Surgical Stapling in Abdominal Surgery

Learn about surgical stapling equipment options that offer alternatives to conventional hand-suturing techniques.

Dr. Michael M. Pavletic
Surgical stapling equipment allows the small-animal surgeon to perform a variety of challenging abdominal surgical procedures more quickly and consistently than with conventional, hand-suturing techniques. This article will summarize the use of these devices.

Surgical staplers I use the following surgical stapling devices routinely for abdominal surgery: skin staplers, Surgiclips, the Ligate-Divide Stapler, the Thoracoabdominal Stapler, the Gastrointestinal Anastomosis Stapler, and the End-to-End Anastomosis Stapler (Tyco Healthcare/Kendall Animal Health). Each device has specific advantages. For small patients, small laparoscopic staplers can also be used during a standard laparotomy approach.

Figure 1: Surgiclip device. Compressing the scissors mechanism will apply a single, flat staple to a small vessel. Upon release, a staple is automatically reloaded for the next application.
Skin staplers are quite useful to quickly close long, abdominal incisions. In thin skin, application of a standard surgical glue to the incision line after staple application helps to stabilize skin staples and minimize occasional postoperative staple movement or rotation. Vascular clips can be used to secure multiple vascular pedicles quickly in a variety of surgical procedures, including bowel resection and anastomosis, splenectomy, partial liver resection, and tumor removal. Surgiclips apply single, flat clips to small vessels, whereas the Ligate-Divide Stapler applies two curved vascular clips simultaneously while the blade within the cartridge divides the vessel between the clips. The long, narrow silhouette of Surgiclip staplers is effective in ligating vessels in recessed areas where hand ligatures are difficult or impossible to apply, such as in the removal of adrenal tumors (Figure 1). The larger Ligate-Divide Stapler is useful for ligating multiple, exposed vascular pedicles rapidly, such as in splenectomies (Figure 2).

The Thoracoabdominal Stapler and Gastrointestinal Anastomosis Stapler apply linear rows of staples. The Thoracoabdominal Stapler, the most commonly used linear stapler, applies two rows of staggered staples (Figures 3a & 3b). The Thoracoabdominal Stapler is particularly useful for gastrotomy incision closure, partial splenectomies, and liver lobectomies. The Gastrointestinal Anastomosis Stapler applies four rows of staggered staples; the most commonly used cartridge contains a blade that divides the tissue between the second and third staple rows. The Gastrointestinal Anastomosis Stapler can staple two edges of divided tissue in a single application (Figures 4a & 4b). The Gastrointestinal Anastomosis Stapler is especially effective for partial gastrectomy in cases of necrosis secondary to gastric torsion. In conjunction with the Thoracoab-dominal Stapler, the Gastrointestinal Anastomosis Stapler can be used to perform rapid, functional end-to-end anastomosis after small bowel resection.

Figure 2: Ligate-Divide Stapler unit. Each cartridge contains 15 pairs of curved vascular clips. Compression of the handle will apply two clips to a vessel as a blade cuts between them. This device is especially useful for complete splenectomies.
In contrast, the End-to-End Anastomosis Stapler applies two rows of surgical staples in a circular configuration—ideal for the end-to-end anastomosis of the larger diameter colon and esophagus in small animals. The Autosuture Pursestring 65 device (Tyco Healthcare/Kendall Animal Health) is used in conjunction with the End-to-End Anastomosis Stapler. The Autosuture Pursestring devise applies a pursestring suture to the cut end of each opposing bowel segment. Each pursestring suture is then tied to the central shaft of the End-to-End Anastomosis Stapler. Closure of the End-to-End Anastomosis Stapler aligns, apposes, and staples the segments together; the circular cutting blade located within the disposable End-to-End Anastomosis Stapler cartridge removes the pursestring and redundant tissue borders.