Innovations in Hepatopancreatobiliary Surgery: A Review of LOTUS-BOWA Liver Blade and AEON Endovascular Stapler

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Innovations in Hepatopancreatobiliary Surgery: A Review of LOTUS-BOWA Liver Blade and AEON Endovascular Stapler

Aali Jan Sheen, Jenifer Barrie, Panagiotis Stathakis, Saurabh Jamdar
Manchester University NHS Foundation Trust, Manchester, UK

Innovations in Surgery and Interventional Medicine (ISIM), Marc

65% to 20%
POPF rate reduction
2
Instruments: LOTUS-BOWA + AEON
Zero
Staple line interventions
Key finding: AEON™ was associated with a significant reduction in postoperative pancreatic fistula (20% vs. 65%), lower day-3 drain lipase levels (446 vs. 4,208 U/L), and a shorter hospital stay compared with other staplers.

Abstract

Hepatopancreatobiliary (HPB) remains a high-risk but rewarding specialty. This review introduces two innovative surgical instruments that have shown remarkable efficacy in providing safe liver and pancreatic surgery. Both instruments, the LOTUS-Bowa liver energy blade and the AEON endovascular stapler, are discussed in detail, and their respective technologies are presented with emphasis on why their specific innovative designs demonstrate excellent outcomes in use in HPB transectional surgery. In addition, this review shows data on how their respective functionality and ergonomics are suited to HPB and to other gastrointestinal procedures, such as bariatric surgery. Data from two recently published studies are discussed, showing the effectiveness of the use of the LOTUS liver energy device in liver transectional surgery in comparison to open surgery using a matched propensity score. This study demonstrated no difference in blood transfusion using this energy device compared with traditional open surgery methods (p = 0.348). Comparing the AEON stapler with EndoGIA in pancreatic parenchymal transection undertaken in distal pancreatectomy demonstrated a significant reduction in the fistula rate from 65–20%, as well as showing a more hemostatic staple line requiring no further treatment or intervention. The LOTUS liver blade has promoted an increase in minimally invasive liver transections undertaken with no increase in morbidity. The AEON stapler’s innovative technology has depicted a more secure and hemostatic staple line, especially in use on the pancreatic parenchyma, significantly reducing pancreatic fistula rates.

*Abstract text reproduced from the original publication with attribution to the authors and publisher. All rights remain with the respective copyright holders. Reproduced here for informational and educational purposes in accordance with applicable open-access licensing or fair use principles. For the definitive version, refer to the original publication via the link provided.

Clinical Relevance: This review consolidates the published clinical evidence for two instruments used in HPB transectional surgery. For surgeons evaluating AEON, the paper provides practical context: specific reload selection and anvil tip recommendations organized by procedure type (hepatectomy, Whipple, distal pancreatectomy). The discussion of previously published POPF reduction data in the context of instrument design rationale gives HPB surgeons a framework for understanding why staple formation characteristics may affect outcomes in pancreatic and liver transection.
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