Surgical Stapling - Techniques and Tricks
Operative Techniques in General Surgery (2008, Vol.10, No.4, December)
Staplers and endomechanical devices have represented a
revolution in surgical technology and operative technique.
Their acceptance, use, and technical development
have been a study in evolution, however.
During their early introduction using such instruments
were thought to be inferior to hand sewn methods of anastomosis
and tissue reconstruction. After many years and many
studies, the safety of mechanical stapling devices were shown
to be comparable to more conventional surgical techniques.
Subsequently, open surgical staplers started to gain a notoriety
and respect of their own. Some instruments allowed the
performance of certain maneuvers or procedures that would
otherwise be very difficult or impossible using conventional
hand sewn methods. Sphincter sparing surgery for low rectal
cancers clearly was facilitated and made safer using the various
versions of the circular stapler, for example. Without a
doubt, procedures requiring extensive suturing (eg, the creation
of an ileal reservoir) were facilitated by the easy and
rapid single fire placement of many staples, decreasing operative
time, and minimizing associated hypothermia and
blood loss. Staplers were not only making surgery easier, but
also safer.
Then came laparoscopic surgery and staplers were re-designed
to accommodate to such small orifice surgery. In fact,
without the prior stapling revolution, the laparoscopic revolution
would have been near impossible. It has been the
engineering and technical wizardry of small caliber endomechanical
devices that has facilitated and promoted the growth
and now widespread use of minimally invasive surgery in
general surgery. The demands and parameters defined by
laparoscopic surgery are now fostering the development of
newer energy delivery devices, newer techniques of anastomotic
creation and newer methods of intracorporeal organ
evaluation and surgical care.
In keeping with this evolution of stapler design and use has
been the discovery of unusual associated complications or
unique applications that were not originally anticipated. This
has led to the use of surgical staplers in different ways, to
overcome unforeseen difficulties or to take advantage of them
in special circumstances. This is the purpose of the present
issue of Operative Techniques in General Surgery, namely to
describe unique and unusual applications or variations on
the use of surgical stapling devices, both open and endomechanical.
Thus, anastomotic stricture after the use of the circular
stapler has led to a method of transanal revision that
avoids laparotomy, using the very same circular stapling device,
as described by Dr. McKenna. The same propensity of
the circular stapler to create such a stricture however, can
minimize subsequent hernia development after stoma creation,
as described by Dr. Stewart. Similarly, the laparoscopic
stapler has been discovered to be a very effective tool in open
liver resection as described by Dr. Kimchi. This issue is filled
with such tricks and techniques that allow the surgeon to
take full advantage of the various staplers unique design
features to overcome several problems in general surgery.
This issue also marks the final installment of OTIGS in its
present form under my editorship. Much like surgery, the
publication industry is changing and the provision of information,
especially one that is dependant on visual illustration,
is redefining and reformulating itself. Without a doubt,
there will always be the continued need for rapid, accurate,
and authoritative delivery of new information, especially in
such a profession as surgery where frequently only the best is
good enough. The general surgeon will always need to maintain
the highest standards of technical expertise and knowledge
and I feel that OTIGS has done its best to provide such to
its readership. I thank Elsevier Publishers and especially
Herb Niemirow and Journal Manager Marla Kipp and all their
staff for allowing me to help in that endeavor over the past
several years. This has been a unique and valuable opportunity
to help serve my surgical colleagues and would have
been impossible without their patient and experienced assistance.
Walter A. Koltun, MD
Professor of Surgery
Peter and Marshia Carlino
Professor of Inflammatory Bowel Disease
Chief, Section of Colon and Rectal Surgery
Penn State College of Medicine
Milton S. Hershey Medical Center
Editor-in-Chief
http://www.book4doc.com/83040
Operative Techniques in General Surgery (2008, Vol.10, No.4, December)
Staplers and endomechanical devices have represented a
revolution in surgical technology and operative technique.
Their acceptance, use, and technical development
have been a study in evolution, however.
During their early introduction using such instruments
were thought to be inferior to hand sewn methods of anastomosis
and tissue reconstruction. After many years and many
studies, the safety of mechanical stapling devices were shown
to be comparable to more conventional surgical techniques.
Subsequently, open surgical staplers started to gain a notoriety
and respect of their own. Some instruments allowed the
performance of certain maneuvers or procedures that would
otherwise be very difficult or impossible using conventional
hand sewn methods. Sphincter sparing surgery for low rectal
cancers clearly was facilitated and made safer using the various
versions of the circular stapler, for example. Without a
doubt, procedures requiring extensive suturing (eg, the creation
of an ileal reservoir) were facilitated by the easy and
rapid single fire placement of many staples, decreasing operative
time, and minimizing associated hypothermia and
blood loss. Staplers were not only making surgery easier, but
also safer.
Then came laparoscopic surgery and staplers were re-designed
to accommodate to such small orifice surgery. In fact,
without the prior stapling revolution, the laparoscopic revolution
would have been near impossible. It has been the
engineering and technical wizardry of small caliber endomechanical
devices that has facilitated and promoted the growth
and now widespread use of minimally invasive surgery in
general surgery. The demands and parameters defined by
laparoscopic surgery are now fostering the development of
newer energy delivery devices, newer techniques of anastomotic
creation and newer methods of intracorporeal organ
evaluation and surgical care.
In keeping with this evolution of stapler design and use has
been the discovery of unusual associated complications or
unique applications that were not originally anticipated. This
has led to the use of surgical staplers in different ways, to
overcome unforeseen difficulties or to take advantage of them
in special circumstances. This is the purpose of the present
issue of Operative Techniques in General Surgery, namely to
describe unique and unusual applications or variations on
the use of surgical stapling devices, both open and endomechanical.
Thus, anastomotic stricture after the use of the circular
stapler has led to a method of transanal revision that
avoids laparotomy, using the very same circular stapling device,
as described by Dr. McKenna. The same propensity of
the circular stapler to create such a stricture however, can
minimize subsequent hernia development after stoma creation,
as described by Dr. Stewart. Similarly, the laparoscopic
stapler has been discovered to be a very effective tool in open
liver resection as described by Dr. Kimchi. This issue is filled
with such tricks and techniques that allow the surgeon to
take full advantage of the various staplers unique design
features to overcome several problems in general surgery.
This issue also marks the final installment of OTIGS in its
present form under my editorship. Much like surgery, the
publication industry is changing and the provision of information,
especially one that is dependant on visual illustration,
is redefining and reformulating itself. Without a doubt,
there will always be the continued need for rapid, accurate,
and authoritative delivery of new information, especially in
such a profession as surgery where frequently only the best is
good enough. The general surgeon will always need to maintain
the highest standards of technical expertise and knowledge
and I feel that OTIGS has done its best to provide such to
its readership. I thank Elsevier Publishers and especially
Herb Niemirow and Journal Manager Marla Kipp and all their
staff for allowing me to help in that endeavor over the past
several years. This has been a unique and valuable opportunity
to help serve my surgical colleagues and would have
been impossible without their patient and experienced assistance.
Walter A. Koltun, MD
Professor of Surgery
Peter and Marshia Carlino
Professor of Inflammatory Bowel Disease
Chief, Section of Colon and Rectal Surgery
Penn State College of Medicine
Milton S. Hershey Medical Center
Editor-in-Chief
http://www.book4doc.com/83040
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