Jonathan R Thompson, MD1, Vikrom K Dhar, MD2, Dennis J Hanseman, PhD2, Brad M Watkins, MD2, Thomas Inge, MD, PhD3, John Morton, MD, MPH4, Tayyab Diwan, MD2. 1University of Cincinnati Research Institute, 2Department of Surgery, University of Cincinnati College of Medicine, 3Children’s Hospital of Colorado, University of Colorado, Denver, 4Department of Surgery, Stanford University
Objective of the technology or device: The Standard Clamp from Standard Bariatrics (Cincinnati, Ohio) is an FDA-approved laparoscopic clamp used to facilitate the proper formation of the sleeve gastrectomy staple line prior to transection. The Standard Clamp is a reusable non-crushing clamp that has a functional clamping length of 25cm and a width of 10mm. The jaws are designed to clamp at an angle to accommodate the variable thickness of the stomach.
We previously found a reduction in staple cartridge waste by simply counting the number of staple cartridges used in each case. Increased awareness led to an improvement from a mean +/- SD of 6.0 +/- 1.6 cartridges per case (n = 116) to 5.0 +/- 0.7 (n = 274). We hypothesized that the Standard Clamp would enable an additional reduction in staple cartridge use.
Description of the technology and method of its use or application: The Standard Clamp is placed through a right mid-abdominal trocar site, clamping the stomach to the anatomic right of the planned staple line. If a bougie is used, it must be downsized to account for the spacer effect of the clamp. In these cases, we used an 18F Salem Sump tube.
When we use the clamp, the sleeve is planned with a ‘three point technique’. Anatomic landmarks of the stomach are used to create the sleeve: 1cm from the gastroesophageal junction, 3cm from the incisura angularis, and 6cm from the pylorus. The stomach is marked with ink at these points, the clamp is placed and the ‘three points’ are brought into alignment to the anatomic left of the clamp. The staple line then proceeds along the anatomic left of the clamp. We used Ethicon Echelon 60mm GST staple cartridges (Cincinnati, Ohio) in these cases.
Preliminary results: Two surgeons at a single institution have performed 115 sleeve gastrectomy cases using the Standard Clamp from 6/2016 to 11/2016. After we introduced the Standard Clamp, we achieved an additional reduction from 5.0 +/- 0.7 staple cartridges per case with Counting to 4.3 +/- 0.5 per case with the Standard Clamp (t-test, p < 0.01).
There is less variability in staple cartridge use with the Standard Clamp (Figure 1). The rate of > 5 cartridges per case fell from 62% in our Historical cohort to 21% in our Counting cohort (odds ratio = 0.17 (95% CI: 0.11 0.27), p < 0.01) to 0% in our Standard Clamp cohort (odds ratio = 0.02 (95% CI: 0.00, 0.27), p < 0.01).
Conclusions/future directions: We have demonstrated reduced staple cartridge use during sleeve gastrectomy with the Standard Clamp. This was achieved consistently, as we have never used more than 5 cartridges in a Standard Clamp case. An ongoing quality improvement study aims to see if other surgeons have the same improvement in staple cartridge utilization with the Standard Clamp in sleeve gastrectomy.
Figure 1: Relative frequency of number of cartridges required to create a sleeve gastrectomy by patient cohort.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84318
Program Number: ETP746
Presentation Session: Emerging Technology Poster
Presentation Type: Poster