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

Abstract

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

Supplementary material

Table S1 Stomach tissue thickness

Acknowledgments

Medtronic provided statistical support (William Mulligan), graphic design support (Chris Switalski), and administrative support (Stephanie Herrmann-Stevenson and Brittany Eno).

This study was sponsored and funded by Medtronic (Minneapolis, MN, USA), which owns Covidien (Mansfield, MA, USA).

Disclosure

Matthew Eschbach reports being employed by Medtronic during the conduct of the study. In addition, Mr Eschbach has medical device patents issued to Medtronic. Gregory M Sindberg, Marisha L Godek, Matthew Nagelschmidt, Nicholas Paquette, Michael Wegener, James Alberino and Jane Mayotte all report being employed by Medtronic during the conduct of the study. Amit Vasanji received financial support from ImageIQ (now ERT) to fund imaging and analysis activity for Medtronic-sponsored study. Andrew M Miesse reports being employed by Medtronic during the conduct of the study. In addition, Mr Miesse has medical device patents issued to Medtronic. The authors report no other conflicts of interest in this work.