May 10, 2007

Stapling inside out

Can endoluminal techniques successfully applied in circular stapling? How

can mechanical fastener devices mimic and minimise the cutting action on
the vessel wall of round bodied needles? Will the staples ever be strong
enough to pass through thick atheromatous tissue?
Occluded artery treatment and the variant, abdominal aortic diseases, with
weakened and dilatated vessel wall, are part of the move towards no scar
surgery. In aortic surgery, both elective and emergency, grafting an aorto-
aortic straight graft or aorto-bifemoral Y graft in abdominal aortic
aneurysm repair is a major challenges to the vascular surgeon. Because
aortic aneurysms increase in size over time and with the progression of the
disease, the chance of the aneurysm to leak or rupture is high, resulting
in fatal bleeding. An endograft is designed like a tube or Y graft of
synthetic fabric, preferably knitted material. New endografts are in
development that are easier to manipulate with the aortic end of the
endograft attaching tightly to the outer transverse ridge in order to
prevent buckling.

However, anastomoses of relatively normal looking infrarenal aorta is a

difficult task with a narrow margin for error. In the past there were
attempts to solve the challenge of minimally invasive anastomosis
techniques with mechanical circular stapling prototypes. It has been shown
that the endograft itself is not the primary factor for the challenges of
successful anastomosis onto the aortic or arterial wall. But rather the
challenge is the condition of the wall of the blood vessel, with calcified
deposits and gel like thrombus ruining the consistent circular deployment
of stapling devices. Because the performance of a mechanical anastomosis
device is measured by the incidence of leakage, dilatation, fistula or
hematoma at the anastomotic sites, many circular stapling manufacturers
have given up the concept of a one shot circular stapler in favor of single
shot mechanical fastener device.

A new generation endo fastener devices is needed as there is only a one

time opportunity to place the mechanical anastomosis correctly. With no
space for uncertainty about placement of individual fasteners or for
inaccurate insertion, the future devices need to be safe of failure.

www.IdeasForSurgery.com - Further the future ain t what it used to be

No Rights Reserved. No One Owns It. Everyone Can Use It. Anyone Can Improve It.