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Guo H, Zheng T, Lin Y, Tang T, Zhang Z, Wang D, Zhao X, Liu Y, Tan B, Yang P, Tian Y, Li Y, Zhao Q. Real-world effectiveness of a new powered stapling system with gripping surface technology on the intraoperative clinical and economic outcomes of gastrectomy for gastric cancer. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:38. [PMID: 38711056 DOI: 10.1186/s12962-024-00534-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/21/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Surgical staplers have been widely used to facilitate surgeries, and this study aimed to examine the real-world effectiveness of a new powered stapling system with Gripping Surface Technology (GST) on intraoperative outcomes of gastrectomy for gastric cancer. METHOD The data were extracted from the Fourth Hospital of Hebei Medical University's (FHHMU) medical records system. Participants (N = 121 patients) were classified into the GST (n = 59) or non-GST group (n = 62), based on the use of the GST system. The intraoperative outcomes such as bleeding were assessed by reviewing video records. T-tests, Chi-square tests, and Mann-Whitney-U tests were used to compare the baseline characteristics between groups. Multivariate logistic regression was conducted for adjusting outcomes to study the effect of variables. RESULTS Compared with the non-GST group, the GST group had significantly lower risks for intraoperative bleeding, intraoperative anastomosis intervention rate, intraoperative suture, and intraoperative pression (aORs: 0.0853 (p < 0.0001), 0.076 (p = 0.0003), 0.167 (p = 0.0012), and 0.221 (p = 0.0107), respectively). The GST group also consumed one fewer cartridge than the non-GST group (GST:5 vs non-GST: 6, p = 0.0241). CONCLUSION The use of the GST system was associated with better intraoperative outcomes and lower cartridge consumption in Chinese real-world settings.
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Affiliation(s)
- Honghai Guo
- Third Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Tao Zheng
- Third Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Yecheng Lin
- Third Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Tiange Tang
- Department of Global Health, School of Public Health, New York University, New York, USA
| | - Zhidong Zhang
- Third Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Dong Wang
- Third Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Xuefeng Zhao
- Third Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Yu Liu
- Third Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Bibo Tan
- Third Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Peigang Yang
- Third Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Yuan Tian
- Third Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Yong Li
- Third Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Qun Zhao
- Third Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China.
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Gutierrez M, Jamous N, Petraiuolo W, Roy S. Global Surgeon Opinion on the Impact of Surgical Access When Using Endocutters Across Specialties. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2023; 10:62-71. [PMID: 37744691 PMCID: PMC10515882 DOI: 10.36469/001c.87644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023]
Abstract
Background: Despite design enhancements in endocutters, key challenges related to limited surgical access and space can impact stapling and, potentially, surgical outcomes. Objectives: This study aimed to develop consensus statements outlining the clinical value of precise articulation and greater anatomical access in minimally invasive surgery performed by bariatric, colorectal, and thoracic surgeons. Methods: Colorectal, bariatric, and thoracic surgeons from Japan, the United States, United Kingdom, and France participated in a 2-round modified Delphi panel. Round 1 included binary, Likert scale-type, multiple-response, and open-ended questions. These were converted to affirmative statements for round 2 if sufficient agreement was reached. Consensus was set at a predefined threshold of at least 90% of panelists across all surgical specialties and regions selecting the same option ("agree" or "disagree") for the affirmative statements. Results: Of the 49 statements in the round 2 questionnaire, panelists (n=135) reached consensus that (1) tissue slippage outside stapler jaws can occur due to limited access and space; (2) greater jaw aperture could help to manipulate thick or fragile tissue more easily; (3) articulation of an endocutter is clinically important in laparoscopic surgeries; (4) improved access to hard-to-reach targets and in limited space would improve safety; and (5) an endocutter with improved access through greater articulation would become common use. Discussion: By understanding user-specific challenges and needs from both specialty- and region-wide perspectives, endoscopic stapling devices can continue to be refined. In this study, improved articulation and greater jaw aperture were the key design features examined. Improved articulation and greater jaw aperture were key stapler design features identified in this study that may mitigate the risk of instrument clashes and intraoperative complications such as anastomotic leaks. Conclusions: This study gained insights into surgeons' perspective across a variety of specialties and from 3 distinct geographies. Participating surgeons reached consensus that an endocutter with greater jaw aperture and articulation may improve surgical access and has potential to improve surgical outcomes.
