BACKGROUND Optimal stapler selection during laparoscopic sleeve gastrectomy requires careful balance between tissue compression, hemostasis, and mechanical integrity. Junctions along a staple line can further increase the risks of technical or mechanical staple line failures. The aim of this study was to compare two commonly utilized laparoscopic linear gastrointestinal staplers (Ethicon, Medtronic) with a novel linear stapler (Titan) designed to perform a sleeve gastrectomy with a single stapler firing. METHODS Excised gastric remnants from laparoscopic sleeve gastrectomy were utilized and tissue thickness was measured from fundus to antrum. An optimized experimental staple line was then created. The greater curve remnant was insufflated to determine the staple line burst pressure and location. The doubly stapled (clinical and experimental) gastric specimen underwent staple analysis for junctional location, malformation, and height. RESULTS The Titan stapler withstood a significantly higher burst pressure than both Ethicon and Medtronic linear cutting staplers. While the Medtronic and Ethicon staplers had a similar percentage of staples in junctions, the Titan stapler has no junctions. In considering the formation of all staples outside of junctions, the Medtronic and Titan staplers had no difference in percentage of malformed staples, while the Ethicon stapler had a significantly higher percentage. Additionally, there were no differences in mismatch between staple height and tissue thickness between experimental groups. CONCLUSIONS The Titan stapler conveys the mechanical benefits of higher burst pressure with the advantage of single load functionality. This single staple load eliminates staple line junctions without sacrificing the integrity of staple formation.

中文翻译：

---

评估用于腹腔镜袖状胃切除术的新型吻合器性能。

背景技术在腹腔镜袖状胃切除术期间选择最佳吻合器需要在组织压缩、止血和机械完整性之间进行仔细平衡。沿主食线的连接点会进一步增加技术或机械主食线故障的风险。本研究的目的是比较两种常用的腹腔镜线性胃肠吻合器（Ethicon，Medtronic）与一种新型线性吻合器（Titan），设计用于通过单次吻合器发射进行袖状胃切除术。方法采用腹腔镜袖状胃切除术切除的残胃，测量胃底至胃窦的组织厚度。然后创建了优化的实验钉线。更大的曲线残余被吹入以确定钉线爆裂压力和位置。双缝合（临床和实验）胃标本进行了缝合位置、畸形和高度的缝合分析。结果 Titan 吻合器承受的爆破压力明显高于 Ethicon 和 Medtronic 线性切割吻合器。虽然 Medtronic 和 Ethicon 订书机在接头处的订书钉比例相似，但 Titan 订书机没有接头。考虑到连接处外所有订书钉的形成，Medtronic 和 Titan 订书机在畸形订书钉的百分比上没有差异，而 Ethicon 订书机的百分比明显更高。此外，实验组之间的缝钉高度和组织厚度之间的失配没有差异。结论 Titan 订书机具有更高爆破压力的机械优势和单次装载功能的优势。这种单一的订书钉负载消除了订书钉线的连接点，而不会牺牲订书钉形成的完整性。