World J Surg Surg Res | Volume 4, Issue 1 | Research Article | Open Access

Comparison of Circular Staplers with Adjustable Staple Height vs. Fixed Graduated Staple Height

Shantanu Shivdekar, Prachi Rojatkar, John F Cummings, Jeffrey W Clymer*, Crystal D Ricketts and William J Petraiuolo

Ethicon, Inc., Cincinnati OH, USA

*Correspondance to: Jeffrey W Clymer 

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Background: The introduction of the Ethicon Echelon Circular Powered Stapler (ECP) has elevated the creation of anastomoses to a new level of precision. The improvement in tissue apposition has been documented both preclinically and more recently in clinical studies. However, there has not been a direct comparison between the ECP, which has adjustable height staples, with the EEA Circular Stapler with Tri-Staple Technology (TRS). This study was undertaken to determine whether the advantages of ECP previously observed in comparison to fixed single height staples are also present when compared to a device with fixed graduated height staples. Methods: In preclinical models, compression force on tissue, leak pressure at the staple line, tissue perfusion in the region of the staple line, and distal tip movement of the device during firing were determined for ECP and TRS. Results: ECP displayed a 38% reduction in compressive forces on tissue (p<0.001) and more evenly distributed compression forces within the staple line than TRS. ECP exhibited a 24% higher mean leak pressure (p=0.006) and 48% fewer leaks at the staple line (p=0.019). ECP showed significantly better perfusion between the inner two rows of staples (p<0.001) and throughout the entire stapled region (p<0.010). ECP had markedly less distal tip movement during firing, with less than half the movement of TRS. Conclusion: In the current study, ECP demonstrated higher leak pressures and had less distal tip movement during firing. The advantages observed for ECP previously vs. fixed single height staples have been confirmed in comparison to fixed graduated height staples in preclinical testing. These advantages may be responsible for the improved outcomes observed clinically for the Echelon Circular Powered Stapler.


Circular stapler; Powered; Staple height; Anastomotic leak


Shivdekar S, Rojatkar P, Cummings JF, Clymer JW, Ricketts CD, Petraiuolo WJ. Comparison of Circular Staplers with Adjustable Staple Height vs. Fixed Graduated Staple Height. World J Surg Surgical Res. 2021; 4: 1344..

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