Finite element modelling of stapled colorectal end-to-end anastomosis: advantages of variable height stapler design.

The impact of surgical staplers on tissues has been studied mostly in an empirical manner. In this paper, finite element method was used to clarify the mechanics of tissue stapling and associated phenomena. Various stapling modalities and several designs of circular staplers were investigated to evaluate the impact of the device on tissues and mechanical performance of the end-to-end colorectal anastomosis. Numerical simulations demonstrated that a single row of staples is not adequate to resist leakage due to non-linear buckling and opening of the tissue layers between two adjacent staples. Compared to the single staple row configuration, significant increase in stress experienced by the tissue at the inner staple rows was observed in two and three rows designs. On the other hand, adding second and/or third staple row had no effect on strain in the tissue inside the staples. Variable height design with higher staples in outer rows significantly reduced the stresses and strains in outer rows when compared to the same configuration with flat cartridge.

[1]  Jingbo Zhao,et al.  Three-dimensional Surface Model Analysis in the Gastrointestinal Tract , 2022 .

[2]  H Gregersen,et al.  Elastic properties in the circumferential direction in isolated rat small intestine. , 1996, Acta physiologica Scandinavica.

[3]  G. A. D. Briggs,et al.  Small Intestine Wall Distribution of Elastic Stiffness Measured With 500 MHz Scanning Acoustic Microscopy , 2001, Annals of Biomedical Engineering.

[4]  Blake Hannaford,et al.  Assessment of Tissue Damage due to Mechanical Stresses , 2006, The First IEEE/RAS-EMBS International Conference on Biomedical Robotics and Biomechatronics, 2006. BioRob 2006..

[5]  R. Miftahof,et al.  Intestinal propulsion of a solid non-deformable bolus. , 2005, Journal of theoretical biology.

[6]  H. Gregersen,et al.  Tension–Strain Relations and Morphometry of Rat Small Intestine in Experimental Diabetes , 2001, Digestive Diseases and Sciences.

[7]  H. Gregersen,et al.  Morphological properties and residual strain along the small intestine in rats. , 2002, World journal of gastroenterology.

[8]  Leo K. Cheng,et al.  Modeling of the mechanical function of the human gastroesophageal junction using an anatomically realistic three-dimensional model. , 2009, Journal of biomechanics.

[9]  J S H M Wismans,et al.  Characterisation of the mechanical behaviour of brain tissue in compression and shear. , 2008, Biorheology.

[10]  H. Gregersen,et al.  Three‐dimensional biomechanical properties of the human rectum evaluated with magnetic resonance imaging , 2005, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[11]  Hans Gregersen,et al.  Biomechanical and morphological properties in rat large intestine. , 2000 .

[12]  H. Gregersen,et al.  Passive elastic wall properties in isolated guinea pig small intestine , 1995, Digestive Diseases and Sciences.

[13]  Blake Hannaford,et al.  Biomechanical properties of abdominal organs in vivo and postmortem under compression loads. , 2008, Journal of biomechanical engineering.

[14]  H. Gregersen,et al.  3d Mechanical properties of the partially obstructed guinea pig small intestine. , 2010, Journal of biomechanics.

[15]  V. Egorov,et al.  Mechanical properties of the human gastrointestinal tract. , 2002, Journal of biomechanics.

[16]  H. Gregersen,et al.  Gastrointestinal tract modelling in health and disease. , 2009, World journal of gastroenterology.

[17]  Ellen Kuhl,et al.  Experimental study and numerical analysis of arterial clamping , 2011 .

[18]  Mark L. Palmeri,et al.  Acoustic Radiation Force Impulse (ARFI) Imaging of the Gastrointestinal Tract , 2004, IEEE Ultrasonics Symposium, 2004.

[19]  L. Bilston,et al.  Unconfined compression of white matter. , 2007, Journal of biomechanics.

[20]  H. Gregersen,et al.  Morphology and stress-strain properties along the small intestine in the rat. , 2003, Journal of biomechanical engineering.

[21]  A. Kartheuser,et al.  Use of the circular stapler in 1000 consecutive colorectal anastomoses: experience of one surgical team. , 1995, Surgery.

[22]  R. Miftahof,et al.  Dynamics of intestinal propulsion. , 2007, Journal of theoretical biology.

[23]  R. Mittal,et al.  A novel ultrasound technique to study the biomechanics of the human esophagus in vivo. , 2002, American journal of physiology. Gastrointestinal and liver physiology.

[24]  Asbjørn Mohr Drewes,et al.  Ultrasound-Determined Geometric and Biomechanical Properties of the Human Duodenum , 2006, Digestive Diseases and Sciences.

[25]  A. Borzotta,et al.  Complications of primary repair of colon injury: literature review of 2,964 cases. , 1999, American journal of surgery.

[26]  W. Hop,et al.  After-hours colorectal surgery: a risk factor for anastomotic leakage , 2009, International Journal of Colorectal Disease.

[27]  H. Gregersen,et al.  Time-dependent viscoelastic properties along rat small intestine. , 2005, World journal of gastroenterology.

[28]  T. Eberl,et al.  Risk factors for anastomotic leakage after resection for rectal cancer. , 2008, American journal of surgery.

[29]  James Foote,et al.  The Science of Stapling and Leaks , 2004, Obesity surgery.

[30]  A. W. Schopper,et al.  Analysis of effects of friction on the deformation behavior of soft tissues in unconfined compression tests. , 2004, Journal of biomechanics.

[31]  H. Gregersen,et al.  History-Dependent Mechanical Behavior of Guinea-Pig Small Intestine , 1998, Annals of Biomedical Engineering.

[32]  H. Gregersen,et al.  Geometric and mechanosensory properties of the sigmoid colon evaluated with magnetic resonance imaging , 2007, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.