2005 Abstracts: Laparoscopic Application of Flexible Stapling System in GI-Surgery
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Laparoscopic Application of Flexible Stapling System in GI-Surgery
Karl H. Fuchs, Lothar Brandt, Klaus Grundmann, Markus-Hospital, Frankfurt, Germany, Germany; Wolfram Breithaupt, Markus-Hospital, Frankfurt, Germany
Introduction:Recently a flexible shaft stapling systemhas been introduced into modern surgery. The technique allowsfor application of the system in laparoscopic as well as open surgery. The purpose of this study is the assessment of initial clinical experience, the problems of the learning curve and technical feasibility in open and laparoscopic procedures.
Methods: Initially an experienced GI-surgeon was trained in an experimental center in the application in both open and laparoscopic application of the flexible shaft stapling system. After 4 experimental sessions the system was trained in clinical open surgery in 20 cases, before laparoscopic approach was used. A stepwise learning curve from laparoscopic appendectomy, colon resection to laparoscopic gastric resection was developed. For intraabdominal application for the linear stapler a 15 mm trocardand for the circular stapler a 33 mm trocard war used. Technical problems, or-time and complications were prospectively documented. Results: 134 patients were operated upon with the flexible stapler, 57 of whom were performed laparoscopically (age 59, range 24-72); cases: appendectomy 9, colon resections and total colectomy 41, partial gastrectomy 7; average firing per patient: 2 (1-6). Intraoperative problems in the learning phase: 1 computer failure during esophageal reconstruction with gastric tube and 3 in colon anastomoses were solved by repetition ofanastomoses; leakage rate 6%; ; Applications/complications: esophageal:16/2; gastric:21/1; colo-rectal: 76/6. Advantage:laparoscopic handling possible for any location and angle in the abdomen, which allows for angeled COLLIS-Plasty within the abdomen and subtotal colectomy with circular stapled anastomosis at higher level of the colon above rectum. Conclusion: Laparoscopic application of the new flexible shaft stapling system allows for special indications in minimal invasive approach. The problems and complications are within the limits of conventional stapling. Since there is a learning curve for handling, proper training in laparoscopicand open surgery is advised.
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