Are Laparoscopic Staplers Effective for Ligation of Large Intraabdominal Arteries?

AbstractObjectives. To evaluate ligation of aortoiliac arteries with laparoscopic staplers in order to develop specifically designed staplers.Methods. Cadaveric study. Seven human cadaver aortas were stapled using EndoGIA60® staplers. Efficiency was evaluated macroscopically and on a hydrodynamic bench.Clinical study. Twelve patients had ligation of 14 large abdominal arteries (aorta: nine, iliac artery: four, hepatic artery: one) using a laparoscopic stapler. Stapling efficiency was judged on peroperative clinical and postoperative CT scan criteria.Results. Cadaveric study. Stapling was performed perfectly on four moderately calcified aortas, without leakage with a pulsatile pressure of >250 mmHg. For three aortas with severe calcification, stapling was not efficient and major leakage occurred.Clinical study. Stapling appeared clinically efficient on all arteries but one aorta: this severely calcified aorta was ligated conventionally. The staplers are not easy to use due to their shape and their lack of articulation. After a mean follow-up of 31.3 months, all the other stapled arteries were effectively ligated.Conclusion. The commercially available staplers can be used securely on moderately calcified arteries but stapling of severely calcified arteries should be avoided. These devices should be redesigned to facilitate their use in vascular surgery