A Better Grip
on Movement
Now experience the least tissue
slippage during firing
Bariatric and Metabolic
Remaining challenges in laparoscopy
Knowing the exact tissue characteristics such as thickness and density
for any firing in a laparoscopic procedure remains a challenge.
While surgeons have become very adept at
managing this with the latest laparoscopic
devices, there are still times when their
experience, technique and devices are tested.
In bariatric and metabolic procedures where
approaches require stapling across the stomach
and bowel — great variations in tissue may
exist from firing to firing. Moreover, different
procedures present different challenges. While
the sleeve gastrectomy may require fewer steps
and not be as technique intensive as other
stapled bariatric procedures, it does present
challenges due to its thicker tissue transections
and range of tissue thicknesses encountered.
Prior to firing, surgeons inspect and adapt to the
conditions of the tissue. After firing, they inspect
the staple line for the presence of malformed
staples that may call into question the integrity of the staple line. As a result,
extra time may be taken to manage the staple line with the use of any number
of adjunctive devices such as cautery, clips or sutures.
Movement matters
One factor that can contribute to the presence of malformed staples is the unintentional movement of not only the
device but the tissue itself during thick or dense tissue firings. When tissue movement or slippage exists, it can result
in poorly formed and spaced staples as well as the need for extra firings to complete the intended tissue transection
as tissue is pushed or “milked” out the end of the stapler.
Staple malformation
Tissue milking
Whether techniques utilize staples only or include the use of staple line reinforcements (e.g., buttressing material,
sutures), consistently formed staples along the length of the staple line should be the foundation of any secure
seal. The effects of movement and tissue slippage during firing may jeopardize this intended result unless they can
proactively be addressed at the time of firing.
A better grip on movement
Experience the next evolution in stapling
The ECHELON FLEX™ GST System* is uniquely
designed with better grip to provide the least tissue
slippage of any endocutter† for outstanding stapling
performance.
Only the GST System combines the ECHELON FLEX™
Powered Plus Stapler with proprietary Reloads with
Gripping Surface Technology (GST) to give you:
•Uniform closed staple height for exceptional
staple line integrity now across a range of tissue
thicknesses with each reload‡.
The Least Tissue Milking During Firing
AFTER FIRING
5.1mm
Endo GIA™
Reloads with
Tri-Staple™
Technology
•4x less tissue slippage during firing compared to
Endo GIA™ Reloads with Tri-Staple™ Technology for
unsurpassed staple performance§.
­– M
ay eliminate 1 reload per procedure† due to
less tissue slippage during firing.
­– D
elivers a more targeted tissue transection
with each firing¶.
•Exclusive reloads with Gripping Surface
Technology, offering a proprietary ridged surface to
provide an atraumatic grip that holds tissue in place
during firing\\.
The ECHELON FLEX GST System is built on the
stability of a powered firing, allowing 88% less
movement at the end effector** and potentially
less trauma to adjacent tissues.
.65mm
BEFORE FIRING
Ridged surface for
an atraumatic grip\\
on tissue—minimizes
the amount of tissue
slippage
ECHELON
FLEX™
GST System
Exceptional staple
formation built
into each reload
Across
aRange
Range
Tissue
Thicknesses
Across
Across
aaRange
of
ofof
Tissue
Tissue
Thicknesses
Thicknesses
THICKEST
THICKESTTISSUE
TISSUE
4.0
4.0
PORCINE TISSUE THICKNESS (mm)
PORCINE TISSUE THICKNESS
(mm)
measured at 8g/mm2 prior to firing
measured at 8g/mm2 prior to firing
By reducing the amount and impact of tissue
slippage through the enhanced design of the
GST System, each reload’s closed staple height
formation reliability now extends across a range
of tissue thicknesses. Whether it is the initial
firings in a sleeve gastrectomy or in the final
firings in the fundus region, each reload is now
designed to handle variation in thicknesses.
With the bariatric procedures commonly
done today, tissue characteristics and the
use of buttressing material may add greater
thicknesses to firings. This surgeon-controlled,
powered stapling system provides exceptional
staple formation with:
Reliable
Staple
Formation
Reliable
Reliable
Staple
Staple
Formation
Formation
•Reload: Proprietary combination of Gripping
Surface Technology, stronger internal
components and redesigned staple geometry
mitigate the amount and effect of tissue
slippage during firing.
3.5
3.5
3.0
3.0
2.5
2.5
2.3mm
2.3mm
_________
_________
2.0
2.0
1.8mm
1.8mm
_________
_________
GREEN
GREEN
GST60D
GST60D
1.0mm
1.0mm
_________
_________
GOLD
GOLD
GST60B
GST60B
BLUE
BLUE
.5.5
GST60W
GST60W
THINNEST
THINNESTTISSUE
TISSUE
WHITE
WHITE
00
Tissue
Tissuecomfortably
comfortablycompressed
compressedtotoclosed
closedstaple
stapleheights
heights
across
acrossa arange
rangeofoftissue
tissuethicknesses.
thicknesses.
©2014
©2014
Ethicon,
Ethicon,
Inc.
Inc.
AllAll
rights
rights
reserved.
reserved.
