Can maneuverability in the robot assisted laparoscopic stapler during ileoileal anastomosis compensate for shorter stapler length? – A randomized experimental porcine study

Abstract

Background

Ileal anastomosis is imperative in patients given a urinary diversion during radical cystectomy. Proper handling and staplers with a certain length are important to prevent stenosis of the bowel. The study aim was to compare the circumference and diameter of ileoileal anastomoses using the Endo GIA tri-stapler 45 mm and 60 mm iDrive systems compared to the RAL Endowrist DaVinci 45 mm. This was to investigate if the better maneuverability of the robotic stapler would compensate for the shorter stapler length in the RAL Endowrist DaVinci 45.

Materials and methods

Twenty ileoileal anastomoses were performed in a total of three pigs after randomization according to the type of anastomosis technique used (depending on stapler and robotic system) allocated to four groups (each with five anastomoses): (1) iDrive 45 mm, (2) iDrive 60 mm, (3) RAL DaVinci 45 mm (Si-system), and (4) RAL DaVinci 45 mm (Xi-system). Diameter (mm) and circumference (mm) were measured and compared.

Results

Diameters and circumferences in Group 1 were significantly smaller compared to all the other groups, which did not differ from each other, except in Group 2 where anastomoses had a significantly higher circumference than Group 4.

Conclusion

The iDrive 60 mm makes the anastomoses with the widest diameter and highest circumference compared to the iDrive 45 mm. With the RAL DaVinci 45 mm, the diameter and circumference were comparable to the iDrive 60 mm and significantly better than the iDrive 45 mm. An explanation may be the better maneuverability and surgeon control of the RAL DaVinci stapler.

Keywords:

• Cystectomy
• ileoileal anastomoses
• stapler length
• comparison
• maneuverability
• robotics

Ethics approval

The present study was conducted in accordance with the French National guidelines for handling and care of animals and general practices and principles at IRCAD, France (L’Institut de Recherche contre les Cancers de l'Appareil Digestif) (license no.: APAFIS#2981-2015120212324587). Reporting of the study followed the ARRIVE guidelines.

Authors’ contributions

The first author wrote the first draft. The other authors critically revised the paper for important intellectual content. All authors have contributed to the work and agreed on the final version. This manuscript is not being considered by any other journal.

Disclosure statement

Jørgen Bjerggaard Jensen is proctor for Intuitive Surgery. The authors reported no other potential conflicts of interest.

Additional information

Funding

Intuitive surgery and Clinical Sales Director –Nordic region Thomas Karup and former Clinical Sales Trainer & Clinical Sales Representative – Denmark Kim Drube provided the technical and financial support to the project.