Preclinical quantification of air leaks in a physiologic lung model: effects of ventilation modality and staple design

Abstract

PurposeThoracic air leaks are a common complication following pulmonary resections. Limitations in clinical studies and preclinical models have hindered efforts to understand the pathophysiology of air leaks. With an emphasis on staple-line specific air leaks, we hypothesize that ventilation modality – intraoperative positive pressure vs postoperative negative pressure – and stapler design may play a role in air leaks.MethodsUsing a novel physiologic lung model, air leaks associated with graduated and uniform staple designs were evaluated under positive and negative pressure ventilation, simulating perioperative breathing in porcine lungs. Air leak incidence, air leak volume, and air leak rate were captured along with ventilation pressure and tidal volume.ResultsIn all cases, negative pressure ventilation was associated with a higher occurrence of leaks when compared to positive pressure ventilation. Lungs leaked more air and at a faster rate under negative pressure ventilation compared to positive pressure ventilation. Graduated staple designs were associated with higher occurrence of leaks as well as larger leak rates when compared to uniform staples. Tissue thickness was not associated with differences in air leaks when tested with appropriate staple heights.ConclusionUsing a novel lung model to investigate the pathophysiology of air leaks, we have identified breathing modality and staple design as two important variables that may impact air leaks. This work will help guide device design and drive future studies in human tissue, and it may help inform clinical practice to ultimately improve patient outcomes.

Air leaks: stapling affects porcine lungs biomechanics

“…state, which is compatible with the relatively high compliance (more flexible to deformation) of the two specimens(4…”

“…To do so, a surgical stapler squeezes tissue around the tumor to cut and seal the healthy tissue from the tumor bearing one. After chest surgery, 28-60% of patients suffer from air leaks [1]- [4]. Patients routinely require a chest tube (drain) until the leak resorbs [2], [5], which results in longer hospital stays and increased care costs [6].…”

“…[2] as "air escaping the lung parenchyma into the pleural space after any kind of surgery in the chest". However, very few ex vivo studies described the origin of the leak [2], [4], [7]- [10]. Imhoff et.…”

Double stapling method for closure of intraoperative alveolar air leakage adjacent to the staple line: a randomized experimental study on ex vivo porcine lungs

“…The third limitation is the extrapolability of this ex vivo porcine lung experiment to clinical practice. Although this model is well established for assessing air leakage (12,(20)(21)(22), we could not assess the long-term results of the double stapling method or its efficacy on emphysematous lungs in this model. These assessments will be the subject of future clinical research.…”

Prolonged Air Leak After Lung Resection

“…Д лительное просачивание воздуха по плевральным дренажам после различных резекций легких является наиболее частой проблемой, осложняющей течение послеоперационного периода и удлиняющей сроки реабилитации пациентов [1,2]. Это проявляется в виде увеличения сроков расправления легкого, утяже-ления и удлинения стационарного послеоперационного периода [3,4].…”