- Email: [email protected]
Staple suturing vs conventional suturing
Staple suturing vs conventional suturing Wilma Dehnel, RN
From a comparative study of 40 operative procedures using staple suturing and conventional suturing, I have concluded that staple suturing techniques contribute to the reduction of operating time, anesthesia time, blood loss and the length of the patient’s hospital stay. A random selection of 20 pneumonectomies and 20 lobedomies performed by one surgeon are the basis of research. Ten cases of each procedure using staple suturing and ten cases using conventional suturing techniques were selected. The ten pneumonectomies using conventional suturing are shown in chart 1; ten pneumonectomies using staple suturing in chart 2; ten lobectomies using conventional suturing in chart 3; and ten lobectomies with staple suturing in chart 4. The LDS (ligating, dividing and stapling) instrument is used for ligating and Wilma Dehnel, RN, i s a private scrub nurse for a thoracic surgeon in Abilene, Kan. She i s a graduate of Shannon Memorial Hospital in San Angelo, Tex.
296
dividing small segmental veins, intercostal nerves, chest wall adhesions and soft tubular structures. The TA (thoracic-abdominal) -30 stapling instrument, which produces a linear row of staples 30 mm in length, is used in pneumonectomy and lobectomy procedures for closure of the bronchus, closure of the pulmonary artery and veins, and for creation of interlobar fissures. This instrument is also used to perform large or small wedge resections and segmental resections of lung tissues. The application of the TA-30 staple sutures before the resection of the bronchus insures accurate approximation of tissue. Gross contamination of an open bronchus is reduced. Stapled tissues undergo less trauma; therefore, there is less leakage of air and blood from the suture line. (Fig 1) Conventional suturing produces tiny holes where leaks occasionally occur. (Fig 2 and 3) The danger of major postoperative com-
AORN Journal, August 1973, Vol18, N o 2
Fig
I . Staple suturing of
bronchus
Fig 3.
Staple suturing of
pulmonary vessels
Fig 2. Conventional suturing of bronchus
Fig 4. Conventional suturing of pulmonary vessels.
AORN Journal, August 1973, V o l 1 8 , N o 2
297
Chart I
l-
Procedure: Pneumonectory with
Number Blood given postoperative during surgery conventional suturing days i n units
I
Left
6
I
I
Operating time
I
3 hrs5min
Right
9
0
2 hrs 40 rnin
Left
II
0
3 hrs 30 min
Lefi
6
2
2 hrs 45 min
Left
8
2
2 hrs 45 min
Left
23
0
2 hrs 15 min
Left
7
2
I hr 50min
2
1 2 hrs IOmin
7
2
3 hrs 5 min
101
12
26 hrs 55 min
I
Left
13
Right Left-8 Rig ht-2
I
10.1
I
I
1.2
I
2 hrs41 min
Chart 2
Date
Case
Sex
Age
Procedure:
Number
Pneumonectomy using TA-30, LDS
8
0
I hr 5 0 m i n
10
0
2 hrs IOmin
Right
6
2
I hr 4 5 m i n
55
Left
5
0
I hr 30min
Male
65
Right
7
0
I hr 25min
Male
64
Right
8
0
I hr 20 min
Male
67
Right
II
I
I hr
Male
67
Right
12
0
I hr 35min
0
1 2 hrs 15min
60
Left
2
9/24/69
Male
65
Right
3
I / 13/70
Male
53
Left
4
2/ 19/70
Male
53
5
9/22/70
Male
6
1/11/72
10
Average
298
I hr 50 min
Male
9/14/71
time
0
7/10/69
I
Operating
12
I
9
Blood given
postoperative during surgery days i n units
I 9/16/71 I Male
I
64
60
I
Right
I
9
I
8.8
AORN Journal, August 1973, V o l 1 8 , N o 2
.3
5 min
I hr 4 0 m i n
--
Chart 3
-I-
Blood given during surgery in units
3
0
I
Operating time
I 2 hrs IOmin I I hr 50min I I hr 4 5 m i n
+ I hr 15min
Totals
Rig ht-7 Left-3
5 males Average
15.1
1 1 11 Date
Ca;
A :;
Sex
7
I 3 hrs IOmin
18
I 9 hrs 18 min
I .8
I hr 56 min
Chart 4
Procedure: Lobectomy w i t h TA-30
~
