On the theater table, the patient was placed in the supine split-leg position “French position ”. First, a supraumbilical optical port (10 mm) was placed 2 cm to the left. The other ports were placed in the following manner: a 15 mm port at 4 cm to the right of the supraumbilical port, a 5 mm port 4 cm to the left of the supraumbilical port, a 5 mm port in the subxiphoid zone (for liver retraction), and a 5 mm trocar in the left mid-axillary line (to raise the stomach). Starting from the pylorus, a LigaSure™ (Covidien, USA) was used to completely release the greater curvature of the stomach from the greater momentum. The dissection was carried out up to the angle of His. Then, the anesthesiologist inserted a 36-F bougie along the lesser gastric curvature. Antral resection was started 2–6 cm from the pylorus and proceeded up to the angle of His 0.5–1 cm from the pylorus using endo GIA ultra-universal stapler with reloads (by Covidien, USA). In Group 1, resection of the antrum began 2 cm from the pylorus, and in Group 2, resection began 6 cm from the pylorus. Endoclips™ (Covidien, USA) or 3/0 Vicryl sutures were used to provide hemostasis. Methylene blue solution (in saline) was applied via the bougie to test for leakage.
Endo gia ultra universal stapler
Manufactured by Medtronic
Sourced in United States
The Endo GIA Ultra Universal staplers are surgical instruments designed for use in endoscopic procedures. They are used to apply surgical staples for the transection and resection of tissue.
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Lab products found in correlation
6 protocols using endo gia ultra universal stapler
1
Laparoscopic Sleeve Gastrectomy Technique
2
Vertical Sleeve Gastrectomy in Rats
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Animal care was performed as previously described [22 (link),25 (link),26 (link),27 (link)]. Briefly, animals were maintained on Osmolite OneCal liquid diet (Abbott Laboratories, North Chicago, IL, USA). In order to encourage a clear digestive tract, no-solid diet was provided 24 h before surgery. For VSG surgery, rats were anesthetized with isoflurane (Piramal Enterprises, Ltd., Andhra Pradesh, Telegana, India). Vertical sleeve gastrectomy involved a medial abdominal incision through the skin and muscular layer. The ligaments were cut to produce stomach externalization. To remove the lateral 80% of the stomach, an ENDO GIA Ultra Universal stapler (#EGIAUSHORT, Covidien, Mansfield, MA, USA) with an ENDO GIA Auto Suture Universal Articulating Loading Unit, 45 mm–2.5 mm (#030454, Covidien, Waltham, MA, USA) was used to reconfigure the now tubular stomach. The gastric sleeve was replaced in the abdominal cavity and sutured with 4-0 vicryl suture. For sham VSG, following laparotomy, the stomach was externalized and forcefully pressed between blunt forceps for 15 s, and then reintegrated into the abdominal cavity.
3
Surgical Repair of Bronchopleural Fistula
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A BPF was defined as any communication between the bronchial tree and the pleural cavity that was confirmed either clinically, by bronchoscopy or high‐resolution computed tomography. Surgery was indicated when the size of the BPF was >8 mm,10 or when a BPF was not improved with pleural drainage and conservative care. The surgical repair was performed through a posterolateral thoracotomy. The technique of surgical repair was either a primary suture closure of the bronchial stump or an additional pulmonary resection. When performing a primary repair or bronchoplasty, the necrotic tissue around the BPF was removed and the surrounding fresh tissue was manually repaired with polydioxanone 3–0 suture (Ethicon) using simple interrupted stitches. When an additional pulmonary resection was performed, more proximal part than the BPF location was additionally resected with mechanical stapler (Covidien Endo GIA Ultra Universal staplers, Medtronic). Afterwards, the air leakage test was performed. After confirming that the BPF restoration site was intact, the stump site was reinforced with a vascularized pedicle flap (e.g., omental or muscle flap) as needed.
4
Standardized Laparoscopic Sleeve Gastrectomy Procedure
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All LSGs were performed according to the standard procedure described by Bhandari et al. [16 (link)]. An ultrasonic dissection device (Medtronic, Covidien, Inc.) and a 36-F bougie size were used. The sleeve started 2–4 cm from pylorus. The Endo GIA™ Ultra Universal Staplers (Medtronic, Covidien, Inc.) were used with 60-mm cartridge depending on stomach thickness. Typically, 3 purple and 2 blue cartridge were used. No staple line reinforcement or buttressing was used. Before the end of surgery, the pneumoperitoneum was lowered to 10 mmHg to check for evidence of bleeding. The clips were placed in case of bleeding points of staple line. If the bleeding cannot be controlled by clipping, the surgeon decided to perform the staple line oversewing with 3–0 PDS stich. The intra-abdominal drainage was not used routinely.
5
VATS Lobectomy with Endoscopic Stapling
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The vast majority of VATS procedures used 3 or 4 incisions, most often 3. The camera port (10 mm) was usually placed on the lower chest. A utility incision (4 to 6 cm) was usually made along the anterior axillary line. The third and/or fourth incision, usually 5 or 10 mm in length, was made through the auscultatory triangle on the low chest. A soft tissue retractor was often used at the utility incision. All patients underwent lobectomy with extensive mediastinal lymph node dissection. VATS was used preferentially in nearly all patients. All operations were performed by 1 of the 6 surgeons of the thoracic surgery unit.
Three types of endoscopic stapler bodies and cartridges were used. The stapler bodies were Covidien Endo GIA Ultra Universal staplers (Medtronic, Minneapolis, MN, USA), Echelon Flex powered vascular staplers (Ethicon, Somerville, NJ, USA), or Echelon Flex powered articulating staplers (Ethicon), and the cartridges were Endo GIA Roticulators (Medtronic), Endo Linear Cutter Cartridges (Ethicon), and Echelon Endoscopic Cartridges (Ethicon), respectively. Surgeons were divided into 2 groups according to their stated preference of pulmonary fissure division methods. One group tended to use staplers for fissure division, while the other group tended not to use staplers.
Three types of endoscopic stapler bodies and cartridges were used. The stapler bodies were Covidien Endo GIA Ultra Universal staplers (Medtronic, Minneapolis, MN, USA), Echelon Flex powered vascular staplers (Ethicon, Somerville, NJ, USA), or Echelon Flex powered articulating staplers (Ethicon), and the cartridges were Endo GIA Roticulators (Medtronic), Endo Linear Cutter Cartridges (Ethicon), and Echelon Endoscopic Cartridges (Ethicon), respectively. Surgeons were divided into 2 groups according to their stated preference of pulmonary fissure division methods. One group tended to use staplers for fissure division, while the other group tended not to use staplers.
6
Comparison of Bronchial Closure Techniques
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The Endo GIA Ultra Universal staplers (EGIAUSHORT; Medtronic) were used for all patients. For the EHS group, the Endo GIA cartridge reload with a flat face and equal height staples was used for bronchial closure (Fig 1A). The selection of either the blue cartridge for medium tissue (no. 030455; Medtronic) or the green cartridge for thick tissue (no. 030456; Medtronic) was made at the discretion of each surgeon. The staple heights of the blue cartridge and the green cartridge are 3.5 mm and 4.8 mm for all rows, respectively. For the GHS group, the Endo GIA cartridge reload with a stepped face and graduated height staples (Tri-Staple technology) was used for bronchial closure (Fig 1B). The purple cartridge for medium/thick tissue (EGIA45AMT; Medtronic) was used for all patients in the GHS group. The staple heights of this reload were 3.0 mm for the inner row, 3.5 mm for the middle row, and 4.0 mm for the outer row.
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