About the changes proposed by Dr. Santoro to improve the safety of stapling, I agree that they could promote hemostasis and sealing of stapling in procedures such as sleeve gastrectomy.

As discussed in my article published in Obesity Surgery [1], my model of "asymmetrical stapler", proposes a cut lateral to apply more rows of staples in the gastric remnant and less in the resected stomach. Thus, not only could create models 4 × 2 rows of staples, but also of 5 × 1 or even 3 × 1 models could be created; smaller intruments but equally safe than current. This is therefore a “functional design”, which can be applied to all fields of resective surgery and would be perfectly compatible with the other improvements such as the system of different sizes of staples, biomaterials and so on. I am pleased to see that Dr. Santoro has already thought of this new concept before [2] and match the opinion of other experts consulted by me. I hope that the medical industry can incorporate this change in the coming years.