• 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
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