Anastomosis Device Research Articles

The New Stapler Device Is Good, But Needs More Evaluation

See Article on Page 77-82 In colorectal surgery, safe anastomosis following complete tumor removal is an essential element. Colorectal surgeons inevitably encounter anastomosis-related complications, such as leakage, stenosis, or bleeding. Anastomosis leakage is associated with not only poorer short-term clinical outcomes, but also unfavorable oncologic outcomes [1]. In addition, anastomosis stenosis compromises the patient's quality of life. The use of the circular stapler has facilitated sphincter-preserving surgery for sigmoid colon or rectal cancer, and the stapling technique has become popular. However, that stapler device does not always guarantee a 100% safe colo-colic or colo-rectal anastomosis. In this regard, a compression anastomosis device (Colon Anastomosis Ring-ColonRing, NiTi Surgical Solutions, Netanya, Israel) has been introduced. However, small-scale animal and human studies have shown comparable results between stapled and compression anastomosis [2]. In this issue of the Annals of Coloproctology, Kwag et al. [3] published their retrospective data. The authors evaluated the safety and efficacy of the compression anastomosis device in 67 colon cancer patients and observed that the compression anastomosis device did not increase the incidence of anastomosis-related complications. This type of study, which investigates a new surgical device, always deserves to be applauded as new techniques carry unknown risks and a learning curve. However, this study was based on a retrospective, small series and only included data on colon cancer patients. In a recent study, Kang et al. [4] evaluated a total of 20 cases of compression anastomosis (anterior resection, 11; low anterior resection, 9) and experienced one anastomosis leakage in patients with rectosigmoid colon cancer. The compression anastomosis technique needs more large-scale clinical studies and more data on rectal cancer surgery before it will be accepted. A bad workman finds fault with his tools. For good gastrointestinal anastomosis, strict adherence to operative principles may be more important than the type of surgical device used. These principles include adequate exposure of the surgical field, the use of well-vascularized tissue, absence of tension, no fecal contamination, watertight closure, mucosal apposition and meticulous technique [5].

Development of New Devices for Translumenal Endoscopic Esophageal Anastomosis

This study aimed to develop new devices for translumenal endoscopic esophageal anastomosis-a stent and a ligating device-and to confirm the feasibility of our novel procedure using those devices. We designed a ligating device as an overtube whose tip worked like the EVL device (Sumitomo Bakelite Co. Ltd., Tokyo, Japan). The newly developed procedure for anastomosis is as follows: a silicone elastic band, which was released from the device located at the upper esophagus, and a custom-made expandable stent, which was expanded by the balloon catheter in the lower esophagus, tightened the upper and lower esophageal walls. After producing the devices, we performed the anastomosis procedure in porcine models. A ligating device and an expandable stent were developed for this study. An ex vivo feasibility study was performed in three porcine models. Endoscopic visualization revealed that all steps in this procedure were technically successful. The median time needed to perform this procedure was 24 (range, 19-25) minutes. Patency of the anastomosis was confirmed in all specimens. Translumenal esophagoesophageal anastomosis using the new devices was feasible. The procedure time was sufficiently short for clinical use. An in vivo survival study is needed to confirm the safety and reliability of this procedure.

Magnets in the GI tract

Magnets in the GI tract

Clampless off-pump coronary artery bypass prevents early post-operative neurologic injury compared to on-pump: a propensity score matched analysis

Background Unaortic coronary artery bypass with all arterial grafts proved to prevent early neurologic injury. Various devices for clampless proximal anastomosis of venous grafts were associated with an increased risk of microembolism. The Cardica PAS-Port is a new, fully automated device that might be able to obtain safe proximal aorto-venous connection without an increased risk of microor macro embolism. We evaluated early post-operative neurologic outcome in a matched population following clampless OPCAB (CCAB) or on-pump CABG.