darl
Operating time
Blood given during surgery in units
Number postop
I hr I 5 m i n
6/27/72
Female
Right lower lobectomy
6/2/72
Female
63
Right upper lobectomy
10
3
5/5/72
Male
59
L e f t upper lobectomy
5
0
I hr 4 0 m i n
4
3/10/72
Male
68
Right lower lobectomy
13
0
I hr 20 min
5
2/14/72
Male
72
Left upper lobectomy
9
I
I hr 35min
6
1/25/71
Male
65
Right lower lobectomy
II
0
2 hrs
7
1/26/71
Male
70
Right lower lobectomy
8
0
I hr 45 min
I 7/1/71 I Male
1
I
I hr 4 5 m i n
I
8
9
Male
63
Left lower lobectomy
8
0
I hr 20 min
10
5/11/70
Male
69
Right lower lobectomy
15
0
I hr
Right-7 Left-3
92
I
9.2
.I
Totals
Average
45
8 males 2 females 60
AORN Journal, August 1973, Vol18, N o 2
0
I I hr
Right upper lobectomyl
6/14/71
8
45min
II 5 hrs 24 min
I
I hr 32 min
299
Synopsis Conventional suturing method
Staple suturing
2 hrs 41 m i n
I hr 40 m i n
10.1 days
8.0 days
Pneumonectomies Average operating time Number o f postoperative days in hospital Total blood units given during surgery10 patients
12 units
3 units
I
Lobectomies Average operating time
I I hr 5 6 m i n
I hr 32 m i n
15.1 days
9.2 days
Number of postoperative days in hospital Total blood units given during surgery-
18 units
10 patients 1
plications is increased when conventional suturing techniques are used. These complications include the incidence of secondary hemorrhage, postoperative infection and bronchopleural fistula . When the staple suture devices are used the average reduction in operating time was approximately one hour in pneumonectomies and 24 minutes in lobwtomies. The total amount of time saved on these two procedures in one year of a busy operating roan could represent an impressive accumulation of extra scheduling time for the operating mom and for the surgeon. It also represents a reduction in operating room cost to the patient. This study reveals that a total of 12 units of blood was administered to the group of ten pneumonectomy patients when conventional suturing techniques were used. A total of only three units of blood was administered to the group of ten pnewnonectomy patients when staple suturing techniques were used. The hazards of blood loss and blood replacement are reduced as well as the cost to the patient and demand on the blood bank. Note: Pertaining t o the charts, average age 60: males 31, females 9, thoracotomy l e f t 21, right 19: no postoperative infections occurred on any case.
300
I unit I
I
The average number of postoperative days of hospitalization following l o k t o m y procedures when the conventional suturing techniques were used was 15.1 compared to 9.2 when the staple suturing techniques were used. The average number of postoperative days following pneumonectomy procedures with conventional suturing techniques used was 10.1, compared to 8.8 when the staple suturing techniques were used. By contributing to reduction of operating time, anesthesia time, blood loss and the hospital stay, staple suturing techniques provide a succession of advantages including reduced surgical risk, faster and safer patient recovery, financial savings t o the patient and increased hospital bed spaces.
17
REFERENCES Ravitch, M D, e t al. "Clinical Experiences with Soviet Mechanical Bronchus Stapler (UKB-25)," Journal of Thoracic and Cardiovascular Surgery, 47 ( 1964), 446-454.
-.
"Technics of Staple Suturing in Gastrointestinal Tract," Annals of Surgery, 175 (June 1972), 815-
837. Specal thanks t o Charles T Meadows, MD, thoracic surgeon, Abilene, Tex, for technical advice: and t o B B Trotter, MD, pathologist, Hendrick Memorial Hospital, Abilene, Tex, for drawings.
