{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T16:39:37Z","timestamp":1793291977854,"version":"4.5.0"},"reference-count":18,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T00:00:00Z","timestamp":1767139200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Laparoendoscopic &amp; Advanced Surgical Techniques"],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Sleeve gastrectomy has become the most commonly performed bariatric procedure worldwide, yet staple line complications including bleeding and leakage remain significant concerns. The EnDrive Zero stapler features an innovative 4 \u00d7 2 configuration with B-Duo reinforced design, theoretically offering superior mechanical integrity and enhanced hemostasis compared with conventional staplers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Fourteen pigs underwent laparoscopic gastric stapling using either the EnDrive Zero test device (n = 6) or a conventional control stapler (n = 6). Gastric stapling was performed along the greater curvature under acute hypertension induced by epinephrine (8 \u03bcg\/kg) to simulate demanding clinical conditions. Primary outcomes included intraoperative hemostasis scores, staple line integrity, and\n                      <jats:italic toggle=\"yes\">ex vivo<\/jats:italic>\n                      burst pressure testing. Animals were followed for 28 days with comprehensive clinical, hematological, and histopathological evaluation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Both devices achieved excellent hemostatic control with no significant differences in bleeding scores (stomach vessels: 2.3\u2009\u00b1\u20090.8 versus 1.7\u2009\u00b1\u20090.8,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .183; gastric tissue: 1.3\u2009\u00b1\u20090.5 versus 1.1\u2009\u00b1\u20090.4,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .552). All animals survived 28 days without adverse events, demonstrating 100% anastomotic success and complete healing. However,\n                      <jats:italic toggle=\"yes\">ex vivo<\/jats:italic>\n                      burst pressure testing revealed significantly superior mechanical integrity for the test device (251.3\u2009\u00b1\u200915.6 mmHg versus 226.3\u2009\u00b1\u200916.3 mmHg,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .013), representing an 11% improvement. Histopathological examination showed minimal tissue reactivity in both groups with no significant differences.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The EnDrive Zero 4 \u00d7 2 stapler demonstrated hemostatic performance equivalent to conventional staplers while providing significantly superior mechanical strength in gastric stapling. This enhanced burst pressure, combined with the theoretical hemostatic advantages of four-row stapling, may offer additional safety margins against both bleeding and leak complications in sleeve gastrectomy, warranting clinical investigation in bariatric surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10926429251406036","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T16:54:45Z","timestamp":1767113685000},"page":"47-51","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["A Novel 4 \u00d7 2 Stapling System for Sleeve Gastrectomy: Enhanced Mechanical Integrity and Hemostatic Performance in a Porcine Model"],"prefix":"10.1177","volume":"36","author":[{"given":"Cristobal","family":"Davanzo","sequence":"first","affiliation":[{"name":"Department of Surgery - Cl\u00ednica IST Lo Curro, Instituto de Seguridad del Trabajo, Santiago, Chile."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Carandina","sequence":"additional","affiliation":[{"name":"Department of Surgery ELSAN, Clinique Saint Michel, Toulon, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariano","family":"Palermo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Centro CIEN-Diagnomed, University of Buenos Aires, Buenos Aires, Argentina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Iannelli","sequence":"additional","affiliation":[{"name":"Department of Surgery ELSAN, Clinique Saint Michel, Toulon, France."},{"name":"Universit\u00e9 C\u00f4te d\u2019Azur, CNRS, Inserm, Institut de Biologie Valrose (iBV), Nice, France."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,31]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-015-1657-z"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-011-2085-3"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.soard.2011.10.019"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.soard.2009.06.001"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1381\/0960892042583888"},{"key":"e_1_3_5_7_2","first-page":"305","article-title":"Surgical stapling device-tissue interactions: What surgeons need to know to improve patient outcomes","volume":"7","author":"Chekan EG","year":"2014","unstructured":"Chekan EG, , Whelan RL. Surgical stapling device-tissue interactions: What surgeons need to know to improve patient outcomes. Med Devices (Auckl), 2014; 7:305\u2013318.","journal-title":"Med Devices (Auckl)"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0300985811402846"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.soard.2012.02.003"},{"issue":"10","key":"e_1_3_5_10_2","first-page":"1616","article-title":"Mechanical stapler in bariatric surgery: Efficacy and safety of a novel device","volume":"13","author":"Milone M","year":"2017","unstructured":"Milone M, , Manigrasso M, , Burati M, et al. Mechanical stapler in bariatric surgery: Efficacy and safety of a novel device. 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