Yuen Nakase, MD PhD, Tsuyoshi Takagi, MD PhD, Kanehisa Fukumoto, MD PhD, Takuya Miyagaki, MD PhD. Department of Surgery, Nishijin Hospital, Kyoto, Japan
1. Objective of the Device: Traditional anvil graspers have a uniquely shaped jaw that enhances grip force. They grasp the anvil stem perfectly. Therefore the anvil head cannot be maneuvered delicately in a tight pelvic space. It may be difficult to use for connecting the stem of an anvil to the center rod of a circular stapler. Many surgeons use a grasper designed for holding the bowel or a dissector to hold the anvil during intra-corporeal circular stapled anastomosis during low anterior resection, sigmoidectomy, and left hemicolectomy although it is difficult to connect segments with these instruments due to slipping. Such difficulties may cause operative complications or instrument damage. We developed a novel anvil grasper “EAGLE” (Evolutional Anvil Grasper for LaparoEndoscopic surgery) for more precise and safer anastomosis procedures.
2. Description of the technology: The EAGLE has curved blades with tungsten carbide-coated tips, which are curved 15 mm from the tip to create a 6 mm grasping surface that is the same diameter as the anvil stem. When the stem of the anvil is held by a grasper designed for the bowel or a dissector, the force of the 2 blades act apically and apply the wrong type of force, based on the vector synthesis method. Increasing the force applied to the grasper also increases the apical force. This can cause the stem of the anvil to slip through the grasper. In contrast, the grasping force of the EAGLE does not generate apical force. This facilitates grasping of the anvil stem at any angle, allowing the surgeon to easily handle the proximal colon and smoothly connect it to the center rod of the circular stapler.
3. Preliminary Results: This study included 15 patients undergoing laparoscopic low anterior resection or sigmoidectomy for colorectal cancer using intra-corporeal circular stapler anastomosis. The time required to connect the anvil head to the center rod of the circular stapler using EAGLE vs. other instruments was 18.6 ± 4.3 s vs. 35.5 ± 73.6 s (p<0.0001). Other instruments require more time, depending on the surgeon’s skill, the level of anastomosis (distance from the anal verge), and patient characteristics (gender, obesity or body frame size, etc.). However, any surgeon using the EAGLE could perform connections smoothly in any patient. All surgeons who used The EAGLE in place of other instruments felt it was comfortable to use and made it easier to connect the anvil to the center rod of the circular stapler.
4. Conclusions: By using the EAGLE, a surgeon can hold the proximal colon in the ideal position and smoothly join segments to perform anastomosis, the most challenging tasks in laparoscopic colorectal surgery. The EAGLE is a very simple anvil grasper, but should be very helpful in allowing surgeons to perform these procedures safely.
Session Number: Poster – Poster Presentations
Program Number: P036