Use of 5-mm Stapler in Infants and Children

Bethany J Slater, MD, Kristen Shipman, MD, Saundra Kay, MD, Steven S Rothenberg. Rocky Mountain Hospital for Children

Objective:

Staplers are used for a variety of purposes in surgical operations. For minimally invasive procedures, staplers have been designed requiring a 12-mm trocar for access. However, in infants and small children, using a 12-mm stapler not only requires a large incision for the port, but there is also very little working space to introduce and manipulate such a large device. Thus, JustRight surgical (Boulder, CO) developed a 5-mm stapler to be used for standard surgical techniques in small children.

Methods:

The 5-mm stapler fires 4 staggered rows of 2.0 mm staples and then cuts between them. It has been FDA approved for use in children. It has a shaft width of 20 cm and staple line length of 25 mm.

Results:

From March 2014 to December 2014, 20 minimally invasive procedures were performed on children at a single institution using the 5-mm stapler. The average age of the patients was 6.6 years (ranging from 2 days to 17 years) and the average weight was 29 kg (ranging from 2.5 to 56 kg). The cases consisted of 11 appendectomies, 2 lung lobectomies, 3 lung biopsies, 3 bowel resections, and 1 gastric pull up to divide the esophagus. In all of the cases, the stapler enabled successful stapling and cutting of the structure intended to be divided. One patient developed a stricture after an extracorporeal stapled anastomosis although there was a large discrepancy between the two sides in this neonate.

Conclusion:

The 5-mm stapler is safe and effective for use in infants and children. The smaller size and ergonomic design of the instrument allows for smaller incisions to be used with enhanced post-operative cosmesis and pain control, better visibility and maneuverability in small spaces, and increased precision of stapling.