Page 34 - WJOLS

Takao Ichihara et al

GUT-CLAMPER AND SURGICAL PROCEDURE

Gut-clamper is a 5 mm width, plastic belt of 20 cm long that
includes two hard sticks made of stainless steel with a diameter
of 3 mm and 40 mm and 45 mm having flexible belts on one ends,
a joint at which sticks are joined. At least one through hole
made in one of the belts, and clips the rectum by using the two
sticks by using the joint as a pivot (Fig. 1). By clipping the
rectum by side surfaces of the sticks, it can be clipped while the
width of the rectum is pressed and widened, so that the rectum
is prevented from being excessively clamped and torn. The
difference of length of the two steel sticks makes the good
effect. As the two steel sticks are arranged tandem, their gaps is
set in the middle of the plastic belt. A distance between these
two sticks is 5 mm and the two steel sticks are hooked using the
hole (3 mm in diameter) by bending with V-shape at this point
(Fig. 2). If it failed to determine the point of clamping, one can
untie the gut-clamper by pulling the belt of the hole. Distal
rectal washout was carried out with 3 liters of water before
dissection of the rectum with or without using gut-clamper. All
other surgical procedures were performed after the manner of
standard laparoscopic low anterior resection of the rectum.
Fig. 2: Schema of clamping using gut-clamper: As the two steel sticks
RESULTS are arranged tandem, their gaps is set in the middle of the plastic belt.
A distance between these two sticks is 5 mm and the two steel sticks
Thirty patients (13 men and 17 women) with rectal cancer are hooked using the hole (3 mm in diameter) by bending with V-
underwent laparoscopic low anterior resection with colorectal shape at this point
washout using gut-clamper (Fig. 3). Ten cases (5 men and 5
women) underwent colorectal washout without using gut-
clamper (Table 1).
Although there were no complications in the thirty cases
with distal rectal washout using gut-clamper, there was one
complication of leakage in the ten cases of distal rectal washout
without using gut-clamper. Among these, four cases were
impossible to complete the distal rectal washout because it was
difficult to hold the forceps and tube for washout.
The number of times using laparoscopic staplers (linear
cutter) was 1.9 ± 1.0 in the cases using gut-clamper, while that
was 3.4 ± 1.1 in the cases underwent colorectal washout without
using gut-clamper. No cases showed relapses of gut-clamper
and there was no postoperative death in all cases.

Fig. 3: Intraoperative view after distal rectal washout using gut-clamper:
Fig. 1: Structure of gut-clamper: Gut-clamper is a 5 mm width, plastic Confirming the location of the tumor, the gut-clamper was closed after
belt of 20 cm long that includes two hard sticks made of stainless steel distal rectal washout. Endoscopic view of rectum before closing (A),
with a diameter of 3 mm and 40 mm and 45 mm having flexible belts on during closing (B), after closing (C) and laparoscopic view of distal
one ends, a joint at which sticks are joined rectal washout using gut-clamper (D)

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