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Use of the new EEA stapler in a laparoscopic Roux-en-Y gastric bypass

Authors

Abstract

This video shows the advantages of performing a laparoscopic gastrojejunostomy in a gastric bypass with the new DST Series EEA stapler. Every operative step is clearly shown and described.

Classification

tips and tricks

Keywords

laparoscopy, RYGB, Roux-en-Y gastric bypass, morbid obesity, tips and tricks, circular stapler

Media type

Duration

04'05''

Publication

2008-06

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Audio

Subtitles

E-publication

WeBSurg.com, Jun 2008;8(06).
URL: http://www.websurg.com/doi-vd01en2181.htm

Use of the new EEA stapler in a laparoscopic Roux-en-Y gastric bypass

1. Division of the jejunum 00'16''

When performing a gastric bypass, generally the entero-enterostomy is made first, then the gastric pouch is prepared. At the beginning of the procedure, the proximal edge of the alimentary limb of the entero-enterostomy was sutured to the stomach’s greater curvature. This stitch is cut and we are ready to create the gastrojejunal anastomosis. We dissect the mesocolon between two arcades in order to pass an Endo-GIA linear stapler (white cartridge). With the aid of the 10mm Ligasure Atlas, we open the mesocolon a little bit to avoid traction on the tissues.

2. Preparation of the jejunal side of the gastrojejunal anastomosis 00'59''

The alimentary limb is now opened distally in order to introduce the circular stapler. The assistant holds the edge of the limb and the surgeon holds the left side: with the hook and monopolar dissection, the limb is opened parallel to the staple lines. To introduce the circular stapler, we increase the diameter of the trocar site located in the left hypochondrium and place a protective plastic sheath to cover the incision. A loop is used around the circular stapler to avoid desufflation of the pneumoperitoneum.

3. Creation of the gastrojejunal anastomosis 01'29''

The new Autosuture circular stapler (DST series) places a double staggered row of titanium staples and resects the excess tissue, creating a circular anastomosis. The fixation suture between the small bowel and the stomach is cut and we may now introduce the circular stapler with circular movements. This stapler has improved anvil’s height by reducing it by 20% and the anvil’s center rod profile was decreased to provide thick tissue doughnuts. This series also has an integrated trocar on the instrument that minimizes tissue tenting and maximises the thickness of the tissue doughnuts. A click can be heard and felt when the anvil is securely in place. The open-close graphic on top of the instrument clearly indicates the direction in which to turn the knob to open and close. Fully opening or fully closing the instrument is achieved in no more than four and a half turns. During the firing sequence, feedback from the instrument can be heard and felt, conveying to the surgeon that staplers are being fired and that the knife is cutting. Integrity of the anastomosis is checked.

4. Specimen retrieval 02'59''

The distal edge of the alimentary limb is cut. The resected tissue is placed in a retrieval bag. A 2/0 non-absorbable Dexon suture is placed on both sides of the anastomosis in order to reduce tension.

5. Methylene blue test 03'47''

A methylene blue test is performed to confirm that there is no leak.

6. Closure of mesenteric defect 04'05''

The mesenteric defect is closed with PDS 2/0.

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