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Affiliation(s)
| | - Nadine Jamous
- Johnson & Johnson MedTech, New Brunswick, New Jersey, USA
| | | | - Sanjoy Roy
- Johnson & Johnson MedTech, New Brunswick, New Jersey, USA
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Gan C, Zeng F, Cong W, Tang T, Feng G. Powered stapling system with gripping surface technology for pulmonary resection of lung cancer: real-world clinical effectiveness. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:72. [PMID: 36564821 PMCID: PMC9789598 DOI: 10.1186/s12962-022-00398-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Surgical lung resection involves a critical task of stapled ligation and transection of major vascular structures and tissue, which may lead to bleeding and complications. A newer powered stapling system with Gripping Surface Technology (GST) was introduced to account for tissue movements. This study aimed to examine the real-world effectiveness of GST system on intraoperative and postoperative outcomes of pulmonary resection. METHODS A retrospective analysis was conducted using the electronic medical records of Sichuan Provincial People's Hospital between July 2020 and March 2021 in China. Patients who underwent their first procedures of single-port lobectomy or multi-port segmentectomy by video-assisted thoracoscopic surgery were identified and grouped as GST group or manual stapler group (manual group) by the stapler types. The intraoperative outcomes such as bleeding rate, blood loss volume, and intervention rate at the staple line (including intraoperative pressure, suture, and electrocoagulation) were documented by trained nurses during the surgery. Propensity score matching was performed between the two groups, controlling forage, BMI, smoking history, history of surgery, complications, and level of complexity of pneumonectomy. RESULTS A total of 108 matched patients were included in the analysis (54 in the GST group and 54 in the manual group). GST group had lower risks for intraoperative bleeding (22.8% vs 51.9%; p = 0.003) and intraoperative interventions (31.5% vs 55.6%; p = 0.02), compared to the manual group. A decrease in the intraoperative blood loss was observed in the GST group, but not statistically significant (134.39 ± 52.82 ml vs 158.11 ± 73.14 ml, p = 0.102). The use of NEOVEIL (reinforcement material to prevent air leakage from the staple line) intraoperatively during surgery was significantly lower in the GST group (24.1%) than in the manual group (50%, p = 0.01). CONCLUSION The GST system was associated with better intraoperative outcomes in clinical practice in China.
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Affiliation(s)
- Chongzhi Gan
- grid.410646.10000 0004 1808 0950Department of Thoracic Surgery, Sichuan Provincial People’s Hospital, Chengdu, 610072 Sichuan People’s Republic of China
| | - Fuchun Zeng
- grid.410646.10000 0004 1808 0950Department of Thoracic Surgery, Sichuan Provincial People’s Hospital, Chengdu, 610072 Sichuan People’s Republic of China
| | - Wei Cong
- grid.410646.10000 0004 1808 0950Department of Thoracic Surgery, Sichuan Provincial People’s Hospital, Chengdu, 610072 Sichuan People’s Republic of China
| | - Tiange Tang
- grid.265219.b0000 0001 2217 8588Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, New Orleans, LA USA
| | - Gang Feng
- grid.410646.10000 0004 1808 0950Department of Thoracic Surgery, Sichuan Provincial People’s Hospital, Chengdu, 610072 Sichuan People’s Republic of China
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Fortin SP, Petraiuolo W, Cafri G, Scapini G, Agarwal P, Chakke D, Johnston S, Johnson BH, Coplan PM, Zhang S. Comparison of Clinical Outcomes of Gripping Surface Technology Staple Reloads versus Standard Staple Reloads Used with Manual Linear Surgical Staplers. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2022; 15:385-399. [PMID: 36545363 PMCID: PMC9762253 DOI: 10.2147/mder.s393881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023] Open
Abstract