Technological Solutions for Cardiac Surgery in the Elderly

The current review addresses contemporary technological advances in cardiac surgery performed on octogenarian patients, namely off-pump coronary artery bypass grafting (CABG), proximal anastomosis device, routine use of intraoperative epiaortic ultrasound, proximal anastomosis without clamping, transcatheter aortic valve implantation (TAVI), and brain protection during cardiac surgery.

Minimally Invasive Device for Rapid Urethrovesical Anastomosis

Radical prostatectomy is a common treatment for patients with prostate cancer [1]. The current surgical technique for radical prostatectomies requires dividing the urethra from the bladder in order to aid the removal of the prostate [2]. At the end of a prostatectomy, the urethra is reconnected to the bladder in a procedure known as urethrovesical anastomosis (UVA) involving suturing the urethra to the bladder with bioabsorbable sutures. This procedure is commonly done first by reconstructing the posterior aspect of the rhabdosphincter, using this reconstruction to bring together the bladder and the urethral stump and lastly performing a running suture to avoid multiple knot tying. UVA is the most challenging and time consuming of the radical prostatectomy procedure due to the constrained surgical field, the proximity of the external urethral sphincter, and the complexity of suturing on very small tubular structures. These have limited the surgical time for the UVA for an experienced surgeon to 15 min [3]. Most current suturing or stapling devices on the market are not designed for UVA and, therefore, lack crucial features necessary for performing the procedure, for example placing the urethra and bladder neck in contact to insert the sutures. One of the challenges in creating a device to automatically perform UVA is that no non-absorbable structures can remain in the urethra or bladder as interaction with urea in the urine can result in stone formation and further complications.

English

Anastomosis in Gastrointestinal surgery is a very commonly performed procedure , since the era of Sushruta, various methods of intestinal anastomosis were followed- recent advancement is the use of stapler as a device for GI anastomosis. Because of the use of staplers technical failures is a rarity, anastomosis is more consistent, and can be used at difficult locations. MATERIALS AND METHODS : A total of 50 cases which met the inclusion and exclusion criteria were included in this hospital based prospective comparative study. The study population included all patients who underwent elective gastrointestinal surgeries . STUDY FACTORS : The subjects were allocated into two groups according to the type of anastomosis, hand sewn and stapler. Both hand sewn and stapled anastomosis were further divided into three sub-groups according to the site of anastomosis viz esophageal, gastrojejunal and colorectal. OUTCOME FACTORS : Anastomotic Integrity, Duration of operation, Return of Bowel activity, Hospital stay. RESULTS: A total of 50 patients with malignant or benign condition of bowel and esophagus, requiring anastomosis were allocated in study group of GI staplers and control group of conventional Hand sewn technique. Out of 50 cases there were 13 esophageal anastomosis, 19 gastrojejunostomies and 18 colorectal anastomosis CONCLUSION: In our present study, we found that stapling technique can significantly reduce the time for anastomotic procedure, less tissue trauma due to less tissue handling, there is early restoration of gastrointestinal function, early resumption of oral feeding and reduced duration of hospital stay which helps ultimately in early return to routine work, importantly staplers can be used at places were hand sewn anastomosis is technically difficult. Technique related complications do not show significant differences which suggests that one can use staplers with same safety and accuracy as sutures

