Using a Panther Healthcare Endo Linear Cutter Stapler (CEAC) and Panther Endoscopic Powered Stapler (PE), in conjunction with the Panther Reloading units for Endo Linear cutter (CAD), reduces the risk of postoperative staple line gastric leakage and bleeding when performing laparoscopic bariatric surgery, according to Dr Mohammed Ali Al Zaben and colleagues from the Sultan Bin Abdulaziz Humanitarian City (SBAHC), Riyadh, Saudi Arabia. The researchers made their conclusions after reviewing the outcomes from 1,000 patients who had undergone two procedures with the devices.
“In our experience, the Panther Endoscopic (PE) motorised cutting, commonly known as Smart Powered Stapler platform, provides intelligent and automatic control over tissue compression, transection, and resection for gastrointestinal, including bariatric, thoracic, colorectal, oncology, gynaecologic and other open and laparoscopic surgical procedures,” commented Dr Al Zaben.
According to the research team, optimal stapler selection during laparoscopic sleeve gastrectomy (LSG) requires a careful evaluation of tissue thickness for adequate compression and haemostasis, as well as an appropriate technique to maximise the mechanical integrity of the staple line, given that overlap and reorientation can occur with multiple staple fires.
However, tissue compression can result in diminished mechanical integrity, as assessed by rupture pressure, whereas over-compression of the tissue can result in serosal tearing and diminished mechanical integrity due to deformed staples inside the staple line. Therefore, stapler junctions and the increase in the number of staple firings along the gastrectomy staple line can increase the probability of technical or mechanical staple line failures.
The Smart Powered Stapler features an opening and firing mechanism that can be activated with just the touch of a button. This helps to reduce the amount of force required to fire the device, which in turn helps to improve suture repair and lowers the likelihood of an injury being sustained as a result of improper use.
The bariatric surgery team evaluated the most recent innovation offered by Panther's Smart Powered and Endo Stapler, and reported the powered stapler demonstrated efficacy, was user-friendly, lightweight and has a high level of intuitiveness.
They noted that proper stapling can be achieved by applying sufficient pressure to the tissues, moving the blade in a steady, uninterrupted motion and avoiding any jerking motions. The stapler performs a scan on the reloads, which are invariable of an exceptionally high standard. Due to the high quality of the devices, the team said they continue to make use of and assess the effectiveness of these staplers in clinical settings.
Study
In total, 1,000 patients were included in this study - 994 had a LSG and six had a laparoscopic gastric bypass (LGB) at SBACH between January 2020 and August 2021. The bariatric team consisted of six surgeons and all the patients went through multidisciplinary preoperative preparation prior to undergoing surgery. The inclusion criteria for the bariatric surgery were severe obesity and/or grade 2 obesity with concomitant comorbidities. Data was collected through the review of the patient’s medical records obtained from the hospital information system (HIS) before and during the operation, as well as at six and twelve months after the surgical procedure.
Outcomes
The mean age of the studied patients was 33.74±10.26 years with most patients aged 21 to 40 years (35.8 % were aged 21-30 years and 33.4% were aged 31-40 years). This was followed by the patients aged 41-50 years who accounted for 17.2% and only 7% of patients were in the age range of 12-20 years and 6.6 % were in the age category of >50 years. Interestingly, 568 (56.8%) were male and 432 (43.2%) were female (Table 1).
There was a significant difference in terms of weight loss from baseline to 12-month follow-up among different age groups and among the different genders. The mean difference in the BMI from baseline was comparable between different age groups that ranged from 19.4kg/m2 in the age group 12-20 years to 14.75kg/m2 in the age group of >50 years. The same observation was found among the two genders where the reduction in the mean BMI did not differ significantly (18.2kg/m2 in males and 16.0kg/m2 in females). The description of the variables in terms of significant change is also shown in Figure 1 and Figure 2.
The median pre-operative weight was 119 (105-135) kg, while it was 85 (76-98) kg after six months of follow-up with a reduction of 34kg, and it was 72 (64-82) kg after 12 months of follow up with a reduction of 47kg from baseline. The mean BMI at baseline was 43.05 (39.13 – 48.14) kg/m2, where it was reduced to 31.08 (27.97– 35.02) kg/m2 and 26.03 (23.87 –29.21) kg/m2 in the six months and 12 months follow-up, respectively.
Complications
Regarding post-surgical complications, from 1,000 patients only five (0.5%) reported surgical complications includeing bleeding (0.1%, n=1), dehydration and low potassium (0.1%, n=1), left port side incarcerated hernia (0.1%, n=1) and gall bladder stone (0.2%, n=2). The rate of complications was higher among females than males, where 1 (20%) male patient had a complication and four (80%) female patients had complications. The male patient experienced a left port side incarcerated hernia. A total of one female had to bleed, one female had dehydration and low potassium, and two females had gallbladder stones.
“The use of surgical endo staplers was a big step forward for minimally invasive surgeries and made a huge difference in terms of safety and effectiveness,” said Dr Al Zaben. “While dehiscence and fistulas were once major concerns during bariatric surgery, the emergence of staplers with three double rows of staggered staples has increased efficiency and reduced the risk of complications during the operation.”
It is of the utmost importance to have a variety of techniques and staplers available in order to communise their use and make them accessible to all surgeons and healthcare facilities, regardless of whether they are public or private which will allow for the most effective surgical application in a variety of settings, the researchers commented.
However, it is noteworthy that the performance of such staplers is primarily dependent on the surgeon’s experience, and technical training while using these stables in his surgical technique. Despite the used technique and surgeon’s qualifications, the main goal of all surgeons is to reduce both intraoperative and postoperative complications.
“The current study demonstrates that the use of the stapler to apply regular staples to the closure of gastrojejunostomy and jejunojejunostomy during laparoscopic bariatric surgery showed that Panther’s innovative anastomotic technical tool is associated with reduced postoperative comorbidities,” Dr Al Zaben concluded. “The results of this study suggest that they can be used safely and effectively during surgery for obese/morbidly obese patients and that this device should be considered as an alternative to current standard practice.”
This article is sponsored by Panther Healthcare. The products featured here are available in Europe, the Middle East, Africa, Asia and Latin America. For more information, please visit: www.pantherhealthcare.com
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