scholarly journals A New Approach to the Laparoscopic Double Stapling Technique: Exploration and Reinforcement of Weak Points

2021 ◽  
pp. 1-7
Author(s):  
Masahiro Kimura ◽  
Yoshiyuki Kuwabara ◽  
Akira Mitsui ◽  
Takaya Nagasaki ◽  
Seiichi Nakaya
Keyword(s):  
Anastomotic Leakage ◽  
Rectal Surgery ◽  
Circular Stapler ◽  
Linear Stapler ◽  
Double Stapling Technique ◽  
Stapling Technique ◽  
Double Stapling ◽  
Pressure Resistance ◽  
Reduced Rate ◽  
Increased Strength

Background: Anastomotic leakage is a serious complication in colorectal surgery, often associated with higher morbidity and mortality. Even with advances in medical technology and devices, the rates of anastomotic leakage is not on downward trend. We describe our experimental and clinical validation of our method to overcome the weakness of the double stapling technique, especially the intersecting staple lines. Methods: Experimentally, we conducted double stapled anastomosis with pig small intestines. In order to verify pressure resistance, the anastomosis was tested and compared with that formed by a conventional stapler and a reinforced cartridge preattached to a Neoveil sheet. Additionally, during the anastomosis performed by the circular stapler, both ends of the Neoveil sheet were grasped by forceps, and the Neoveil sheet was pulled tight to fit the anastomotic surface. The burst pressure of the anastomosis was recorded. Clinically, we used a reinforced cartridge for rectal surgery performing a low anterior resection and verified its efficacy and safety. Results: Unlike a conventional stapler, our methods with the use of a reinforced cartridge showed no leakage from the intersecting staple lines. Clinically, our method has been used for 20 patients without complications, including leakage and bleeding. Conclusion: The addition of reinforcing material to the linear stapler should lead to increased strength of the anastomosis. We believe that a double stapling anastomosis that uses our method for the intersection lines provides increased safety and security and thereby should lead to a reduced rate of suture failure after rectal resection.

scholarly journals The Use of a Circular Side Stapling Technique in Laparoscopic Low Anterior Resection for Rectal Cancer: Experience of 30 Serial Cases

2015 ◽  
Vol 100 (6) ◽  
pp. 979-983 ◽  
Author(s):  
Eiji Oki ◽  
Koji Ando ◽  
Hiroshi Saeki ◽  
Yuichiro Nakashima ◽  
Yasue Kimura ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Operating Time ◽  
Colorectal Anastomosis ◽  
Rectal Surgery ◽  
Linear Stapler ◽  
Stapling Technique ◽  
Double Stapling ◽  
Laparoscopic Assisted

The double-stapling technique using a circular stapler (CS) to create an end-to-end anastomosis is currently used widely in laparoscopic-assisted rectal surgery. However, a high rate of anastomotic failure has been reported. We report new side-to-side anastomosis creation using a CS, the so-called circular side stapling technique (CST). After excising the rectum at the oral and anal sides of the tumor with a linear stapler, a side-to-side colorectal anastomosis was made on the anterior wall of the rectosigmoid colon and the anterior or posterior wall of the rectum with a CS. Between 2012 and 2013, we recorded 30 serial cases of rectal-sigmoid or rectal cancer that were treated with laparoscopic-assisted surgeries using this method. In the 30 cases, the mean age was 68 ± 12 years, operating time was 288 ± 80 minutes, and blood loss was 66 ± 67 mL. None of the patients suffered from anastomosis leakage or postoperative anastomotic bleeding, and none complained of their stool habits. Three months after the last surgery in this cohort, no anastomosis strictures were reported. Based on these results, we propose an alternative method of side-to-side anastomosis for low anterior resection by using a CS to prevent staple overlap. Our experience indicates that the CST is easy and safe. Therefore, this method is a useful alternative to the current method used in laparoscopic surgery.

scholarly journals Robotic low anterior resection for rectal cancer with side-to-end anastomosis in a patient with anal stenosis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yosuke Tajima ◽  
Tsunekazu Hanai ◽  
Hidetoshi Katsuno ◽  
Koji Masumori ◽  
Yoshikazu Koide ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Colorectal Anastomosis ◽  
Circular Stapler ◽  
Anal Stenosis ◽  
Robotic Assistance ◽  
Double Stapling Technique ◽  
Stapling Technique ◽  
Double Stapling

Abstract Background Colorectal anastomosis using the double stapling technique (DST) has become a standard procedure. However, DST is difficult to perform in patients with anal stenosis because a circular stapler cannot be inserted into the rectum through the anus. Thus, an alternative procedure is required for colorectal anastomosis. Case presentation A 78-year-old woman presented with bloody stool. Colonoscopy and computed tomography revealed advanced low rectal cancer without lymph node or distant metastasis. We initially planned to perform low anterior resection using a double stapling technique or transanal hand-sewn anastomosis, but this would have been too difficult due to anal stenosis and fibrosis caused by a Milligan-Morgan hemorrhoidectomy performed 20 years earlier. The patient had never experienced defecation problems and declined a stoma. Therefore, we inserted an anvil into the rectal stump and fixed it robotically with a purse-string suture followed by insertion of the shaft of the circular stapler from the sigmoidal side. In this way, side-to-end anastomosis was accomplished laparoscopically. The distance from the anus to the anastomosis was 5 cm. The patient was discharged with no anastomotic leakage. Robotic assistance proved extremely useful for low anterior resection with side-to-end anastomosis. Conclusion Performing side-to-end anastomosis with robotic assistance was extremely useful in this patient with rectal cancer and anal stenosis.

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