1410 NOVEL USE OF THE CAPIO URETHRAL ANASTOMOTIC SUTURING DEVICE: A 50 CASE ASSESSMENT

You have accessJournal of UrologyTechnology & Instruments: Robotics: Benign & Malignant Disease (II)1 Apr 20131410 NOVEL USE OF THE CAPIO URETHRAL ANASTOMOTIC SUTURING DEVICE: A 50 CASE ASSESSMENT Elleson A. Schurtz, Jhanelle E. Markes, Mark R. Newton, and James A. Brown Elleson A. SchurtzElleson A. Schurtz Iowa City, IA More articles by this author , Jhanelle E. MarkesJhanelle E. Markes Iowa City, IA More articles by this author , Mark R. NewtonMark R. Newton Iowa City, IA More articles by this author , and James A. BrownJames A. Brown Iowa City, IA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2764AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Reported advantages of robot-assisted laparoscopic prostatectomy (RALP) over open radical retropubic prostatectomy (RRP) include less blood loss and a lower bladder neck contracture (BNC) rate. A recent modification to the RRP is the utilization of the Capio suture capture device for placement of urethrovesical anastomotic sutures. This device eliminates the need to place freehand sutures and increases control and precise placement of sutures. We hypothesized that use of the Capio device would reduce RRP BNC rates. We examined a 50-case, single-surgeon, single-institution sequential series for the incidence of BNC using the Capio device for urethrovesical anastomosis in RRP and compared it to published rates for RRP and RALP. METHODS A retrospective chart review was performed evaluating a series of 50 RRP utilizing the Capio device between February 2010 and May 2012. Variables examined included patient demographics, pathology, and postoperative complications. Postoperative BNC rates were compared to previously published BNC rates in RRP and RALP performed without the Capio device. RESULTS In all 50 cases, a resident physician surgeon used the Capio device and performed the majority of the anastomoses. The mean follow-up was 13.1 months. Forty-seven patients (94%) had follow-up data available for longer than 90 days postop. No patients were diagnosed with BNC within 90 days. Two patients (4%) subsequently developed BNC requiring treatment. One patient had a clinically insignificant BNC that was diagnosed 18 months postop due to inability to pass a Foley catheter when hospitalized for sepsis. The second patient was diagnosed 8 months postop after complaints of weak stream and frequency. An overall 4% BNC rate, and a clinically symptomatic 2% rate, was observed in a 50 sequential case series using the Capio device. This rate was on the lower end of published RRP BNC rates of 2-19%. It and was near the published RALP BNC rates of 0-3%. Many of these RALP series included procedures in which a faculty surgeon performed the anastomotic procedure. CONCLUSIONS Control and precision of the Capio device in creation of the anastomosis, even in a training situation, allows for BNC rates similar to those reported after a RALP continuous anastomosis, but larger studies with longer follow-up are needed to fully evaluate the efficacy of the Capio device. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e577-e578 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elleson A. Schurtz Iowa City, IA More articles by this author Jhanelle E. Markes Iowa City, IA More articles by this author Mark R. Newton Iowa City, IA More articles by this author James A. Brown Iowa City, IA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

One-shot aortic anastomosis with an automatic stapling gun

We performed aortic arch replacement with a circular staple gun (Intraluminal Stapler System, ILS; Ethicon Endo-Surgery Inc, Somerville ,N J), an automatic anastomosis device used in gastrointestinal surgery. The features of the ILS are adjustable stapler height and controlled compressed tissue thickness, allowing uniform staple formation and providing a leak-free anastomosis and good hemostasis. The circular staple gun has been used in gastrointestinal operations since the 1980s, but its early use was controversial. Now that the device has been standardized, this first report of clinical use in aortic aneurysm surgery is pivotal and likely to change practice in cardiovascular surgery. CLINICAL SUMMARY

Use of a New Device for Distal Coronary Anastomosis -Pig Model-

Use of a New Device for Distal Coronary Anastomosis -Pig Model-

Rating and issues of mechanical anastomotic staplers in surgical practice: a survey of 241 Japanese gastroenterological surgeons

Commercially available mechanical devices for gastrointestinal anastomosis are mostly made in overseas. Japanese female surgeons have described these devices as being too large and difficult to handle. This study investigated the degree of satisfaction and problems experienced by Japanese surgeons in using various staplers for mechanical anastomosis. A questionnaire was prepared and sent via email to 5,537 members of the Japanese Society of Gastroenterological Surgery. The questionnaire included sex, age, surgical glove size, degree of satisfaction with various mechanical staplers, stress felt when using the staplers in anastomosis, and problems regarding the devices. Valid responses were received from 241 respondents (167 males, 74 females, response rate 4.9 %). The satisfaction rate ranged from 0 to 100 %. The average glove size in males was significantly larger than that in females (median: 7.0 versus 6.0; P < 0.0001). Surgeons with glove size 6.0 or smaller felt stress more frequently than those with size 6.5 or larger (median: 40 vs. 20 %; P < 0.0001). Surgeons with glove size 6.0 and smaller experienced more difficulties during firing and releasing. The satisfaction rates with currently available mechanical staplers were low. Japanese surgeons with small hands felt more stress when using the staplers. Ergonometric consideration is necessary in stapler design.

