Nowadays, gastric sleeve is the most common bariatric surgery. While many studies have evaluated factors that may reduce postoperative bleeding and some complications, such as leakage, researchers are still not aware of any study that compares results between those provided by modern staplers used in this surgery, Like Covidien and Ethicon.
The purpose of searching for the best modern staplers in gastrectomy is to compare features during the procedure, such as the time needed to create the stomach bag, bleeding during the operation, and the time required to staple the stomach tissue. And also postoperative conditions, like any complications that require re-intervention as leakage or bleeding or require surgical intervention again. It also compares the weight loss in patients who underwent sleeve gastrectomy with Covidien and Ethicon devices.
Recently, many surgeons use cheaper devices most of the time, but the cost should not be the main determining factor if one device is more expensive than the other.
If a device has better clinical results, it should be the favored one regardless of the cost. If none of them proves its superiority, the surgeon can excuse using the cost to determine the device that will be used for the patient.
What are the staplers used in the sleeve gastrectomy procedure?
Different tissues have definitely different features. Different staplers and staples are available to be modified according to the type of surgery that will be performed and the different tissue types for each person.
Depending on the shape of the stapler, they can be linear, curved, or circular. Either disposable after a single-use or reusable again.
Staples are made of different materials, like titanium, which causes less immune reactions, stainless steel which resists rust, or absorbable artificial material. Cartridges are classified according to color depending on the properties of the main ingredient material.
Each stapler model has specific features to adapt to particular situations:
- Non-linear staplers.
- Linear cutting stapler.
- Curved cut stapler.
- Round stapler.
Each type of stapler has its own set of cartridges, because of different staples length. The most important factor in staples is the length of the closed staples because they should be able to involve the attached tissues when it is closed. Each length adapts to different tissues, such as the mesentery, which require smaller staples, and intestinal vessels or tissues, which require larger staples. Each size differs in color according to its brand.
Comparison between the best modern staplers in the gastric sleeve
Now, there are two modern stapler factories. A drawing from a study in 2018 shows that Covidien and Ethicon owned 69.3% of the global market.
These are the most recent stapler models used in endoscopic surgery, such as gastric or colon sleeve surgeries:
- Echelon Flex ™ GST system provides a better grip and less tissue slipping.
- The ECHELON FLEX ENDOPATH Stapler provides battery power and more stability, decreasing the possibility of tissue injury.
- ENDOPATH® EMS Endoscopic Multi-feed Stapler is designed for single use with closed staples measuring 5.3 x 3.7 mm.
- The Endo GIA™ reinforced reload with Tri-Staple™ technology enables you to work on many tissues, due to its ergonomic design, accurate articulation, and one-hand grip.
Comparison of Covidien Endo GIA staplers and Ethicon Echelon Flex staplers
Based on marketing studies, the following is a comparison of two of the most used modern stapler models on the global market for gastrectomy:
1- On one hand, COVIDIEN Endo GIA with Tri-Staple Technology showed:
- Higher staple line strength: Tri-Staple Technology gives superior staple line strength compared to other commercially available products.
- Improves leak force inside the stomach: Purple Endo GIA ™ AMT reloads with Tri-Staple were superior, with a 90% improvement in relation to other reloads.
- Flexibility: provides a 45-degree angle in each direction.
- Relatively higher absorbable power: Tri-Staple ™ AVM tan, AMT Purple, and AXT reloads in black have more than double the stability power compared to their Endo GIA ™ reloads.
2-On the other hand, ETHICON Echelon flex technology showed:
- Better tissue sliding: with 88% movement less in the last responder and less possible trauma to nearby tissues.
- Excellent maneuverability: provides narrower anvil, a thinner column, and greater flexibility.
- More flexibility: The advanced position header is designed to provide an additional 10 degrees of the total hinge, providing a range of 100 degrees or around 50 degrees in each direction.
- Reliable Staple co: Each reload is designed to handle thickness change.
Experts’ opinion about the best modern staplers used in sleeve gastrectomy
Additional aspects of modern staplers are reviewed based on the opinions of expert surgeons.
Advantages of Covidien staplers:
Covidien Tri-Staple ™ provides a wider range of thickness coverage. Endo GIA provides the articulations with a very narrow-angle with a new knife every time.
In addition, Endo GIA technology provides a wide range of loads within 10 drips and 10 straight loads, with a better stapling line, and the work is easier to be done.
Another notable feature is that the staples in COVIDIEN staplers are lighter in weight, more flexible, and easier to handle than those in other companies.
Disadvantages of Covidien staplers:
The most important disadvantage seen in Covidien staplers is the sealed steel they are made of, which deviates easily especially in thick tissues. In addition, they are sometimes hard to push into thick tissues.
Advantages of Ethicon Staplers:
On the other hand, ETHICON staplers seem to be better for thick tissues due to the load switch and tissue therapy before burning, the articulating tip provides more accuracy in compact structures.
In addition, Ethicon stapler has a precision machined anvil that provides a steady and consistent primary line every time.
It is also mentioned that it is easier to use because it is not necessary to be closed every time by hand.
Disadvantages of Ethicon staplers:
The main disadvantage of Ethicon staplers is that they are heavier and uncomfortable to handle.
There are multiple staplers available on the market for gastric sleeve surgery. Surgeons should be aware of the different characteristics of each stapler model, each stapler size, and the target tissue in order to choose the most suitable stapler in each case.
Personal opinions may also affect the choice of a suitable stapler.