PURPOSE Linear surgical staplers reduce rates of surgical adverse events (bleeding, leaks, infections) compared to manual sutures thereby reducing patient risks, surgeon workflow disruption, and healthcare costs. However, further improvements are needed. Ethicon Gripping Surface Technology (GST) reloads, tested and approved by regulatory authorities in combination with powered staplers, may reduce surgical risks through improved tissue grip. While manual staplers are used in some regions due to affordability, clinical data on GST reloads used with manual staplers are unavailable. This study compared surgical adverse event rates of manual staplers with GST vs standard reloads. These data may be used for label changes in China and Latin America. PATIENTS AND METHODS Patients undergoing general or thoracic surgery between October 1, 2015 and August 31, 2021 using ECHELON FLEX™ manual staplers with GST or standard reloads were identified from the Premier Healthcare Database. GST reloads were compared to standard reloads for non-inferiority in bleeding and anastomotic leak for general surgery. Secondary outcomes included sepsis for general surgery, and bleeding and prolonged air leak for thoracic surgery. Covariate balancing was performed using stable balancing weights. RESULTS The general and thoracic surgery cohorts contained 4571 (GST: 2780; standard: 1791) and 814 (GST: 514; standard: 300) patients, respectively. GST reloads were non-inferior to standard reloads for bleeding and anastomotic leak (adjusted cumulative incidence ratio: 1.02 [90% CI: 0.71, 1.45] and 1.03 [90% CI: 0.72, 1.46], respectively) for general surgery. Compared with standard reloads, GST reloads had a similar incidence of sepsis (2.2% vs 2.1%) for general surgery and lower incidences of bleeding (9.5% vs 16.0%) and prolonged air leak (12.6% vs 14.0%,) for thoracic surgery. CONCLUSION GST reloads, compared to standard reloads, used with ECHELON FLEX™ manual staplers had comparable perioperative bleeding and anastomotic leak for general surgery, and lower incidences of safety events for thoracic surgery.
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Affiliation(s)
- Stephen P Fortin
- MedTech Epidemiology and Real-World Data Science, Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, NJ, USA
| | | | - Guy Cafri
- MedTech Epidemiology and Real-World Data Science, Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, NJ, USA
| | - Gustavo Scapini
- Regional Medical Affairs, Johnson & Johnson, São Paulo, Brazil
| | | | | | - Stephen Johnston
- MedTech Epidemiology and Real-World Data Science, Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, NJ, USA
| | - Barbara H Johnson
- MedTech Epidemiology and Real-World Data Science, Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, NJ, USA
| | - Paul M Coplan
- MedTech Epidemiology and Real-World Data Science, Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, NJ, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Shumin Zhang
- MedTech Epidemiology and Real-World Data Science, Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, NJ, USA
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Multisite study of Titan SGS stapler in longitudinal gastric resection. Surg Endosc 2022; 36:6285-6292. [PMID: 35080675 PMCID: PMC8791084 DOI: 10.1007/s00464-022-09051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 01/11/2022] [Indexed: 11/16/2022]
Abstract
Background Standardization of the laparoscopic sleeve gastrectomy procedure is needed to improve patient outcomes. A single-fire 23 cm stapler was developed to streamline the operation. Comparative testing conducted on excised human tissue has demonstrated the superiority of the novel Titan SGS stapler to two commonly utilized commercial devices in both staple line integrity and burst pressure. We hypothesized that the stapler would be safe and effective in creating longitudinal gastric resections in human patients. Methods 61 patients were enrolled to undergo gastric resection with the Titan SGS stapler. Perioperative interventions and post-operative adverse events were recorded. Upper GI study was completed on post-operative day 1, and patients were followed for 6 weeks post-operatively to determine any subacute device-related adverse events. Results Surgeon feedback for intraoperative device utilization and post-operative gastric pouch shape were positive. Adverse events were found to be mild, limited, and generally well-known effects of bariatric surgery. One episode of post-operative hemorrhage required surgical takeback, with no criminal bleeding vessel identified. Conclusion The Titan SGS stapler is both safe and effective in sleeve gastrectomy pouch creation.
