<p>Clinical Outcomes And Cost-Effectiveness Of Different Staplers For Lung Lobectomy With Video-Assisted Thoracic Surgery</p>

Abstract

The aim of this study was to compare intra-operative adverse events (AE), postoperative outcomes, and costs of three different types of Echelon staplers (manual activated SC45A and electrical power-activated PSE45A & PSEE60A) used during video-assisted thoracic surgery (VATS) for lung lobectomy. Patients and methods: We carried out a retrospective chart review of patients undergoing VATS lobectomies using one of three staplers (SC45A, PSE45A, or PSEE60A) during a 2year period at our institution. We compared intra-operative AEs, post-operative outcomes (drainage volume, chest tube duration, prolonged air leaks [PALs]), endoscopic product costs [ECs], and hospitalization costs [HCs]) amongst the three stapler groups. Results: In all 204 peripheral lung cancer patients were included in the study (95 in the SC45A group, 72 in the PSE45A group, and 37 in the PSEE60A group). We observed intraoperative AEs in 6 patients of the SC45A group, in 4 of the PSE45A group, and in 1 of the PSEE60A group (P>0.05). Drainage volumes among the three groups were similar. The mean chest tube duration was shorter]st in the PSE45A group followed by those in the PSEE60A and SC45A groups (P<0.05). PALs were lowest in the PSE45A group and highest in the SC45A group (P<0.05). The mean EC in the PSEE60A group was significantly higher than those in the other two groups (P<0.05). We found no statistically significant differences in terms of HCs among groups. Conclusion: The three endoscopic staplers had similar incidences of intra-operative AEs when used for lobectomy with VATS. Use of the PSE45A stapler was associated with the shortest chest tube duration and least PALs, while use of the PSEE60A resulted in the highest EC rate.

Cost-effectiveness evaluation of powered staplers in video assisted thoracoscopic lung resection procedures

“…The advantages of VATS have been well documented in the literature (3,(8)(9)(10)(11)(12). Given the increasing prevalence of VATS, particularly in lung cancer treatment, staplers are now becoming one of the key enabling technologies.…”

“…The peri-operative e cacy of staplers in VATS lobectomies was measured by PAL rates reported in a published clinical study. A head-to-head comparison of PAL rates among one type of MES and two types of PES was reported by Xiao et al in 2019 (3). The outcomes reported by Xiao et al were based on retrospective study of VATS lobectomy surgeries performed by a single surgeon in a large tertiary hospital in China.…”

“…Video-assisted thoracoscopic surgery (VATS) was introduced in the early 1990s as a minimally invasive, alternative approach to open thoracotomy surgery. The VATS approach provides advantages such as a shorter duration requiring a chest tube during operation, fewer complications, less postoperative pain, and similar clinical results for tumor eradication when compared with traditional thoracotomy (3). VATS is currently established as the preferred approach for surgical resection of early-stage lung cancer and has been recommended by the American College of Chest Physicians (ACCP), the National Comprehensive Cancer Network (NCCN), and the European Society for Medical Oncology (ESMO) (4).…”