Complications of Bronchial Stapling in Thoracic Surgery

Yano, Motoki; Yokoi, Kohei; Numanami, Hiroki; Ohde, Yasuhisa; Sugaya, Masakazu; Narita, Kentaro; Chihara, Koji; Matsushima, Yasushi; Kobayashi, Ryo; Hikosaka, Yu

doi:10.1007/s00268-013-2292-2

Cited by 21 publications

(16 citation statements)

References 25 publications

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“…Postoperative bleeding requiring a reoperation after a VATS procedure is reported to be 0.6% [1] and surgical devices are often responsible [2][3][4][5]. An endostapler is one of the most essential devices for a VATS and could cause parenchymal injury by the direct contact of the reinforced materials [3,6] or tip of the stapler itself [2,5]. However, the delayed bleeding due to the protruding edge of the staple line has not been previously described in the literature.…”

Section: Discussionmentioning

confidence: 99%

Delayed bleeding due to a sharp protruding edge of the endostaplers after a wedge resection of the lung: a case report

2020

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Background: Endoscopic devices often cause device-related surgical morbidities such as postoperative bleeding. Delayed bleeding due to a protruding edge of an endostapler has not been previously described in the literature. Case presentation: An 80-yr-old man with a second primary lung cancer underwent a wedge resection of the right lower lobe. He developed sudden hypotension and massive bleeding from the chest tube 4 h after the surgery and underwent an emergency reoperation. A torn parietal pleura was found to have caused a persistent bleeding. There was a sharp protruding edge created by multiple firings of the endostapler. The subsequent lung expansion would have promoted a direct contact between the edge and parietal pleura resulting in delayed bleeding. Conclusions: A protruding edge due to multiple firings of an endostapler could injure the parietal pleura and cause delayed bleeding after a lung resection. This type of injury would be more common in wedge resection cases because of the larger residual lung volume preserved, which is expected to have a better lung expansion and facilitate the direct contact of the staple line and parietal pleura.

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Section: Discussionmentioning

confidence: 99%

Delayed bleeding due to a sharp protruding edge of the endostaplers after a wedge resection of the lung: a case report

2020

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“…Issues with abrasion and concomitant bleeding complications have been reported when using staple line reinforcements. 18,19 In this study, we examined the potential for abrasion and compared the novel buttress to a commercially available product without a history of increased abrasion or bleeding. EER was found to be non-inferior to GSG, with no evidence of marked abrasion and a lower rate of moderate abrasion.…”

Section: Discussionmentioning

confidence: 99%

<p>A Novel, Easy-to-Use Staple Line Reinforcement for Surgical Staplers</p>

Wong¹,

Henninger²,

Clymer³

et al. 2020

MDER

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Background: Staple line reinforcement (SLR) is a popular tool used by surgeons to increase staple line strength and improve peri-operative hemostasis. However, currently marketed buttress materials require special attention in attachment to the staple anvil and cartridge and may come loose during typical maneuvering of stapling procedures. We have evaluated a new SLR that has an attachment material that affixes buttress across the entire anvil and cartridge face to prevent slipping, twisting, sliding and/or bunching. Methods: In benchtop and preclinical testing, the new buttress material (ECHELON ENDOPATH™ Staple Line Reinforcement) was compared to a commercially available SLR for physical characteristics, including strength, absorption, security on the anvil and cartridge during stapler manipulation, impact on the tissue healing response and tissue abrasion. The two SLR's were also compared to a staple line without buttress for hemostasis. Results: The new SLR was 180% stronger initially and maintained a greater strength for up to 14 days of exposure to an in vitro solution (p≤0.001), even though it was lighter and exhibited a faster rate of degradation. The new buttress material maintained complete adherence to the anvil and cartridge throughout tissue manipulation, whereas the commercial product lost substantial coverage in 72% of samples. Both SLR's provided superior hemostasis to the non-buttress control, with minimal impact on tissue healing or abrasion. Conclusion: Because the new buttress material comes with attachment material affixed across the entire anvil and cartridge face of the stapler and maintains coverage during manipulations, it should be much easier to use. The physical characteristics of the new SLR were as good as or better than current product that requires the buttress to be applied to the cartridge and anvil. In addition, the new SLR is similar in hemostasis to standard products and superior to stapling without the use of buttress. Further research is needed to determine whether these preclinical benefits carry over into a clinical setting.

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“…Today, there is no doubt about their usefulness and convenience, and they are indispensable for operations. However, we can find several reports about complications and unfavorable events associated with staplers [12,13]. Manufacturers continue to invent new devices and make mechanical modifications to existing devices with the objective of improving patient outcomes.…”

Section: Commentmentioning

confidence: 99%