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Clapp B, Schrodt A, Ahmad M, Wicker E, Sharma N, Vivar A, Davis B. Stapler Malfunctions in Bariatric Surgery: An Analysis of the MAUDE Database. JSLS 2022; 26:JSLS.2021.00074. [PMID: 35281706 PMCID: PMC8896815 DOI: 10.4293/jsls.2021.00074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Staple line leaks are a serious problem in bariatric surgery and a major cause of serious morbidity and mortality. Adverse events caused by medical devices are reported to the Food and Drug Administration which maintains the Manufacturer and User Facility Device Experience (MAUDE) database. We examined adverse stapler events reported to the MAUDE database, specifically with regards to bariatric surgery. Methods The MAUDE database was queried for adverse events caused by staplers between January 1, 2018 - December 31, 2020; events reported by Intuitive, Ethicon, and Medtronic/Covidien; and limited our search to "gastric bypass", "sleeve gastrectomy", "stapler malfunction" combined with each company. Results There were 883 adverse events reported for Medtronic, 353 for Ethicon, and 35 for Intuitive. Approximately 3.5 million staple reloads sold in the study period. The reported misfire rate for Medtronic was 0.04% and for Ethicon was 0.02%. Data for Intuitive was unavailable. The most common reported event for Medtronic was failure to fire (n = 349), followed by misfire (n = 186). For Ethicon, the most common event was failure to fire (n = 146), followed by mechanical problems (n = 27). The most common event with the Intuitive stapler was leak (n = 10) and bleeding from staple line (n = 8). Conclusions Stapler malfunction is a very rare event in metabolic and bariatric surgery. All of the major stapler producers have transitioned to powered staplers with excellent safety profiles. Open and honest reporting about stapler malfunction is essential to determine the true safety of these ubiquitous devices.
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Affiliation(s)
- Benjamin Clapp
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Alexander Schrodt
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Maria Ahmad
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Ellen Wicker
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Nishtha Sharma
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Andres Vivar
- Universidad Autonoma Guadalajara, Guadalajara, Mexico
| | - Brian Davis
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
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Yeo E, Thompson J, Hanseman D, Dunki-Jacobs A, Thompson B, Goodman M, Diwan T. Increased staple loading pressures and reduced staple heights in laparoscopic sleeve gastrectomy reduce intraoperative bleeding. Surgery 2020; 169:1110-1115. [PMID: 33261823 DOI: 10.1016/j.surg.2020.10.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/22/2020] [Accepted: 10/31/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND In laparoscopic sleeve gastrectomy, tissue thickness and closed staple height of the staple cartridge determine the pressure applied to the tissue. Prior studies have suggested 8 g/mm2 to be ideal to minimize leaks or bleeding. METHODS We evaluated the relationship between staple loading pressure applied to gastric tissue and bleeding rate prospectively with a novel tissue measuring device and video-recorded operative findings for 116 patients undergoing laparoscopic sleeve gastrectomy performed by 2 surgeons at a single institution. Stapling protocol 1 was used for 64 cases, defined as standard practice, typically using green-blue-blue-blue Ethicon staple cartridges. Stapling protocol 2 was defined as blue-blue-white-white or gold-blue-white-white. RESULTS Tissue thickness measurements from 39 cases and staple load selection showed that surgeons preferred a median staple loading pressure of 15 g/mm2. Tissue thickness measurements at 15 g/mm2 had a mean of 1.86 mm at the antrum, 1.71 mm at the body, and 1.15 mm at the fundus, all significantly thinner than tissue thickness at 8 g/mm2. For each 10 g/mm2 increase in minimum pressure and maximum pressure value within each cartridge zone, there was a reduction in bleeding rate by 59.8% and 38.7%, respectively. Compared with stapling protocol 1, stapling protocol 2 had a lower intraoperative bleeding rate (90.2% vs 70.7%; P < .0001), usage of preventive hemostatic techniques (100% vs 10%; P < .0001), and hemostatic treatments (66% vs 46%; P = .04). In the 30-day postoperative period, there was 1 bleed in stapling protocol 1; there were no leaks. CONCLUSION Our data suggest using shorter closed staple heights to exert higher staple loading pressures decreases intraoperative bleeding rates in laparoscopic sleeve gastrectomy.