AORN Journal, August 1973, Vol18, N o 2
From a comparative study of 40 operative procedures using staple suturing and conventional suturing, I have concluded that staple suturing techniques contribute to the reduction of operating time, anesthesia time, blood loss and the length of the patient’s hospital stay. A random selection of 20 pneumonectomies and 20 lobedomies performed by one surgeon are the basis of research. Ten cases of each procedure using staple suturing and ten cases using conventional suturing techniques were selected. The ten pneumonectomies using conventional suturing are shown in chart 1; ten pneumonectomies using staple suturing in chart 2; ten lobectomies using conventional suturing in chart 3; and ten lobectomies with staple suturing in chart 4. The LDS (ligating, dividing and stapling) instrument is used for ligating and Wilma Dehnel, RN, i s a private scrub nurse for a thoracic surgeon in Abilene, Kan. She i s a graduate of Shannon Memorial Hospital in San Angelo, Tex.
296
dividing small segmental veins, intercostal nerves, chest wall adhesions and soft tubular structures. The TA (thoracic-abdominal) -30 stapling instrument, which produces a linear row of staples 30 mm in length, is used in pneumonectomy and lobectomy procedures for closure of the bronchus, closure of the pulmonary artery and veins, and for creation of interlobar fissures. This instrument is also used to perform large or small wedge resections and segmental resections of lung tissues. The application of the TA-30 staple sutures before the resection of the bronchus insures accurate approximation of tissue. Gross contamination of an open bronchus is reduced. Stapled tissues undergo less trauma; therefore, there is less leakage of air and blood from the suture line. (Fig 1) Conventional suturing produces tiny holes where leaks occasionally occur. (Fig 2 and 3) The danger of major postoperative com-
AORN Journal, August 1973, Vol18, N o 2
Fig
I . Staple suturing of
bronchus
Fig 3.
Staple suturing of
pulmonary vessels
Fig 2. Conventional suturing of bronchus
Fig 4. Conventional suturing of pulmonary vessels.
AORN Journal, August 1973, V o l 1 8 , N o 2
297
Chart I
l-
Procedure: Pneumonectory with
Number Blood given postoperative during surgery conventional suturing days i n units
I
Left
6
I
I
Operating time
I
3 hrs5min
Right
9
0
2 hrs 40 rnin
Left
II
0
3 hrs 30 min
Lefi
6
2
2 hrs 45 min
Left
8
2
2 hrs 45 min
Left
23
0
2 hrs 15 min
Left
7
2
I hr 50min
2
1 2 hrs IOmin
7
2
3 hrs 5 min
101
12
26 hrs 55 min
I
Left
13
Right Left-8 Rig ht-2
I
10.1
I
I
1.2
I
2 hrs41 min
Chart 2
Date
Case
Sex
Age
Procedure:
Number
Pneumonectomy using TA-30, LDS
8
0
I hr 5 0 m i n
10
0
2 hrs IOmin
Right
6
2
I hr 4 5 m i n
55
Left
5
0
I hr 30min
Male
65
Right
7
0
I hr 25min
Male
64
Right
8
0
I hr 20 min
Male
67
Right
II
I
I hr
Male
67
Right
12
0
I hr 35min
0
1 2 hrs 15min
60
Left
2
9/24/69
Male
65
Right
3
I / 13/70
Male
53
Left
4
2/ 19/70
Male
53
5
9/22/70
Male
6
1/11/72
10
Average
298
I hr 50 min
Male
9/14/71
time
0
7/10/69
I
Operating
12
I
9
Blood given
postoperative during surgery days i n units
I 9/16/71 I Male
I
64
60
I
Right
I
9
I
8.8
AORN Journal, August 1973, V o l 1 8 , N o 2
.3
5 min
I hr 4 0 m i n
--
Chart 3
-I-
Blood given during surgery in units
3
0
I
Operating time
I 2 hrs IOmin I I hr 50min I I hr 4 5 m i n
+ I hr 15min
Totals
Rig ht-7 Left-3
5 males Average
15.1
1 1 11 Date
Ca;
A :;
Sex
7
I 3 hrs IOmin
18
I 9 hrs 18 min
I .8
I hr 56 min
Chart 4
Procedure: Lobectomy w i t h TA-30
~
darl
Operating time
Blood given during surgery in units
Number postop
