title: In vivo evaluation of a modified linear stapling device designed to facilitate accurate pathologic examination of the surgical margin.
abstract: BACKGROUND
  Microscopic involvement of the resection margin could influence the long-term outcome of patients undergoing curative surgery for gastric cancer. Linear staplers, commonly used for gastrectomies, are often equipped with three lines of staples on either side of the resection line. Although multiple lines of staples reinforce closure of the gastric or intestinal stump, they could hinder accurate histopathologic evaluation of the surgical margin of the resected specimen.
  
  
  METHODS
  We modified a linear stapling device by removing one line (stapler E2) or two lines (stapler E1) of staples on the specimen side, and attempted to dissect a silicon film and then the stomach from a porcine model using the stapling device and examined the distances between the cutting edge and the nearest staple line.
  
  
  RESULTS
  The distance between the cutting edge and the staple line for stapler E1 was significantly greater than the distance between the cutting edge and the nearest staple line for stapler E2 or the control device. Consequently, specimens of exemplary quality were available for pathologic examination of the surgical margin. Moreover, the lack of multiple layers of staples did not result in contamination of the abdominal cavity with gastric juice during laparoscopic procedures in the porcine model.
  
  
  CONCLUSIONS
  Stapler E1 is safe and could be useful for the pathologic evaluation of the true surgical margin.
authors.affiliation: Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan. tsujihi@ndmc.ac.jp.
authors.forename: Hironori
authors.initials: H
authors.lastname: Tsujimoto
authors.affiliation: Department of Basic Pathology, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tsuda
authors.affiliation: Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Hiraki
authors.affiliation: Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Nomura
authors.affiliation: Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Ito
authors.affiliation: Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan.
authors.forename: Kyohei
authors.initials: K
authors.lastname: Kanematsu
authors.affiliation: Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Horiguchi
authors.affiliation: Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan.
authors.forename: Suefumi
authors.initials: S
authors.lastname: Aosasa
authors.affiliation: Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hase
mesh_terms: D000818:Animals; D005260:Female; D005743:Gastrectomy / Q000295:instrumentation / Q000379:methods; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods; D000072662:Margins of Excision; D013270:Stomach / Q000601:surgery*; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000295:instrumentation* / Q000379:methods; D034421:Sus scrofa
keywords: Clinical outcome; Laparoscopic surgery; Pathologic examination; Surgical margin