The proper reload selection during laparoscopic sleeve gastrectomy

Although the basic tenets of the bariatric surgery are similar between surgeons, a number of technical variations exists. The technology behind stapling devices has advanced considerably since their advent. The purpose of this communication is to reinforce the importance of following proper reload selection during laparoscopic sleeve gastrectomy, that involve the sealing and cutting of thicker tissue. Tissue thickness should be carefully evaluated before firing any stapler. Changes in tissue thickness of stomach at the fourth staple fires suggest stepwise alteration in staple cartridge color selection [1].

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Linear cutters stapling devices are intended for transection, resection, and/or creation of anastomoses [2]. The instruments have application in multiple open or minimally invasive surgical procedures [3]. They provide remarkable speed and convenience in surgery in comparison to hand suturing. When choosing the appropriate stapling device, the issues of tissue thickness, staple line security and tissue tension should be taken into consideration [4]. As more advanced procedures shift to a laparoscopic approach, endocutter platforms are being more and more used in thick tissue applications. In minimally invasive procedures, smaller trocar diameters are preferred. A 12 mm trocar will limit the space available within the endocutter to house the unformed staple legs, along with the anvil and staple forming mechanisms [5]. As a result, the ability to deliver a closed staple height greater than 2.0 mm ta accommodate extra thick tissue has been limited due to the constraints of the 12 mm diameter of the endocutter delivery device.

Ethicon Endo-Surgery (EES) has developed an improved laparoscopic stapler cartridge that can deliver a closed staple height of 2.3 mm with a heavier gauge wire, but still be compatible with a 12 mm trocar. This new cartridge is the ECR60T black cartridge [5]. There are six staggered rows of staples, three on either side of the cut line of the ECHELON 60 mm Endoscopic Linear Cutter Reloads Black. The ECHELON 60 instruments have a staple line that is approximately 60 mm long and a cut line that is approximately 57 mm long. The shaft can rotate freely in both directions and an articulation mechanism on articulating instruments enables bending the distal portion of the shaft to facilitate lateral access of the operative site. Because any given stapler reload performance may be stressed at tissue thicknesses that cannot comfortably compress to a reload's closed staple height, moving towards larger staple reloads may improve performance in these thicker tissues. Echelon Black reload was specifically designed to meet the clinical needs for a thicker tissue application. EES overcame the challenge of incorporating a longer staple leg by slightly extending the ends of the pocket in which the staple is loaded. Staples normally reside in a pocket with their tips flush with or slightly below the cartridge surface. In the new cartridge, the staple leg extends above the main deck of the cartridge, but a rounded pocket extension has been added to extend the cartridge stabilization and protection of the staple leg tip. The pocket extensions prevent the staple tips from contacting tissue du ring stapler advancement and placement. The pocket extensions also prevent tissue from inadvertently bending the staple tins. A series of studies was conducted to determine whether the new extended pocket design produced any noticeably different tissue effect in comparison to the conventional flat-cartridge deck design. No substantial differences were observed between the test device with pocket extensions and the control device. Rawlins demonstrates that in male patients and with higher BMI have gastric tissue whose thicknesses in the antrum may be greater than surgeon experience would anticipate. Rawlins concludes that “Surgeons should consider using a thicker staple load, such as black, when these factors are present. Also, significant changes in tissue thickness at the fourth and fifth staple fires suggest stepwise alteration in staple cartridge color selection.” [6].

Ethical approval

None required.

Financial support

None.

Author contribution

Radwan Kassir, Olivier Tiffet, Alexia Boueil-Bourlier and Pierre Blanc, Jean-Luc Berger, Karine Abboud, Joelle Dubois, Imed Ben Amor and Tarek Debs: reviewed the paper.

Conflict of interest

None.

Guarantor

Dr Christophe Breton.

In the field of surgery, precision and efficiency are of utmost importance. Surgeons rely on advanced tools and equipment to perform complex procedures with accuracy and speed. One such revolutionary tool that has transformed the surgical landscape is the Disposable Linear Cutter Stapler. With its innovative design and functionality, this surgical instrument has become a staple in modern operating rooms.

The Disposable Linear Cutter Stapler is a cutting-edge surgical device used for tissue transection and staple line formation in various surgical procedures. It combines the functions of cutting and stapling into a single instrument, streamlining the surgical process and minimizing the risk of complications. This versatile tool offers surgeons the ability to perform precise and efficient tissue dissection, reducing operative time and enhancing patient outcomes.

Disposable Linear Cutter Stapler (Single)  Code Color Length(mm) Staple Height(mm) Closure Height (mm) LMDQ-60 Blue 61 60 3.8 1.5 Green 61 60 4.5 2.0 LMDQ-80 Blue 81 80 3.8 1.5 Green 81 80 4.5 2 LMDQ-100 Blue 101 100 3.8 1.5 Green 101 100 4.5 2 LMDQZ- 60/3.8 Blue 3.8 1.5 LMDQZ- 60/4.5 Green 4.5 2.0 LMDQZ- 80/3.8 Blue 3.8 1.5 LMDQZ- 80/4.5 Green 4.5 2.0 LMDQZ- 100/3.8 Blue 3.8 1.5 LMDQZ- 100/4.5 Green 4.5 2.0 Note: The material for the stapler is imported titanium.

Key Features of Disposable Linear Cutter Stapler:

---Knife inside the cartridge, Better incision effect and avoid cancer cell transfer.

---Space locking device, Make sure the staples to be formed consistently and good hemostasis result.

---Safety of empty cartridge, Prevent mis-operation of empty cartridge before firing.

---Two ways Push-knob, Convenient for operation by left or right hand.

---Special rear lock, Realizes one-handed operation, convenient for operation

---Quick release knob, Unlock the instrument quickly.

