Page 70 - World Journal of Laparoscopic Surgery

Medtronic I-Drive vs Ethicon Echelon
with the Echelon and I-Drive powered staplers was $1,906.25 and 8. Kehagias I, Zygomalas A, Karavias D, et al. Sleeve gastrectomy: have
$2,037.26 in the commercial sector and $2,356.24 and $2,097.66 we finally found the holy grail of bariatric surgery? A review of the
in the government sector, respectively. The difference in cost literature. Eur Rev Med Pharmacol Sci 2016;20(23):4930–4942.
between platforms was not statistically significant with a p-value 9. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve
of 0.4774 in the commercial sector, but the cost of the I-Drive gastrectomy as an initial weight-loss procedure for high-risk patients
platform was significantly lower in the government sector with a with morbid obesity. Surg Endosc 2006;20:859–863. DOI: 10.1007/
s00464-005-0134-5.
p-value of 0.0002. Thus, our single-center, randomized control trial 10. Tucker ON, Szomstein S, Rosenthal RJ. Indications for sleeve
demonstrated a significant decrease in cost for the I-Drive platform gastrectomy as a primary procedure for weight loss in the morbidly
in the government sector, no difference in the time needed to reload obese. J Gastrointest Surg 2008;12:662–667. DOI: 10.1007/s11605-008-
the I-Drive and Echelon platforms, a statistically significant—but 0480-4.
not clinically significant—overall time to sleeve creation, and no 11. Trastulli S, Desiderio J, Guarino S, et al. Laparoscopic sleeve
difference in perioperative or postoperative complications such gastrectomy compared with other bariatric surgical procedures:
as leak or bleeding rates. a systematic review of randomized trials. Surg Obes Relat Dis
Our study is not without limitations. Previous studies have 2013;9:816–829. DOI: 10.1016/j.soard.2013.05.007.
evaluated patient characteristics, calibration size, and percentage 12. Dapri G, Cadière GB, Himpens J. Reinforcing the staple line during
26
of excess weight lost, which we did not assess in our analysis. laparoscopic sleeve gastrectomy: prospective randomized clinical
The scope of the data reported focuses on the relatively absent study comparing three different techniques. Obes Surg 2010;20:
462–467. DOI: 10.1007/s11695-009-0047-9.
cost and time differential between commercially and publicly 13. Shi X, Karmali S, Sharma AM, et al. A review of laparoscopic sleeve
available powered linear staplers on the market for laparoscopic gastrectomy for morbid obesity. Obes Surg 2010;20:1171–1177. DOI:
sleeve gastrectomies in bariatric surgery. Moreover, the absence 10.1007/s11695-010-0145-8.
of a statistically significant difference in our results is potentially 14. ASMBS Clinical Issues Committee. Updated position statement on
a result of modest sample size due to fall-out and suboptimal sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis
recruitment prior to randomization in the study. 2012;8:e21–e26. DOI: 10.1016/j.soard.2012.02.001.
15. Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease
conclusIon leak after laparoscopic sleeve gastrectomy: a systematic review and
meta-analysis of 9991 cases. Ann Surg 2013;257:231–237. DOI: 10.1097/
The cost per sleeve gastrectomy at commercial facilities and the SLA.0b013e31826cc714.
time needed to change staple loads for the Medtronic I-Drive and 16. Ferrer-Márquez M, Belda-Lozano R, Ferrer-Ayza M. Technical
the Ethicon Echelon powered staplers is not significantly different controversies in laparoscopic sleeve gastrectomy. Obes Surg
in our military facility. 2012;22:182–187. DOI: 10.1007/s11695-011-0492-0.
17. Taha O, Abdelaal M, Talaat M, et al. A randomized comparison
between staple-line oversewing versus no reinforcement during
AcknowledgMents laparoscopic vertical sleeve gastrectomy. Obes Surg 2018;28:218–225.
Though our study is a randomized controlled trial, our data-sharing DOI: 10.1007/s11695-017-2835-y.
plan will not include making individual participant data publically 18. Sajid MS, Khatri K, Singh K, et al. Use of staple-line reinforcement in
available. Because our study was performed at a military facility, laparoscopic gastric bypass surgery: a meta-analysis. Surg Endosc
individual participant data are considered sensitive government 2011;25:2884–2891. DOI: 10.1007/s00464-011-1637-x.
information and will remain classified. 19. Choi YY, Bae J, Hur KY, et al. Reinforcing the staple line during
laparoscopic sleeve gastrectomy: does it have advantages? A
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68 World Journal of Laparoscopic Surgery, Volume 15 Issue 1 (January–April 2022)