gms | German Medical Science

Introduction: Gastrointestinal anastomosis using stapler-devices in general is easy, fast and safe. But in case of a circular-stapler anastomosis the linear stapler line of a resected organ has to cross the circular-staple lines of the anastomosis, which is performed for reconstruction of passage.

Oftentimes the knife of the circular stapler does not cut completely through those cross-sections, with the consequence of staples that are hooked to each other which leads to a notchy and traumatizing extraction of the circular stapler.

The linear-staple line does also result in an up-folded wall of tissue, which results in an uneven distribution of pressure during the circular anastomosis. This leads to incomplete staple forming as well as to insufficient tissue grasping of the staples of the circular-stapler.

The consequences of both mentioned mechanisms not seldom is an incomplete circular anastomosis and anastomosis leakage, which is a significant surgical complication.

Material and methods: We propose two pair of instruments by which a linear staple line can be avoided and by which the application of the anvil as well as the resection of the organ can be performed simultaneously and in a minimal-invasive technique.

The pivotal idea is the trans-luminal application of the anvil (ante- or retrograd) and the fixation of the cut–off section of the hollow organ right at the latching plane between the two spheres. The two spheres guide the slip-knot-slings off to the outer diameter of the spheres and between both slings an electric cutter-sling is used to cut the organ at the latching-plane between both spheres, after both spheres are detached.

The circular anastomosis is then completed regularly.

Results: A prototype of the instrument setup is under construction and will be tested ex-vivo and in an animal model. Figure 1 [Fig. 1].