Abstract
BackgroundThe purpose of this study was to compare in human cadavers the applicability of a commonly used stapling device, the CONTOUR® curved cutter (CC) (Ethicon Endo-Surgery, Cincinnati, OH) to a newly released, curved stapler, the Endo GIA™ Radial Reload with Tri-Staple™ Technology (RR) (Covidien, New Haven, CT)MethodsFour experienced surgeons performed deep pelvic dissection with total mesorectal excision (TME) of the rectum in twelve randomized male cadavers. Both stapling devices were applied to the ultra-low rectum in coronal and sagittal configurations. Extensive measurements were recorded of anatomic landmarks for each cadaver pelvis along with various aspects of access, visibility, and ease of placement for each device.ResultsThe RR reached significantly lower into the pelvis in both the coronal and sagittal positions compared to the CC. The median distance from the pelvic floor was 1.0 cm compared to 2.0 cm in the coronal position, and 1.0 cm versus 3.3 cm placed sagitally, p < 0.0001. Surgeons gave a higher visibility rating with less visual impediment in the sagittal plane using the RR Stapler. Impediment of visibility occurred in only 10% (5/48) of RR applications in the coronal position, compared to a rate of 48% (23/48) using the CC, p = 0.0002.ConclusionsThe RR device performed significantly better when compared to the CC stapler in regards to placing the stapler further into the deep pelvis and closer to the pelvic floor, while causing less obstructing of visualization.
Highlights
The purpose of this study was to compare in human cadavers the applicability of a commonly used stapling device, the CONTOURW curved cutter (CC) (Ethicon Endo-Surgery, Cincinnati, OH) to a newly released, curved stapler, the Endo GIATM Radial Reload with Tri-StapleTM Technology (RR) (Covidien, New Haven, CT)
Surgeons are aware of the importance of proper distal rectal resection and the need to achieve with clear margins, as this may lead to a decrease in local recurrence and may increase the rate of sphincter salvage in patients with low rectal cancers [1,2,3,4,5]
This was demonstrated in the coronal position with a median distance from the pelvic floor of 1.0 cm for the RR, compared to 2.0 cm (0 – 5.0 cm) for the CC (p = 0.001)
Summary
The purpose of this study was to compare in human cadavers the applicability of a commonly used stapling device, the CONTOURW curved cutter (CC) (Ethicon Endo-Surgery, Cincinnati, OH) to a newly released, curved stapler, the Endo GIATM Radial Reload with Tri-StapleTM Technology (RR) (Covidien, New Haven, CT). Performing surgery in the deep pelvis is often a challenging endeavor for surgeons, with mobilization and division of the ultra-low/distal rectum. It is well-established that patients with distal rectal cancers have the best results with a sound oncologic approach such as the total mesorectal excision (TME) with clear circumferential and distal rectal margins. Improvements in stapling devices which include less bulky and lower profile designs would allow for easier placement deeper in the pelvis and onto the ultra-low rectum. This may allow for improved visualization and potentially increased distal negative margins
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