Intraoperative ultrasound was used for intraoperative intrahepatic staging, to identify tumour margin and hepatic anatomy. If required, subsegmental resection was performed to clear the future liver remnant of tumour. Anatomical resection was performed in accordance with Couinaud's liver segmental classification. Portal and hepatic arterial inflow to the segments for resection were dissected extrahepatically and occluded with vascular bulldog clamps to allow for ICG clearance assessment (ICG3). Liver parenchymal transection was performed using a combination of an ultrasonic surgical aspirator (CUSA, Radionics, Burlington, MA, USA), Harmonic shears (Ethicon, Somerville, NJ, USA), and linear surgical stapler (EndoGIA, Covidien, Mansfield, MA, USA; Echelon Endopath, Ethicon, Somerville, NJ, USA). Following complete parenchymal transection, an ICG clearance was performed with the inflow occluded and with outflow (hepatic vein) patent (ICG4). A final ICG clearance was performed with both inflow and outflow occlusion (ICG5). Following this step, the liver resection was completed with ligation and division of the hepatic artery, portal vein, and hepatic vein to the pertinent hemiliver.
Echelon endopath
Manufactured by Johnson & Johnson
Sourced in United States
The Echelon Endopath is a surgical instrument designed for use in minimally invasive procedures. It is a cutting and stapling device that allows surgeons to create precise incisions and apply surgical staples during operations. The Echelon Endopath is a versatile tool that can be used in a variety of surgical procedures.
Automatically generated - may contain errors
Lab products found in correlation
Harmonic shears, by Johnson & Johnson (1 mentions)
Endo gia, by Medtronic (1 mentions)
Echelon endopath, by Takeda Pharmaceuticals (1 mentions)
Endogia 60 mm reload with tri staple technology, by Takeda Pharmaceuticals (1 mentions)
Tachosil, by Takeda Pharmaceuticals (1 mentions)
Endogia 60 mm reload with tri staple technology, by Medtronic (1 mentions)
3 protocols using echelon endopath
1
Intraoperative Ultrasound-Guided Liver Resection
2
Standardized Laparoscopic Roux-en-Y Gastric Bypass Revision
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The revision from LAGB to rLRYGB was done in two stages. In the first stage, only the gastric band was removed. The second stage was performed after 3–6 months, to allow resolution of fibrosis and scarring, and included the definitive surgery, i.e., rLRYGB. The revision from LSG to rLRYGB was a single-stage procedure.
Patients in both groups underwent a standardised ante-gastric ante-colic LRYGB, the salient features of which are as follows: the omentum was divided vertically to decrease the tension on the ante-colic Roux limb. The lengths of bilio-pancreatic and alimentary limbs were 75 cm and 100 cm, respectively. The jejuno-jejunostomy (JJ) was done by “triple stapled technique,” i.e., side-to-side anastomoses with application of 60 mm linear endo-stapler (Echelon ENDOPATH™, Ethicon) (white cartridge) in both directions from the enterotomy, and closure of the common enterotomy by a third application of the same stapler. A gastric pouch 20–30 ml size is formed by the serial application of 60 mm linear endo-stapler (blue cartridge). The gastro-jejunostomy was created using 25 mm circular stapler (3.5 mm stapler height, DST Series™ EEA™ OrVil™ 25 mm). Both the Petersen's and JJ mesenteric defect were closed from base to apex using a continuous non-absorbable suture technique.
Patients in both groups underwent a standardised ante-gastric ante-colic LRYGB, the salient features of which are as follows: the omentum was divided vertically to decrease the tension on the ante-colic Roux limb. The lengths of bilio-pancreatic and alimentary limbs were 75 cm and 100 cm, respectively. The jejuno-jejunostomy (JJ) was done by “triple stapled technique,” i.e., side-to-side anastomoses with application of 60 mm linear endo-stapler (Echelon ENDOPATH™, Ethicon) (white cartridge) in both directions from the enterotomy, and closure of the common enterotomy by a third application of the same stapler. A gastric pouch 20–30 ml size is formed by the serial application of 60 mm linear endo-stapler (blue cartridge). The gastro-jejunostomy was created using 25 mm circular stapler (3.5 mm stapler height, DST Series™ EEA™ OrVil™ 25 mm). Both the Petersen's and JJ mesenteric defect were closed from base to apex using a continuous non-absorbable suture technique.
3
Laparoscopic Pancreas Transection Techniques
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As previously described [3 (link),4 (link)], to safely transect the pancreas during laparoscopy, we used endoscopic linear staplers of various heights, depending on the thickness or hardness of the pancreas. Two endoscopic stapler cartridges, Echelon Endopath (Ethicon Endosurgery, Cincinnati, OH, USA) and EndoGIA™ 60-mm Reload with Tri-Staple™ Technology (Covidien Medtronic, Plymouth, MN, USA), included (i) a regular-height cartridge (3.8-mm gold Echelon Endopath or 3- to 4-mm purple EndoGIA™ 60-mm Reload with Tri-Staple™ Technology), (ii) a long-height cartridge (4.1-mm green Echelon Endopath or 4- to 5-mm black EndoGIA™ 60-mm Reload with Tri-Staple™ Technology), and (iii) a short-height cartridge (3.5-mm blue Echelon Endopath).
In most cases, after transecting the pancreas, the pancreatic remnant was covered with a fibrinogen-coated and thrombin-coated collagen sponge (TachoComb or TachoSil; Nycomed GmbH, Konstanz, Germany) or a polyglycolic acid felt (Neoveil®) and fibrin sealant (Tissucol; Baxter GmbH, Unterschleissheim, Germany).
In most cases, after transecting the pancreas, the pancreatic remnant was covered with a fibrinogen-coated and thrombin-coated collagen sponge (TachoComb or TachoSil; Nycomed GmbH, Konstanz, Germany) or a polyglycolic acid felt (Neoveil®) and fibrin sealant (Tissucol; Baxter GmbH, Unterschleissheim, Germany).
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