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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

Pelvic Measurements. Pelvic inlet measured as transverse diameter between right and left pelvic sidewall. Umb = umbilicus; Pubis = pubic symphysis; ASIS = anterior superior iliac spine; SP = sacral promontory; PF = pelvic floor; Coccyx = tip of coccyx; AV = anal verge.
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Figure 6: Pelvic Measurements. Pelvic inlet measured as transverse diameter between right and left pelvic sidewall. Umb = umbilicus; Pubis = pubic symphysis; ASIS = anterior superior iliac spine; SP = sacral promontory; PF = pelvic floor; Coccyx = tip of coccyx; AV = anal verge.

Mentions: The RR performed significantly better than the CC when placed in both the coronal and sagittal positions with respect to the number of readjustments of the stapler that allow for optimal placement into the deep pelvis (Table1). In addition, the RR was superior to the CC in the coronal position with respect to 1. lower incidence of interference by the symphysis pubis, 2. lower impediment of visibility, and 3. access rating. (Tables2,3) Applied in the sagittal position, the RR was statistically superior to the CC with respect to: 1. lower incidence of interference by the symphysis pubis, 2. ease of placement in the pelvis 3. Ability to contain the whole rectum in the device after clamping 4. visibility rating, and 5. Access rating. (Tables4,5) Obscured visibility was encountered 10% (5/48) of the time when the RR stapling device was used and this was favorable when compared to the higher visual impairment rate (48% [23/28]) which occurred with the CC device, p = 0.0002 (Table2). The lack of visibility was mostly attributed to the anterior area of the deep pelvis due to the prostate in 95% of the cases. The measurements of pelvic anatomic factors in the twelve cadavers are listed in Figure6. In regards to the ability to hold and retain tissue without slippage, the CC scored significantly higher than the RR stapler (96% [45/47] vs. 57% [26/46]).


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)

Pelvic Measurements. Pelvic inlet measured as transverse diameter between right and left pelvic sidewall. Umb = umbilicus; Pubis = pubic symphysis; ASIS = anterior superior iliac spine; SP = sacral promontory; PF = pelvic floor; Coccyx = tip of coccyx; AV = anal verge.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Pelvic Measurements. Pelvic inlet measured as transverse diameter between right and left pelvic sidewall. Umb = umbilicus; Pubis = pubic symphysis; ASIS = anterior superior iliac spine; SP = sacral promontory; PF = pelvic floor; Coccyx = tip of coccyx; AV = anal verge.
Mentions: The RR performed significantly better than the CC when placed in both the coronal and sagittal positions with respect to the number of readjustments of the stapler that allow for optimal placement into the deep pelvis (Table1). In addition, the RR was superior to the CC in the coronal position with respect to 1. lower incidence of interference by the symphysis pubis, 2. lower impediment of visibility, and 3. access rating. (Tables2,3) Applied in the sagittal position, the RR was statistically superior to the CC with respect to: 1. lower incidence of interference by the symphysis pubis, 2. ease of placement in the pelvis 3. Ability to contain the whole rectum in the device after clamping 4. visibility rating, and 5. Access rating. (Tables4,5) Obscured visibility was encountered 10% (5/48) of the time when the RR stapling device was used and this was favorable when compared to the higher visual impairment rate (48% [23/28]) which occurred with the CC device, p = 0.0002 (Table2). The lack of visibility was mostly attributed to the anterior area of the deep pelvis due to the prostate in 95% of the cases. The measurements of pelvic anatomic factors in the twelve cadavers are listed in Figure6. In regards to the ability to hold and retain tissue without slippage, the CC scored significantly higher than the RR stapler (96% [45/47] vs. 57% [26/46]).

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