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Affiliation(s)
- Eujin Yeo
- Department of Surgery, University of Cincinnati School of Medicine, OH
| | - Jonathan Thompson
- Department of Surgery, University of Cincinnati School of Medicine, OH; Standard Bariatrics, Inc, Cincinnati, OH
| | - Dennis Hanseman
- Department of Surgery, University of Cincinnati School of Medicine, OH
| | | | | | - Michael Goodman
- Department of Surgery, University of Cincinnati School of Medicine, OH
| | - Tayyab Diwan
- Department of Surgery, University of Cincinnati School of Medicine, OH; Mayo Clinic Rochester, MN.
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Evaluation of a Powered Vascular Stapler in Video-Assisted Thoracic Surgery Lobectomy. J Surg Res 2020; 253:26-33. [DOI: 10.1016/j.jss.2020.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/24/2020] [Accepted: 03/09/2020] [Indexed: 11/22/2022]
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Rawlins L, Johnson BH, Johnston SS, Elangovanraaj N, Bhandari M, Cohen RV, Rheinwalt KP, Fryrear R, Roy S. Comparative Effectiveness Assessment of Two Powered Surgical Stapling Platforms in Laparoscopic Sleeve Gastrectomy: A Retrospective Matched Study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:195-204. [PMID: 32765125 PMCID: PMC7368239 DOI: 10.2147/mder.s256237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/04/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To compare outcomes between the two latest innovations in powered stapling technology, the ECHELON FLEX™ GST system (GST) and the Signia™ Stapling System (SIG), among patients undergoing sleeve gastrectomy for obesity. Patients and Methods Using the Premier Healthcare Database of US hospital discharge records, we selected patients undergoing inpatient sleeve gastrectomy with dates of surgical admission between March 1, 2017 (SIG launch), and December 31, 2018. Outcomes measured during the surgical admission included in-hospital hemostasis-related complications (bleeding/transfusion; primary outcome), leak, total hospital costs, length of stay (LOS), and operating room time; 30-, 60-, and 90-day all-cause inpatient readmissions were also examined. We used 1:1 cardinality matching to balance the GST and SIG groups on numerous patient and hospital/provider characteristics, allowing a maximum standardized mean difference (SMD) ≤0.05 for all matching covariates. Generalized estimating equations (GEE) accounting for hospital-level clustering were used to compare the study outcomes between the GST and SIG groups. Results Of the 5573 identified cases, there were 491 patients in each group (982 total) after matching. The observed incidence proportion of hemostasis-related complications during the surgical admission was lower in the GST group as compared with the SIG group (3 events/491 [0.61%] vs 11 events/491 [2.24%]; odds ratio [SIG=reference] = 0.28, 95% CI=0.13–0.60, P=0.0012). Differences between the GST and SIG groups were not statistically significant for leak, total hospital costs, LOS, OR time, and all-cause inpatient readmission at 30, 60, and 90 days. Conclusion In this retrospective study of 982 matched patients undergoing sleeve gastrectomy, the ECHELON FLEX™ GST system was associated with a lower rate of hemostasis-related complications as compared with the Signia™ Stapling System. Further controlled prospective studies are needed to confirm the validity of this finding.
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Affiliation(s)
- Logan Rawlins
- Allegheny Health Network Bariatric & Metabolic Institute, Pittsburgh, PA, USA
| | | | | | | | - Mohit Bhandari
- Mohak Bariatric and Robotic Surgery Centre, Indore, India
| | - Ricardo V Cohen
- The Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | | | - Raymond Fryrear
- Johnson & Johnson Medical Device Company, Cincinnati, OH, USA
| | - Sanjoy Roy
- Johnson & Johnson Medical Device Company, Cincinnati, OH, USA
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Enhancing the precision of circular stapled colorectal anastomosis: could powered stapler technology provide the solution? Tech Coloproctol 2019; 23:687-689. [PMID: 31278457 PMCID: PMC6692292 DOI: 10.1007/s10151-019-02031-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/20/2019] [Indexed: 11/15/2022]
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