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MCC 2011 - Slide 17
MCC 2011 - Slide 17
MCC 2011 - Slide 17
MCC 2011 - Slide 17
MCC 2011 - Slide 17
MCC 2011 - Slide 17
MCC 2011 - Slide 17
MCC 2011 - Slide 17
MCC 2011 - Slide 17
MCC 2011 - Slide 17
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MCC 2011 - Slide 17

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  • 1. Workshop Stapling Techniques Klaas Havenga University Medical Center Groningen The Netherlands
  • 2. Overview <ul><ul><li>Transverse stapling of the rectal stump </li></ul></ul><ul><ul><li>Mobilizing the afferent loop </li></ul></ul><ul><ul><li>Handling the anvil </li></ul></ul><ul><ul><li>Introducing the circular stapling </li></ul></ul><ul><ul><li>Firing </li></ul></ul><ul><ul><li>Drains, temporary ostomy </li></ul></ul>
  • 3. Transverse stapling of the rectal stump <ul><li>Where? </li></ul><ul><ul><li>Total mesorectal excision vs partial mesorectal excision </li></ul></ul><ul><ul><li>Acceptable distal margins? </li></ul></ul><ul><li>How? </li></ul><ul><ul><li>What type of stapler? </li></ul></ul><ul><ul><li>cleaning the rectal stump? </li></ul></ul>
  • 4. Mobilizing the afferent loop <ul><li>Possibilities: </li></ul><ul><ul><li>Mobilizing the splenic flexure </li></ul></ul><ul><ul><ul><li>Caveats </li></ul></ul></ul><ul><ul><li>Dividing the inf mesenteric artery </li></ul></ul><ul><ul><ul><li>Collateral left colic – sigmoid </li></ul></ul></ul><ul><ul><ul><li>Dividing the inf mesenteric vein </li></ul></ul></ul><ul><li>Tension: </li></ul><ul><ul><li>What is acceptable? </li></ul></ul><ul><ul><li>Tension and anastomotic dehiscence: mechanisms. </li></ul></ul>
  • 5. Handling the anvil <ul><li>Evaluation of perfusion </li></ul><ul><li>Side to end vs. end to end </li></ul><ul><ul><li>rationale </li></ul></ul><ul><li>Introducing the anvil: </li></ul><ul><ul><li>Through the open colon </li></ul></ul><ul><ul><li>Through an incision </li></ul></ul><ul><ul><li>Purse string </li></ul></ul><ul><ul><li>Removing appendices epiploicae </li></ul></ul>
  • 6. Introducing the circular stapling <ul><li>What size? </li></ul><ul><li>Dilating the anus </li></ul><ul><ul><li>caveats </li></ul></ul><ul><li>Introduction and positioning </li></ul><ul><ul><li>one hand in, one hand out </li></ul></ul><ul><li>Putting the spike through the stump </li></ul>
  • 7. Firing <ul><li>Are you sure? </li></ul><ul><ul><li>What can go wrong?? </li></ul></ul>
  • 8. Testing the anastomosis? Gerrie Knetemann (Amsterdam, 6 maart 1951 - Bergen (Noord-Holland), 2 november 2004), bijnaam 'de Kneet', was een Nederlandse beroepswielrenner van 1974-1989.
  • 9. C-seal
  • 10. C-seal <ul><li>Biodegradable polyurethane sheath </li></ul><ul><li>Compatible with any circular stapler </li></ul><ul><li>Hypothesis: </li></ul><ul><ul><li>anastomotic dehiscence will not lead to leakage </li></ul></ul><ul><li>Fase I and II studies: n=52 </li></ul><ul><ul><li>Technical succes in 50 </li></ul></ul><ul><ul><li>Only 1 anastomotic leakage requiring reintervention </li></ul></ul><ul><ul><li>No anastomosis dismantled </li></ul></ul><ul><li>Observation of retraction of C-seal through anus </li></ul>

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