Comparison of the Time Needed to Complete a Staple Firing Sequence between a Manual and Powered Laparoscopic Stapler

Donald R Peterson, PhD, MS, Drew Seils, MS, Tarek Tantawy, MS, Angela S Kueck, MD

University of Connecticut Health Center

The poor ergonomic design characteristics of the typical manual laparoscopic stapler pose a significant risk for operator errors. For example, the speed at which a user operates the instrument during staple firing may influence tip motion and the applied stress on the target tissue. In this study, data from two thin-film force sensors (Tekscan, Boston, MA) placed on the levers of a commonly-used manual stapler and on the activation switches of a fully-powered stapler, designed to control various stapling functions such as staple pushing rate and blade retraction rate, were used to determine the time needed to complete a firing sequence (i.e., from the time the stapler was closed on the tissue to the time the jaw was opened and moved off the tissue). Ten experienced laparoscopic surgeons were recruited to perform firing simulations on indicated tissue surrogates (i.e., foam) in a laparoscopic trainer. Simulations were performed in positions representing neutral and awkward postures commonly observed in laparoscopic surgeries and none of the subjects had any prior experience in using powered staplers. Results showed mean firing times of 10.5 seconds for the manual stapler and 22.4 seconds for the powered stapler. A single-tailed t-test applied to the distribution of the firing durations indicated that manual stapler had significantly inconsistent firing times when compared to that of the powered stapler (t=2.2242, df=178, p<0.05). Although the manual stapler exhibited shorter firing times, controlled and consistent staple firing, as observed with the powered stapler, may result in improved performance and outcomes overall.

Session: Poster Presentation

Program Number: P398

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