Marra Alessandro, Yankulov Aleksandar
Department of Thoracic Surgery, Lung Centre, Rems-Murr-Klinikum Winnenden, Winnenden/Stuttgart, Germany.
J Thorac Dis. 2023 Feb 28;15(2):893-900. doi: 10.21037/jtd-22-192. Epub 2022 Aug 19.
Surgical staplers play an important role in the contemporary minimally invasive thoracic surgery including resection of lung tissue. However, staple line failure resulting in postoperative air leaks is a common complication after lung surgery, that if persist more than five days are defined as prolonged air leaks (PALs). PALs are associated with increased length of stay, patient morbidity and mortality, and hospital costs. To reduce the incidence of PALs, stapler devices underwent in the last years ongoing development aimed at improving device-to-tissue interaction. This clinical practice review explores the most important aspects of the evolution of surgical staplers, based on the review of the available literature. Modern staple cartridges entail small bumps to engage tissue and minimize tissue movement during compression and firing. Staplers with graduated staple heights are advocated to generate less stress on tissue during compression and clamping, thus affording greater perfusion into the staple line. However, air leaks may occur from an appropriate staple line with complete pleural coverage and perfusion due to enlarged staple canals after lung inflation, particularly in case of emphysema. To buttress staple line, thus prevent air leaks in high-risk patients, several types of tissue coverage (bovine pericardium, polytetrafluoroethylene, knitted calcium alginate, bioabsorbable polyglycolic acid) have been successfully developed in the last years. Finally, the most advanced stapler technology is represented by the new energy powered staplers, able to eliminate the manual firing force, monitor tissue compression during firing, and making automatic adjustments to optimize the staple line.
外科吻合器在当代包括肺组织切除在内的微创胸外科手术中发挥着重要作用。然而，吻合口漏导致术后气胸是肺手术后的常见并发症，若持续超过五天则被定义为持续性气胸（PALs）。PALs与住院时间延长、患者发病率和死亡率以及医院成本增加相关。为降低PALs的发生率，吻合器设备在过去几年不断发展，旨在改善器械与组织的相互作用。本临床实践综述基于对现有文献的回顾，探讨了外科吻合器演变的最重要方面。现代钉仓有小凸起以夹住组织，并在压缩和击发过程中尽量减少组织移动。提倡使用具有渐变钉高的吻合器，以便在压缩和夹紧过程中对组织产生较小的压力，从而为吻合口提供更好的灌注。然而，由于肺膨胀后钉道扩大，即使吻合口覆盖完整且灌注良好，仍可能发生气胸，尤其是在肺气肿患者中。为加强吻合口，从而防止高危患者出现气胸，近年来已成功开发出几种类型的组织覆盖物（牛心包、聚四氟乙烯、针织海藻酸钙、可生物吸收的聚乙醇酸）。最后，最先进的吻合器技术以新能源动力吻合器为代表，它能够消除手动击发力，在击发过程中监测组织压缩情况，并进行自动调整以优化吻合口。
