title: Anvil extension technology in thoracic surgery.
abstract: OBJECTIVE
  Endoscopic staplers are the dominant tools to divide tubular structures in thoracoscopic lobectomy. However, passing these devices can be challenging because of limitations in their design.
  
  
  METHODS
  Two independent concepts were combined into one design aiming to overcome the limitation of passing the straight anvil of an endoscopic stapler through a tunnel typically created by a curved dissection instrument within the complex cluster of tubular structures that comprise the pulmonary hilum.
  
  
  RESULTS
  A library of 45 unedited advanced thoracoscopic lung resection videos containing a balance of all major anatomic resections (36 lobectomy and 9 pneumonectomy) spanning 2004 to 2011 were reviewed, and 220 hilar structure division times were measured along with the adjunctive techniques like catheter leaders or silicone slings. Prolonged passage times occurred throughout the series despite improved experience; however, early experience with 51 passes using the new design showed significant time savings (median 61 s versus 115 s, p = 0.005).
  
  
  CONCLUSIONS
  Curved tip anvils for endoscopic linear cutting staplers appear useful to speed thoracoscopic lung resections.
authors.affiliation: Department of Thoracic Surgery, Roswell Park Cancer Institute and University at Buffalo, Buffalo, New York 14263, USA. todd.demmy@roswellpark.org
authors.forename: Todd L
authors.initials: TL
authors.lastname: Demmy
authors.forename: William R
authors.initials: WR
authors.lastname: Mayfield
mesh_terms: D004210:Dissection; D006801:Humans; D008168:Lung / Q000601:surgery*; D011013:Pneumonectomy / Q000295:instrumentation*; D013528:Surgical Staplers; D013906:Thoracoscopy / Q000295:instrumentation*; D014741:Video Recording