A novel powered circular stapler designed for creating secure anastomoses

Rojatkar, Prachi; Henderson, Cortney E.; Hall, Sudeepa; Jenkins, Scott A.; Paulin-Curlee, Geisa G; Clymer, Jeffrey W.; Nagle, Deborah

doi:10.15761/mdde.1000123

Cited by 20 publications

(36 citation statements)

References 25 publications

(31 reference statements)

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“…A preclinical study of ECP compared to manual staplers found ECP required reduced force to fire with less movement during staple application, and benchtop testing demonstrated less leaking at the staple line with ECP versus manual circular staplers. 20 In a clinical study (N=17) of left-sided anastomoses, ECP demonstrated acceptable safety results and anastomotic integrity immediately following surgery. 23 In a propensity score matched cohort study (119 cases manual circular stapler [MCS] versus 60 ECP stapler), anastomotic leak was observed in 14 (11.8%) patients in the MCS group and in 1 (1.7%) patient in the ECP group (P = 0.022).…”

Section: Introductionmentioning

confidence: 93%

“…They are easier to operate, requiring a reduced force to fire which allows more stability of the device while creating the anastomosis, possibly improving the reliability of the staple line. 20 In March of 2019, the first powered circular stapler, the ECHELON CIRCULAR™ Powered Stapler (ECP, Ethicon Endo-Surgery, Inc., Cincinnati, OH, USA) was launched in the US and European markets. 22…”

Section: Introductionmentioning

confidence: 99%

“…14 Colorectal anastomosis using surgical stapling has been shown to be safe and effective. 2,15 Circular staplers and the double stapling technique were first used over three decades ago to facilitate left-sided (ie, hemicolectomy, low anterior resection, or sigmoidectomy) and/or low anastomoses [16][17][18][19][20] and are now widely used during colorectal resections. Manual circular staplers have been the standard until recently.…”

Section: Introductionmentioning

confidence: 99%

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Economic Analysis of Leak Complications in Anastomoses Performed with Powered versus Manual Circular Staplers in Left-Sided Colorectal Resections: A US-Based Cost Analysis

Pollack¹,

Johnston²,

Petraiuolo³

et al. 2021

CEOR

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Purpose To estimate the cost impact of using the ECHELON CIRCULAR™ Powered Stapler (ECP) compared with manual circular staplers (standard of care, SOC) among patients undergoing colectomy procedures that involve left-sided anastomosis. Methods A US hospital-based budget impact model was developed to estimate the impact of ECP in reducing the surgical complication of anastomotic leak. The incremental acquisition cost of ECP vs SOC was compared to the net potential savings from reduced complication costs. The model was based on complication rates from a recently published matching-adjusted indirect comparison (MAIC) that compared clinical and healthcare utilization outcomes of patients using ECP with those of a propensity score-matched retrospective SOC control cohort from a real-world clinical practice population. The model assessed total cost, average length of stay (LOS), proportion of patients with a non-home discharge, and all-cause readmission. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were conducted to evaluate the robustness of the model assumptions and inputs. Results Despite a higher device cost of $412 for ECP compared with $298 for a manual stapler, annual savings due to avoided complications with ECP was $53,987 for anastomotic leak, assuming 100 procedures per year with each type of circular stapler. ECP also helped to avoid 27 LOS days, 0.38 readmissions and 0.22 non-home discharges. Sensitivity analyses around potential drivers of costs established the robustness of economic savings with the use of ECP – with annual savings being most impacted by the probability of anastomotic leak complication in the DSA. Conclusion This model demonstrates that among patients undergoing left-sided colectomy procedures, the incremental cost of using the ECHELON CIRCULAR™ Powered Stapler instead of a manual circular stapler was offset by the savings from lowered incidence and cost of management of anastomotic leaks in the hospital setting.

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Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Economic Analysis of Leak Complications in Anastomoses Performed with Powered versus Manual Circular Staplers in Left-Sided Colorectal Resections: A US-Based Cost Analysis

Pollack¹,

Johnston²,

Petraiuolo³

et al. 2021

CEOR

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“…After exposing, the staples were removed using biopsy forceps to the greatest extent possible, because of a probability of high-frequency current being conducted from the target lesion to the staples, which have a low electrical resistance. In cases where staple removal was difficult, the excision line was made below the staples within the thickened muscularis propria due to anastomosis 8 . This was carefully performed with a FlushKnife N 1.0-mm device, which has the shortest electrode knife, to avoid the damage to the deep muscle layer ( Fig.…”

Section: Methodsmentioning

confidence: 99%

Feasibility of endoscopic submucosal dissection of lesions at anastomosis site post-colorectal surgery: a case series

et al. 2019

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Background and study aims Patients who have undergone colorectal surgery for resection of cancer and benign lesions are at risk for recurrent, residual, or metachronous lesions at the anastomosis site. Surgical resection of such lesions is difficult because of adhesions, and a stoma may be required as there are risks for leakage after resection. The feasibility and safety of endoscopic submucosal dissection (ESD) for these lesions remain unknown. Therefore, this case series aimed to examine the feasibility and safety of ESD by evaluating the clinical outcomes. Patients and methods We retrospectively investigated five patients who underwent ESD by a single expert for superficial neoplastic lesions at the anastomosis site after previous colorectal surgery. Results R0 resections were achieved for all lesions. Mean procedure time was 160.6 minutes. Mean dimensions of the resected specimen and tumor were 52.4 mm and 31.8mm, respectively. None of the patients had complications or recurrence after surveillance colonoscopy 1-year post-resection. Conclusions In an expert’s hands, ESD at the anastomosis site might be feasible minimally invasive treatment for superficial neoplastic lesions.

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“…In addition, the total number of specimens that exhibited a leak of any type (staple or cutline) at pressures at or below 30 and 52 mmHg was recorded. Evaluation of leak performance at 52 mmHg was included as a high threshold, as it was twice the average leak test pressure of 26 mmHg noted in porcine colon [14]. This testing was performed for EPS, as well as the Medtronic EGIA and Signia systems.…”

Section: Ex Vivo Leak Testingmentioning

confidence: 99%

Measuring Staple Line Security and Compression Uniformity With an Advanced Endoscopic Powered Stapler

Wise¹,

Rector²,

K³

et al. 2021

J Surg Open Access

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A novel powered circular stapler designed for creating secure anastomoses

Cited by 20 publications

References 25 publications

Economic Analysis of Leak Complications in Anastomoses Performed with Powered versus Manual Circular Staplers in Left-Sided Colorectal Resections: A US-Based Cost Analysis

Economic Analysis of Leak Complications in Anastomoses Performed with Powered versus Manual Circular Staplers in Left-Sided Colorectal Resections: A US-Based Cost Analysis

Feasibility of endoscopic submucosal dissection of lesions at anastomosis site post-colorectal surgery: a case series

Measuring Staple Line Security and Compression Uniformity With an Advanced Endoscopic Powered Stapler

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