Mechanical and Conventional Manual Sutures of the Bronchial Stump.A Comparative Study of 298 Surgical Patients

Abstract

A U.S.-made TA-30 model stapling device was utilized to close the bronchial stump in 146 patients, while conventional manual suturing with chromic catgut was performed for the same purpose in 152 patients. The two groups were comparable in respect of pre-operative status and operative diagnosis. Patients, in whom the stapler was utilized, showed a decreased incidence of bronchial fistula (1% vs. 3%) and empyema without fistula (1% vs. 3%). The stapler, compared with conventional manual sutures, allows a simpler and swifter suture of the bronchial stump, reduces the contamination of the operative field, achieves uniform and tighter closure of the bronchus, leaves a better preserved terminal blood perfusion of the stump and utilizes a more tolerated sewing material with less resultant tissue inflammation.

Estudo comparativo entre a resistência das suturas manual e mecânica do coto brônquico em cães submetidos a pneumonectomia esquerda

“…(23) Approximately one decade later, the Americans at the U.S. Surgical Corporation manufactured the Auto Suture TA models, which are currently the most widely used. (15,23) The advantages reported are the reduced dissection of the bronchus, the symmetry of the staples, the evenness of the tension on the bronchial tissue, the minimal granulomatous reaction, the increased speed of execution, and the radiographically visible suture line. (15,23) In addition, staplers reduce surgical time and are easy to handle.…”

“…(15,23) The advantages reported are the reduced dissection of the bronchus, the symmetry of the staples, the evenness of the tension on the bronchial tissue, the minimal granulomatous reaction, the increased speed of execution, and the radiographically visible suture line. (15,23) In addition, staplers reduce surgical time and are easy to handle. (15,23) However, there are certain disadvantages related to the high cost of the staplers, the inability to visualize the lumen of the stump, and the possible devitalization due to the excessive pressure of the staples.…”

“…(4,6,14,15) It is accepted that, although mechanical suture is safe, easily performed, and rapid, it is not totally free of complications. However, no statistically significant difference has been found between manual mechanical sutures.…”

Adverse Events of Lung Tissue Stapling in Thoracic Surgery

“…1) As the staplers became more sophisticated, the use of staplers has been widely accepted and regarded as a safe procedure. 2,3) Now the widespread use of video-assisted thoracic surgery (VATS) is supported by the frequent use of staplers. However, sometimes stapling failure or other adverse events (AEs) of stapling are experienced.…”

Adverse Events of Stapling in Thoracic Surgery: Relations between an Incidence of Adverse Events and a Stapling Volume

“…1,2) As the staplers became more sophisticated, the use of staplers has been widely accepted and regarded as a safe procedure. 3,4) Now, the widespread use of videoassisted thoracic surgery (VATS) is supported by the frequent use of staplers. However, sometimes stapling failure or other adverse events (AEs) of stapling are experienced.…”