The utility of the Stapler with PGA sheet for pulmonary wedge resection: a propensity score-matched analysis

Shigeeda, Wataru; Deguchi, Hiroyuki; Tomoyasu, Makoto; Kaneko, Yuka; Kanno, Hironaga; Tanita, Tatsuo; Saito, Hajime

doi:10.21037/jtd.2019.03.05

Cited by 13 publications

(16 citation statements)

References 22 publications

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“…The second limitation is the selection of surgical devices in this study. We generally use buttressed staplers for fragile lungs at our institution based on previous studies reporting its efficacy for preventing air leakage (7)(8)(9)(10). We sutured the lung parenchyma with 2-0 non-absorbable monofilament sutures, such as Surgipro.…”

Section: Discussionmentioning

confidence: 99%

“…Interlobar fissures dissected with electrocautery or scissors, and dissected areas from pleural adhesions to the chest wall are frequent sites of alveolar leakage during lung surgery. On the other hand, the air leakage adjacent to the staple lines after wedge resection is a challenging air leakage in terms of intraoperative closure (6)(7)(8)(9)(10). After closing the pleural defect by conventional suturing with the pledget method, the visceral pleura occasionally tears from the needle holes due to tension around the staple line.…”

Section: Introductionmentioning

confidence: 99%

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

Suzuki¹,

Asakura²,

Egawa³

et al. 2022

J Thorac Dis

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Background: Alveolar air leakage from a pleural defect around the staple line is one of the complications after wedge resection of the lung. An intraoperative closure of the pleural defect by suturing can cause additional pleural rupture due to tension of the pleura adjacent to staple lines. Therefore, we have introduced a novel closure method for pleural defect adjacent to the staple line, named the double stapling method. This study compared the efficacy of two closure methods; the double stapling method and conventional suturing method with pledgets using ex vivo porcine lungs. Methods:The double stapling method involves closing the pleural defect by suturing the two parallel staple lines at both sides of the pleural defect. This method was developed to distribute the pleural tension around the needle holes of suturing. As a model of pleural defect adjacent to the staple line after wedge resection, wedge resection of the caudal lobe of left porcine lungs was performed, and a superficial square pleural defect (10 mm × 10 mm) adjacent to the staple line was made by scalpel. The defect was closed using the following two methods: (I) suturing with pledgets (n=10); and (II) double stapling method (n=10). The lobe was inflated in water at an airway pressure of 20, 25, and 30 cmH 2 O; closure success or failure was judged by the absence or presence of air leakage. Results:The closure success was confirmed in 2 (20%) out of 10 cases in the suturing with pledgets group and 9 (90%) out of 10 in the double stapling method group (P=0.007). In 4 out of 10 cases in the suturing with pledgets group, new pleural clefts longer than 3 mm were created around the needle holes of suturing. Conclusions:Ex vivo experiments have suggested the superiority of the double stapling method for the intraoperative closure of alveolar air leakage adjacent to the staple line after wedge resection, compared to conventional suturing with the pledget method.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Suzuki¹,

Asakura²,

Egawa³

et al. 2022

J Thorac Dis

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“…Recently, a commercial stapler preloaded with a fixed PGA felt (Endo GIA TM , Medtronic, Minneapolis, MN; Neoveil, Gunze Medical, Osaka, Japan) was available with superior sealing performance to reduce prolonged postoperative air leakage from the staple lines after pulmonary resection [ 18 ]. Furthermore, Nakano et al presented their initial experiences that endoscopic plombage with PGA sheets and fibrin glue could be a promising therapeutic option for GI fistulas [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic Repair of Adult-Onset Congenital Tracheoesophageal Fistula Using a Polyglycolic Acid Sheet-Buttressed Stapler

2022

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Congenital tracheoesophageal fistula (TEF) without esophageal atresia is usually diagnosed and treated in the neonatal period. It is uncommon to occur in adulthood. Conventional treatment of adult-onset TEF involves repair by either cervicotomy or thoracotomy. We reported the case of a 31-year-old male patient with clinical and radiographic evidence of congenital H-type TEF. Although this fistula was located at the level of the second thoracic vertebra, the repair of the anomaly was performed successfully using a thoracoscopic approach with the novel use of a polyglycolic acid sheet reinforcement.

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“…Different materials have different effects on complication rates; a meta-analysis of reinforcement methods found, for example, that of four materials compared, only fibrin glue and buttressing significantly reduced the odds of developing PAL, while synthetic glue and collagen patch yielded non-significant reductions (12). Buttressing reduces the incidence of air leaks at the staple lines, while it does not affect the duration of postoperative air leaks (12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of pre-attached reinforced stapler reloads in thoracic surgery: a prospective case series

Lim¹,

Baste²,

Shackcloth³

2022

J Thorac Dis

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Background: Reinforced staple lines are less susceptible to leaks or bleeding and may consequently reduce morbidity and complications during or after surgery. However, their safety and benefits as well as the best form of reinforcement are still under debate. This study evaluates the safety of a stapler with pre-attached buttressing material based on adverse events (AEs) in thoracic surgery.Methods: A multi-center prospective study was conducted to assess the use of stapler reloads with preattached staple line reinforcement material in thoracic surgery. The primary endpoint was the rate of devicerelated AEs reported within 30 days of lung cancer thoracic surgery. AEs, bleeding ≥50 mL, leaks, and 30-day readmissions were reported as additional outcomes.Results: A total of 40 patients underwent lobectomy (n=22), wedge resection (n=10), or other thoracic surgery (n=8). Access was open (n=9) or by video-assisted thoracoscopic surgery (VATS, n=31). One patient was lost to follow-up. Intraoperatively, there were no cases of bleeding ≥50 mL requiring staple line intervention, and three cases (8%) experienced minor leaks that were treated conservatively. Bleeding unrelated to the staple line occurred in 20 patients intraoperatively (50%) and 21 patients postoperatively (54%). Three patients were readmitted (8%) for procedure-related causes and deemed unrelated to the investigational device. Of the AEs reported, one device-related event occurred intraoperatively, associated with minor bleeding. The other 33 AEs were related to infection (15%), bleeding (12%), or leak (9%). There were no deaths during the follow-up period.Conclusions: This study demonstrates that AEs related to the use of reinforced reloads and occurring during or within 30 days of lung cancer surgery pose minimal safety concerns.

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The utility of the Stapler with PGA sheet for pulmonary wedge resection: a propensity score-matched analysis

Cited by 13 publications

References 22 publications

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

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

Thoracoscopic Repair of Adult-Onset Congenital Tracheoesophageal Fistula Using a Polyglycolic Acid Sheet-Buttressed Stapler

Clinical outcomes of pre-attached reinforced stapler reloads in thoracic surgery: a prospective case series

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