Micro-CT imaging as a method for comparing perfusion in graduated-height and single-height surgical staple lines

• Published in: Medical devices (Auckland, N.Z.) N.Z.), 2018-01, Vol.11, p.267-273
• Main Authors: Eschbach, Matthew, Sindberg, Gregory M, Godek, Marisha L, Nagelschmidt, Matthew, Paquette, Nicholas, Wegener, Michael, Alberino, James, Mayotte, Jane, Vasanji, Amit, Miesse, Andrew M
• Format: Article
• Language: English
• Subjects: Barium; CAT scans; Design; Diagnostic imaging; Endoscopy; Formaldehyde; graduated-height staples; Image processing; Laboratory animals; Laparoscopy; Medical imaging; Methods; Micro-CT; Novels; Original Research; perfusion; Stomach; Surgery; surgical staplers; Technology; Tomography; Wound care; Wound healing
• ISSN: 1179-1470; 1179-1470
• DOI: 10.2147/MDER.S171357

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. 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. Average perfusion volume was significantly higher with graduated-height staples (0.33% ± 0.18%) compared to single-height staples (0.16% ± 0.09%, =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, =0.18). Graduated-height staples had significantly higher perfusion volume than single-height staples, which likely has a downstream benefit on wound healing and clinical outcomes. 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.