Outpatient Surgery Magazine

Backbreaker - April 2019 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://magazine.outpatientsurgery.net/i/1101250

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Page 31 of 146

• Have a range of staple sizes available and select the appropriate size cartridge for the tissue type and thickness. • If you have difficulty squeezing the handle of the stapler, you may need to select a different size staple. • Avoid using the stapler on tissue that is too thick or too thin for the selected staple size, as this could result in staple malformation. • Be aware that different companies may use different color schemes to indicate different staple sizes. • Consider other options if the patient's tissue is edematous (swollen with fluid), friable (tissue that readily tears, fragments or bleeds with gently palpated or manipulated), or necrotic (death of tis- sue) as the staples may be less likely to securely approximate tissue. • Be familiar with the structures around the intended staple site and check that unintended structures — such as urinary bladder or foreign objects such as clips — are not in the staple line. • Avoid using on large blood vessels, such as the aorta. • Avoid clamping the stapler on delicate tissue, as clamping can cause injury even if no staple is fired. • If a malfunction of the stapler occurs while applying staples across a blood vessel, then clamp or ligate the vessel before releasing the sta- pler while it is still closed on the tissue. Better reporting But these recommendations won't do much additional good unless there is a better system in place for reporting device failures, accord- ing to one doctor. "We need a real-time, transparent system to move information to the people who need it. And the people who actually need it the most are the companies, with the FDA providing oversight," says Steven Schwaitzberg, MD, FACS, professor and chairman of the University at Buffalo 3 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A P R I L 2 0 1 9

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