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Laparoscopic anterior resection: new anastomosis technique in a pig model.

Bedirli A, Yucel D, Ekim B - JSLS (2014 Jul-Sep)

Bottom Line: The rectosigmoid segment to be resected was removed through the anus with a grasper, and distal transection was performed.We observed that the proximal and distal donuts were completely removed in all pigs.No anastomotic air leakage was observed in any of the animals.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Gazi University Medical Faculty, Ankara, Turkey.

ABSTRACT

Background and objectives: Bowel anastomosis after anterior resection is one of the most difficult tasks to perform during laparoscopic colorectal surgery. This study aims to evaluate a new feasible and safe intracorporeal anastomosis technique after laparoscopic left-sided colon or rectum resection in a pig model.

Methods: The technique was evaluated in 5 pigs. The OrVil device (Covidien, Mansfield, Massachusetts) was inserted into the anus and advanced proximally to the rectum. A 0.5-cm incision was made in the sigmoid colon, and the 2 sutures attached to its delivery tube were cut. After the delivery tube was evacuated through the anus, the tip of the anvil was removed through the perforation. The sigmoid colon was transected just distal to the perforation with an endoscopic linear stapler. The rectosigmoid segment to be resected was removed through the anus with a grasper, and distal transection was performed. A 25-mm circular stapler was inserted and combined with the anvil, and end-to-side intracorporeal anastomosis was then performed.

Results: We performed the technique in 5 pigs. Anastomosis required an average of 12 minutes. We observed that the proximal and distal donuts were completely removed in all pigs. No anastomotic air leakage was observed in any of the animals.

Conclusion: This study shows the efficacy and safety of intracorporeal anastomosis with the OrVil device after laparoscopic anterior resection.

No MeSH data available.


Related in: MedlinePlus

Transection of proximal colon just below perforation site with endoscopic linear stapler.
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Figure 4: Transection of proximal colon just below perforation site with endoscopic linear stapler.

Mentions: A 10-cm anterior rectosigmoid resection was planned for all of the pigs. A 5-mm LigaSure device (Covidien) was used for mediolateral mesocolon dissection. The colon segment was completely dissected from the surrounding tissues. After anal dilatation, a 25-mm OrVil device was inserted into the anus and advanced proximally to the colon segment to be resected under a laparoscopic view (Figure 2). A 0.5-cm incision was made, and a perforation was formed where the anvil was located; the 2 sutures attached to its delivery tube were then cut. The anvil was externally gripped with an atraumatic grasper while the delivery tube was evacuated through the anus. The tip of the anvil that was to be placed in the circular stapler was taken out from this perforation to the abdominal cavity (Figure 3). If necessary, the orifice was narrowed with a primary suture composed of No. 2–0 polyglactin 910 (Vicryl; Ethicon, Somerville, New Jersey). The proximal line of the sigmoid colon was transected just distal to the perforation with an articulating endoscopic linear stapler (EndoGIA; Covidien) (Figure 4). The rectosigmoid segment to be resected was extracted through the anus with a grasper, and distal transection was performed again with the EndoGIA device (Figure 5). A 25-mm EEA circular stapler (Covidien) was inserted and combined with the tip of the anvil. Finally, end-to-side colorectal anastomosis was performed in an intracorporeal manner (Figure 6).


Laparoscopic anterior resection: new anastomosis technique in a pig model.

Bedirli A, Yucel D, Ekim B - JSLS (2014 Jul-Sep)

Transection of proximal colon just below perforation site with endoscopic linear stapler.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4208905&req=5

Figure 4: Transection of proximal colon just below perforation site with endoscopic linear stapler.
Mentions: A 10-cm anterior rectosigmoid resection was planned for all of the pigs. A 5-mm LigaSure device (Covidien) was used for mediolateral mesocolon dissection. The colon segment was completely dissected from the surrounding tissues. After anal dilatation, a 25-mm OrVil device was inserted into the anus and advanced proximally to the colon segment to be resected under a laparoscopic view (Figure 2). A 0.5-cm incision was made, and a perforation was formed where the anvil was located; the 2 sutures attached to its delivery tube were then cut. The anvil was externally gripped with an atraumatic grasper while the delivery tube was evacuated through the anus. The tip of the anvil that was to be placed in the circular stapler was taken out from this perforation to the abdominal cavity (Figure 3). If necessary, the orifice was narrowed with a primary suture composed of No. 2–0 polyglactin 910 (Vicryl; Ethicon, Somerville, New Jersey). The proximal line of the sigmoid colon was transected just distal to the perforation with an articulating endoscopic linear stapler (EndoGIA; Covidien) (Figure 4). The rectosigmoid segment to be resected was extracted through the anus with a grasper, and distal transection was performed again with the EndoGIA device (Figure 5). A 25-mm EEA circular stapler (Covidien) was inserted and combined with the tip of the anvil. Finally, end-to-side colorectal anastomosis was performed in an intracorporeal manner (Figure 6).

Bottom Line: The rectosigmoid segment to be resected was removed through the anus with a grasper, and distal transection was performed.We observed that the proximal and distal donuts were completely removed in all pigs.No anastomotic air leakage was observed in any of the animals.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Gazi University Medical Faculty, Ankara, Turkey.

ABSTRACT

Background and objectives: Bowel anastomosis after anterior resection is one of the most difficult tasks to perform during laparoscopic colorectal surgery. This study aims to evaluate a new feasible and safe intracorporeal anastomosis technique after laparoscopic left-sided colon or rectum resection in a pig model.

Methods: The technique was evaluated in 5 pigs. The OrVil device (Covidien, Mansfield, Massachusetts) was inserted into the anus and advanced proximally to the rectum. A 0.5-cm incision was made in the sigmoid colon, and the 2 sutures attached to its delivery tube were cut. After the delivery tube was evacuated through the anus, the tip of the anvil was removed through the perforation. The sigmoid colon was transected just distal to the perforation with an endoscopic linear stapler. The rectosigmoid segment to be resected was removed through the anus with a grasper, and distal transection was performed. A 25-mm circular stapler was inserted and combined with the anvil, and end-to-side intracorporeal anastomosis was then performed.

Results: We performed the technique in 5 pigs. Anastomosis required an average of 12 minutes. We observed that the proximal and distal donuts were completely removed in all pigs. No anastomotic air leakage was observed in any of the animals.

Conclusion: This study shows the efficacy and safety of intracorporeal anastomosis with the OrVil device after laparoscopic anterior resection.

No MeSH data available.


Related in: MedlinePlus