STAPLE PENETRATION AND STAPLE HISTOLOGICAL RESPONSE FOR ATTACHING AN EPIMYSIAL ELECTRODE ONTO THE ABDOMINAL SURFACE OF THE DIAPHRAGM USING A LAPAROSCOPIC APPROACH

Background: Laparoscopic stapling was found to be a viable option for attaching epimysial electrodes onto the abdominal surface of the diaph ragm. Stapling was preferable to suturing due to its simplicity and sp eed. Methods: Of the two staplers tested in this study, the Ethicon En dopath was preferred over the Autosuture Endo Hernia because the stapl es did not penetrate the diaphragm when an electrode tab thickness gre ater than 0.75 mm was used. Results: The thickness of the electrode ta b was an important factor in determining staple penetration but large variation in penetration depth indicated that other factors may also p lay a role. An electrode tab thickness of 1.0-1.25 mm was suggested to minimize the risk of diaphragm perforation. Conclusions: The histolog ical reaction to staples implanted up to 14 months was unremarkable, r eflecting the safety of laparoscopic staples for permanently anchoring electrodes on the diaphragm.