This step is repeated along the length of the lateral vaginal wall down to the endopelvic fascia opening, on both sides of the vagina. We tend to preferably use a 45 mm vascular stapler. One of the jaws of the Endo GIA stapler is inserted in this tunnel and the staples are fired ( Figures 1, ,2, 2, ,3). With this maneuver, a tunnel-like space parallel longitudinally with the vaginal wall is created. The structures lateral to the vagina, are dissected away from the lateral vaginal wall with a long tonsil or a ‘long nose’ right angle forceps. The mounted gauze pad in the vaginal fornix is very helpful for this maneuver. After the severing of the superior and mid-bladder pedicles, blunt dissection of the posterior vaginal wall from the recto sigma is performed. The major steps of cystectomy in female patients have been described elsewhere. Also, if the paravaginal dissection is not performed correctly, the classical suture ligatures may tether the remnant vaginal walls making a functional reconstruction of the vagina very difficult if not impossible.Surgical technical point As it is well known, the para colpos is abundant in blood vessels, especially veins, that may cause severe bleeding if tempered with improperly during dissection at the time of the anterior exenteration. performed in the classical way of lateral vaginal suture ligature technique.

This maneuver is mandatory for prevention of the tethering of the vaginal circumference. ‘skeletonization’ of the vagina from the lateral vaginal vascular connective tissue structures. In addition to the severing of the bladder pedicles we used the stapling device for the lateral vaginal dissection (para colpos) i.e. In the last three years, we have successfully used the Endo GIA stapler in radical cystectomy and anterior exenteration in 7 female patients. RC in the female patient is technically challenging because of the close relationship of the bladder with the internal genitalia and especially the vagina. Even though it is relatively expensive, it represents an important step forward in the surgical armamentarium since it considerably reduces operative time and blood loss. While the ETS-Flex stapler was less expensive, it was associated with more technical failures requiring surgeon intervention to reduce potential patient morbidity, compared with the Endo-GIA.The use of the articulated Endo GIA stapler for the haemostatic transection of the bladder pedicles during radical cystectomy (RC) has been previously described. The Endo-GIA group averaged $319 more per case for staple cost. There was one postoperative leak associated with the ETS-Flex group and two postoperative bleeds with the Endo-GIA group, which were not a significant differences. The ETS-Flex group experienced significantly more misfires (28% vs 2%, P <.001), hemoclips applied (30+/-9 vs 21+/-7, P <.001), estimated blood loss (132+/-56 vs 100+/-32 ml, P <.001) and OR time (66+/-19 vs 58+/-13 mins, P <.02) compared with the Endo-GIA group respectively. Mean follow-up was 135 days (range 90- 180).

Parameters measured included quantity of cartridges, handles, hemoclips, estimated blood loss, misfires, OR time, postoperative leaks and bleeds, and cost. Mean preoperative BMI was 49+/-8 for 50 Endo-GIA patients, and 49+/-7 for 50 ETS-Flex patients. We report our experience with a prospective randomized comparison of 6-row linear staplers during laparoscopic Roux-en-Y gastric bypass (LRYGBP).įrom January to March 2003, 100 patients were randomly assigned to undergo LRYGBP with either an Endo-GIA Universal 6-row stapler (USSC) or the ETS-Flex 6-row stapler (Ethicon). The development of laparoscopic linear staplers has enabled minimally invasive approaches to bariatric surgery, but there have been no comparison studies of the two current 6-row devices.

100 endo gia stapler