Modified Circular Stapler for Laparoscopic Intracorporeal Colorectal Anastomoses

Objective of the device. During standard colorectal laparoscopic resection, in order to insert the anvil with the purse-string technique, anastomosis is performed by extracting the left colon through a small laparotomy. Intracorporeal colon anastomosis avoids extensive and unnecessary colon mobilisation, but is considered technically challenging. During intracorporeal colorectal anastomoses with the circular stapler, the anvil must be inserted through the abdominal wall and subsequenlty into the colon. In order to facilitate the introduction of the anvil, we propose a new device, which can be easily inserted through a 12-mm trocar skin incision.

Description of the technology. The tilting anvil head of a 25-mm circular stapler is currently used in bariatric surgery and passed transorally during stapled gastrojejunostomy. The same device, with an anvil of a bigger diameter (29 or 30 mm), can be used to create a larger colorectal anastomosis. Once the device is inside the abdominal wall it can be tilted back in the standard position.

Preliminary results. We have performed 20 colorectal anastomosis, using the intracorporeal technique. Current 29 or 30 mm anvils are difficult to introduce, prolonging operative time. We have tested the 25 mm tilting anvil and found it very easy and rapid to pass through a 12 mm trocar incision.

Conclusions. Intracorporeal colorectal anastomosis is not commonly performed because of technical difficulties. This technical innovation might improve and facilitate the insertion of the anvil head into the abdominal cavity. In the future, intracorporeal colorectal anastomosis may become as popular as ileorectal intracorporeal ones.

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