020295-140820
020295-140820
†
Less Tissue
Less
TissueMilking
Milking*
Across aaRange
Thicknesses
Across
RangeofofTissue
Tissue
Thicknesses
2.5
mm
3.3 m
m
mm
1. 5 m
m
4.0
6.0
The unique gripping surface technology on each
reload provides a superior tissue grip†† without
additional trauma during firing\\. This means you
can transect more tissue¶ — especially in thick
tissue — with each firing. The increased transection
efficiency may eliminate 1 reload per procedure.†
BLACK
BLACK
GST60G
GST60G
•End Effector: Rigid, closed bottom cartridge
channel minimizes deformation of the
device during firing across a range of tissue
thicknesses.
Transect the tissue
you intended
GST60T
GST60T
1.5mm
1.5mm
_________
_________
1.5
1.5
1.0
1.0
2.0mm
2.0mm
_________
_________
4.5
3.0
1.5
TISSUE SLIPPAGE
(mm per firing)
Endo GIA™ Reloads
with Tri-Staple™
Technology
1.5
3.0
4.5
6.0
TISSUE SLIPPAGE
(mm per firing)
ECHELON FLEX™
GST System
A complete stapling solution for
the least tissue slippage during firing†
The ECHELON FLEX GST System gives you the next evolution in laparoscopic stapling. Built on the
stability of the ECHELON FLEX™ Powered Stapler, this system delivers exceptional tissue handling during
firing to accommodate a range of tissue characteristics faced in bariatric and metabolic procedures.
Contact your ETHICON Sales Professional or visit www.ethicon.com/gst to learn more
about the performance of the ECHELON FLEX™ Powered Plus Stapler and ENDOPATH
ECHELON™ Reloads with Gripping Surface Technology (GST).
ECHELON FLEX™ GST System
* System components include ECHELON FLEX™ Powered Plus Stapler and ENDOPATH ECHELON™ Reloads with Gripping Surface Technology.
† Benchtop testing in porcine stomach tissue. Mean tissue movement from after clamping on tissue to after firing ECHELON FLEX Powered Plus Stapler
(PSEE60A) and ECHELON Reload with GST vs ENDO GIA™ ULTRA Handle (EGIAUSTND) and Endo GIA™ Reload with Tri-Staple™ Technology at 1.5, 2.5, 3.3 and
4.0mm tissue thicknesses (1.5mm; GST60B 1.067mm vs EGIA60AMT 2.452mm p<0.001; 2.5mm: GST60G 1.148mm vs EGIA60AMT 3.261mm p<0.001; 3.3mm:
GST60T 0.642mm vs EGIA60AMT 4.806mm p<0.001; 4.0mm: GST60T 0.654mm vs EGIA60AXT 5.116mm p<0.001).
‡ Porcine tissue thickness measured at 8g/mm2 prior to firing.
§ Benchtop testing in porcine stomach tissue. Mean tissue movement from after clamping on tissue to after firing ECHELON FLEX™ Powered Plus Stapler
(PSEE60A) and ECHELON Reload with GST vs ENDO GIA™ ULTRA Handle (EGIAUSTND) and Endo GIA™ Reload with Tri-Staple™ Technology at 3.3 and 4.0mm
tissue thicknesses (3.3mm: GST60T 0.642mm vs EGIA60AMT 4.806mm p<0.001; 4.0mm: GST60T 0.654mm vs EGIA60AXT 5.116mm p<0.001).
¶ Benchtop testing in porcine stomach tissue. Mean tissue movement from before clamping on tissue to release of tissue after firing ECHELON FLEX™ Powered
Plus Stapler (PSEE60A) and ECHELON Reload with GST vs ENDO GIA™ ULTRA Handle (EGIAUSTND) and Endo GIA™ Reload with Tri-Staple™ Technology at 1.5,
2.5, 3.3 and 4.0mm tissue thicknesses (1.5mm; GST60B 2.835mm vs EGIA60AMT 2.369mm NS; 2.5mm: GST60G 2.864mm vs EGIA60AMT 3.273mm p<0.001;
3.3mm: GST60T 0.897mm vs EGIA60AMT 6.814mm p<0.001; 4.0mm: GST60T 1.415mm vs EGIA60AXT 4.616mm p<0.001).
\\ Based on 10-15 second clamp and release testing on animate preclinical lung and vasculature. Visual comparisons of 40 paired clampings immediately
following, and at 1hr after clamping.
** Benchtop testing on porcine stomach tissue. Surgeons (n=19) fired each instrument/reload once: PSE60A/ ECR60G, 030449/ 030459, and EGIAUSTND/
EGIA60AMT. Median reduction of distal tip motion was 88%, range of reduction was 71% to 95%.
†† Benchtop testing in porcine stomach tissue. Mean peak load required to pull tissue from the clamped jaws of ECHELON FLEX Powered Plus Stapler
(PSEE60A) and ECHELON Reload with GST vs ENDO GIA ULTRA Handle (EGIAUSTND) and Endo GIA Reload with Tri-Staple Technology (GST60B 6.496lbf &
GST60T 7.789lbf vs EGIA60AMT 1.325lbf & EGIA60AXT 1.920lbf, all p<0.001).
Ethicon Endo-Surgery, Inc.
4545 Creek Road
Cincinnati, OH 45242
www.ethicon.com
©2015 Ethicon Endo-Surgery, Inc. All rights reserved. 030235-150225
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