Implementation of a Safe Cost Reduction Strategy for Laparoscopic Sleeve Gastrectomy

Study Overview

A 4-year retrospective quality improvement (QI) study of 638 sleeve gastrectomy cases demonstrates that adopting the easyEndo™ Lite stapler paired with selective use of staple line reinforcement and clip appliers achieves a $1,200+ savings per case versus ECHELON+ and Titan SGS — with no increase in length of stay, reoperation, readmission, or early weight loss failure. Operative time decreased, and 30-day ED visits were lower.Led by Dr. Alan A. Saber (FACS, FASMBS) at Newark Beth Israel Medical Center, a high-volume MBSAQIP-accredited bariatric center in the USA, this research provides real-world evidence that smarter device selection delivers meaningful cost reduction without compromising safety.

Published in JSLS, January–March 2026, a peer-reviewed journal with over 1.5 million annual downloads, widely recognized in the field of minimally invasive surgery.

Study Design

The study was conducted at a single, high-volume, MBSAQIP-accredited center and included 638 primary LSG cases performed between January 2020 and June 2024 (approximately four years). The team applied a Plan–Do–Study–Act (PDSA) QI framework to implement and measure sequential workflow changes. Three stapling platforms and usage strategies were compared across the cycles:

• Cycle 1 (Baseline): stapler E, Brand J, routine staple-line buttressing, routine clip applier opened

• Cycle 2: switch to a single-fire stapler (stapler T, Brand S) to reduce reload variability

• Cycle 3: switch to easyEndo™ Lite stapler platform, disposable minimization pathway (shorter staple heights preferred when appropriate; selective reinforcement; selective clip applier)

Direct Cost Comparison by Stapler Platform:

Key Findings

The final cycle demonstrated meaningful per-case savings without evidence of a safety trade-off:

• Cost reduction: $1,283 saved per case versus baseline (95% CI $1,216–$1,351; P < .001)

  
  

• No significant differences in quality signals: no meaningful differences were observed across cycles in length of stay, 30-day readmission, reoperation, or short-term weight-loss metrics

  
  

• OR efficiency improvement: the final cycle was associated with an approximately 11-minute reduction in OR time versus baseline

  
  

• Material-use reduction (drivers of savings):

                Clip appliers: required in only ~20% of cases in the final cycle (avoided in ~80%)

                Reinforcement: omitted in ~50% of final-cycle cases

Overall, the findings suggest that standardization and selective disposable use—when implemented and monitored through a QI framework—can produce measurable economic impact without degrading key short-term outcome measures.

The Role of easyEndo™ Lite in Enabling Strategy Execution

In the final PDSA cycle, easyEndo™ Lite was implemented as part of a bundled pathway intended to make cost reduction operationally reliable at the team level. The final-cycle approach paired: support for shorter staple height selection (with 1.5/1.0 mm preferred when appropriate), and a selective-use strategy for reinforcement and clip appliers.

easyEndo™ Lite enabled this cost-reduction strategy through two key features: shorter staple heights (1.5/1.0 mm) that reduce bleeding risk, and a lower unit cost that amplifies savings at scale. Combined with a selective-use protocol, the team was able to save 50% reinforcement and 80% clip appliers usage — turning "reduce waste safely" into repeatable daily practice.

Clinical Perspective

The study confirms that cost reduction and patient safety are not trade-offs. With structured workflows and outcome tracking, the final cycle achieved lower costs, shorter OR time, and a 52% reduction in 30-day ED visits — demonstrating that optimizing device utilization improves both economics and care quality.

Industry Significance

This work provides a real-world reference for bariatric programs seeking to advance value-based surgery. It demonstrates that substantial OR disposable savings can be achieved through pathway standardization and selective disposable use, with maintained short-term outcomes and potential gains in OR efficiency—offering an actionable direction for bariatric centers worldwide facing similar cost and reimbursement pressures.

While limited by its retrospective, single-center design, this study reinforces a key principle of value-based surgery: cost efficiency is best achieved through thoughtful device selection and judicious adjunct use—not by compromising surgical technique or patient safety. For high-volume bariatric programs, Lite stapling platforms may represent a practical and scalable pathway to sustainable cost containment.

Source:

Mu SZ, El-Matbouly M, Lopez HM, Saber AA. Implementation of a Safe Cost Reduction Strategy for Laparoscopic Sleeve Gastrectomy. JSLS (Journal of the Society of Laparoendoscopic Surgeons), 2026; Vol. 30, Issue 1. DOI: 10.4293/JSLS.2025.00099