A step forward in stapling: pilot evaluation of a novel asymmetric stapler in sleeve gastrectomy

Background: Staple line bleeding remains a common intraoperative challenge in sleeve gastrectomy (SG), despite advancements in stapling technology. Traditional staplers deliver symmetrical rows of staples on both sides of the tissue, potentially compromising hemostasis on the retained gastric tube side. Methods: This prospective pilot study evaluated the Powered Endoscopic Stapler Endrive Zero, a novel 4+2 asymmetric stapler delivering four staple rows on the gastric tube side and two on the resected side, in 210 patients undergoing laparoscopic SG. No reinforcement materials, oversewing, or glues were used. Results: No intraoperative or postoperative bleeding events occurred. The mean number of hemostatic clips used was 1.3, with 68% of patients requiring none. No complications, readmissions, or reinterventions were observed at the 30-day follow-up. Pain scores at 24 hours averaged 3.1 (standard deviation ± 1.2), and mean opioid use was 3.75 mg morphine equivalent. All patients were discharged within 26 hours. Conclusion: In this pilot, hypothesis-generating study, the Endrive Zero stapler was associated with excellent intraoperative hemostasis and favorable short-term outcomes without reinforcement. Indirect benchmarking is exploratory; the 95% confidence interval (0.00–1.76%) does not exclude bleeding, so these single-arm, high-volume–center results require prospective, controlled confirmation and do not establish superiority.