An in vitro assessment of tissue compression damage during circular stapler approximation tests, measuring expulsion of intracellular fluid and force

Abstract Circular staplers are among the many instruments used during minimally invasive or open surgery that should approximate soft tissue within safe compression limits. Previous in vivo sutureline blood flow measurement has suggested a safe thickness reduction limit of 25 per cent during circula...

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Bibliographic Details
Published in:Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine Journal of engineering in medicine, 2001-01, Vol.215 (6), p.589-597
Main Authors: McGuire, J, Wright, I C, Leverment, J N
Format: Article
Language:English
Subjects:
Animals
Biological and medical sciences
Blood
Compression testing
Force measurement
In Vitro Techniques
Intracellular Fluid
Investigative techniques, diagnostic techniques (general aspects)
Medical sciences
Miscellaneous. Technology
Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques
Photometers
Photometry
Potassium - analysis
Stiffness
Strain
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgical Wound Dehiscence
Sutures - adverse effects
Swine
Technology. Biomaterials. Equipments
United Kingdom
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Summary:Abstract Circular staplers are among the many instruments used during minimally invasive or open surgery that should approximate soft tissue within safe compression limits. Previous in vivo sutureline blood flow measurement has suggested a safe thickness reduction limit of 25 per cent during circular stapling procedures. The present work investigates in vitro assessment of the maximum safe compression of large and small porcine intestines, measuring the required compressive force and the expelled intracellular fluid (measured as a potassium solution). A test-rig mounted on a materials testing machine allowed staplers of three sizes to compress tissue samples to thicknesses ranging from 90 to 45 per cent of original thickness. The expelled fluid was collected in 40 ml of 0.9 per cent NaCl and analysed in a flame photometer. The force measurements indicated that the small intestinal tissue samples underwent a sharp increase in stiffness over a strain range of 0.19-0.34. The large bowel tissue underwent a similar increase in stiffness over a planar compressive strain range of 0.19-0.40. The regularity of the potassium output results was limited, making it difficult to draw firm conclusions, although there was some indication that the potassium output from small intestinal tissue may change from erratic to approximately linear at a strain of approximately 0.19, while that of the large bowel tissue appeared to be approximately linear over the entire strain range tested. From the force measurements, it is concluded that strain-induced structural change may help provide a useful definition of safe tissue approximation. The possible implications for reduced dehiscence (wound disintegration) and stricture incidence in stapled anastomoses are discussed.
ISSN:0954-4119
2041-3033
DOI:10.1243/0954411011536190