Clinical experience using the computerized digital stapling system in open gastric bypass surgery for morbid obesity.

Abstract

Roux-en-Y gastric bypass is currently the preferred method of surgical treatment for morbid obesity. Complications associated with this technique include anastomotic leaks and anastomotic strictures. Our technique employs a computerized digital stapling system (SurgASSIST). This stapling system has been utilized in affecting both the end-to-end gastrojejunostomy and end-to-side enteroenterostomy anastomoses. SurgASSIST is a computerized stapling system consisting of a power console and a 2.13-meter flexshaft. Using a remote control, various stapling cartridges can be opened and closed, and the tip of the flexshaft can be steered in four directions prior to firing. Because the firing mechanism and force are generated away from the surgical field, torque applied to the anastomotic site is minimized. The system is designed to approximate tissue to the correct staple height, based on tissue thickness, which precludes excessive compression of the tissues. We have employed the SurgASSIST computerized digital stapling system in a series of 403 cases with 558 applications. We have experienced no anastomotic leaks. There were 7 strictures (1.7%) requiring balloon dilatation. There were no strictures requiring surgical intervention. Our extensive clinical experience using the SurgASSIST computerized digital stapling system has shown it to be a safe and effective method for performing stapled anastomoses.