Sam Atallah, FACS, FASCRS. FLORIDA HOSPITAL
Objective: The purpose of video stapling is to provide a method to precisely navigate the stapler arm to target and to provide direct evaluation of the anastomosis.
Description: Using the technique of circular stapling in which the arm of the stapler is mated to an anvil to create an anastomosis, it can in some instances be difficult to introduce the stapler arm to the target, such as with a high anterior resections and restoration of bowel continuity using the double-stapled technique. It is probable that this is due in part to delivery of a bulky device though a desufflated rectum and guidance is conducted primarily via crude tactile feedback and visualizing the direction and orientation of the device externally as it driven toward the staple target. Here, a conventional EEA stapler has been fitted with an access channel to facilitate video guided stapling using a precilinical model.
Preliminary results: The feasibility of video guided stapling is successfully demonstrated; how existing staplers can be adapted to accommodate a narrow diameter scope, through which insufflation is possible and the use of an effector arm can be delivered is described. The advantages of video guided stapling are summarized as follows: (a ) ability to navigate the stapler arm to the target by visualizing the path of the stapler through an insufflated rectosigmoid colon; (b) ability to inspect the target, and confirm the target is clear of neoplasia (eg, residual polyp) prior to completing the anastomosis; (c) ability to inspect and test via air leak assessment of the rectal cuff prior to stapling; (d) ability to visualize the process of the anastomosis as well as the anastomotic line in real-time (e) ability to evaluate the proximal lumen for ischemia (f) ability to perform a leak test post-anastomosis, immediately after stapling (g) the potential to manipulate the anastomosis, such as for control of focal bleeding using an effector arm.
Conclusion: Video guided stapling should be the next step in evolution of the endoluminal surgical stapler, as it allows for navigation to the target via optics and insufflation. Luminal and anastomotic evaluation in real-time is an important adjunct of this technology.
Video-guided stapling device: a modification of an existing stapler permits a 4 mm flexible scope through it, thus allowing for precise delivery of the shaft for endoluminal stapling; the anastomosis can be evaluated in real-time.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84269
Program Number: ETP748
Presentation Session: Emerging Technology Poster
Presentation Type: Poster