In vivo evaluation of a modified linear stapling device designed to facilitate accurate pathologic examination of the surgical margin

Abstract

Background Microscopic involvement of the resection margin could influence the long-term outcome of patients undergoing curative surgery for gastric cancer. Linear staplers, commonly used for gastrectomies, are often equipped with three lines of staples on either side of the resection line. Although multiple lines of staples reinforce closure of the gastric or intestinal stump, they could hinder accurate histopathologic evaluation of the surgical margin of the resected specimen. Methods We modified a linear stapling device by removing one line (stapler E2) or two lines (stapler E1) of staples on the specimen side, and attempted to dissect a silicon film and then the stomach from a porcine model using the stapling device and examined the distances between the cutting edge and the nearest staple line. Results The distance between the cutting edge and the staple line for stapler E1 was significantly greater than the distance between the cutting edge and the nearest staple line for stapler E2 or the control device. Consequently, specimens of exemplary quality were available for pathologic examination of the surgical margin. Moreover, the lack of multiple layers of staples did not result in contamination of the abdominal cavity with gastric juice during laparoscopic procedures in the porcine model. Conclusions Stapler E1 is safe and could be useful for the pathologic evaluation of the true surgical margin.

Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience

“…This could be attributed to the fact that linear staplers are often placed on either side of the resection line, and might hinder accurate histopathologic evaluation of the surgical margin of the resected specimen. Linear staplers generally have four or six rows of staples and form two or three staple lines on a margin of length approximately 4-5 mm as exempted staples on the resection line, in contrast to conventional circular staplers[ 30 ]. Moreover, the linear staplers used in TLTG require a substantial length of esophagus for anastomosis.…”

Mechanical Stapling Devices for Soft Tissue Repair: A Review of Commercially Available Linear, Linear Cutting, and Circular Staplers

“…In comparison with the same typology of staplers, the NALS device showed no squeezing artifact at the resection margin on microscopic examination, and all of the alveolar structures for evaluation were preserved [39]. However, no other information was found on this new linear cutter stapler, and a modification was reported to improve the pathologic evaluation of the true surgical margin after the use of the Ethicon ENDOPATH stapler [43].…”