title: Keyhole procedure: a new technique for intestinal anastomosis with a large opening and less tissue trauma, using both circular and linear staplers.
abstract: BACKGROUND
  We designed a new technique, termed the keyhole procedure, that uses a linear stapler to enlarge the anastomotic opening made with a circular stapler. The present study was performed to evaluate this technique in terms of maximum bursting pressure and area of anastomotic opening and compare it with conventional anastomosis using a circular stapler in an animal model.
  
  
  METHODS
  Anastomoses were created by the new technique or by the conventional method in swine small intestine. Anastomosis integrity was assessed by the air leakage test. Anastomotic openings were photographed and measured with an image analyzer.
  
  
  RESULTS
  It was found that the area of the anastomotic opening obtained with the new technique was more than 3 times that of the control (P <.001). There was no significant difference between the methods in maximum bursting pressure.
  
  
  CONCLUSIONS
  The keyhole procedure provides a larger anastomotic opening than conventional anastomosis with a circular stapler, without impairing the integrity of anastomosis.
authors.affiliation: First Department of Surgery, Nagoya City University Medical School, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Takeyama
authors.forename: Mikinori
authors.initials: M
authors.lastname: Sato
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Akamo
authors.forename: Moritsugu
authors.initials: M
authors.lastname: Tanaka
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Hayakawa
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Hasegawa
authors.forename: Hirozumi
authors.initials: H
authors.lastname: Sawai
authors.forename: Minoru
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Eiko
authors.initials: E
authors.lastname: Ohara
authors.forename: Tadao
authors.initials: T
authors.lastname: Manabe
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D000818:Animals; D004867:Equipment Design; D007421:Intestine, Small / Q000293:injuries / Q000601:surgery*; D011312:Pressure; D013528:Surgical Staplers; D013552:Swine