Skip to main content
SpringerLink
Log in

A novel single-stapling technique for colorectal anastomosis: a pre-ligation single-stapling technique (L-SST) in a porcine model

  • Dynamic Manuscript
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Poon JT, Law WL (2009) Laparoscopic resection for rectal cancer: a review. Ann Surg Oncol 16:3038–3047

    Article  PubMed  Google Scholar 

  2. Cheung YM, Lange MM, Buunen M, Lange JF (2009) Current technique of laparoscopic total mesorectal excision (TME): an international questionnaire among 368 surgeons. Surg Endosc 23:2796–2801

    Article  CAS  PubMed  Google Scholar 

  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 24:476–484

    Article  PubMed  Google Scholar 

  4. Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253:890–899

    Article  PubMed  Google Scholar 

  5. Cohen Z, Myers E, Langer B, Taylor B, Railton RH, Jamieson C (1983) Double stapling technique for low anterior resection. Dis Colon Rectum 26:231–235

    Article  CAS  PubMed  Google 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 751–742

  7. Knight CD, Griffen FD (1980) An improved technique for low anterior resection of the rectum using the EEA stapler. Surgery 88:710–714

    CAS  PubMed  Google Scholar 

  8. Brisinda G, Vanella S, Cadeddu F, Civello IM, Brandara F, Nigro C, Mazzeo P, Marniga G, Maria G (2009) End-to-end versus end-to-side stapled anastomoses after anterior resection for rectal cancer. J Surg Oncol 99:75–79

    Article  PubMed  Google Scholar 

  9. Kawasaki K, Fujino Y, Kanemitsu K, Goto T, Kamigaki T, Kuroda D, Kuroda Y (2007) Experimental evaluation of the mechanical strength of stapling techniques. Surg Endosc 21:1796–1799

    Article  PubMed  Google Scholar 

  10. Marecik SJ, Chaudhry V, Pearl R, Park JJ, Prasad LM (2007) Single-stapled double-pursestring anastomosis after anterior resection of the rectum. Am J Surg 193:395–399

    Article  PubMed  Google Scholar 

  11. Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18:281–289

    Article  CAS  PubMed  Google Scholar 

  12. Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N (2008) Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis 23:703–707

    Article  PubMed  Google Scholar 

  13. Bluett MK, Healy DA, Kalemeris GC, O’Leary JP (1986) Comparison of automatic staplers in small bowel anastomoses. South Med J 79:712–716

    Article  CAS  PubMed  Google Scholar 

  14. Salameh JR, Schwartz JH, Hildebrandt DA (2006) Can LigaSure seal and divide the small bowel? Am J Surg 191:791–793

    Article  PubMed  Google Scholar 

  15. Sanchez-De Pedro F, Moreno-Sanz C, Morandeira-Rivas A, Tenias-Burillo JM, De Guzman CAR (2014) Colorectal anastomosis facilitated by the use of the LigaSure sealing device: comparative study in an animal model. Surg Endosc 28:508–514

    Article  PubMed  Google Scholar 

  16. Kang J, Lee HB, Cha JH, Hur H, Min BS, Baik SH, Kim NK, Sohn SK, Lee KY (2013) Feasibility and impact on surgical outcomes of modified double-stapling technique for patients undergoing laparoscopic anterior resection. J Gastrointest Surg 17:771–775

    Article  PubMed  Google Scholar 

  17. Ruurda JP, Broeders IA (2003) Robot-assisted laparoscopic intestinal anastomosis. Surg Endosc 17:236–241

    Article  CAS  PubMed  Google Scholar 

  18. Stefanidis D, Wang F, Korndorffer JR Jr, Dunne JB, Scott DJ (2010) Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc 24:377–382

    Article  PubMed  Google Scholar 

  19. Myers SR, Rothermel WS Jr, Shaffer L (2011) The effect of tissue compression on circular stapler line failure. Surg Endosc 25:3043–3049

    Article  PubMed  Google Scholar 

  20. Demura Y, Ishikawa N, Hirano Y, Inaki N, Matsunoki A, Watanabe G (2013) Transrectal robotic natural orifice translumenal endoscopic surgery (NOTES) applied to intestinal anastomosis in a porcine intestine model. Surg Endosc 27:4693–4701

    Article  PubMed  Google Scholar 

  21. Sodergren M, Clark J, Beardsley J, Bryant T, Horton K, Darzi A, Teare J (2011) A novel flexible endoluminal stapling device for use in NOTES colotomy closure: a feasibility study using an ex vivo porcine model. Surg Endosc 25:3266–3272

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by a Grant for young surgeon awards from the Japan Surgical Society (to H.Takeyama).

Disclosures

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.

Author information

Authors and Affiliations

  1. Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan

    Hiroshi Takeyama, Hirofumi Yamamoto, Taishi Hata, Yusuke Takahashi, Masahisa Ohtsuka, Ryoji Nonaka, Akira Inoue, Atsushi Naito, Tae Matsumura, Mamoru Uemura, Junichi Nishimura, Ichiro Takemasa, Tsunekazu Mizushima, Yuichiro Doki & Masaki Mori

Authors
  1. Hiroshi Takeyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hirofumi Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Taishi Hata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yusuke Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masahisa Ohtsuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ryoji Nonaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akira Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Atsushi Naito
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tae Matsumura
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mamoru Uemura
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Junichi Nishimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ichiro Takemasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Tsunekazu Mizushima
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Yuichiro Doki
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Masaki Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hirofumi Yamamoto.

Electronic supplementary material

Below is the link to the electronic supplementary material.

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)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Takeyama, H., Yamamoto, H., Hata, T. et al. A novel single-stapling technique for colorectal anastomosis: a pre-ligation single-stapling technique (L-SST) in a porcine model. Surg Endosc 29, 2371–2376 (2015). https://doi.org/10.1007/s00464-014-3960-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3960-5

Keywords

Search

Navigation