Endoscopic Surgical Stapler Cartridge Usage Guide

In modern surgery, staplers have become essential instruments in gastrointestinal, thoracic, urology, gynecology, and bariatric & metabolic surgery. Compared with traditional hand suturing, staplers offer significant advantages in efficiency, stability, and tissue handling consistency, which is why they are increasingly used in laparoscopic and robotic procedures. However, in real clinical practice, a very practical question remains: how many cartridges are required for different procedures, and how should cartridge colors be selected? These decisions directly affect surgical workflow and consumable management.

Based on clinical experience, different cartridge colors correspond to different tissue thickness ranges. White cartridges are typically used for extremely thin tissues, such as lung tissue or delicate vascular structures. Blue cartridges are commonly used for thin tissues, such as standard gastrointestinal tissue thickness. Gold cartridges are suitable for medium-thickness tissues, such as parts of the stomach wall or ileum. Green cartridges are used for thicker tissues, such as hypertrophic colon or high-tension tissue areas. Black cartridges are mainly designed for very thick tissues, such as high-BMI patients or significantly thickened tissue structures. This classification system has become an important intraoperative reference for rapid decision-making.

In gastrointestinal surgery, staplers are used relatively frequently. For procedures such as partial gastrectomy, distal gastrectomy, and total gastrectomy, surgeons typically select combinations of blue and gold cartridges depending on tissue thickness. The total cartridge usage per case generally ranges from 2 to 6 units. In procedures such as radical colectomy or ileocolic anastomosis, due to variations in intestinal diameter and thickness, blue and green cartridges are often used alternately, with a typical total usage of around 3 to 5 units. With advances in minimally invasive techniques, segmental transection and multi-step reconstruction have made cartridge use more refined, rather than bulk application.

In bariatric and metabolic surgery, stapler usage is more concentrated. In sleeve gastrectomy, due to significant variation in gastric wall thickness, gold or even green cartridges are commonly used for multi-segment transection, with typical usage ranging from 4 to 6 cartridges per case. In gastric bypass procedures, which involve gastric pouch creation and intestinal reconstruction, alternating use of blue and gold cartridges is common, with total usage typically around 5 to 7 units. In complex or revisional surgeries, due to adhesions and uneven tissue thickness, green or black cartridges may also be required, increasing overall consumable demand.

In thoracic surgery, staplers are primarily used for lung tissue transection and lobectomy. Since lung tissue is relatively thin, white and blue cartridges are the main choices. In lobectomy or segmentectomy procedures, approximately 3 to 5 cartridges are typically required. In mediastinal tumor resections or esophageal surgeries, where anatomical structures are more complex and close to major vessels, cartridge selection must be more cautious, usually relying on blue and gold cartridges, with usage ranging from 2 to 6 units.

In gynecological surgery, procedures such as total hysterectomy or myomectomy involve relatively consistent tissue thickness, making blue cartridges the most commonly used option, with gold cartridges occasionally used in more complex cases. Overall, cartridge usage per procedure typically ranges from 1 to 4 units. In more complex pelvic surgeries, such as lymph node dissection, usage may increase due to more intricate anatomical layers.

In urological surgery, procedures such as radical prostatectomy, partial cystectomy, and partial nephrectomy are key applications of staplers. Due to the deep pelvic space and complex anatomy, blue and gold cartridges are commonly used in combination, with typical usage ranging from 2 to 5 units. In renal reconstruction or ureteral procedures, greater precision is required, and overall usage tends to be lower.

Overall, the use of staplers is shifting from experience-driven selection to tissue-driven decision-making. In the past, surgeons often relied on a fixed cartridge type for a given procedure, but today, more surgeons adjust cartridge selection dynamically based on tissue thickness, tension, and patient BMI differences. With the widespread adoption of laparoscopic and robotic surgery, segmental transection and refined reconstruction have increased, leading to a slight rise in cartridge usage per case, while overall safety and controllability have also improved.

It is important to emphasize that there is no absolute standard for cartridge selection. Different hospitals, surgeons, and patient conditions all influence final decisions. This guide is intended as a clinical reference based on common practice patterns, mainly for preoperative planning and consumable preparation rather than strict procedural rules.

From a broader perspective, the evolution of surgical staplers is shifting from simply “achieving closure” toward “optimizing tissue management,” and cartridge selection itself is becoming an integral part of surgical precision management.