Abstract
Objectives
Mechanical stapling is widely used for lung resection. Complications related to the stapling are few but not infrequent. This varies from complete disruption of the staples to incomplete sealing of vascular structures. A stapling platform that has a strong clamping force with precise and consistent staple formation suitable for thickness of tissue is likely to be an advance in existing devices and may reduce the complication rate. A new, computer-mediated power stapling is currently available for lung resections, with three types of digital loading units (DLU). Clinical data on its use are limited. We report our experience with this stapling platform (SurgASSIST) in our first 100 patients undergoing anatomic lung resection.
Methods
Fifty-four men and forty-six women (mean age, 64 ± 7 years) underwent anatomic lung resections, using a lateral, muscle-sparing mini-thoracotomy, during 2004 to 2005, with the SurgASSIST platform. Three types of DLUs were used for lung resection: a linear cutter, a right-angled vascular cutter, and a right-angled bronchial cutter. Observational data were collected prospectively on the operative procedure, type of staples used, duration of operation, chest tube drainage, and hospital length of stay.
Results
There were 83 lobectomies, 5 bilobectomies, 5 segmental resections, and 7 pneumonectomies. A total of 502 DLUs (mean, 5 per patient; 102 vascular, 91 bronchial, and 309 linear cutters) were used in this series. There were no major operative complications. The mean operating time was 136 ± 41 minutes. One bronchial dehiscence and one incomplete sealing of the pulmonary vein in the staple line were observed. In one patient, the linear cutter could not be opened in the automatic setting. There were 15% misreads by the computer on the DLU or their inserts. There was one hospital death unrelated to the stapling. Twenty additional complications included prolonged chest tube drainage (n = 8), reoperations (n = 2), atrial fibrillation (n = 5), hemothorax (n = 1), chylothorax (n = 1), C-dif colitis (n = 1), myocardial ischemia (n = 1), and incarcerated ventral hernia (n = 1). The median hospital length of stay was 5 days (range, 3 to 26 days) and the median length of chest tube drainage was 3 days (1 to 22 days).
Conclusions
Our experience shows that the computer-mediated power stapling of lung parenchyma and hilar structures during anatomic resection is safe and reproducible.
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