State-of-art Digest: Endoscopic Powered Linear Stapler (i)
As the name implies, the powered endoscopic linear stapler is a stapling instrument driven by a linear motor and working under endoscopic scenarios. Standing on the shoulders (Medtronic & J&J) of the giant, many players contribute their own design on this kind of device. I would try my best to extrapolate such franchise of the devices on the market in this series of articles. To prevent repetition, I would summarize some of the common features below:
Normally, the shaft length
SURGNOVA: ALLIGATOR
Endoscopic linear stapler is always featured with long shaft and distal clamping mechanism, manufacturers enjoy using an analogy of jaws for reptiles to their distal structures. One is Caiman bipolar vessel sealing device from Aesculap, Alligator from SurgNova is another.
"Smart, Precise and Reliable Stapling with One Hand"
Key features:
Tissue thickness clamped within the jaws is of vital importance. The thicker the tissue clamped, the more difficult the knife would encounter. The state-of-art sensor may be a pressive force censor connected with the proximal end of the shaft. Therefore, the precision of the sensor leaves a question mark.
The indicator at the top would flash green light when the tissue is within its designed range of thickness. Once the tissue detected is thick, the indicator would flash yellow to warn the surgeon of this situation. And if the indicator turns red, the firing function would be forbidden as the tissue detected is too thick.
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Powered controlled bidirectional articulation enables Alligator wiping 45 degrees bidirectionally in a uniform speed. A uniform speed of wiping the distal jaws would further prevent tissue damage as it would not introduce significant impact force towards the delicate organs.
Most of the endoscopic linear staplers are equipped with manual override to navigate the distal knife back and even opening the distal jaw under an emergency. Alligator powered stapler used another mechanical structure to deflect the distal jaw back to zero degree at emergency status.
To be of notion, the distal jaw "snaps" back to axial direction of the shaft instead of wiping at uniform speed. This might induce some safety consideration as the snapping of distal jaw might hit the tissues within the abdomen.
The button layout of this powered stapler is unique and controversial. Except from the previously mentioned articulation button, two integrated buttons functionalize "jaw closing/firing" and "jaw opening/blade reverse" respectively. The latter is set below the articulation buttons and behind the rotational knot. In clinical practice, the jaw opening, and blade reversal would require the surgeons to lift the index finger up. The consideration behind this design is mainly to prevent unexpected touch of the jaw opening button during the firing procedure. However, critics of this design were heard as this request extra learning and intraoperative attention. Moreover, both buttons mentioned are set to be activated after a long press. This design further ensures the safety factors while using the device.
The battery of this stapler is protected by an anti-slippery cover at the very proximal end. Unlike the classical design of EchelonFlex, the design of SURGNOVA prevents the battery from unexpected exposure to surgical contaminants.
However, this design also has its drawbacks. It requires at least two nurses to load the battery during the procedure, as the battery cover needs to be handled aseptically and the battery needs to be handled by a scrub nurse.
Some Specs:
Alligator has two different stapling lengths, the nominated stapling line is 45mm and 60mm respectively. Each 45 mm reload is facilitated with 66 staples and each 60mm reload consists of 90 staples.