A novel single-stapling technique for colorectal anastomosis: a pre-ligation single-stapling technique (L-SST) in a porcine model
- 531 Downloads
In low anterior resections, anastomosis continues to present major problems. Although the single-stapling technique (SST) is considered to be superior to the double-staple technique (DST) in terms of leakage and stenosis, SST requires suturing, which is particularly difficult during laparoscopic surgery. A simpler and safer method of anastomosis is needed. In this study, we developed a pre-ligation SST (L-SST) that does not require suturing and evaluated the usefulness of L-SST in an ex vivo and an in vivo porcine model.
Porcine rectums were ligated using SurgiTie™ and sharply resected instead of using a linear stapler. The burst pressures of the closed rectums after using a linear stapler and SurgiTie™ (each group; n = 5) and the burst pressures of the anastomoses performed with L-SST and DST (each group; n = 4) were measured. During in vivo porcine laparoscopic surgery, we performed and evaluated the feasibility of L-SST.
After completing the anastomosis with L-SST, the ligated portion using SurgiTie™ was completely removed. The stump closed using SurgiTie™ was much stronger than that closed using a stapler (131.2 and 25.6 mmHg, respectively; P = 0.01). The average burst pressure of the anastomoses performed with L-SST was 33.8 mmHg, whereas that performed with DST was 30.5 mmHg. We did not find significant difference between these two groups (P = 0.88). We also confirmed the feasibility of L-SST in an in vivo porcine laparoscopic surgery model.
We developed a novel SST, the L-SST. We were able to perform L-SST successfully using an ex vivo porcine rectum and during in vivo porcine laparoscopic surgery.
KeywordsSingle-stapling anastomosis (SSA) Single-stapled technique (SST) Double-stapling anastomosis (DSA) Double-stapling technique (DST) Laparoscopy Laparoscopic surgery Colorectal neoplasm SurgiTie™
This study was supported by a Grant for young surgeon awards from the Japan Surgical Society (to H.Takeyama).
Drs. H. Takeyama, H. Yamamoto, T. Hata, Y. Takahashi, M. Ohtsuka, R. Nonaka, A. Inoue, A. Naito, T. Matsumura, M. Uemura, J. Nishimura, I. Takemasa, T. Mizushima, Y. Doki, and M. Mori have no conflicts of interest or financial ties to disclose.
The porcine rectum was ligated firmly using SurgiTie and the rectum was cut with LCS close to the ligated portion. The shaft of the circular stapler was introduced through the anal side of the distal rectum. The anvil rod of a circular stapler was sharply punctured just close to the ligated portion. The anvil head of a circular stapler was placed and fixed in the oral colon with a purse string suture beforehand. Now, the anvil rod was connected with the anvil head and the anastomosis was then completed. (WMV 17,513 kb)
The closed portion of the rectum using SurgiTie was totally removed after the firing of the circular stapler. (WMV 3,653 kb)
- 3.Fujii S, Ota M, Yamagishi S, Kunisaki C, Osada S, Suwa H, Ichikawa Y, Shimada H (2010) A Y-shaped vinyl hood that creates pneumoperitoneum in laparoscopic rectal cancer surgery (Y-hood method.): a new technique for laparoscopic low anterior resection. Surg Endosc 24:476–484PubMedCrossRefGoogle Scholar
- 6.Griffen FD, Knight CD, Sr., Whitaker JM, Knight CD, Jr (1990) The double stapling technique for low anterior resection. Results, modifications, and observations. Ann Surg 211: 745–751; discussion 751–742Google Scholar