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Totally intracorporeal delta-shaped B-I anastomosis following laparoscopic distal gastrectomy using the Tri-Staple™ reloads on the manual Ultra handle: a prospective cohort study with historical controls

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Abstract

Background

A delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy could be performed easily and sufficiently using only laparoscopic linear staplers. However, the restricted maneuverability and severe blurring of these staplers along with their limited hemostability induced strain. In this study, we determined the feasibility and safety of performing delta-shaped anastomosis using the Endo GIA™ Reloads with Tri-Staple™ Technology combined with Endo GIA™ Ultra Universal stapler (Tri-Staple) with a particular focus on short-term surgical outcomes.

Methods

We performed a single-institutional prospective interventional study (UMIN 000008014). The Tri-Staple was prospectively used on 23 consecutive patients who underwent a curative totally laparoscopic Billroth I gastrectomy with delta-shaped anastomosis. These patients were matched with the 19 patients previously treated using the ENDOPATH® ETS Articulating Linear Cutters (ETS) on clinical and demographic characteristics.

Results

There were no differences between the groups in anastomosis-related local complications, morbidity, non-anastomosis-related local complications, total systemic complications, and short-term outcomes with the exception of significantly reduced blood loss in the Tri-Staple group (ETS vs. Tri-Staple: 37 [10–306] vs. 15 [5–210] mL, p = 0.02). Intraoperative bleeding from the staple line was significantly reduced in the Tri-Staple group. The postoperative drain indwelling period (ETS vs. Tri-Staple, 6 [4–10] vs. 4 [2–43] days, p = 0.032), fasting period (5 [3–7] vs. 3 [3–24] days, p = 0.022), and hospital stay (14 [10–47] vs. 11 [6–58] days, p = 0.025) were significantly shorter in the Tri-Staple group. There was no mortality in this series. Acceleration assessed as indices of blurring of stapler tip might have a significant adverse influence on staple-line bleeding at stapling sites.

Conclusion

Totally laparoscopic Billroth I distal gastrectomy using Tri-Staple was feasible and safe with favorable short-term surgical outcomes. Reduced blurring while stapling may be a novel endpoint which newly developed stapling devices should target.

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Abbreviations

LADG:

Laparoscopically assisted distal gastrectomy

TLDG:

Totally laparoscopic distal gastrectomy

ETS:

ENDOPATH® ETS Articulating Linear Cutters

Tri-Staple:

Endo GIA™ Reload with Tri-Staple™ Technology combined with Endo GIA™ Ultra Universal stapler

Ccr:

Creatinine clearance

ECOG:

Eastern Cooperative Oncology Group

ASA:

American Society of Anesthesiologists

PaO2 :

Arterial oxygen pressure

UMIN-CTR:

University Hospital Medical Information Network Clinical Trials Registry

JGCA:

Japanese Gastric Cancer Association

AUC:

Area under the curve

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Disclosures

Our “Feasibility Study of Delta-Shaped Anastomosis in Totally Laparoscopic Billroth I Gastrectomy using Tri-Staple” was funded by Covidien Surgical Devices Investigator Sponsored Research Grants (2,100,000JPY), and Koichi Suda and Ichiro Uyama have conflicts of interest and financial ties to disclose. Mariko Man-i, Kenji Kikuchi, Tsuyoshi Tanaka, Shimpei Furuta, Masaya Nakauchi, Ken Ishikawa, and Yoshinori Ishida have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Mariko Man-i, Koichi Suda, Kenji Kikuchi, Tsuyoshi Tanaka, Shimpei Furuta, Masaya Nakauchi, Ken Ishikawa, Yoshinori Ishida & Ichiro Uyama

Authors
  1. Mariko Man-i
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  2. Koichi Suda
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  3. Kenji Kikuchi
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  4. Tsuyoshi Tanaka
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  5. Shimpei Furuta
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  6. Masaya Nakauchi
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  7. Ken Ishikawa
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  8. Yoshinori Ishida
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  9. Ichiro Uyama
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Corresponding author

Correspondence to Koichi Suda.

Additional information

Clinical Trial Registration We registered the trial procedure described in this manuscript in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) under the following authors: Ichiro Uyama and Koichi Suda. UMIN-CTR ID: UMIN 000008014.

Electronic supplementary material

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Supplementary Video clip: Blurring of the stapler tip in the process of firing analyzed with motion analysis software (M4 V 6702 kb)

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Man-i, M., Suda, K., Kikuchi, K. et al. Totally intracorporeal delta-shaped B-I anastomosis following laparoscopic distal gastrectomy using the Tri-Staple™ reloads on the manual Ultra handle: a prospective cohort study with historical controls. Surg Endosc 29, 3304–3312 (2015). https://doi.org/10.1007/s00464-015-4085-1

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  • DOI: https://doi.org/10.1007/s00464-015-4085-1

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