FDA Adverse Event Malfunction Summary report: N

ECHELON*FLEX60 LONG

MDR report key: 2122784 · Received June 14, 2011

Report

Report Number
3005075853-2011-02394
Event Type
Malfunction
Date Received
June 14, 2011
Date of Event
May 18, 2011
Report Date
May 18, 2011
Manufacturer
ETHICON ENDO-SURGERY, LLC.
Product Code
GDW
PMA / PMN Number
K081146
Removal / Correction Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
WI, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

(B)(4). THE ANALYSIS FOUND THAT THE LONG60A DEVICE WAS RECEIVED IN GOOD VISUAL CONDITION AND WITHOUT A RELOAD PRESENT. THE DEVICE WAS TESTED FOR FUNCTIONALITY IN THE ARTICULATED POSITION WITH A TEST CARTRIDGE RELOAD AND IT FIRED, CUT AND FORMED ALL THE STAPLES AS INTENDED. THE CUT WAS NOTED TO BE JAGGED DUE TO A DAMAGED KNIFE. ONE POSSIBLE CAUSE FOR THIS TYPE OF DAMAGE TO THE KNIFE IS WHEN THE DEVICE IS FIRED OVER AN ALREADY EXISTING STAPLE LINE, HARD OBJECT OR THICKER TISSUE THAN INDICATED. REPEATEDLY FIRING ACROSS EXISTING STAPLE LINES CAN ALSO REDUCE THE ABILITY TO CUT CLEANLY. TO MITIGATE THE POTENTIAL FOR STAPLES GETTING INTO THE CARTRIDGE AND INTERFERING WITH THE KNIFE PATH DURING DEVICE FIRING, PRIOR TO RELOADING THE DEVICE, RINSE THE ANVIL AND CARTRIDGE JAW IN STERILE SOLUTION AND THEN WIPE THE ANVIL AND CARTRIDGE JAW TO CLEAN ANY FORMED BUT UNUSED STAPLES FROM THE DEVICE. ADDITIONALLY, PROPER CARE SHOULD BE TAKEN WHEN PLACING THE DEVICE ON THE TISSUE TO BE STAPLED, TO ENSURE THAT NO HARD OBSTRUCTION SUCH AS A CLIP IS INCLUDED WITH THE TISSUE INSIDE THE JAWS. AS PART OF OUR QUALITY PROCESS, EACH DEVICE IS VISUALLY INSPECTED AND FUNCTIONALLY TESTED DURING MANUFACTURING TO ENSURE THAT THE DEVICE MEETS THE REQUIRED SPECIFICATIONS PRIOR TO SHIPMENT.

Description of Event or Problem · 1

IT WAS REPORTED THAT DURING A LAPAROSCOPIC ROUX EN Y PROCEDURE, THE DEVICE WAS FIRED ACROSS THE OPENING OF THE JEJUNUM-JEJUNOSTOMY CLOSING THE ANASTOMOSIS AND THE OUTER ROW OF STAPLES DID NOT FORM SO THE SURGEON HAD TO REMOVE THOSE STAPLES. THE SURGEON OVER SEWED THE OPENING WHICH ADDED TWENTY MINUTES TO THE CASE. AN LTS60A DEVICE WAS USED TO COMPLETE THE PROCEDURE. NO ADVERSE CONSEQUENCES REPORTED. ADDITIONAL FOLLOWUP: BUTTRESSING MATERIAL WAS USED FOR THE FIRST FIRING ON THE JEJUNUM WITH WHITE RELOAD. HOWEVER REP DOES NOT BELIEVE THAT BUTTRESS MATERIAL WAS INVOLVED IN STAPLE LINE WITH UNFORMED STAPLES.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 ECHELON*FLEX60 LONG STAPLE, IMPLANTABLE GDW ETHICON ENDO-SURGERY, LLC. UNK G4U329

Patients

Seq Age Sex Outcome Treatment
1 ECR60W-F4PZ4J