The disposable arc-shaped cutting stapler solves the problem of anastomotic leakage during the use of linear cutting staplers
The difficulty of low anterior resection for rectal cancer lies in pelvic colorectal anastomosis after low resection
Especially in obese or male patients, the pelvis is small, the anastomotic site is deep, and the field of view is small. Due to the narrow pelvic cavity, the linear cutting stapler is difficult to place in the pelvic floor, which cannot achieve the purpose of low anastomosis. Moreover, it is easy to cause partial tearing of the intestinal wall and give up anal sphincter preservation. In order to solve the practical difficulty of low consistency in pelvic depth, Johnson&Johnson changed the linear cutting stapler to an arc-shaped cutting stapler, known as Kaitu, in 2005, which improved the visibility of the surgical field and made it easier to perform deep operations. Its unique curved tip conforms to the natural anatomy of the pelvic cavity, which can better expose the anatomical structure and surgical field when entering the pelvic cavity. It is easy to enter lower positions of the pelvic cavity, especially narrow pelvis, which can be closed and removed according to the minimum degree of intestinal freedom, achieving low and ultra-low anastomosis, and expanding the application scope of anal protection surgery
Based on the literature, we believe that attention should be paid to the application of curved cutting staplers
(1) The 213cm lower edge of the tumor should be completely naked in the intestine, otherwise the equipment is difficult to place. The surgical thumb and index finger can basically clamp the intestine to be removed. In rabbits, the rectum may not be completely closed due to excessive tissue thickness;
(2) Before cutting and suturing, it is important to note that the diameter of the target tissue is smaller than the diameter of the closure device. If the positioning needle is not in the correct position, the suturing may not form properly, which may result in leakage or incomplete suturing. Before cutting and suturing, it should be confirmed that there are no other tissues, such as the posterior wall of the bladder or urine, present;
(3) When using an arc-shaped cutting stapler, it can be flipped along the anatomical curvature of the pelvic cavity from the anterior or posterior side of the rectum to the anterior position. The position for removing the intestinal tract can be semi closed or closed. Anastomotic leakage is one of the most common and important complications in low anterior resection surgery. Compared with linear cutting staplers and traditional hand staplers, the incidence of curved cutting staplers has not increased.