---Larger front fork hatch, convenient for operation

Benefits of the Disposable Linear Cutter Stapler

The Disposable Linear Cutter Stapler offers several notable benefits that make it an indispensable tool in the hands of skilled surgeons. 

1. Enhanced Precision and Accuracy

The Disposable Linear Cutter Stapler provides surgeons with exceptional precision and accuracy during tissue transection and staple line formation. Its ergonomic design and intuitive controls allow for smooth maneuverability, ensuring clean and consistent incisions. The precise alignment of staples minimizes the chances of tissue dehiscence, reducing the risk of postoperative complications.

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2. Time Efficiency

By combining cutting and stapling functions, the Disposable Linear Cutter Stapler significantly reduces the time required for surgical interventions. This time-saving advantage allows surgeons to perform procedures more efficiently, leading to shorter operation durations. As a result, patients experience reduced anesthesia exposure and a faster recovery period.

3. Minimized Bleeding and Tissue Trauma

The design of the Disposable Linear Cutter Stapler incorporates specialized mechanisms that minimize bleeding and tissue trauma. The device applies even pressure along the staple line, effectively sealing blood vessels and reducing the risk of excessive bleeding. Additionally, the stapler's sharp cutting edge ensures clean and precise tissue division, minimizing trauma to surrounding structures.

4. Versatility Across Surgical Specialties

The Disposable Linear Cutter Stapler is widely used across various surgical specialties, including gastrointestinal, thoracic, and gynecologic surgeries. Its versatility stems from the availability of different sizes and configurations tailored to specific surgical requirements. Surgeons can choose the appropriate stapler model based on factors such as tissue thickness, accessibility, and procedural goals.

Applications of the Disposable Linear Cutter Stapler

1. Gastrointestinal Surgeries

In gastrointestinal surgeries, such as bowel resections and anastomoses, the Disposable Linear Cutter Stapler plays a pivotal role. It enables surgeons to efficiently transect the bowel and create a secure staple line, ensuring optimal healing and preventing leaks. The device's ability to handle thick tissues and provide reliable hemostasis makes it an indispensable tool in these procedures.

2. Thoracic Surgeries

Thoracic surgeries, including lung resections and lobectomies, benefit greatly from the Disposable Linear Cutter Stapler. Its precise cutting and stapling capabilities facilitate the removal of diseased lung tissue while ensuring a watertight seal of the remaining lung tissue. This helps in preventing air leaks and reducing the risk of complications, promoting successful surgical outcomes.

3. Gynecologic Surgeries

Gynecologic procedures, such as hysterectomies and oophorectomies, involve intricate tissue dissection and hemostasis. The Disposable Linear Cutter Stapler offers gynecologic surgeons a valuable tool for efficient tissue transection and staple line formation. Its versatility and ease of use contribute to a streamlined surgical process, allowing for quicker surgeries and improved patient care.

Indication: Transection, resection, and the creation of anastomoses for digestive tissue and organ

Packaging & Delivery

Selling Units: Single item

Single package size: 310*118*47mm

Single gross weight: 0.38 kgs

Package Type: 1pc/box, 10pcs/carton

Lead Time :

Quantity(Pieces) 1 - 500 >500 Est. Time(days) 20 To be negotiated

Frequently Asked Questions (FAQs)

FAQ 1: What are the key components of a Disposable Linear Cutter Stapler?

The Disposable Linear Cutter Stapler typically consists of three main components: the handle, the shaft, and the cartridge. The handle provides ergonomic control and houses the firing mechanism. The shaft connects the handle to the cartridge and allows for precise manipulation. The cartridge contains the staples and cutting blade, enabling tissue transection and staple line formation.

FAQ 2: Are Disposable Linear Cutter Staplers safe to use?

Yes, Disposable Linear Cutter Staplers are designed with safety in mind. They undergo rigorous testing and meet stringent quality standards to ensure patient safety. The devices incorporate safety features, such as lockout mechanisms and audible feedback, to prevent accidental firing and provide reassurance to surgeons.

FAQ 3: Can the Disposable Linear Cutter Stapler be used in minimally invasive surgeries?

Yes, the Disposable Linear Cutter Stapler is compatible with minimally invasive surgical approaches. The stapler's slim profile and maneuverability make it suitable for use through small incisions or ports. Surgeons can perform laparoscopic or robotic-assisted procedures using the stapler, benefiting from its precise cutting and stapling capabilities.

FAQ 4: How do surgeons choose the appropriate size of Disposable Linear Cutter Stapler?

Surgeons select the size of the Disposable Linear Cutter Stapler based on factors such as the thickness of the tissue being stapled and the surgical procedure being performed. The stapler size is determined by the closed staple height, which corresponds to the tissue thickness it can accommodate. Surgeons consult surgical guidelines and their experience to make informed decisions regarding stapler size selection.

FAQ 5: What are the postoperative considerations when using a Disposable Linear Cutter Stapler?

After using a Disposable Linear Cutter Stapler, it is essential to monitor patients for any signs of complications, such as bleeding or leakage. Adequate postoperative care, including regular wound assessment and follow-up appointments, is crucial to ensure proper healing and prevent any adverse outcomes. Surgeons provide patients with detailed postoperative instructions tailored to their specific surgical procedure.

FAQ 6: Are Disposable Linear Cutter Staplers cost-effective?

Disposable Linear Cutter Staplers offer a cost-effective solution in many surgical scenarios. While the initial investment may be higher compared to traditional staplers, the potential for reduced operative time, decreased postoperative complications, and improved patient outcomes can lead to long-term cost savings. Surgeons and healthcare facilities often consider these factors when evaluating the cost-effectiveness of surgical tools.

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