Curved cutter stapler vs. linear stapler in rectal cancer surgery: A pilot prospective randomized study
Department of Surgery, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea. International Journal of Colorectal Disease
(Impact Factor: 2.45).
08/2009; 24(11):1327-32. DOI: 10.1007/s00384-009-0771-6
This study aimed to compare the safety and technical accessibility of linear stapler and curved cutter stapler (CCS) during mid to low rectal cancer surgery.
Between April and November 2006, 60 patients were randomly assigned to either linear staplers (DST TA; United States Surgical, Tyco Healthcare Group LP, Norwalk, CT) or the CCS (Contour Curved Cutter Stapler(R); Ethicon Endo-Surgery, Inc., Cincinnati, OH) during low anterior resection for mid to low rectal cancers.
There were no significant differences in age, gender, body mass index, and mean carcinoembryonic antigen level between the two groups. Distal resection margin was longer in the CCS group as compared with the linear stapler group but did not reach statistical significance (24.7 vs. 20.8 mm, P = 0.065). There was no difference in the incidence of postoperative complications.
In this study, both the CCS and linear staplers were satisfactory devices for securing the distal rectum during low anterior resection in mid to low rectal cancers.
Available from: Jeroen L.A. van Vugt
- "Therefore, a stapler device that allows good visibility, maneuverability and transection with the use of only one stapler firing would be preferable in low rectal surgery. The staplers for securing the distal rectum can be broken down into two categories: linear staples and curved cutter staplers . The latter have the advantage that a knife is integrated in the device and that the curve allows deeper positioning in the pelvis. "
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Low rectal surgery remains challenging. New surgical stapler devices have been developed to counteract problems of impaired visibility and inability to get low into the pelvis. One of them is the Radial Reload (RR) with Tri-staple(™) Technology (Covidien, New Haven, CT, USA). The aim of this study was to assess the first impressions and experiences regarding handling of this new stapler device in low anterior resection procedures in living humans.
A questionnaire, consisting of 27 statements concerning accessibility, maneuverability and visibility, was sent to 35 surgeons worldwide.
A total of 85 rectal surgical procedures, both open and laparoscopic, were assessed by 31 surgeons. In 97% of the procedures the surgeons agreed that the RR stapler device facilitated access in the low pelvis. The first stapler device firing achieved complete transection in 54% of the procedures. According to the surgeons' assessments, in 91% percent of the procedures the RR stapler device enabled creation of adequate margins. Visualization of the pelvic floor was reported in 93% of the procedures. In the surgeons' opinion, the RR stapler device was considered clinically acceptable in 93% of the procedures. In 79% of the procedures the surgeon preferred the RR stapler device over the stapler device they normally used.
This study showed that the first experiences with the RR stapler device of 33 surgeons in 85 low rectal procedures are positive. It facilitates low stapling in both open and laparoscopic procedures. Good visibility, maneuverability and the possibility to create adequate distal margins were reported.
Available from: ejcts.oxfordjournals.org
- "At the Thoracic Surgery U.O.C. of San Paolo Hospital in Bari, Italy, the efficency of a new curved stapler for bronchial suturing was verified, comparing it to the linear staplers currently used. This stapler is characterized by similar features to the linear staplers and it had been only used (until our experience reported in this study) in rectal surgery  "
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ABSTRACT: One of the fundamental steps in an anatomical pulmonary resection is the main and lobar bronchus suture. Nowadays, two different types of staplers are on the market: the linear TA stapler for open surgery (Tyco Healthcare Group LP, Norwalk, CT, USA), which is based on a 'guillotine' mechanism, sewing, but not cutting the bronchus, and the endoscopic linear stapler which both cuts and sews. This study aimed to fill the void in the use of an instrument used to staple and cut at the same time in 'open' thoracic surgery, eliminating the need for a scalpel: the curved cutter stapler (Contour Curved Cutter Stapler; Ethicon Endo-Surgery, Inc., Cincinnati, OH, USA).
Between May 2009 and March 2011, the Contour Curved Stapler (Ethicon) was used for the bronchus in 139 cases of non-small cell lung carcinoma (NSCLC)-29 females and 110 males ranging between 48 and 85 years (average 71.1)-and comprising 115 lobectomies (8 bilobectomies) and 24 pneumonectomies (8 on the right lung, 16 on the left lung).
All patients underwent a bronchoscopic check-up 30 days after they were discharged: in all cases, the bronchial stump was clearly within normal limits. No cases of bronchopleural fistulas were observed in the 139 patients.
On the basis of this study, the curved cutter stapler showed to be a satisfactory device for securing the bronchus during an anatomic resection (whether lobar or main), in 'open' thoracic surgery. However, even though there were no cases of fistula, we consider that our data is still too limited to be statistically significant.
Available from: Andrea Vignali
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ABSTRACT: At present time, there is evidence from randomized controlled studies of the success of laparoscopic resection for the treatment of colon cancer with reported smaller incisions, lower morbidity rate and earlier recovery compared to open surgery. Technical limitations and a steep learning curve have limited the wide application of mini-invasive surgery for rectal cancer. The present article discusses the current status of laparoscopic resection for rectal cancer. A review of the more recent retrospective, prospective and randomized controlled trial (RCT) data on laparoscopic resection of rectal cancer including the role of trans-anal endoscopic microsurgery and robotics was performed. A particular emphasis was dedicated to mid and low rectal cancers. Few prospective and RCT trials specifically addressing laparoscopic rectal cancer resection are currently available in the literature. Improved short-term outcomes in term of lesser intraoperative blood loss, reduced analgesic requirements and a shorter hospital stay have been demonstrated. Concerns have recently been raised in the largest RCT trial of the oncological adequacy of laparoscopy in terms of increased rate of circumferential margin. This data however was not confirmed by other prospective comparative studies. Moreover, a similar local recurrence rate has been reported in RCT and comparative series. Similar findings of overall and disease free survival have been reported but the follow-up time period is too short in all these studies and the few RCT trials currently available do not draw any definitive conclusions. On the basis of available data in the literature, the mini-invasive approach to rectal cancer surgery has some short-term advantages and does not seem to confer any disadvantage in term of local recurrence. With respect to long-term survival, a definitive answer cannot be given at present time as the results of RCT trials focused on long-term survival currently ongoing are still to fully clarify this issue.
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