Journal of Minimal Access Surgery

INSTRUMENTS AND EQUIPMENTS
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Year : 2012  |  Volume : 8  |  Issue : 4  |  Page : 161--162

Efficacy of the modified anvil grasper for laparoscopic intra-corporeal circular stapled anastomosis

Yuen Nakase, Tsuyoshi Takagi, Kanehisa Fukumoto, Takuya Miyagaki 
 Department of Surgery, Nishijin Hospital, Kyoto, Japan

Correspondence Address:
Yuen Nakase
Department of Surgery, Nishijin Hospital, 1035 Roken-machi, Kamigyo-ku, Kyoto
Japan

Abstract

The traditional anvil grasper may be difficult to use for connecting the stem of an anvil with the centre rod of a circular stapler because the grasper holds the anvil completely still. In addition, the head angle is fixed and cannot handle the anvil head delicately in a tight pelvic space. Many surgeons use a grasper designed for holding the bowel or a dissector for holding the anvil during intra-corporeal circular stapled anastomosis during low anterior resection, sigmoidectomy, left hemi colectomy and know that it is difficult to connect segments with these instruments due to slipping. A new modified anvil grasper was developed with curved blades that can easily grasp the stem of an anvil and smoothly connect it with the centre rod of the circular stapler. This grasper should be useful for surgeons performing laparoscopic intra-corporeal circular stapled anastomoses, which are the most challenging part of laparoscopic colorectal surgery.



How to cite this article:
Nakase Y, Takagi T, Fukumoto K, Miyagaki T. Efficacy of the modified anvil grasper for laparoscopic intra-corporeal circular stapled anastomosis.J Min Access Surg 2012;8:161-162


How to cite this URL:
Nakase Y, Takagi T, Fukumoto K, Miyagaki T. Efficacy of the modified anvil grasper for laparoscopic intra-corporeal circular stapled anastomosis. J Min Access Surg [serial online] 2012 [cited 2019 Aug 21 ];8:161-162
Available from: http://www.journalofmas.com/text.asp?2012/8/4/161/103132


Full Text

 Introduction



Intra-corporeal anastomoses during laparoscopic low anterior resection or sigmoidectomy, left hemi colectomy for colorectal cancer are performed using a circular stapler. [1],[2] The traditional anvil grasper is often difficult to use for connecting the stem of the anvil with the centre rod of a circular stapler, because the grasper holds the anvil completely still. In addition, the head angle is fixed and cannot handle the anvil head delicately in the tight pelvic space. The grasper was modified to simplify the process of circular stapled anastomosis.

 Design of the New Anvil Grasper



The 22 mm straight blades of the normal grasper were curved 15 mm from the tip to create a 6 mm grasping surface that is the same diameter as the anvil stem with pliers by us carefully [Figure 1]a-c. The blades can grasp the stem without slipping and are easy to control [Figure 1]d. The new grasper allows a surgeon to hold the proximal colon in the ideal position and smoothly join the segments and perform the anastomosis, which are the most challenging tasks in laparoscopic colorectal surgery [Figure 2].{Figure 1}{Figure 2}

 Discussion



Laparoscopic colorectal surgery has become more common as the number of trained surgeons has increased. Although the incidence of anastomotic leakage for laparoscopic colorectal stapled anastomosis is no worse than that for open surgery, [3] anastomotic leakage should be avoided and the anastomosis procedure must be precisely completed. Many surgical videos show that even expert surgeons occasionally choose to use a grasper designed to hold the bowel or a dissector rather than the anvil grasper when they connect the stem of the anvil with the centre rod of the circular stapler. Performing intra-corporeal anastomosis in the tight pelvic space requires the fine control of the anvil head. However, the traditional anvil grasper cannot handle the anvil head delicately due to the shape and confined space. Therefore, many surgeons have to use a grasper designed for holding the bowel or a dissector. However, it is difficult to connect segments with these instruments due to slipping. When the stem of the anvil is held by a grasper designed for the bowel or a dissector, the force of the two blades act apically and apply the wrong type of force, based on the Parallelogram Law [4] [Figure 3]a. Increases the force applied to the grasper, also increases the apical force. This can cause the stem of the anvil to slip through the grasper. On the other hand, the grasping force of the new grasper does not generate apical force not occur [Figure 3]b. This simplifies grasping the stem of anvil any at any angle, and allows the surgeon to easily handle the proximal colon and smoothly connect it with centre rod of the circular stapler. This grasper should be very helpful for surgeons to perform laparoscopic intra-corporeal circular stapled anastomosis in the tight pelvic space. We plan to collaborate with a manufacturing company to produce and market this new type of grasper based on our design.{Figure 3}

References

1Zucker KA. Laparoscopic left hemi colectomy and sigmoidectomy. In: Bruce V, editor. Laparoscopic surgery of the abdomen. New York: Springer; 2004. p. 369-79.
2Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Yamaguchi T, Muto T. Standardized technique of laparoscopic intra-corporeal rectal transection and anastomosis for low anterior resection. Surg Endosc 2008;22:557-61.
3Goriainov V, Miles AJ. Anastomotic leak rate and outcome for laparoscopic intra-corporeal stapled anastomosis. J Min Access Surg 2010;6:6-10.
4Whitehead AN. Dynamics. In: An Introduction to Mathematics. Scholarly Publishing Office, University of Michigan Library; 2005. p. 42-57.