Per-oral circular stapler in laparoscopic Roux-en-Y gastric bypass.
ABSTRACT Circular staplers are used to create the gastrojejunostomy of the Roux-en-Y gastric bypass. The anvil of the stapler can be placed within the pouch by way of the oropharynx or trans-abdominally, but these methods have limitations. The SurgASSIST Computer Mediated Stapler (Power Medical Interventions, New Hope, PA, USA) is a new technology that changes surgical stapling. The staplers are closed and fired under surgeon control by a computer for better accuracy and reliability. It has a 21-mm stapler, which can be passed orally for endoluminal stapling. The SurgASSIST has several advantages over the traditional circular stapled gastrojejunal anastomosis, including no need to dilate trocars to accommodate the stapler through the abdominal wall and decreased wound infections.
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ABSTRACT: Intracorporeal esophagogastrostomy after laparoscopic proximal gastrectomy is technically challenging. We employed a computer-mediated flexible circular stapler (SurgASSIST) for esophagogastrostomy in 2 cases with gastrointestinal stromal tumor located near the esophagogastric junction. Esophagogastrostomy was successfully constructed intracorporeally using the double-stapling technique. Operation times for the 2 cases were 225 and 170 minutes. No anastomotic leakage was encountered. However, anastomotic stricture requiring balloon dilatation occurred in 1 patient. The SurgASSIST system was feasible for esophageal anastomosis in laparoscopic proximal gastrectomy. However, the digital loading unit (DLU) is too large to introduce transorally, and attempting introduction of the DLU through the narrow lumen may create lesions or perforate the organ. Further improvements in the DLU will facilitate wider use of this system for various procedures in laparoscopic surgery.Surgical laparoscopy, endoscopy & percutaneous techniques 03/2008; 18(1):59-63. DOI:10.1097/SLE.0b013e318156deda · 0.94 Impact Factor
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ABSTRACT: Natural orifice transluminal surgery (NOTES) offers a new option for abdominal surgery. However, despite the initial interest and enthusiasm for its potential advantages, NOTES has some major drawbacks which include the purposeful injury to an organ that may not be otherwise injured or diseased. Roux-en-Y gastric bypass may be a procedure that is suited for NOTES because the stomach wall is breached during the normal course of the operation. We have experimented with a technique for a NOTES gastric bypass in the human. A transvaginal, transgastric gastric bypass (TVTG-GBP) was performed in a human cadaver.Obesity Surgery 07/2008; 18(9):1192-9. DOI:10.1007/s11695-008-9553-4 · 3.74 Impact Factor
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ABSTRACT: In the abdominal-transhiatal approach for resection of adenocarcinoma of the cardia or subcardia, and in laparoscopy-assisted total gastrectomy (LATG), the use of a circular stapling device has potential problems with the placement of the purse-string suture and insertion of the anvil of the instrument. We describe a new double-stapling technique for esophagojejunostomy and esophagogastrostomy, using a peroral intraluminal approach with a digital stapling system, a flexible shaft remote-control stapler - the Surg-ASSIST and Power Circular Stapler 21 mm (PCS). The overtube of the flexible shaft of the PCS is prepared with a nylon tie and secured to a nasogastric (NG) tube. The flexible shaft is manually advanced down the esophagus with guidance by pulling the NG tube from the abdominal cavity side. The trocar of the flexible shaft is removed from the stump of the abdominal esophagus and connected to the anvil and they are approximated; the stapler device is then fired to form a double-stapled esophagojejunostomy and esophagogastrostomy. Our peroral intraluminal approach does not require a suturing technique, and it can make anastomosis after resection for carcinoma of the esophagogastric junction and after LATG safe and simple.Gastric Cancer 02/2009; 12(2):101-5. DOI:10.1007/s10120-009-0510-2 · 4.83 Impact Factor