Magnamosis III: delivery of a magnetic compression anastomosis device using minimally invasive endoscopic techniques

Magnamosis creates a secure sutureless anastomosis through magnetic compression. In this study, we further develop and test delivery devices capable of creating a secure duodeno-colonic anastomosis using available minimally invasive endoscopic techniques. Eight pigs underwent general anesthesia. Colonoscopy was used to deliver 1 magnetic ring to the hepatic flexure. Simultaneously, upper endoscopy delivered the other magnetic ring into the duodenum using a variety of techniques. The 2 magnetic rings were brought into magnetic proximity under laparoscopic guidance. The pigs were recovered and examined daily followed by sacrificing at 1, 2, 4, and 6 weeks. The device designed to deliver and release each magnetic ring evolved from using a guide wire and balloon devices to redesigning the magnetic ring casing with a groove to accommodate an endoscopic snare. Laparoscopic visualization assured safe magnet mating of intestinal segments. The duodeno-colonic anastomoses created with the snare yielded widely patent anastomoses. In vitro testing revealed excellent burst pressure. Histology revealed complete healing as early as 1 week. We redesigned the magnamosis device to facilitate delivery by endoscopic techniques. The snare technique allows endoscopic positioning and controlled release of the magnetic rings for a secure side-to-side duodeno-colonic anastomosis.

Experimental study of a novel mechanical connector for sutureless open arterial anastomosis

This study assessed the feasibility and efficacy of a new sutureless connector for end-to-end arterial anastomosis. The anastomotic device is a connector consisting of a bare-metal stent with spikes covering its outer surface, which is introduced through the prosthesis. The seal of the anastomosis is obtained by inflating a balloon anchoring the stent with the spikes in the prosthesis and in the receiving artery. This experiment was conducted in three phases: (1) A feasibility study was done on four cadaveric femoral arteries using a polytetrafluoroethylene prosthesis, with measurement of the penetration of the spikes into the layers of the arterial wall. (2) Bench tests were conducted in seven automated and in seven sutured anastomoses. Anastomosis sealing was tested using a pump system (≤250 mm Hg) in a water-filled closed circuit. (3) The infrarenal aorta of seven pigs was replaced with a 6- to 8-mm diameter prosthesis, using this automated device for the proximal anastomosis. The distal anastomosis was handsewn on the aortic bifurcation. After completion angiography, animals were euthanized for macroscopic and histologic studies of the aorta, connector, and prosthesis. Explantations were done immediately (2 pigs), and at 15 (2 pigs), at 30 (2 pigs), and 42 days (1 pig). Study end points were the automated anastomosis time compared with manual suturing, leakage, mechanical strength, and patency of the anastomosis together with the histologic changes of the aortic wall in contact with the spiked stent. Tests performed on four cadaveric arteries showed complete penetration of the spikes into the arterial wall layers without metal fracture. Tests of traction showed that the median force needed to rupture the automated anastomosis was 18.3 N (interquartile range [IQR], 17.7-19.9 N), with no significant difference from the handmade anastomosis (19.5 N; IQR, 17.9-20.2 N, P = .33). No leakage was demonstrated in vitro with a pulsatile flow and a pressure up to 250 mm Hg. The median automated anastomosis time on pig aorta was 2.4 minutes (IQR, 1.4-3.3 min) vs 17.0 minutes (IQR, 15.1-17.2 minutes) for the handmade aortic anastomosis performed on the same animals (P = .002). There was no anastomotic leak. Histology showed incorporation of the connector spikes in the aortic wall, without intimal hyperplasia or false aneurysm. This preliminary study confirms the feasibility of this sutureless system, suggesting its usefulness for a faster and simpler anastomosis in hybrid arterial surgery.

