Advertisement

Surgical Endoscopy

, Volume 29, Issue 11, pp 3304–3312 | Cite as

Totally intracorporeal delta-shaped B-I anastomosis following laparoscopic distal gastrectomy using the Tri-Staple™ reloads on the manual Ultra handle: a prospective cohort study with historical controls

  • Mariko Man-i
  • Koichi SudaEmail author
  • Kenji Kikuchi
  • Tsuyoshi Tanaka
  • Shimpei Furuta
  • Masaya Nakauchi
  • Ken Ishikawa
  • Yoshinori Ishida
  • Ichiro Uyama
Article

Abstract

Background

A delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy could be performed easily and sufficiently using only laparoscopic linear staplers. However, the restricted maneuverability and severe blurring of these staplers along with their limited hemostability induced strain. In this study, we determined the feasibility and safety of performing delta-shaped anastomosis using the Endo GIA™ Reloads with Tri-Staple™ Technology combined with Endo GIA™ Ultra Universal stapler (Tri-Staple) with a particular focus on short-term surgical outcomes.

Methods

We performed a single-institutional prospective interventional study (UMIN 000008014). The Tri-Staple was prospectively used on 23 consecutive patients who underwent a curative totally laparoscopic Billroth I gastrectomy with delta-shaped anastomosis. These patients were matched with the 19 patients previously treated using the ENDOPATH® ETS Articulating Linear Cutters (ETS) on clinical and demographic characteristics.

Results

There were no differences between the groups in anastomosis-related local complications, morbidity, non-anastomosis-related local complications, total systemic complications, and short-term outcomes with the exception of significantly reduced blood loss in the Tri-Staple group (ETS vs. Tri-Staple: 37 [10–306] vs. 15 [5–210] mL, p = 0.02). Intraoperative bleeding from the staple line was significantly reduced in the Tri-Staple group. The postoperative drain indwelling period (ETS vs. Tri-Staple, 6 [4–10] vs. 4 [2–43] days, p = 0.032), fasting period (5 [3–7] vs. 3 [3–24] days, p = 0.022), and hospital stay (14 [10–47] vs. 11 [6–58] days, p = 0.025) were significantly shorter in the Tri-Staple group. There was no mortality in this series. Acceleration assessed as indices of blurring of stapler tip might have a significant adverse influence on staple-line bleeding at stapling sites.

Conclusion

Totally laparoscopic Billroth I distal gastrectomy using Tri-Staple was feasible and safe with favorable short-term surgical outcomes. Reduced blurring while stapling may be a novel endpoint which newly developed stapling devices should target.

Keywords

Stomach neoplasms Laparoscopic distal gastrectomy Delta-shaped anastomosis Complication Staple-line bleeding Endo GIA Tri-Staple 

Abbreviations

LADG

Laparoscopically assisted distal gastrectomy

TLDG

Totally laparoscopic distal gastrectomy

ETS

ENDOPATH® ETS Articulating Linear Cutters

Tri-Staple

Endo GIA™ Reload with Tri-Staple™ Technology combined with Endo GIA™ Ultra Universal stapler

Ccr

Creatinine clearance

ECOG

Eastern Cooperative Oncology Group

ASA

American Society of Anesthesiologists

PaO2

Arterial oxygen pressure

UMIN-CTR

University Hospital Medical Information Network Clinical Trials Registry

JGCA

Japanese Gastric Cancer Association

AUC

Area under the curve

Notes

Disclosures

Our “Feasibility Study of Delta-Shaped Anastomosis in Totally Laparoscopic Billroth I Gastrectomy using Tri-Staple” was funded by Covidien Surgical Devices Investigator Sponsored Research Grants (2,100,000JPY), and Koichi Suda and Ichiro Uyama have conflicts of interest and financial ties to disclose. Mariko Man-i, Kenji Kikuchi, Tsuyoshi Tanaka, Shimpei Furuta, Masaya Nakauchi, Ken Ishikawa, and Yoshinori Ishida have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary Video clip: Blurring of the stapler tip in the process of firing analyzed with motion analysis software (M4 V 6702 kb)

