Early Experience and Lessons Learned with New 60mm Robotic Stapler in Sleeve Gastrectomy

Azure G. Adkins, MD; Ajay G. Upadhyay, MD, FACS

Product Details
Product ID: ACS-5779
Year Produced: 2019
Length: 5 min.


This video details our early experience with the new SureForm 60mm robotic stapler during a robotic-assisted sleeve gastrectomy. We had the opportunity to utilize this technology five months prior to the official release date due to being a high-volume robotic program. Prior this we had been using a handheld stapler with the largest staple height available on the market with the thinnest available integrated reinforcement. We demonstrate our technique with educational points and possible limitations of the new 60mm robotic stapler as well as troubleshooting tips. Due to the thickness of the stomach utilizing the stapler with the reinforcement causes compression to be incomplete and stapling to be aborted. The technology of this stapler calculates compression of the tissue; shown in the lower left corner during the attempted firings. To successfully transect this tissue, we used a handheld stapler. After this the robotic stapler without reinforcement can complete the sleeve without issue. Standard imaging of the sleeve on the first postoperative day showed no leak and expected anatomy. Our conclusions are that the robotic stapler is efficient due to the ability of the console surgeon to operate it and is a useful addition to robotic surgery because if there is no skilled bedside assist stapling can be performed with ease. However, we caution that the staple height (4.6mm) may not be enough for thick antral tissue, particularly if any reinforcement is added. Five additional cases were completed uneventfully with the robotic stapler without buttress material.