title: A Single Institution Review of Initial Application of a 5-mm Stapler.
abstract: BACKGROUND
  Operating in small spaces presents physical constraints that can be even more challenging in minimally invasive operations. Recently, a 5-mm stapler was approved for use in general surgery and pediatric surgery. Here, we present our initial experience using the 5-mm stapler in pediatric general surgery.
  
  
  METHODS
  A retrospective chart review was conducted to identify cases using the 5-mm stapler at our institution. Demographic data included age (in months) and weight (in kilograms). Operative data included indication for use, number of loads used, complications related to 5-mm stapler use, and interventions to address complications. A second review focused on patients undergoing the same operations, but using a 10-mm stapler.
  
  
  RESULTS
  A total of 60 staple loads were deployed in 32 procedures. There were four adverse outcomes, all recognized intraoperatively. One bleed resulted from application on irradiated tissue and another bleed from application to a small noninflamed mesoappendix. A bronchial staple line leak resulted from improper stapler loading, and a bowel anastomosis leak was oversewn with a single stitch. When compared with 32 matched cases using a 10-mm stapler, there was no difference in age (5-mm = 39.11 months, 10-mm = 50.21 months, P = .49) or weight (5-mm = 16.34 kg, 10-mm = 19.93 kg, P = .51). A total of 60 staple applications were used, with one bleed noted. There was no significant difference in overall complication rate (5-mm rate = 4/60, 10-mm rate = 1/60; P = .36).
  
  
  CONCLUSIONS
  Our initial experience suggests that although there were more complications with the 5-mm stapler, there is no statistically significant difference in complication rates when compared with the 10-mm stapler. Furthermore, the 5-mm stapler complications can be corrected with device training and proper patient selection. In appropriately selected pediatric surgery cases with size limitations, the 5-mm stapler can be used to minimize the invasiveness of the operation.
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Rogers
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.
authors.forename: Tiffany J
authors.initials: TJ
authors.lastname: Zens
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Kohler
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.
authors.forename: Hau D
authors.initials: HD
authors.lastname: Le
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Nichol
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Leys
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000295:instrumentation; D057868:Anastomotic Leak / Q000209:etiology; D001980:Bronchi / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007422:Intestines / Q000601:surgery*; D007431:Intraoperative Complications / Q000209:etiology; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D012189:Retrospective Studies; D013528:Surgical Staplers / Q000009:adverse effects; D017792:Surgical Stapling / Q000379:methods