Microvascular anastomosis using the vascular closure device in free flap reconstructive surgery: A 13-year experience

The achievement of patency of the microvascular anastomosis in free flap surgery is dependent on a number of factors, central to which is atraumatic handling of the vessel lumen, and intimal apposition. Initial laboratory studies demonstrating the superiority of the non-penetrating vascular closure staple (VCS - Anastoclip ®) were followed by our report in 1999 on a series of free flaps. There is still a paucity of data in the literature on the use of non-penetrating devices for microvascular anastomosis, and our review gives evidence to support the routine use of the VCS in microsurgical free flap surgery. We now report on its successful use over a thirteen year period in 819 free flap reconstructions. Our data indicates the VCS device to be as effective as sutured anastomoses in free tissue transfer surgery. There is also statistically significant data (Barnard's Exact Test) to demonstrate a higher vascular patency rate of the VCS device over sutured anastomoses when sub group analysis is performed. 'Take-back' revision rates were lower amongst flaps that employed VCS use. For arterial anastomoses, this equated to 3/654(0.05%) vs 4/170(2.4%) with hand-sewn anastomoses (p=0.02). Similarly, for venous anastomoses the 'take-back' revision rate was 7/661(1.1%) vs 8/165(4.8%) with hand-sewn anastomoses (p=0.003). Furthermore, the major advantage of the VCS is reduction in anastomosis time, from approximately 25min per anastomosis for sutures to between five and 10min for staples.

Off-pump coronary artery bypass grafting with an aortic nonclamping technique may reduce the incidence of cerebral complications

Cerebrovascular accidents after coronary artery bypass grafting (CABG) remain a complication despite the advancements in techniques. Aortic partial clamping should be avoided to prevent this cerebral complication. We use pedicle arterial grafts (bilateral internal-mammary arteries and the right gastroepiploic artery) and saphenous vein graft with a proximal anastomosis device for off-pump CABG without aortic partial clamping. We call this technique the aortic nonclamping technique. Between 2001 and 2007, a total of 468 patients underwent coronary bypass operations; 8 who were operated on with cardiopulmonary bypass were excluded from this study. Altogether, 451 patients underwent off-pump CABG using the aortic nonclamping technique. Among the procedures, 354 were performed using pedicle arterial grafts alone, and 99 were done using a saphenous vein graft with a proximal anastomosis device. Nine were performed with aortic partial clamping for any reason. Postoperative cerebral complications, especially cerebral infarction, were analyzed. Cerebral infarction occurred in two cases (0.47%) in the aortic nonclamping group. They were delayed in both cases, one occurring on the third day after operation and the other on the fourth day. One patient in the aortic clamping group had an intraoperative (early) cerebral infarction. The aortic nonclamping technique might reduce the incidence of cerebral complications and produce ideal bypass grafts using arterial grafts and saphenous vein grafts with a proximal anastomosis device.

UP-02.218 Surgical and Functional Outcomes Using a Novel Device for Urethro-Vesical Anastomosis in Extraperitoneal Videolaparoscopic Prostatectomy

UP-02.218 Surgical and Functional Outcomes Using a Novel Device for Urethro-Vesical Anastomosis in Extraperitoneal Videolaparoscopic Prostatectomy

FE Analysis of Nitinol Leaf Springs Used in a Compression Anastomosis Device

Reconstruction of the digestive system lumen patency (anastomosis creation) after its partial surgical removal is a common and crucial procedure. The conventional anastomosis methods use devices for mechanical suturing which are associated with high failure risk and can lead to major complications. The compression anastomosis as a sutureless method seems to be a promising alternative. However, attempts during the last two centuries have not been completely successful due to the complex character of the tissue-healing process. The specific mechanical behavior of Nitinol alloys was applied to the force element of the compression devices. These devices are becoming more widely adopted in surgery practice. The compression anastomosis device enables the anastomosis of colonic and intestinal tissue based on compression forces exerted by Nitinol leaf springs. By means of changing the strain distribution in the stressed leaves with varying moments of inertia, one can gain full control of the different stages in the force-deflection profile (i.e., linear elastic stage and the force plateau stage). The target of this study is the comparison of different Nitinol leaf geometries and evaluation of the finite elements analysis as a tool for preliminary design of such geometries. The results of this analysis allow us to establish regulation of the spring’s mechanical behavior, thus controlling the anastomosis creation in the compression anastomosis device.