I hr I 5 m i n
6/27/72
Female
Right lower lobectomy
6/2/72
Female
63
Right upper lobectomy
10
3
5/5/72
Male
59
L e f t upper lobectomy
5
0
I hr 4 0 m i n
4
3/10/72
Male
68
Right lower lobectomy
13
0
I hr 20 min
5
2/14/72
Male
72
Left upper lobectomy
9
I
I hr 35min
6
1/25/71
Male
65
Right lower lobectomy
II
0
2 hrs
7
1/26/71
Male
70
Right lower lobectomy
8
0
I hr 45 min
I 7/1/71 I Male
1
I
I hr 4 5 m i n
I
8
9
Male
63
Left lower lobectomy
8
0
I hr 20 min
10
5/11/70
Male
69
Right lower lobectomy
15
0
I hr
Right-7 Left-3
92
I
9.2
.I
Totals
Average
45
8 males 2 females 60
AORN Journal, August 1973, Vol18, N o 2
0
I I hr
Right upper lobectomyl
6/14/71
8
45min
II 5 hrs 24 min
I
I hr 32 min
299
Synopsis Conventional suturing method
Staple suturing
2 hrs 41 m i n
I hr 40 m i n
10.1 days
8.0 days
Pneumonectomies Average operating time Number o f postoperative days in hospital Total blood units given during surgery10 patients
12 units
3 units
I
Lobectomies Average operating time
I I hr 5 6 m i n
I hr 32 m i n
15.1 days
9.2 days
Number of postoperative days in hospital Total blood units given during surgery-
18 units
10 patients 1
plications is increased when conventional suturing techniques are used. These complications include the incidence of secondary hemorrhage, postoperative infection and bronchopleural fistula . When the staple suture devices are used the average reduction in operating time was approximately one hour in pneumonectomies and 24 minutes in lobwtomies. The total amount of time saved on these two procedures in one year of a busy operating roan could represent an impressive accumulation of extra scheduling time for the operating mom and for the surgeon. It also represents a reduction in operating room cost to the patient. This study reveals that a total of 12 units of blood was administered to the group of ten pneumonectomy patients when conventional suturing techniques were used. A total of only three units of blood was administered to the group of ten pnewnonectomy patients when staple suturing techniques were used. The hazards of blood loss and blood replacement are reduced as well as the cost to the patient and demand on the blood bank. Note: Pertaining t o the charts, average age 60: males 31, females 9, thoracotomy l e f t 21, right 19: no postoperative infections occurred on any case.
300
I unit I
I
The average number of postoperative days of hospitalization following l o k t o m y procedures when the conventional suturing techniques were used was 15.1 compared to 9.2 when the staple suturing techniques were used. The average number of postoperative days following pneumonectomy procedures with conventional suturing techniques used was 10.1, compared to 8.8 when the staple suturing techniques were used. By contributing to reduction of operating time, anesthesia time, blood loss and the hospital stay, staple suturing techniques provide a succession of advantages including reduced surgical risk, faster and safer patient recovery, financial savings t o the patient and increased hospital bed spaces.
17
REFERENCES Ravitch, M D, e t al. "Clinical Experiences with Soviet Mechanical Bronchus Stapler (UKB-25)," Journal of Thoracic and Cardiovascular Surgery, 47 ( 1964), 446-454.
-.
"Technics of Staple Suturing in Gastrointestinal Tract," Annals of Surgery, 175 (June 1972), 815-
837. Specal thanks t o Charles T Meadows, MD, thoracic surgeon, Abilene, Tex, for technical advice: and t o B B Trotter, MD, pathologist, Hendrick Memorial Hospital, Abilene, Tex, for drawings.
AORN Journal, August 1973, Vol18, N o 2