A new stapling system developed for minimally invasive surgery (MIS) technologies provides surgeons with real-time feedback and automated responses.

The Medtronic Signia system is a fully powered ambidextrous laparoscopic stapler designed for single-handed use, which allows the surgeon to operate and access all functions and controls with either the left or right hand. Improved ergonomics ensure that the controls are seamless and intuitive, enabling surgeons to open, close, fire, articulate, and rotate the device using just the thumb and fingers of one hand, thus freeing their other hand and allowing them to stay focused on the surgical site.

An innovative feature of the Signia system is adaptive firing technology, which measures the firing force and adjusts the stapler’s speed based on tissue variability measurements, providing consistent staple lines. Feedback at the tissue level is provided via a microprocessor-controlled computer in the device’s handle, which relays the information to an intelligent light emitting diode (LED) screen on the top of the handle. The screen also walks technicians through every step of the setup process, from inserting the power pack into the clamshell and how to fit the adapter.

During stapling, the device provides the surgeon with an initial reading of the force that it took the stapler to clamp down on the tissue, displayed on-screen. Once the thickest zone of tissue is detected, the surgeon has the option to change the reload selection based on that zone. The LED screen also informs users how many times the stapler has been fired, and if a reload has already been used; none of the reloads can be re-fired thanks to a mechanical lockout function.

“In open procedures, surgeons can directly touch the tissue, which provides them with a sense of how they need to interact with it. During laparoscopic procedures, surgeons’ ability to sense the tissue is definitely muted, as they look down a port and up at a screen,” said Ethan Loiselle, senior director of global surgical stapling at Medtronic. “Our aim with adaptive firing technology, and Signia, is to give surgeons back the direct knowledge of tissue open procedures provide.”

“In my experience to date, I believe the articulation, rotation, and firing of the Signia system provides an important new option in the performance of minimally invasive surgical procedures,” said Dana Portenier, MD, of Duke Regional Hospital (Durham, NC, USA). “Its ability to provide the surgeon with helpful data and real-time response has the potential to contribute to more informed surgical decision-making.”