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Application of Double Stapling Technique in TME surgeries

 Application of Double Stapling Technique in TME surgeries

Total mesorectal excision (TME) strictly applies when performing a low anterior resection for tumors of the middle and the lower rectum, wherein it is essential to remove the rectum along with the mesorectum up to the level of the levators. The principles of total mesorectal excision (sharp mesorectal excision) are also applied during an abdominoperineal excision of the rectum and for tumors of the upper rectum, although these are considered distinct from standard total mesorectal excision. In an abdominoperineal excision of the rectum where the tumor exists below the level of the levators, the lateral margins of the tumor are inferior to the mesorectum and the benefits of total mesorectal excision do not apply. Anterior resections involving the upper rectum may be completed with mobilization of the rectum to beyond 5 cm of the lower margin of the tumor, and which is often above the level of the levator and is sometimes referred to as partial mesorectal excision.

The application of Double Stapling Technique by using staplers in TME surgery offers a more reliable, faster and safer way than traditional anastomosis. In case that patients’ pelvis is narrow or stump rectum is so short that it retracts to the depth of pelvis, the operation to sew purse is very difficult, sometimes impossible, even with purse-string forceps. Doctor Knight and doctor Griffen firstly introduced Double Stapling Technique in 1980. Linear stapler, one of them, was developed to overcome the above shortcoming.

(Golden Stapler has developed 45mm linear stapler to especially accommodate this situation. Rectum diameter≈30mm, Rectum circumference: 2 x 3.14 x 3/2≈90mm, therefore, the stapler suturing linear length: 9/2=45mm). It changed manually sewing purse into onetime suture with instruments in stump rectum operation, which makes the operation simple, convenient and more reliable, and lower to reach anus. Consequently, the introduction of 45mm Linear stapler complies with the natural anatomy of pelvic cavity and is easy to insert in lower site, which makes low anastomosis more feasible. By using together with Golden Stapler circular staplers, double stapling technique can be achieved. Staples of 45mm Linear stapler can be easily cut into 2 segments by circular knife corresponded in audible sound with no stuck at the anastomosis (refer to homepage picture of circular stapler).