Gastrointestinal Surgical Techniques in Small Animals. Группа авторов
Newer DST TA linear staplers use reloadable linear cartridges with directional staple technology titanium staples. This technology uses a cross‐sectional rectangular staple wire that bends more reliably into a fully formed “B”‐shaped secure staple (http://www.medtronic.com/covidien/en‐us/products/surgical‐stapling/open‐staplers.html).
Cutting linear staplers have a cutting blade that divides the tissue after two rows of staggered staples are fired on either side of line. The gastrointestinal staplers (GIA, Medtronic, Minneapolis, MN) are commonly used in veterinary surgery and they are 60, 80, or 100 mm long (Figure 2.4).
Linear cutting and stapling devices are often used for pulmonary, cardiac, gastrointestinal, hepatobiliary, or reproductive applications. The staplers allow occlusion and division of tissue in a single surgical maneuver. GIA 4.8 mm staplers (4.8 mm open to 2.0 mm closed) are often used for partial gastrectomy during GDV surgery, and GIA 3.8 mm staplers (3.8 mm open to 1.5 mm closed) are used for intestinal anastomosis. Gastrointestinal staplers (Endo GIA, Medtronic, Minneapolis, MN) are used during endoscopic procedures. These cutting linear staplers have staples that continue past the cutting blade limit to ensure that incomplete incisions into vessels or hollow organs do not leak.
Circular stapling devices are used to perform end‐to‐end, end‐to‐side, or side‐to‐side anastomoses in the gastrointestinal tract. It fires a circular staggered double‐row staple line, and an inner circular cutting device creates a stoma within the circular staple line (Figure 2.5). Circular staplers create an inverted anastomosis. Circular staplers need to be sized correctly according to the diameter of the organ, and should not be used when the combined tissue thickness is less than 1 mm or more than 2.5 mm. In small animal surgery, the 21 and 25 mm EEA devices with 3.5 or 4.8 mm staples are used most often in gastrointestinal surgeries. The device diameter must fit inside the lumen of the organ to be stapled without tension. Patient size is a limiting factor for circular staplers in small animal surgery. Generally EEAs can be used in large bowel of most small animals and only medium‐ to large‐breed dogs for the small bowel. A Furniss device is used to place a purse‐string of monofilament sutures on either side of the tubular organ ends to be anastomosed. A detachable anvil is secured with one purse‐string suture. The other end is secured in a similar fashion to the stapler head. The anvil is connected to the head and the ends are firmly brought together. After the stapler is fired a circular cutting blade cuts a donut of tissue within the circular staple line (Figure 2.6). Always inspect the donut to be sure all layers of the bowel have been cut and there is a patent lumen.
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