Editing Stapling (section)

=== '''Circular staplers''' (EEA - end to end anastomosis) ===

** Utilises a circular anvil, a circular staple cartridge, and a circular knife to produce a double staggered row of staples that approximate two tubular structures in inversion while the knife cuts the tissue just inside the staple line
** Creates an end-to-end anastomosis with a lumen ranging from 12 to 24mm
** Compresses tissues to approximately 2mm, although this can be customised on many staplers
** Ethicon EEA staplers
*** 21mm (yellow)
*** 25mm (white)
*** 29mm (blue)
*** 33mm (green)
** Ethicon EEA Powered stapler 
*** 23mm
*** 25mm
*** 29mm
*** 31mm (commonly use for colon)
** Medtronic (aka Covidien) - comes in purple (thick) or black (extra thick)
*** 25mm
*** 28mm (purple, common for colorectal anastomosis in women)
*** 31mm (purple, common for colorectal anastomosis in men)
*** 33mm
** OrVil stapler for upper GI
** Technique
*** Open proximal staple line by cutting across it with Mayo scissors, then insert anvil (largest size that fits easily), secure with whip stitch purse-string (3/0 Prolene, start outside to inside, repeat, then end outside; throw first knot then insert anvil and tighter)
*** Insert rectal stapler. Guide to right location. Spike advanced through rectum, usually just posterior to the stapled stump (turn knob anti-clockwise).
*** Apply spike to anvil
*** Recheck - be certain no gaps, and that the purse-string is secure. Don't allow bulky puckering of excess tissue.
*** Tighten stapler to correct thickness for the height of its staples, as shown on colour-bar indicator on the stapler handle, by turning the knob clockwise. If a lot of force is required, there might be too much tissue captured, or the stapler might be too small.
*** Wait 15 seconds then trigger released, handles squeezed to fire and create anastomosis
*** Detach stapler by returning safety to lock position, then turn knob 720 degrees anti-clockwise. Rotate 90 degrees both directions then slowly remove while rotating.
*** Inspect doughnuts - if gaps, reinforce with sutures
*# Step by Step Guide to Use Ethicon Circular Stapler | Ethicon