Tips and tricks: a new method for colorectal anastomosis using a triple stapling technique

This video presents a new method for colorectal anastomosis in an easy and reproducible stepwise approach.

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Tips and tricks: a new method for colorectal anastomosis using a triple stapling technique

Authors

J Leroy, J Marescaux

Abstract

This video presents a new method for colorectal anastomosis in an easy and reproducible stepwise approach.

Classification

tips and tricks

Keywords

colorectal anastomosis, triple stapling technique, laparoscopy, tips and tricks

Media type

Surgical video

Duration

03'53''

Publication

2008-06

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E-publication

WeBSurg.com, Jun 2008;8(06).
URL: http://www.websurg.com/doi-vd01en2290.htm

Tips and tricks: a new method for colorectal anastomosis using a triple stapling technique

1. Preparation of colonic resection 00'19''

We present the triple stapling technique for a colonic anastomosis. Even though the mesocolon in obese patients is importantly thick and short, with the 10mm Ligasure Atlas device, it is possible to dissect up to the level of the colonic layer and prepare the section point where the stapler will be applied. Colonic resection is performed with a 60mm Endo-GIA linear stapler (blue cartridge). Care must be taken to avoid any injury to the neighbouring structures such as the ureter and the pelvic vessels. Notice the change in colour of the colon, secondary to the venous compression exerted over the proximal colon through the abdominal wall.

2. Anvil insertion into proximal colon 01'04''

Notice the change in colour of the colon, secondary to the venous compression exerted over the proximal colon through the abdominal wall. Here we show the anvil of the new stapler, its height was reduced by 20% and the anvil’s center rod profile was decreased to provide thick tissue doughnuts. A small colotomy is performed on the distal edge of the proximal colon and we introduce it. Notice its progression under laparoscopic control.

3. Proximal colon resection 01'37''

Once the anvil is inside, we divide the colon with the Endo-GIA stapler (blue cartridge).

4. Specimen extraction 01'45''

The abdominal wall is covered by a protective plastic sheath and the specimen is extracted.

5. Anvil\'s positioning and colotomy closure 02'05''

A small incision is made at the edge of the proximal colon’s stapling. The anvil is pushed through this colotomy. In order to close the colotomy, a single preformed knot is placed around the anvil.

6. Circular stapler insertion and intracorporeal anastomosis 03'07''

The circular stapler is introduced into the rectum and prepared to be connected to the anvil. We check that there are no twists and we continue to perform the colo-colonic end-to-end anastomosis in a mechanical fashion.

7. Air test 03'36''

We check the patency of the anastomosis by performing an air test.