title: Early experience with computer-mediated flexible circular stapling technique for upper gastrointestinal anastomosis.
abstract: BACKGROUND
  Creating the proximal anastomosis in laparoscopic biliopancreatic diversion with duodenal switch (LBPD-DS) and Roux-en-Y gastric bypass (LRYGBP) is a critical step in ensuring the success of the procedures. The aim of this study was to assess the safety and efficiency of performing this anastomosis using a flexible, computerized, circular stapling device.
  
  
  METHODS
  We prospectively monitored the use of a newly FDA-approved stapling device (SurgASSIST, Power Medical Intervention) for the construction of the proximal anastomosis by a variety of approaches and reviewed the charts of 10 patients.
  
  
  RESULTS
  We successfully constructed 9 out of 10 proximal anastomoses: 2 gastro-jejunostomies and 7 duodeno-ileostomies, without any signs of leakage. In 2 patients, the stapling technique involved a transpyloric instrumental passage; both were complicated by the difficulty to pass either the flexible scope or the anvil through the narrow pyloric lumen. In 5 patients, the anvil was placed directly through a duodenotomy and no technical problems were encountered. The median time for performing the proximal anastomosis was 19 minutes (range 9-55). There were no postoperative complications in any patients.
  
  
  CONCLUSIONS
  Stapling using the SurgASSIST was feasible and safe for performing laparoscopic anastomoses in bariatric bypass procedures. A duodenotomy for direct placement of the anvil into the postpyloric region seems to be most feasible for duodenoileostomies, while transoral passage of the anvil can be recommended for gastro-jejunostomies. In its current form, we do not recommend transoral placement of the flexible shaft of the SurgASSIST device. Further clinical trials need to be performed for comparison with existing devices.
authors.affiliation: Mount Sinai School of Medicine, Department of Surgery, Division of Laparoscopic Surgery, New York, NY 10029, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Waage
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
authors.forename: John J
authors.initials: JJ
authors.lastname: Feng
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000295:instrumentation; D015904:Biliopancreatic Diversion; D015390:Gastric Bypass / Q000295:instrumentation; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D017792:Surgical Stapling / Q000295:instrumentation / Q000379:methods*