Enhancing the precision of circular stapled colorectal anastomosis: could powered stapler technology provide the solution?

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Title: Enhancing the precision of circular stapled colorectal anastomosis: could powered stapler technology provide the solution?
Authors: Mirnezami, R
Soares, A
Chand, M
Item Type: Journal Article
Abstract: The use of circular stapling devices to facilitate low colorectal anastomosis (CRA) was first described in the 1970s. This approach is now standard practice and has consistently demonstrated equivalence in terms of safety and efficacy compared with hand-sewn anastomosis, with the added advantages of shorter anastomotic time and greater reproducibility. Briefly, the key elements of circular stapled CRA comprise: (1) selecting a stapler gun of appropriate size; (2) securing the anvil in the distal end of the mobilised colonic conduit; (3) performing a rendezvous manoeuvre to securely dock the anvil onto the end of the stapler gun, which has been advanced from below; and (4) firing the stapler to complete the anastomosis. While there have been subtle modifications to staple design and configuration, there has been relatively little progress made in circular stapler functionality over the past few decades. Further advances in stapling technology could enhance the precision of CRA with the potential to positively impact on the incidence of anastomotic leakage and on the need for diverting stoma. However, refining the existing design requires the four key steps outlined above to be carefully considered to determine how and/or where the technology can be fine-tuned; sizing and anvil application are obligatory steps, while the rendezvous technique represents an elegant design that lends itself readily to both open and intra-corporeal CRA. The final and arguably most critical step in the technique, namely, discharging the stapler, represents a component in the pathway, where refinement may be both feasible and advantageous, and in this regard, the powered surgical stapler is emerging as a potential solution. Powered surgical stapler devices were first introduced in 2011 and have been applied to a wide variety of clinical applications. More recently, powered circular stapling devices have been developed specifically intended for use in colorectal surgery. We provide a technical description of our initial experience with the ECHELON CIRCULAR™ Powered Stapler (Ethicon, Somerville, NJ, USA), which was employed during laparoscopic anterior resection carried out at a tertiary colorectal referral centre (University College London Hospital (UCLH), London, UK).
Issue Date: 1-Jul-2019
Date of Acceptance: 20-Jun-2019
ISSN: 1123-6337
Publisher: Springer Verlag
Start Page: 687
End Page: 689
Journal / Book Title: Techniques in Coloproctology
Volume: 23
Issue: 7
Copyright Statement: © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Keywords: Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
1103 Clinical Sciences
Publication Status: Published
Online Publication Date: 2019-07-05
Appears in Collections:Division of Surgery

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