You have accessJournal of UrologyBladder Oncology/Testis/Transplantation/Trauma1 Apr 2015V8-12 MALFUNCTION OF LINEAR CUTTING STAPLER IN KIDNEY SURGERY Rene Sotelo, Erik Castle, Robert De Andrade, Luis Medina, Leonardo Brunacci, Oscar Martín, Igor Kislinger, Nelson Ramírez-Troche, David Canes, Paul Andrews, Camilo Giedelman, and Hernán Aponte Rene SoteloRene Sotelo More articles by this author , Erik CastleErik Castle More articles by this author , Robert De AndradeRobert De Andrade More articles by this author , Luis MedinaLuis Medina More articles by this author , Leonardo BrunacciLeonardo Brunacci More articles by this author , Oscar MartínOscar Martín More articles by this author , Igor KislingerIgor Kislinger More articles by this author , Nelson Ramírez-TrocheNelson Ramírez-Troche More articles by this author , David CanesDavid Canes More articles by this author , Paul AndrewsPaul Andrews More articles by this author , Camilo GiedelmanCamilo Giedelman More articles by this author , and Hernán AponteHernán Aponte More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2136AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Numerous techniques exist for hilar control during laparoscopic and robotic nephrectomy. These include locking polymer clips, titanium clips, and individual or en bloc staple ligation. Staplers are most commonly employed for renal vein division and control. Stapling has proven safe, reproducible, rapid, and secure. Nevertheless, various types of stapler malfunction have been reported in the MAUDE (Manufacturer and User Device Experience) database with a failure incidence of 0.003%. Urologists must be acutely aware of these rare but potentially devastating scenarios. This video summarizes and illustrates various malfunction scenarios, and their proper management. METHODS This video is a multicenter cases collection including 6 videos which exemplify linear cutting stapler failure on both the artery, and vein. Both inciting factors, and techniques for the surgeon to extricate themselves from these terrifying scenarios are depicted. The authors collected their experiences to offer recommendations, technical maneuvers and tips, both to prevent and solve these problems. RESULTS There are two mechanism of action, depending on the brand and stapling mechanism. Some simultaneously staple and cut, others make a complete staple line, followed by cutting. We only present malfunction that occur with the second mechanism. Failures depicted include complete vein or artery transection, cutting failure with incomplete staple line, failure to release from tissue, staple line over a previous clip, as well as an unspecified stapler malfunction. CONCLUSIONS Staplers are frequently used in urologic surgery, however the incidence of malfunction is quite low, so low that a resident may never see a staple malfunction during training. This educational video was therefore made to demonstrate the spectrum of potential types of device malfunctions. We hope that our recommendations serve as a teaching tool to minimize the risk of stapler misuse, and to deal with these dangerous complications. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e719 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rene Sotelo More articles by this author Erik Castle More articles by this author Robert De Andrade More articles by this author Luis Medina More articles by this author Leonardo Brunacci More articles by this author Oscar Martín More articles by this author Igor Kislinger More articles by this author Nelson Ramírez-Troche More articles by this author David Canes More articles by this author Paul Andrews More articles by this author Camilo Giedelman More articles by this author Hernán Aponte More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...