SpringerLink - Journal Article

Symposium: Selected Papers Presented at the 2008 Meeting of the Musculoskeletal Tumor Society

The Linear Cutting Stapler May Reduce Surgical Time and Blood Loss with Muscle Transection: A Pilot Study

Daniel C. Allison^{1, 2}, Elke R. Ahlmann³, Anny H. Xiang⁴ and Lawrence R. Menendez³

(1)	Division of Musculoskeletal Oncology, Southern California Permanente Medical Group, 1011 Baldwin Park Boulevard, Baldwin Park, CA 91706, USA

(2)	Department of Orthopedics, University of Southern California + Los Angeles County Medical Center, USC University Hospital, Los Angeles, CA, USA

(3)	Department of Orthopedics, Keck School of Medicine, University of Southern California + Los Angeles County Medical Center, USC University Hospital, Los Angeles, CA, USA

(4)	Department of Biostatistics, University of Southern California + Los Angeles County Medical Center, Los Angeles, CA, USA

Received: 4 December 2008 Accepted: 13 April 2009 Published online: 19 May 2009

Abstract Because of skeletal muscle’s density and vascularity, its transection with standard electrocautery can be tedious. In a pilot study we asked whether a linear cutting stapling device decreased surgical time, blood loss, transfusion rates, and complications in patients undergoing above-knee amputation when compared to traditional electrocautery. We retrospectively reviewed 11 patients with above-knee amputation cases using a linear cutting stapling device over a 10-year period and compared those to 13 patients in whom we used electrocautery. The patients treated with the linear cutting stapling device had an average of 97 minutes of surgical time, 302 cc blood loss, and 1.55 units transfusion, compared to an average 119 minutes, 510 cc, and 2.15 units, respectively, with the electrocautery cases. Despite the trends, these parameters, as well as major complications, were similar in these two small groups. In skeletal muscle transection, we believe the linear cutting stapler is a reasonable and potentially cost-effective technical alternative to electrocautery, possibly resulting in less blood loss and shorter surgical time with similar rates of complications.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at University of Southern California, Baldwin Park, CA.

Daniel C. Allison
Email: dallison12@hotmail.com

References

1.	American College of Surgeons Committee on Trauma. Advanced Trauma and Life Support for Doctors: Instructor Course Manual. 6th Ed. Chicago: American College of Surgeons; 1997.

2.	Civil War Battlefield Surgery: A Description of Civil War Field Surgery. Available at: http://ehistory.osu.edu/ucsw/features/medicine/cwsurgeon/amputations.cfm. Accessed July 13, 2008.

3.	Dalstrom DJ, Venkatarayappa, I, Manternach AL, Palcic MS, Heyse BA, Prayson MJ. Time-dependant contamination of opened sterile operating-room trays. J Bone Joint Surg Am. 2008;90:1022–1025.

4.	Innerhofer P, Klingler A, Klimmer C, Fries D, Nussbaumer W. Risk for postoperative infection after transfusion of white blood cell-filtered allogeneic or autologous blood components in orthopedic patients undergoing primary arthroplasty. Transfusion. 2005;45:103–110.

5.	Isaacs JH. GIA stapler in radical neck dissection. Laryngoscope. 1989;99:225.

6.	Levin DA, Bendo JA, Quirno M, Errico T, Goldstein J, Spivak J. Comparative charge analysis of one and two level lumbar total disc arthroplasty versus circumferential lumbar fusion. Spine. 2007;32:2905–2909.

7.	Malone JM. Amputations in the dysvascular patient. In: Hobson RW, Wilson SE, Veith FJ, eds. Vascular Surgery Principles and Practice. 3^rd Ed. New York, NY: Marcel Dekker, Inc; 2004:555.

8.	Netter, FH. Atlas of Human Anatomy. East Hanover, NJ: Novartis; 1989.

9.	Sitges-Serra A, Insenser JJ, Membrilla E. Blood transfusions and postoperative infections in patients undergoing elective surgery. Surg Infect (Larchmt). 2006;7(Suppl 2):S33–S35.

10.	Sozio, RB, Riley EJ, Shklar G. A histologic and electronic evaluation of electrosurgical currents. J Prosthet Dent. 1975;33:300–312.

11.	Sozio, RB, Riley EJ, Shklar G. A controlled study of electrosurgical currents and wound healing. Oral Surgery. 1976;41:709–717.

12.	Turowski GA, Koshima I, Upton J. Muscle stapling technique for free muscle transfer to the face. Plast Reconstr Surg. 1998;102:1639–1641.

13.	Zilberberg MD, Stern LS, Wiederkehr DP, Doyle JJ, Shorr AF. Anemia, transfusions and hospital outcomes among critically ill patients on prolonged acute mechanical ventilation: a retrospective cohort study. Crit Care. 2008;12:R60.