title: Comparison of endostapler performance in challenging tissue applications.
abstract: BACKGROUND
  Surgical staplers are frequently used in a variety of applications, demanding exacting instrument performance over a huge range of tissue compositions and disease states. The shape of a staple that is formed by a stapling device is one industry-accepted indicator of device performance; typically a B-shaped staple is considered the gold standard for staple formation. This B shape allows blood flow through the tissue, which is one important factor in the healing events that take place clinically after stapling. With the use of an animal model, this ex vivo study investigated staple formation when thick tissue endoscopic staplers were used on challenging and variable tissue. The setting was a corporate institution in the United States.
  
  
  METHODS
  Two 60-mm linear endoscopic thick tissue reloads, a varied-height stapler (VHS), and a single-height stapler (SHS) were fired on 7 different regions of porcine stomach. Resultant staple formation was assessed per region of the stomach and evaluated for proper B-shaped staple formation and staple malformation.
  
  
  RESULTS
  The VHS reload had significantly better B-shaped formation (P<.001) for all regions of the stomach and reduced occurrence of malformed staples in 5 of the 7 regions compared with the SHS reload, wherein the remaining 2 regions exhibited comparable malform occurrence.
  
  
  CONCLUSIONS
  This study compared 2 thick tissue reloads and found that the VHS reload had superior outcomes, with respect to staple formation, compared with the SHS reload.
authors.affiliation: Covidien Surgical Solutions, Fundamental Biomedical Research Department, North Haven, Connecticut. Elizabeth.Contini@covidien.com
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Contini
authors.forename: Jennifer
authors.initials: J
authors.lastname: Whiffen
authors.forename: Dwight
authors.initials: D
authors.lastname: Bronson
mesh_terms: D000818:Animals; D004867:Equipment Design; D004868:Equipment Failure; D013528:Surgical Staplers / Q000592:standards*; D017792:Surgical Stapling / Q000592:standards*; D034421:Sus scrofa