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Micro-CT imaging as a method for comparing perfusion in graduated-height and single-height surgical staple lines

Authors Eschbach M, Sindberg GM, Godek ML, Nagelschmidt M, Paquette N, Wegener M, Alberino J, Mayotte J, Vasanji A, Miesse AM

Received 17 April 2018

Accepted for publication 26 June 2018

Published 15 August 2018 Volume 2018:11 Pages 267—273


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Matthew Eschbach,1 Gregory M Sindberg,2 Marisha L Godek,1 Matthew Nagelschmidt,1 Nicholas Paquette,3 Michael Wegener,1 James Alberino,1 Jane Mayotte,1 Amit Vasanji,4 Andrew M Miesse1

1Minimally Invasive Therapies Group, Medtronic, North Haven, CT, USA; 2Minimally Invasive Therapies Group, Medtronic, Plymouth, MN, USA; 3Minimally Invasive Therapies Group, Medtronic, Mansfield, MA, USA; 4Image IQ, Cleveland, OH, USA

Background: Wound healing is a goal for advanced technology in the surgical space to benefit clinical outcomes. Surgical staplers are commonly used in a variety of open and minimally invasive abdominal and thoracic procedures. Assessment of wound healing traits, such as perfusion, has been challenging due to technical limitations. A novel technique that utilizes micro-computed tomography methodology to measure perfusion was designed to compare the micro-perfusion of staple lines between commercial stapler reloads that employ different staple height strategies.
Materials and methods: Following an Institutional Animal Care and Use Committee-approved protocol, rats were euthanized and immediately heparinized prior to a subtotal gastrectomy with either graduated-height or single-height staples. Rats were then perfused with barium, following which stomachs were removed and immediately fixed in formalin to prevent degradation. Stomachs were then imaged using micro-computed tomography and subsequent analysis was utilized to quantify fluid volume and patent vasculature proximity to staples within the staple line region for each group.
Results: Average perfusion volume was significantly higher with graduated-height staples (0.33% ± 0.18%) compared to single-height staples (0.16% ± 0.09%, P=0.011). Average vessel-to-staple line distance was not significant but trended lower with graduated-height staples (0.35±0.02 mm) compared to single-height staples (0.36±0.03 mm, P=0.18).
Discussion: Graduated-height staples had significantly higher perfusion volume than single-height staples, which likely has a downstream benefit on wound healing and clinical outcomes.
Conclusion: This study shows a higher perfusion volume around the staple lines using graduated-height staples as compared to single-height staples and this may contribute to better wound healing in patients.

Keywords: micro-computed tomography, wound healing, Tri-Staple, image processing, laparoscopic surgery, microvasculature

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