Endovascular Stapler Complications During Minimally Invasive Nephrectomy: An Updated Review of the FDA MAUDE Database From 2009-2019

Urology. 2021 Jul:153:181-184. doi: 10.1016/j.urology.2021.02.010. Epub 2021 Feb 15.

Abstract

Objective: To characterize the rates of endovascular stapler complications during hilar ligation in minimally invasive radical nephrectomy over the last 10 years.

Material and methods: We reviewed the Food and Drug Administration Manufacturer and User Facility Device Experience database from January 1, 2009 to August 1, 2019. Staplers were categorized according to type, namely Ethicon Inc. endocutters (Johnson & Johnson, New Brunswick NJ); Endo-GIA (Medtronic, Minneapolis MN); and Endo-TA (Medtronic, Minneapolis MN).

Results: There were 383 cases of complications involving staplers, 63% with Ethicon endocutters; 28% with GIA; and 9% with TA. 22 deaths (5.7% of total complications) were attributed to staplers. No deaths or reoperations occurred due to TA staplers. TA staplers were also associated with a reduced incidence of conversion to open as compared to Ethicon and GIA staplers. Apart from one device, manufacturer evaluation of returned devices either showed no abnormalities or attributed fault to improper use of staplers.

Discussion: We characterized stapler complications during a 10-year period for minimally invasive radical nephrectomy. No deaths or reoperations occurred due to TA staplers, perhaps due to cutting and stapling occurring in separate steps. Based on manufacturer evaluation attributing stapling malfunctions to human errors, training of operating room staff on proper use of these devices is critical to prevent potentially significant complications from occurring.

MeSH terms

  • Comparative Effectiveness Research
  • Conversion to Open Surgery / statistics & numerical data*
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / instrumentation*
  • Equipment Failure / statistics & numerical data*
  • Equipment Failure Analysis
  • Humans
  • Incidence
  • Minimally Invasive Surgical Procedures / adverse effects
  • Minimally Invasive Surgical Procedures / instrumentation
  • Minimally Invasive Surgical Procedures / methods
  • Needs Assessment
  • Nephrectomy* / adverse effects
  • Nephrectomy* / instrumentation
  • Nephrectomy* / methods
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Postoperative Complications* / prevention & control
  • Surgical Staplers* / adverse effects
  • Surgical Staplers* / classification
  • United States
  • United States Food and Drug Administration / standards
  • United States Food and Drug Administration / statistics & numerical data