References

  1. 1.
    Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S (2000) Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 135:806–810CrossRefPubMedGoogle Scholar
  2. 2.
    Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs. laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:S306–S311CrossRefPubMedGoogle Scholar
  3. 3.
    Ikeda O, Sakaguchi Y, Aoki Y et al (2009) Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc 23:2374–2379CrossRefPubMedGoogle Scholar
  4. 4.
    Guzman EA, Piazzi A, Lee B et al (2009) Totally laparoscopic gastric resection with extended lymphadenectomy for gastric adenocarcinoma. Ann Surg Oncol 16:2218–2223CrossRefPubMedGoogle Scholar
  5. 5.
    Song KY, Park CH, Kang HC et al (2008) Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy? Prospective, multicenter study. J Gastrointest Surg 12:1015–1021CrossRefPubMedGoogle Scholar
  6. 6.
    Huscher CG, Mingoli A, Sgarzini G et al (2007) Totally laparoscopic total and subtotal gastrectomy with extended lymph node dissection for early and advanced gastric cancer: early and long–term results of a 100-patient series. Am J Surg 194:839–844CrossRefPubMedGoogle Scholar
  7. 7.
    Kanaya S, Gomi T, Momoi H et al (2002) Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 195:284–287CrossRefPubMedGoogle Scholar
  8. 8.
    Hansen H (2011) Applications of Tri-staple Technology in minimally invasive thoracic surgery. Gen Surg News 38(3):22–23Google Scholar
  9. 9.
    Cottam D (2011) Tri-staple Technology offers improved experience for laparoscopic bariatric surgery. Gen Surg News 38(6):8–9Google Scholar
  10. 10.
  11. 11.
    Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd edition. Gastric Cancer 14:101–112CrossRefGoogle Scholar
  12. 12.
    Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655CrossRefPubMedGoogle Scholar
  13. 13.
    Pedersen T, Eliasen K, Ravnborg M, Viby-Mogensen J, Qvist J, Johansen SH et al (1986) Risk factors, complications and outcome in anaesthesia. A pilot study. Eur J Anasethesiol 3:225–239Google Scholar
  14. 14.
    Warner MA, Shields SE, Chute CG (1993) Major and mortality within 1 month of ambulatory surgery and anesthesia. JAMA 270:1437CrossRefPubMedGoogle Scholar
  15. 15.
    Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123CrossRefGoogle Scholar
  16. 16.
    Shinohara T, Satoh S, Kanaya S et al (2013) Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 27:286–294CrossRefPubMedGoogle Scholar
  17. 17.
    Kanaya S, Haruta S, Kawamura Y et al (2011) Video: laparoscopy distinctive technique for suprapancreatic lymph node dissection: medial approach for laparoscopic gastric cancer surgery. Surg Endosc 25:3928–3929CrossRefPubMedGoogle Scholar
  18. 18.
    Uyama I, Suda K, Satoh S et al (2013) Laparoscopic surgery for advanced gastric cancer: current status and future perspectives. J Gastric Cancer 13:19–25PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Japan Clinical Oncology Group. Postoperative complication criteria according to Clavien–Dindo classification ver. 2.0. http://www.jcog.jp/doctor/tool/Clavien_Dindo.html
  20. 20.
    McCulloch P, Ward J, Tekkis PP (2003) Mortality and morbidity in gastroesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BMJ 22:1192–1197CrossRefGoogle Scholar
  21. 21.
    Kim MC, Choi HJ, Jung GJ et al (2007) Techniques and complications of laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer. Eur J Surg Oncol 33:700–705CrossRefPubMedGoogle Scholar
  22. 22.
    Hori S, Ochiai T, Gunji Y et al (2004) A prospective randomized trial of hand-sutured versus mechanically stapled anastomosis for gastroduodenostomy after distal gastrectomy. Gastric Cancer 7:24–30CrossRefPubMedGoogle Scholar
  23. 23.
    Tanimura S, Higashino M, Furkunaga Y et al (2005) Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer. Surg Endosc 19:1177–1181CrossRefPubMedGoogle Scholar
  24. 24.
  25. 25.
    Satoh Y, Matui Y, Ogawa F et al (2009) Clinical report on a computer-controlled hand-actuated stapling system for general lung surgery: the first application in Japan. Gen Thorac Cardiovasc Surg 57:402–405CrossRefPubMedGoogle Scholar
  26. 26.
    Abel M (2011) The covidien iDrive TM powered stapling system: a new evolution in surgical transection and stapling. Gen Surg News 38(1):6–7Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Mariko Man-i
    • 1
  • Koichi Suda
    • 1
    Email author
  • Kenji Kikuchi
    • 1
  • Tsuyoshi Tanaka
    • 1
  • Shimpei Furuta
    • 1
  • Masaya Nakauchi
    • 1
  • Ken Ishikawa
    • 1
  • Yoshinori Ishida
    • 1
  • Ichiro Uyama
    • 1
  1. 1.Division of Upper GI, Department of SurgeryFujita Health UniversityToyoakeJapan

Personalised recommendations