Use of a Tissuetunneler guide for an automatic suture device in robot-assisted thoracic surgery

Abstract

The SureForm stapler curved tip is a useful approach for vessels. Unless adequate space is maintained below the vessels, damage to the back of vessels with the curved tip may occur. The recommended methods include passing silk threads or vessel loops under the vessels and applying traction or using a Penrose drain to guide the tip of the stapler during insertion. However, these methods often risk putting tension on the vessels or becoming caught in the surrounding tissues. Additionally, the Penrose drain is soft, causing difficultly in guiding the stapler effectively. Furthermore, after removing the Penrose drain, there is a risk of accidental vascular injury by the tip of the stapler. To improve safety and efficiency, we devised a new method using a Tissuetunneler, which guides the stapler properly, prevents entanglement, and allows vessel transection without removal, reducing surgical time.

Keywords: Robot-assisted thoracic surgery; SureForm stapler curved tip; Tissuetunneler.

Fig. 1

This guide is made of a soft silicone tube with an inner diameter of 6 mm, a thickness of 4 mm, and a length of 8 cm, featuring a smooth surface

Fig. 2

Five ports RATS for right upper lobectomy. A, B The tip of the Tissuetunneler is grasped using a curved bipolar forceps to perform dissection, followed by tunneling. C, D The distal end of the anvil of the SureForm stapler curved tip is attached to the caudal end of the Tissuetunneler to guide and complete stapling. RUL, right upper lobe; TS, Truncus superior pulmonary artery