Medical Devices: Evidence and Research (Aug 2018)
Micro-CT imaging as a method for comparing perfusion in graduated-height and single-height surgical staple lines
Abstract
Matthew Eschbach,1 Gregory M Sindberg,2 Marisha L Godek,1 Matthew Nagelschmidt,1 Nicholas Paquette,3 Michael Wegener,1 James Alberino,1 Jane Mayotte,1 Amit Vasanji,4 Andrew M Miesse1 1Minimally Invasive Therapies Group, Medtronic, North Haven, CT, USA; 2Minimally Invasive Therapies Group, Medtronic, Plymouth, MN, USA; 3Minimally Invasive Therapies Group, Medtronic, Mansfield, MA, USA; 4Image IQ, Cleveland, OH, USA Background: Wound healing is a goal for advanced technology in the surgical space to benefit clinical outcomes. Surgical staplers are commonly used in a variety of open and minimally invasive abdominal and thoracic procedures. Assessment of wound healing traits, such as perfusion, has been challenging due to technical limitations. A novel technique that utilizes micro-computed tomography methodology to measure perfusion was designed to compare the micro-perfusion of staple lines between commercial stapler reloads that employ different staple height strategies. Materials and methods: Following an Institutional Animal Care and Use Committee-approved protocol, rats were euthanized and immediately heparinized prior to a subtotal gastrectomy with either graduated-height or single-height staples. Rats were then perfused with barium, following which stomachs were removed and immediately fixed in formalin to prevent degradation. Stomachs were then imaged using micro-computed tomography and subsequent analysis was utilized to quantify fluid volume and patent vasculature proximity to staples within the staple line region for each group. Results: Average perfusion volume was significantly higher with graduated-height staples (0.33% ± 0.18%) compared to single-height staples (0.16% ± 0.09%, P=0.011). Average vessel-to-staple line distance was not significant but trended lower with graduated-height staples (0.35±0.02 mm) compared to single-height staples (0.36±0.03 mm, P=0.18). Discussion: Graduated-height staples had significantly higher perfusion volume than single-height staples, which likely has a downstream benefit on wound healing and clinical outcomes. Conclusion: This study shows a higher perfusion volume around the staple lines using graduated-height staples as compared to single-height staples and this may contribute to better wound healing in patients. Keywords: micro-computed tomography, wound healing, Tri-Staple, image processing, laparoscopic surgery, microvasculature