Lower extremity free flap reconstruction outcomes using venous coupler

Microvascular anastomotic coupling devices have been available to microsurgeons for over 20 years. Many studies have validated the efficacy of these devices for venous anastomosis. To date, there have been no large reports of their success in the anatomical region with the highest free flap failure rate, the lower extremity. A retrospective review of 67 consecutive patients who underwent lower extremity microvascular reconstruction performed from August 2003 to September 2010 was performed. Patient charts were reviewed for age, sex, medical comorbidities, etiology of defect, location of defect, flap type, anastomotic technique, complications, flap survival, and limb salvage outcome. No patients returned to the operating room to have an arterial or venous anastomosis revised. Despite 100% vascular anastomosis patency rates in 67 consecutive lower extremity free flaps, flap survival rate was 95.5%. Total complication rate (13.4%) was due to two partial and one complete flap loss, three infections, two skin graft loses, and one hematoma. There were no intraoperative or perioperative complications involving the use of a microvascular anastomotic coupling device itself. Thirty-day and long term limb salvage rate was 97% and 92.5%, respectively. Microvascular anastomotic coupling devices create effective venous anastomoses in lower extremity microvascular reconstruction. Thus, it presents an important tool in the armamentarium for lower extremity microsurgical reconstruction.

Prospective study on the use of nickel-titanium temperature-dependent memory-shape device (CAR27) for anastomosis after colorectal surgery

To prospectively evaluate the safety and efficacy of nickel- titanium temperature-dependent memory-shape device(CAR27) for colorectal anastomosis. Sixty colorectal cancer patients were randomly divided into two groups and received colorectal anastomosis with CAR27 or traditional stapling device. Complications, bowel function return, and the extrusion of anastomosis ring were prospectively monitored. Both CAR27 and stapler group had one case of anastomotic leakage. Other complications such as stricture or obstruction were not found. Time for anastomosis of the two groups were (10.1±1.2) minutes and (11.2±2.1) minutes respectively. Time to first flatus was(3.2±1.2) days and (3.5±1.4) days respectively. Time to food intake resumption was (4.0±1.4) days and (4.3±1.3) days respectively. The differences above between the two groups were not statistically significant(P>0.05). The ring was expelled with stool within 7-16 days. The two groups were similar in operative time and the return of bowel function. CAR27 is safe and simple for colorectal anastomosis.

Animal experimental study of compression anastomosis ring for low anterior resection

To evaluate the feasibility and safety of nickel-titanium compression anastomosis ring (CAR27) in colorectal anastomosis after low anterior rectal resection in animal models. End-to-end colorectal anastomosis was performed using CAR27 in 6 experimental pigs after resection of the middle and lower third of the rectum. The animals were observed postoperatively for up to 56 days. Five pigs were sacrificed at day 14 and the other at day 56. Distance from anal verge to anastomosis and anastomotic circumference were measured. Histopathologic examination was performed. The median distance from anal verge was 5.3(4-6) cm. No anastomotic leak or other complications were observed. All the pigs recovered and gained weight. In 5 animals sacrificed at day 14, the mean circumference of the anastomosis was 6.8(6.5-7.0) cm, and histopathological examination showed mild inflammatory reaction and fibrosis. In the one sacrificed at day 56, the circumference expanded to 9.3 cm, and no inflammation and fibrosis were observed. Minor adhesion was noticed in only one pig, while smooth and intact serosa in the anastomosis was seen in the rest of the animals. CAR27 is a promising device for mid and low colorectal anastomosis.