapler and/or staples.…”

Section: Discussionsupporting

confidence: 80%

“…If a stapler is used inappropriately for hepatic vascular division, staple line disruption can occur and potentially lead to significant hemorrhage; however, with correct stapler use, reported incidence of this complication is rare 22 . Other factors affecting stapler use are tissue thickness and stiffness; stapling failure has been found to increase with increasing tissue thickness, and it has been suggested that tissue thickness has a greater effect on stapler success compare with tissue stiffness 27,28 . We report similar findings in this study; the right division lobes were assessed to be too challenging for stapler resection in all cadavers due to anatomic location as well as increased lobe thickness.…”

Section: Discussionsupporting

confidence: 72%

“…Furthermore, the unsuccessful clinical case involved a large and more proximal hepatic mass that resulted in stapler failure because of the increased tissue thickness, and, ultimately, elective conversion. Therefore, tissue thickness may affect the risk of stapling failure in dogs just as it does in humans, although this requires further investigation 28 . Although partial parenchymal dissection could be performed with a harmonic scalpel prior to stapler application, this was not performed because of the technical difficulty as well as the requirement for laparoscopic ultrasound, which is not readily available in veterinary practice.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, tissue thickness may affect the risk of stapling failure in dogs just as it does in humans, although this requires further investigation. 28 Although partial parenchymal dissection could be performed with a harmonic scalpel prior to stapler application, this was not performed because of the technical difficulty as well as the requirement for laparoscopic ultrasound, which is not readily available in veterinary practice. Partial parenchymal dissection would minimize both the tissue thickness and stiffness, which would, in theory, improve the potential for stapled hepatectomy in larger liver lobes.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of laparoscopic liver lobectomy in dogs

et al. 2021

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Objective: To determine the feasibility of laparoscopic liver lobectomy (LLL) in dogs by using canine cadavers and to describe the clinical application in dogs with liver disease. Study design: Ex vivo experiment and descriptive case series.Sample population: Twelve canine cadavers and six client-owned dogs. Methods: Cadavers underwent LLL with an endoscopic stapler. The percentage of liver lobe resected was determined by volume. The distance from the staple line to hilus was measured. Medical records of dogs undergoing LLL were reviewed.Results: In cadavers ≤15 kg, left lateral lobectomy completeness was 87.3% (84.6%-96.6%), and remaining median (interquartile range) hilar length was 1 cm (0.25-1.75). Left medial lobectomy completeness was 72.5% (66.7%-80%), and remaining hilar length was 1.6 cm (0.47-1.75). Central division resection completeness was 68.3% (60%-92.9%), and remaining hilar length was 2.7 cm (0.8-5). Laparoscopic liver lobectomy was not feasible for right division lobes and in cadavers >15 kg. Five dogs with peripheral quadrate or left lateral lobe masses underwent stapled, partial laparoscopic lobectomy (30%-90%). One dog underwent stapled, left lateral lobectomy (90%) after open procedure conversion. Histopathological diagnoses included hepatocellular carcinoma (3), nodular hyperplasia (1), biliary cyst adenoma (1), and fibrosis (1). Conclusion:Laparoscopic liver lobectomy of the left and central divisions is feasible in cadavers ≤15 kg with an endoscopic stapler. Partial LLL of the left and central divisions is feasible in select dogs with liver disease. Clinical significance: Laparoscopic liver lobectomy may be a viable alternative to laparotomy in small-to-medium size dogs with peripheral liver massesof the left and central divisions.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Feasibility of laparoscopic liver lobectomy in dogs

et al. 2021

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PID Model for Real-Time Measurement of Tissue Thickness in Bariatric Surgery

Mansour,

Hassan,

Cheery

et al. 2023

2023 Fifth International Conference on Advances in Computational Tools for Engineering Applications (ACTEA)

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Application of stapling devices in liver surgery: Current status and future prospects

Yao¹,

Wu²

2016

WJG

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The liver is a vascular-rich solid organ. Safe and effective dissection of the vessels and liver parenchyma, and control of intraoperative bleeding are the main concerns when performing liver resection. Several studies have confirmed that intraoperative blood loss and postoperative transfusion are predictors of postoperative morbidity and mortality in liver surgery. Various methods and instruments have been developed during hepatectomy. Stapling devices are crucial for safe and rapid anastomosis. They are used to divide hepatic veins and portal branches, and to transect liver parenchyma in open liver resection. In recent years, laparoscopic liver surgery has developed rapidly, and is now preferred by many surgeons. Stapling devices have also been gradually introduced in laparoscopic liver surgery, from dividing vascular and biliary structures to parenchymal transection. This may be because staplers make manipulation more simple, rapid and safe. Even in single incision laparoscopic surgery, which is recognized as a new minimally invasive technique, staplers are also utilized, especially in left lateral hepatectomy. For safe application of stapling devices in liver surgery, more related designs and modifications, such as application of a suitable laparoscopic articulating liver tissue crushing device, a staple line reinforcement technique with the absorbable polymer membrane or radiofrequency ablation assistance, are still needed. More randomized studies are needed to demonstrate the benefits and find broader indications for the use of stapling devices, to help expand their application in liver surgery.

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Effect of the thickness and nonlinear elasticity of tissue on the success of surgical stapling for laparoscopic liver resection

Cited by 3 publications

References 9 publications

Feasibility of laparoscopic liver lobectomy in dogs

Feasibility of laparoscopic liver lobectomy in dogs

PID Model for Real-Time Measurement of Tissue Thickness in Bariatric Surgery

Application of stapling devices in liver surgery: Current status and future prospects

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