Juan-Carlos Verdeja, MD1, Bernard Hausen, MD, PhD2. 1Baptist Health Medical Group, 2Private practice
INTRODUCTION: Surgical endostaplers are used to simultaneously divide and staple tissue, creating hemostatic transections in a variety of surgical applications. In particular, endostaplers are well suited to laparoscopic approaches due to their maneuverability and reach. However, most commercial endostaplers have large diameter shafts and their articulation may be insufficient to allow perpendicular approach to blood vessels. To address these limitations, this report describes the use of a more flexible, miniaturized endostapler for nephrectomy in a porcine model.
METHODS AND PROCEDURES: Laparoscopic removal of the right kidney using the Dextera MicroCutter Stapler (5 mm diameter) or a conventional endostapler (12 mm diameter) for transections of the vasculature and ureters was undertaken in four pigs for each endostapler. Intraoperative complications, such as bleeding at the staple line, were captured. Animals were survived for a minimum of 34 days followed by gross evaluation and histological examination of the stapled sites.
RESULTS: The MicroCutter was used for 9 vascular transections and the control device for 10; the vessels were 3-8 mm in diameter. Each device was also used to transect four ureters. There was no post-transection intraoperative bleeding at any of the blood vessels including during induced hypertension. The surgical time was 30-60 minutes for both devices, and resulted in minimal blood loss. There were no adverse events and no conversions to open procedures. All animals were healthy at sacrifice, and samples from the MicroCutter and control devices were histologically indistinguishable.
CONCLUSION: The MicroCutter device functioned as intended and achieved hemostasis in all applications. The MicroCutter’s small size and flexibility (80° of articulation) may lend itself particularly well to the vessels in the renal hilum and improve outcomes by reducing the burden of dissection. Additionally, its slim jaws may maximize the length of retained vascular stump, which is important in donor nephrectomies.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79832
Program Number: P421
Presentation Session: Poster (Non CME)
Presentation Type: Poster