Investigation of colorectal stapled anastomosis by means of experimental and numerical approaches

通过实验和数值方法研究结直肠吻合术

• 批准号: 428438713
• 负责人: Professor Dr.-Ing. Wojciech Grzegorz Kowalczyk
• 金额: --
• 依托单位: Lehrstuhl für Mechanik und Robotik
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2019
• 资助国家: 德国
• 起止时间: 2018-12-31 至 2022-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/428438713?language=en
• 关键词: Investigation; colorectal; stapled; anastomosis; means

Diseases of the colon, the lower part of the digestive tract, are very common and according to the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) more than 600,000 surgical procedures are performed in the United States every year to treat them. Colorectal surgery is performed to repair damage to the colon, rectum, and anus, caused by diseases such as cancer, diverticulitis, intestinal polyps and inflammatory bowel. Note that colorectal cancer is the fourth most common cancer in men and the third most common cancer in women worldwide. During a colon resection, the diseased part of the bowel is removed and the two healthy sections of the colon are reattached which is called a colorectal anastomosis. Anastomotic technique has traditionally been influenced by surgeons’ preference to use either suturing or stapling. Although the later technique is more standardized, quicker and easier than the former one with benefits such as excellent blood control, reduced tissue manipulation and uniformity of tissue adaptation, there remain complications like leakage, stricture and postoperative bleeding. Anastomotic leak is the most serious complication and is a significant cause of morbidity and mortality. Postoperative rates of leak and mortality up to 16% and 3.2% have been reported. Scientific literature shows that technical errors can play a significant role, potentially increasing the risk of postoperative complications.The integrity of the staple lines, which depends on adequate tissue compression, is the primary factor in making a stable anastomosis. Understanding how tissues interact with stapler and staples is the key to improving patient outcomes. The purpose of this research is to study the overall mechanical performance of the end-to-end stapled colorectal anastomosis by means of experimental measurement and finite element simulation in order to initially fill the existing knowledge gap in anastomotic technique. This would help manufacturers to develop optimal stapler configurations and surgeons to handle these instruments correctly, and subsequently to improve patient outcomes. To do this, biomechanical tests will be done to characterize colon tissues. Computational models based on two current circular staplers that are frequently used in colorectal surgery will be developed and simulated. The effect of initial tissue thickness and properties, staple height, number of staple rows and number of staples per row will be investigated through a parametric study. Optimal design of circular stapler for use in minimally invasive surgery will be ascertained. Best-fitted staple heights as a function of the tissue thickness will also be evaluated and discussed for clinical decision making.

结肠疾病，消化道的下半部，是非常常见的，根据美国胃肠道和内窥镜外科医生协会（SAGES）的数据，美国每年有超过60万例外科手术来治疗它们。结肠外科手术是为了修复由癌症、憩室炎、肠息肉和炎症性肠等疾病引起的结肠、直肠和肛门的损伤。请注意，结直肠癌是全球男性第四大常见癌症，女性第三大常见癌症。在结肠切除术中，患病的肠部分被切除，两个健康的结肠部分被重新连接，这被称为结肠吻合术。传统上，吻合技术受到外科医生对缝合或吻合器的偏好的影响。虽然后一种技术比前一种技术更规范、更快、更容易，具有良好的血液控制、减少组织操作和组织适应均匀性等优点，但仍存在渗漏、狭窄和术后出血等并发症。吻合口漏是最严重的并发症，是导致发病率和死亡率的重要原因。据报道，术后泄漏率和死亡率分别高达16%和3.2%。科学文献表明，技术错误可以发挥重要作用，潜在地增加术后并发症的风险。缝合线的完整性依赖于足够的组织压缩，是实现稳定吻合的主要因素。了解组织如何与订书机和订书钉相互作用是改善患者预后的关键。本研究的目的是通过实验测量和有限元模拟来研究端到端吻合器结肠直肠吻合术的整体力学性能，以初步填补现有的吻合技术知识空白。这将有助于制造商开发最佳订书机配置和外科医生正确处理这些器械，并随后改善患者的治疗效果。为此，将进行生物力学测试以表征结肠组织。基于目前常用于结直肠手术的两种圆形订书机的计算模型将被开发和模拟。初始组织厚度和性质、订书钉高度、订书钉行数和每行订书钉数的影响将通过参数研究进行研究。确定用于微创手术的圆形订书机的最佳设计。最合适的钉钉高度作为组织厚度的函数也将被评估和讨论用于临床决策。