Suture is often needed to reconstruct the continuity of tissues and organs in surgery, so suture is one of the keys to the success of surgery. There are many traditional surgical suture methods, but most of them use one-needle-one-line Bare-hand operation, which is not only time-consuming, but also affected by the difference of surgeon's clinical experience and suture technology. Especially when the location of the operation is deeper, because of poor vision and inconvenient operation, manual suture is often very difficult. Sometimes, the tissue is irregular or torn, and complications such as bleeding at the suture site, anastomotic leakage and anastomotic stenosis are easy to occur. In order to improve the quality of operation, shorten the operation time and reduce postoperative complications, many surgeons in China have tried and developed stapler surgery. With the development of medicine and its related frontier disciplines, and the extensive application and accumulation of experience of staplers in clinical practice, stapler instruments have been continuously improved, and satisfactory clinical results have been achieved. In recent years, with the development of minimally invasive surgery, the application of staplers in thoracoscopy and laparoscopy has been more widely promoted. It can be said that staplers have become the necessary instruments and methods in modern surgery.
Taking the circular stapler as an example, the principle of anastomosis is to arrange two rows of B shaped suture nails which are arranged in a circular arrangement in a tissue, and to cut off the medial tissue by ring scalpel, so as to anastomoses the lumen and organs. In order to ensure the blood supply of the anastomotic tissue, the circular stapler has a special structure, which can change the height of the stapler in the range of 1.0-2.5 mm according to the thickness of the anastomotic tissue. Because of the self-healing ability of the intestinal canal, slight difference in the height of the suture nail is not a big problem when anastomosing the intestinal canal.
Indications For The Use Of Staplers
The anastomosis of hand suture can be performed by the surgical staplers in all cases. Specifically, the stapler is suitable for end-to-end, end-to-side and side-to-side anastomosis of esophagus, stomach, duodenum, small intestine, colon, rectum and biliary tract. The suture device is suitable for suturing digestive tract, pancreas, lung, thyroid and other organs. The advantages of using this kind of instrument are simple operation, shorter operation time (only a few minutes), less bleeding, less trauma and fewer complications. The operation quality is high because the mucosa or tissue is tidy, the anastomosis is firm and reliable, the hemostasis effect and the blood supply are good. Especially for exposing difficult esophageal and cardiac operations and low rectal operations, and for critically ill patients who need to finish the operation as soon as possible. Because the suture device is used to suture and seal before cutting, it reduces the chance of peritoneal contamination and effectively reduces the possibility of exfoliation and implantation of gastrointestinal cancer cells.
The digestive tract mucosa is edema, the muscular layer is too thick and the healing ability is poor, so it is not suitable to use. If the lumen is too thin or the muscular layer of the tube wall is too thin, the tear of the tube wall is easy to occur. If the first mechanical anastomosis fails, the second anastomosis should not be done in principle, because the incision edge of the tube wall is not uniform, and the tissue is severely pressed by the instrument and the blood supply is poor, and the anastomotic stoma has expanded, so it is difficult to achieve success again. Mechanical anastomosis is not suitable for those with suspected residual cancerous tissue at the incision end or severe injury at the incision end. Other anastomotic indications were consistent with those of hand seam anastomosis.