Major Lung Resections Using Manual Suturing Versus Staplers During Fiscal Crisis

Abstract

During fiscal crisis there was a period of shortage of staplers in our hospital, which drove us to manual suturing of bronchi and pulmonary vessels during major lung resections. We present our experience during that period in comparison to a subsequent period when staplers became available again. A total of 256 lobectomies and 78 pneumonectomies using manual suturing (group A) were performed between September 2009 and September 2010, and were compared regarding surgical outcome with 248 lobectomies and 60 pneumonectomies using staplers (group B), performed between September 2011 and September 2012. Although we did not observe statistically significant differences but only a trend toward shorter operative time, for both lobectomies (P ¼ 0.21) and pneumonectomies (P ¼ 0.31) we actually noted savings of 41 and 47 minutes, respectively, in operative time using staplers (group B), in comparison with manual suturing (group A). We also observed a trend toward lower morbidity rates in group B patients who underwent lobectomy (10.48%) and pneumonectomy (20%) versus group A patients who underwent lobectomy (15.62%) and pneumonectomy (30.76%); we did not observe any substantial differences in the other surgical outcome variables, in patients' demographic, comorbidities, or in anatomic allocation of surgical procedures performed. The use of staplers offers safety with secure bronchial or vascular sealing, as well as reduction of operative time. Their unavailability at an interval during fiscal crisis, although it did not affect surgical outcome, revealed their usefulness and value.

Bronchopleural Fistula after Pulmonary Resection: Risk Factors, Diagnoses and Management

“…The preferred technique of pulmonary hilum vessel ligation and bronchial stump closure has troubled thoracic surgeons for years. In 1909, regarding bronchial stump closure, Meyer advised his inversion technique [29]. In 1945, Sweet described the longitudinal, single interrupted silk suture closure [29,30].…”

“…In 1909, regarding bronchial stump closure, Meyer advised his inversion technique [29]. In 1945, Sweet described the longitudinal, single interrupted silk suture closure [29,30]. Dr. Mark Ravitch started using staplers in the United States in 1964 after having observed their early development in Russia [29].…”

“…In 1945, Sweet described the longitudinal, single interrupted silk suture closure [29,30]. Dr. Mark Ravitch started using staplers in the United States in 1964 after having observed their early development in Russia [29]. In 1970, Kirksey reported 147 patients who underwent pulmonary resection with disposable and plastic American staplers called Thoraco-Abdominal (TA) [29].…”

“…Dr. Mark Ravitch started using staplers in the United States in 1964 after having observed their early development in Russia [29]. In 1970, Kirksey reported 147 patients who underwent pulmonary resection with disposable and plastic American staplers called Thoraco-Abdominal (TA) [29]. Reluctance to use vascular staplers due to fear of fatal hemorrhage because of malfunction continued the debate concerning pulmonary hilum vessel manual ligation versus stapled division for many decades [29].…”

“…In 1970, Kirksey reported 147 patients who underwent pulmonary resection with disposable and plastic American staplers called Thoraco-Abdominal (TA) [29]. Reluctance to use vascular staplers due to fear of fatal hemorrhage because of malfunction continued the debate concerning pulmonary hilum vessel manual ligation versus stapled division for many decades [29]. The cessation of the alarm resulted after Asamura et al, in 2002 published results of 842 vascular divisions using endoscopic staples with 0.1% incidence of stapling failure and Yano et al, in 2013 reported 3393 pulmonary vein and artery stapling uses with a failure rate of only 0.27% [29].…”