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Improved access and visibility during stapling of the ultra-low rectum: a comparative human cadaver study between two curved staplers.

Rivadeneira DE, Verdeja JC, Sonoda T - Ann Surg Innov Res (2012)

Bottom Line: The RR reached significantly lower into the pelvis in both the coronal and sagittal positions compared to the CC.Impediment of visibility occurred in only 10% (5/48) of RR applications in the coronal position, compared to a rate of 48% (23/48) using the CC, p = 0.0002.The RR device performed significantly better when compared to the CC stapler in regards to placing the stapler further into the deep pelvis and closer to the pelvic floor, while causing less obstructing of visualization.

View Article: PubMed Central - HTML - PubMed

Affiliation: Saint Catherine of Siena Medical Center, Smithtown, NY, USA. david.rivadeneira@chsli.org.

ABSTRACT

Background: The purpose of this study was to compare in human cadavers the applicability of a commonly used stapling device, the CONTOUR® curved cutter (CC) (Ethicon Endo-Surgery, Cincinnati, OH) to a newly released, curved stapler, the Endo GIA™ Radial Reload with Tri-Staple™ Technology (RR) (Covidien, New Haven, CT) METHODS: Four experienced surgeons performed deep pelvic dissection with total mesorectal excision (TME) of the rectum in twelve randomized male cadavers. Both stapling devices were applied to the ultra-low rectum in coronal and sagittal configurations. Extensive measurements were recorded of anatomic landmarks for each cadaver pelvis along with various aspects of access, visibility, and ease of placement for each device.

Results: The RR reached significantly lower into the pelvis in both the coronal and sagittal positions compared to the CC. The median distance from the pelvic floor was 1.0 cm compared to 2.0 cm in the coronal position, and 1.0 cm versus 3.3 cm placed sagitally, p < 0.0001. Surgeons gave a higher visibility rating with less visual impediment in the sagittal plane using the RR Stapler. Impediment of visibility occurred in only 10% (5/48) of RR applications in the coronal position, compared to a rate of 48% (23/48) using the CC, p = 0.0002.

Conclusions: The RR device performed significantly better when compared to the CC stapler in regards to placing the stapler further into the deep pelvis and closer to the pelvic floor, while causing less obstructing of visualization.

No MeSH data available.


Related in: MedlinePlus

Illustration of sagittal placement of RR.
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Figure 2: Illustration of sagittal placement of RR.

Mentions: Four surgeons with extensive experience in pelvic/rectal surgery were selected to conduct the protocol procedures on each cadaver (N = 12) for a total of 48 data points. There were 12 RR staplers which were matched with 12 CC staplers. The stapling devices and orientation of placement were randomized for each of the four surgeons in order to increase study objectivity. The TME dissection proceeded to the most distal aspect of the rectum down to the pelvic floor muscles at which time both the RR and CC stapling devices were placed in the coronal and sagittal orientations (see Figures1 and2 for computer-aided drawings of stapler positioning).


Improved access and visibility during stapling of the ultra-low rectum: a comparative human cadaver study between two curved staplers.

Rivadeneira DE, Verdeja JC, Sonoda T - Ann Surg Innov Res (2012)

Illustration of sagittal placement of RR.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539907&req=5

Figure 2: Illustration of sagittal placement of RR.
Mentions: Four surgeons with extensive experience in pelvic/rectal surgery were selected to conduct the protocol procedures on each cadaver (N = 12) for a total of 48 data points. There were 12 RR staplers which were matched with 12 CC staplers. The stapling devices and orientation of placement were randomized for each of the four surgeons in order to increase study objectivity. The TME dissection proceeded to the most distal aspect of the rectum down to the pelvic floor muscles at which time both the RR and CC stapling devices were placed in the coronal and sagittal orientations (see Figures1 and2 for computer-aided drawings of stapler positioning).

Bottom Line: The RR reached significantly lower into the pelvis in both the coronal and sagittal positions compared to the CC.Impediment of visibility occurred in only 10% (5/48) of RR applications in the coronal position, compared to a rate of 48% (23/48) using the CC, p = 0.0002.The RR device performed significantly better when compared to the CC stapler in regards to placing the stapler further into the deep pelvis and closer to the pelvic floor, while causing less obstructing of visualization.

View Article: PubMed Central - HTML - PubMed

Affiliation: Saint Catherine of Siena Medical Center, Smithtown, NY, USA. david.rivadeneira@chsli.org.

ABSTRACT

Background: The purpose of this study was to compare in human cadavers the applicability of a commonly used stapling device, the CONTOUR® curved cutter (CC) (Ethicon Endo-Surgery, Cincinnati, OH) to a newly released, curved stapler, the Endo GIA™ Radial Reload with Tri-Staple™ Technology (RR) (Covidien, New Haven, CT) METHODS: Four experienced surgeons performed deep pelvic dissection with total mesorectal excision (TME) of the rectum in twelve randomized male cadavers. Both stapling devices were applied to the ultra-low rectum in coronal and sagittal configurations. Extensive measurements were recorded of anatomic landmarks for each cadaver pelvis along with various aspects of access, visibility, and ease of placement for each device.

Results: The RR reached significantly lower into the pelvis in both the coronal and sagittal positions compared to the CC. The median distance from the pelvic floor was 1.0 cm compared to 2.0 cm in the coronal position, and 1.0 cm versus 3.3 cm placed sagitally, p < 0.0001. Surgeons gave a higher visibility rating with less visual impediment in the sagittal plane using the RR Stapler. Impediment of visibility occurred in only 10% (5/48) of RR applications in the coronal position, compared to a rate of 48% (23/48) using the CC, p = 0.0002.

Conclusions: The RR device performed significantly better when compared to the CC stapler in regards to placing the stapler further into the deep pelvis and closer to the pelvic floor, while causing less obstructing of visualization.

No MeSH data available.


Related in: MedlinePlus