The Minimal Access surgery course was created in a manner that after this program surgeon & gynecologist will be able to do all the taught surgery their own on their patients.
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Register for TrainingDoes it fire consistently? And does it give you a uniform staple line formation? "No malfunctions and no leakage — that's all surgeons care about when it comes to surgical staplers," says David Renton, MD, MPH, an assistant professor of surgery at Ohio State University's Center for Minimally Invasive Surgery in Columbus.
Marlene Brunswick, RN, MSN, CNOR, RNFA, director of perioperative services at Mercy St. Vincent's Medical Center in Toledo, Ohio, takes it a step further. She says a surgeon she once worked with was so concerned about whether his laparoscopic staples would hold that it often meant the difference between a restful or a sleepless night. She says his mind would race with what-ifs from the day's cases:
Dr. Renton still remembers when his stapler malfunctioned during a case. Not misfired. Malfunctioned.
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The stapler fired all the way through, but its jaws, as though locked in cement, wouldn't let go. Thankfully, the stapler rep was in the room. He got his manager on the and they were able to dismantle the stapler inside the patient. "Let's just say there's a lot of moving parts, and we didn't have a sterile screwdriver," says Dr. Renton. "You don't want to dismantle a stapler on the field."
Kidding aside, staplers that misfire or jam will surely draw your surgeons' ire. "The more uniform the staple formation, the better seal you have" says Dr. Renton. "You want every staple to look like it's supposed to look after you fire it." Across tissue or a vessel, staples should fire like "the dotted center line on a highway," says Tina Frank, RN, BSN, nurse manager of the operating room, endoscopy and anesthesia technicians at Pinnacle Health in Harrisburg, Pa. The key to perfectly aligned staples is choosing the proper staple height and width.
"One key physician need is accurate deployment of the staple," says Nancy Burden, RN, manager of ASC quality and education at the BayCare Health System in South Florida. "When a staple becomes lodged in the gun with a misfire, the physician wastes time and can become frustrated when his attention must be directed to the instrument."
As a general rule, to prevent blood leakage in vascular tissue, you want to use "real small, real tight" staples, says Dr. Renton. For abdominal and bowel stapling, you'll want to use larger staplers so that they form and meet on the other side of the tissue. "It all depends on how thick the tissue is that you want to staple," says Ms. Frank. Dr. Renton prefers to use staplers with different tiers of staple sizes: larger on the outer edge and smaller on the insider edge. "With tiered staple height," he says, "you'll reach the cut end and seal it so it doesn't leak."
Advances in technology
Today's staplers offer greater access to the surgical cavity and let surgeons perform more abdominal cases laparoscopically. Ergonomically designed staplers not only let surgeons reach deeper, but also get better margins and better anastamosis. "Con-sidering the larger size of the population, a stapler of this sort will allow more patients a chance at minimally invasive surgery," says a nurse manager at a government facility.
Applying mesh to an abdominal defect during an open hernia repair has been compared to trying to wallpaper your ceiling. Dr. Renton recently trialed a new stapler that he says improves open hernia repairs. He says the ergonomically designed stapler lets surgeons reach deeper into the abdominal cavity to apply tacks uniquely designed to take a bite of mesh when fired at any angle.
Laparoscopic staplers need to be able to reach and approximate the tissue intended to be stapled, says Ms. Brunswick. "To get there, the device needs to be the right length — from pediatric length to bariatric length," she says. The angle at which the tissue needs to be approached is not always the most direct, of course. Manufacturers have responded so that you can rotate, turn and articulate the stapler shaft in many directions to make the use more comfortable for the surgeon and more appropriate for the patient's best outcomes, says Ms. Brunswick. Ergonomics matter, too (see "Can Staplers Cause Surgeon Fatigue?"). Manufacturers have improved stapler handles and grips, and accounted for right- and left-handed use.
All of these advances are not without their challenges. Purchasing and materials management staff must keep track of the many new products and SKUs on the shelf. The scrub and circulator have to learn how to operate the multiple devices. "In-service staff to make sure how they know how to take the stapler apart and put it back together," says Ms. Frank.
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