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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

Distal Placement of RR on the Rectum.
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Figure 3: Distal Placement of RR on the Rectum.

Mentions: Overall results demonstrate a statistical significance in favor of the RR stapler when compared to the CC stapler in regards to the ability to place the stapler deeper in the pelvis onto the ultra-low rectum, with an improved visibility rating in the sagittal plane and less visual impedement in the coronal plane. Surgeons were able to apply the RR lower into the pelvis in both the coronal and sagittal positions when compared to the CC stapling device (see Figures3,4for RR and CC depictions, respectively). This was demonstrated in the coronal position with a median distance from the pelvic floor of 1.0 cm (range, 0 – 5.0 cm) for the RR , compared to 2.0 cm (0 – 5.0 cm) for the CC (p = 0.001). These significant differences for the RR stapler were also observed in the sagittal position with a median distance from the pelvic floor of 1.0 cm (0 – 5.0 cm) compared to 3.3 cm (0 – 5.0 cm) for the CC (p < 0.0001). (Figure5)


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)

Distal Placement of RR on the Rectum.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Distal Placement of RR on the Rectum.
Mentions: Overall results demonstrate a statistical significance in favor of the RR stapler when compared to the CC stapler in regards to the ability to place the stapler deeper in the pelvis onto the ultra-low rectum, with an improved visibility rating in the sagittal plane and less visual impedement in the coronal plane. Surgeons were able to apply the RR lower into the pelvis in both the coronal and sagittal positions when compared to the CC stapling device (see Figures3,4for RR and CC depictions, respectively). This was demonstrated in the coronal position with a median distance from the pelvic floor of 1.0 cm (range, 0 – 5.0 cm) for the RR , compared to 2.0 cm (0 – 5.0 cm) for the CC (p = 0.001). These significant differences for the RR stapler were also observed in the sagittal position with a median distance from the pelvic floor of 1.0 cm (0 – 5.0 cm) compared to 3.3 cm (0 – 5.0 cm) for the CC (p < 0.0001). (Figure5)

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