Bariatric Times

Spotlight on Technology April 2015

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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How does the iDrive™ Ultra Powered Stapling System compare to other staplers when it comes to staple formation quality and cut line? Dr. Portenier: When using the iDrive™ U ltra system, you can visually inspect the quality of the cutline. The cut that the iDrive™ Ultra system makes is smooth and consistent in comparison to other products, which, at times, can leave you with a jagged cut line. 1 I believe this is because of the level of sophistication in the Covidien group's iDrive™ Ultra system. First, with the iDrive Ultra p owered stapling system and Tri-Staple™ technology, you get a fresh blade every time. Second, it allows you to have better control and to hold your hand steady. Additionally, you can visually inspect the quality of staple formation. After stapling ex-vivo tissue, you can dissolve the tissue and observe the staples, which are formed more properly in the shape of a capital letter "B" than the competition. 1–3 How does superior performance in these two areas drive better clinical performance? Dr. Portenier: When put against the competition, you can see that the iDrive™ Ultra Powered Stapling System outperforms in a wide range of tissue thicknesses, especially in thick tissue. It also outperforms with regard to leak pressure consistency and staple line strength. The Covidien group has done comparative animal and bench top studies to prove these benefits. The data demonstrated that superior results were achieved using a combination of the iDrive™ Ultra Powered Stapling System with Endo GIA™ Black Reloads with Tri-Staple™ Technology compared to the ECHELON FLEX™* powered ENDOPATH™* stapler with ECHELON Black Reload with Gripping Surface Technology with respect to percentage of malformed staples in an ex-vivo porcine stomach model (p<0.015).1The adaptive firing technology contributes toward better staple formation, which has provided the following: • Superior staple formation 1–3 • Leak pressure consistency 1 • Superior staple line strength 1–3 • Superior cut line consistency 1 • Potential for less bleeding. 1 What advancements does the iDrive™ Ultra stapler offer in terms of leak resistance, staple line strength, and hemostasis? Dr. Portenier: As laparoscopic skill sets improve, we are faced with more challenging patient cases. For me, the iDrive™ Ultra system offers security and confidence when performing these challenging cases. I know that it can handle them. The challenge of preventing hemostasis is two-fold. First, when staples do not form appropriately (i.e., not forming perfect B shape), they are not performing the way they should. S econd, if the staples are too tight, it might lead to an ischemic staple line and leak potential. The outermost row of staples is key in preventing hemostasis. When utilizing iDrive™ Ultra Powered Stapling System in metabolic and bariatric procedures do you reinforce the staple line, and if so, what benefits are you e xpecting? What methods do you use (e.g., staple line reinforcement product, over sewing) and why? Dr. Portenier: I feel that Tri-Staple™ Technology is superior enough to question whether we need to reinforce the staple line; however, the International Sleeve Gastrectomy Expert Panel Consensus recommends reinforcement of the staple line in SG procedures. I use the recently released Endo GIA™ Reinforced Reload with Tri-Staple™ Technology. Since using this product, I have observed many advantages, including the following: 1) it is absorbable 2) it offers sufficient thickness, 3) it is comparable to biologic material, and 4) it is pre-loaded onto the stapler itself. The advantage of having the stapler pre-loaded leads to other important advantages. First, it takes less time to set up and use. 6 Second, it eliminates the waste of older varieties in that, if you needed more reinforcement material, you would have to open another package. 6 Also, after opening another package for additional material, the staff would have to spend extra time in loading it on the stapler. I reinforce the staple line with Endo GIA™ Reinforced Reload with Tri-Staple™ Technology because I find that it is consistent in good performance time after time. What does the future of stapling in metabolic and bariatric surgical procedures look like? What trends to you foresee in treatment modalities and the technology that will drive them? Dr. Portenier: Initially I thought the advantage of a powered stapler was simply physical in preventing surgeon's arms and hands from getting tired. 4 With the iDrive™ Ultra Powered Stapling System and Tri-Staple™ Technology, I understand there is more to it. We can see its intelligence through the Adaptive Firing™ Technology. Today, the technology can determine appropriate firing speed based on real-time information from resistance feedback from the tissue being fired upon, and make adjustments accordingly. It represents the beginning of a trend toward intelligent technology, and I believe we are just at the beginning of seeing what this technology can do. References 1. When compared to ECHELON FLEX™* Powered ENDOPATH™* stapler with ECHELON Black Reload with Gripping Surface Technology. Covidien Engineering Report # PCG-019 2. When compared to ECHELON FLEX™* ENDOPATH™* manual stapler with ECHELON Black Reload with Gripping Surface Technology. Covidien Engineering Report # PCG-019. 3. When compared to Endo GIA™ Ultra manual stapler and Endo GIA™ Black Reloads with Tri-Staple™ Technology when fired in thick tissue. Covidien Engineering Report # PCG-019 Endo GIA 4. UCONN Biodynamics: Final Report on Results. Baker RS, Foote, J, Kemmeter P, et all. Obesity Surgery 2004;14:1290–1298. 5. When compared to Echelon Flex™ green reloads in computer-generated Aachen model to demonstrate stress imparted on porcine GI tissue during compression. Benefits are due to graduated compression technology. Device is not software controlled. 6. Survey of tissue reinforcement users to determine waste and time loss attributed to separately loaded buttress materials in the OR. Online U.S. national sample of 125 surgeons and 125 OR nurses. Covidien-sponsored study by ORC International, 11/9/11. Supported by: Financial disclosure: Dr. Portenier was compensated for his time by Covidien Group. View a video of Dr. Portenier utilizing the iDrive™ Ultra Powered Stapling System and Tri-Staple™ Technology at B2 Bariatric Times [V O L U M E 1 2 , N U M B E R 4 • A P R I L 2 0 1 5 • S U P P L E M E N T B ] S POTLIGHT ON TECHNOLOGY

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