How to work with offset lung staplers
Surgeons around the world currently work with two principal surgical stapler design, where the anvil jaw (thin part) is either inline (e.g. Medtronic) or offset (e.g. Johnson and Johnson).
Proficient surgeons are comfortable working with both, but a common issue for those who are more used to working with inline anvil jaw staplers (where the staple line pass is pointed directly inline such that the “thin part” is directly behind the tissue ) is how to work with offset anvil jaw staplers.
Single port surgery has the most demanding requirements for staple line passes (as there is only one point of entry), so here are some tips if you are new or have difficulties, with my personal estimate of increasing likelihood of success if used in order:
1.Use a Belcher to estimate the angle (70%)
If a Belcher (long Roberts) can easily pass, then you will have no problems with the offset stapler.
2.Use a tie (80%)
Place a thick absorbable suture behind the structure and apply gentle traction to open more space for the stapler.
3.Partial closure (90%)
As you proceed through the pass, close the jaw to allow it to pass through more of a straight line
4.Rotation (95%)
As you exit, rotate rotate the jaw as this has the effect of (turning) out from a tight pass. This technique is especially useful for exiting from an upper lobe bronchus pass.
5.Use a suction (99%)
A a nifty move that Diego Gonzalez showed me, is to place an endoscopic sucker into the proposed staple line pass. Then (my own application), move it to the side to allow space to advance the offset staple jaw. This usually sorts out the most difficult of passes.
6.Use another port (almost 100%)
If all else fails, place an additional port to facilitate an easier line to pass.
Consider using these tips for your single port surgery, and with practice you can only get better!