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- Title
Predicting the level of difficulty of the double-stapling technique in laparoscopic total mesorectal excision.
- Authors
Foo, Chi Chung; Hung, Hing Tsun; Ho, Yuen Chi; Lam, Wendy Wai Man; Law, Wai Lun
- Abstract
<bold>Background: </bold>The transection of rectum and fashioning of anastomosis is a crucial step in laparoscopic total mesorectal excision (TME) and the double-stapling technique (DST) is often employed. This study aimed to evaluate the factors that were associated with difficult DST.<bold>Method: </bold>Cases of laparoscopic TME were retrospectively reviewed. The clinico-anatomical parameters were retrieved from a prospectively maintained database. In addition, pelvic dimensions were taken by reviewing the magnetic resonance imaging scan. The number of stapler cartridges used for intracorporeal transection of rectum was used as a surrogate for the level of difficulty of DST and its relationship with various parameters were evaluated.<bold>Results: </bold>There were a total of 121 consecutive cases analyzed. The mean number of stapler cartridges used was 2.1 ± 0.7. Pelvic inlet (p = 0.002) and tumor height (p = 0.015) were predictors of the number of cartridges used, R2 = 0.366. A model was developed to predict the likelihood of transecting the rectum with two or less stapler cartridges, which included the following parameters: gender, pelvic inlet, interspinous distance, intertuberous distance, and tumor height. The predicted probability also correlated with overall operation time (p = 0.009) and anastomotic leakage (p = 0.023).<bold>Conclusion: </bold>The difficulty of DST was associated with patient's clinico-anatomical factors. Surgeons can consider other feasible alternatives, like transanal anastomosis, when a technically challenging DST is anticipated.
- Subjects
LEVEL of difficulty; KEGEL exercises; MAGNETIC resonance imaging; RECTUM; RECTAL surgery; SURGICAL anastomosis; RECTUM tumors; RETROSPECTIVE studies; PSYCHOLOGICAL tests; LAPAROSCOPY; STAPLERS (Surgery)
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2020, Vol 34, Issue 8, p3382
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-019-07112-2