Bariatric News talked to Dr Jassim Fakhro, Senior Consultant in General, Metabolic, Bariatric and Robotic Surgery, Vice President of the Gulf Obesity Surgery Society (GOSS) and Co-Founder of the Masters Medical Center (Doha, Qatar), about the limitations of current staplers and the unique advantages of XNY Medical’s next-generation, ENDO NOVA Powered Stapler.
“When we are talking about our specialty, bariatrics, one of the limitations is the length of the reload. A longer reload firing would reduce the length of the operation and in our patients, especially those with a high BMI, a shorter surgical time reduces the patients’ exposure to anaesthesia and their comorbidities related to time. A second limitation is the ability to give and objective measurement of tissue thickness. For us, especially when we are training young fellows, sometimes they do not have enough experience to decide the correct reload according to the thickness. So, having the ability to measure tissue thickness - a tactile feedback – would be an excellent addition, especially for our trainee surgeons,” explained Dr Jassim Fakhro. “Thirdly, ergonomics is very important. You know a lot of staplers, they are very good at stapling but have limitations when considering movement, functionality and how to rotate the anvil – so I believe an easy user-friendly stapler is needed. Finally, you need to have a good compression without jeopardising the safety of the compression when it comes to damaging the tissue by adequately deploying the formation of the staples.”
Dr Fakhro has been using the ENDO NOVA Powered Stapler for about five months and has utilised the device for both sleeve gastrectomies and gastric bypasses, as well as revisional bypasses. He revealed that one of the key advantages of the device is the tissue density profiling algorithm that employs a sophisticated array of multi-modality sensors to perform real-time bioacoustics assessments of tissue density. This dynamic feedback loop offers surgical practitioners’ precise data on tissue characteristics, thereby mitigating operative risks associated with variable anatomical conditions.
The Integrated Pressure Transduction System features an advanced system of piezoelectric pressure transducers that continuously monitor the biomechanical parameters at the anastomotic junction. This real-time data dissemination guarantees optimal stability of the anastomosis while averting deleterious over compression of the tissue matrix.
Using electrical impedance tomography the system analysers the resistive properties of the tissue, classifying the morphological and density characteristics of the tissue interface. In addition, employing spectroscopic optical sensing array, the system discriminates tissue composition and density attributes through sophisticated light reflection and absorption metrics.
“This results in an accurate measurement regarding tissue thickness. The device gives you feedback as to whether the reload that you are using is really suitable for the thickness of the tissue or not. This has played a major role in reducing the possibility of malfunctioning and malstapling of any stapler,” he added. “The ENDO NOVA Powered Stapler also incorporates an ‘Autonomously Adaptive Mechanism’ and this dynamic staple leg length modulation gives an intelligent stable row configuration, which compared to other manual staplers, provides concise very staple line without any deformities of the staple.”Dr Fakhro said he was “really surprised” with the ergonomics of this stapler. Having trained initially on robotic surgery, he understands the great advantages robotic surgery has in providing improved ergonomics for the surgeon.
“This handle was very easy to work with and I like that the rotation is fully manual. I like to have the advantage of having the full motorised stapler, by having the rotation being controlled manually because this give you better angle and to work even faster. The amazing thing in the handle also it has a universal compatibility. It has six level angle adjustment up to 45 degree which is amazing. Returning knob for reload exchange was very easy. And all this reduces the risk of infection during the surgery,” he commented. “In general, if we talk about the artificial intelligence (AI) enhanced features of the ENDO NOVA Powered Stapler, it offers a sophisticated blend of precision, adaptability and usability that addresses the demand of modern surgery. By delivering real time feedback, customised stabling adjustments and ergonomic handling - it empowers the surgeon to perform with greater confidence, precision and consistency. This ultimately leads to enhanced patient outcome, reduce complication and optimise procedural efficacy.”
The ENDO NOVA Powered Stapler also features motorised staplers designed to bring consistent stapling force, reduced hand fatigue, precise control with feedback, controlled tissue compression, and multiple firing modes. According to Dr Fakhro, the stapler embodies a level of a lot of sophistication that enhances the entire surgical process by automating the stabling force, providing feedback driven control.
“The motorised staplers enable greater consistency, reduce surgeon failure and ensure optimal compression for faster and safer recovery,” he remarked. “This results in fewer potential complications, a higher level of confidence for the surgical team, and ultimately a more reliable and efficient stapling experience that align with the evolving standards of modern surgical care.”
The ENDO NOVA Powered Stapler offers a 75mm Reload, which the company believes, is an advanced feature that enhances its performance, usability and patient outcome for various surgical procedures. For example, the step cartridge phase design provides a secure grip on the tissue, ensuring stable positioning and preventing tissue slippage during stabling. This also ensures a real secure staple line formation, which is critical for preventing leaks, particularly in gastrointestinal and bariatric surgeries in general. In addition, the length of the device also delivers a gentle and controlled compression, resulting in better perfusion for the staple lines.
“I would also say that we know the amount of staple compression force the ENDO NOVA Powered Stapler delivers and, in my opinion, it is even higher than any other competitor in the market. And the most important thing, by using 75mm Reload, we are reducing the reload junction,” stated Dr Fakhro. “So, we are actually using less cartilage, compared to using the standard 60mm Reload. By reducing the number of junctions, we are crucially also reducing the potential places at the junction where there could be weak points, thereby eliminating a potential anastomotic leak or bleed. Finally, if a surgeon uses the device’s centrifuge reload, they are also reducing the need for multiple reloads as well, which is also beneficial.”
Other features of the device include:
Rechargeable battery (with C-Type Charge) with 100 fires from one charge
One hand control for (rotation , firing, open and closing the jaws)
Universal compatibility (can be used with 30mm 45mm 60mm and 75mm reload)
Dedicated chips for device recognition
Easier placement wider jaw aperture can make placing the jaws on thick tissue easier, with potentially less tissue manipulation
“Finally, I would add that the device is very cost efficient since the handle is reusable up to 600 reloads, and I believe this is the first powered reusable handle that's been approved by FDA, which is a great selling point!” he concluded. “This is a great advantage because this really reduces the cost for the surgeon, as well as reducing the costs for the patient.”
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