The application of a new stapling device for open surgery (Contour Curved Cutter Stapler) in the laparoscopic...

Anastomotic leakage is a serious problem in the laparoscopic resection of rectal cancer. Although stapling devices and techniques for colorectal or coloanal anastomosis have been improved, laparoscopic anastomosis is still technically difficult and the rate of leakage is high. To resolve this problem, a new stapling device (the Contour Curved Cutter Stapler) for open surgery was applied to the laparoscopic resection of rectal cancer. After intracorporeal mobilization and vessel ligation, a 6-cm Pfannenstiel incision was made to insert the device into the peritoneal cavity, and a hand access device was placed on the site. The head of the device was put through a cutoff of the middle finger of a surgical glove, after which the wrist of the glove was attached to the hand access device. To prevent leakage of CO2 gas through the gap between the shaft and the glove, the shaft covered by the glove was tied, and the gap was filled with bone wax. After re-creation of the pneumoperitoneum, the rectum was transected with the stapling device, and the anastomosis was accomplished by the double stapling technique. This technique enabled a reliable transection of the rectum because of the easy handling of the device and the wide laparoscopic view of the lower rectum in the deep pelvis.