I understand that stapling thicker lung tissue can be challenging due to the potential for inconsistent staple formation and air leaks. I noticed you experienced a few error messages from the robot while trying to clamp and fire and I also observed that the time it took from calibration to the knife return was longer than I see in other cases. The error messages and reduced speed are signals that the stapler is at or beyond the limit for what it is designed to handle and that continuing may compromise staple formation. 

Not all surgical staplers are created equal and the ECHELON™ 3000 Stapler combined with GST Reloads is designed to handle thick, variable and challenging lung parenchyma . The ECHELON™ 3000 60mm Stapler with GST Reloads has a 39% greater jaw aperture compared to Medtronic Signia™ with Tri-Staple™ Reloads.^*1 Staple formation is achieved by combining multiple features of both the ECHELON™ 3000 stapler and GST reloads. Firstly, pre-compression, focal compression, and dynamic firing in the stapler all work together to prepare the tissue for stapling, exudate fluids, and enable compression to be delivered throughout the firing sequence. The GST reloads include proprietary gripping surface technology that holds tissue in place during firing, minimizing tissue slippage, and allowing you to transect where you intend.² Most importantly, the inclusion of these features has been shown in benchtop testing to improve staple formation and reduce leaks.^3,4 In addition, the ECHELON™ family of staplers has been demonstrated to lead to better patient outcomes in thoracic procedures. ^5,6 One other concern that surgeons and nurses raise with me is the exposed knife blade that is present in the SureForm™ stapler when it does not complete the firing.  When the system is unable to fully transect, it leaves the sled and knife blade at whatever longitudinal position it attained. The knife blade protrudes from the reload deck without any way to retract the blade into a safe position for handling which poses a risk of trauma to tissue as it is retracted. Given that the articulation joint is fully wristed and floppy, the scrub nurse must also exercise extreme caution to not damage his/her glove during reload unloading which can be difficult to control. This creates an infection risk for the assistant and nursing staff. This design feature is not present in the ECHELON™ 3000 stapler because the blade can always be retracted to the home position through powered knife retraction or manual override.⁷ 

Therefore, next time you are preforming a robotic wedge procedure and receiving error messages from the stapler, would you consider performing a bedside firing with the ECHELON™ 3000 and GST reloads? I’d be happy to attend your next 10 cases and ensure it is available for you to use if those error messages occur again.