Thoracoscopic partial resection without using a stapler. (complete republication)

Surgical techniques using low-power monopolar scissors in robotic-assisted thoracic surgery

We analyzed the electrical characteristics of the da Vinci system's low-power monopolar coagulation mode with an electrocautery analyzer to determine its suitability as an alternative to monopolar soft coagulation mode. The voltage at the plateau of the power limit between 15 and 16 W and between 23 and 24 W of the forced coagulation mode of the da Vince system was close to that of the effect 8 and 10 of the soft coagulation mode, respectively. Experiments using chicken meat and an infrared thermographic camera confirmed the safety and effectiveness of low-power monopolar coagulation mode showing no carbonization at temperatures below 90 °C. In 73 robotic-assisted lung resection using low-power coagulation mode, no electric spark or carbonization was observed and all cauterizations were similar to soft coagulation mode. In conclusion, Forced coagulation mode of the da Vinci system can be used as an alternative to monopolar soft coagulation mode with appropriate effect and power limit settings.

Significance of very-low-voltage coagulation plus coverage with polyglycolic acid sheet after bullectomy for primary spontaneous pneumothorax

BACKGROUND

The purpose of this study was to clarify the efficacy of the combination of low-voltage coagulation plus staple line coverage with a polyglycolic acid sheet after bullectomy for primary spontaneous pneumothorax to prevent a postoperative recurrence.

METHODS

A total of 143 patients who underwent bullectomy for primary spontaneous pneumothorax between January 2014 and December 2019 were enrolled in this study. We classified the patients into two groups based on additional procedures after bullectomy, namely, low-voltage coagulation for the margin of the staple line plus coverage with a polyglycolic acid sheet (Group A) and staple line coverage with a polyglycolic acid sheet alone (Group B). We evaluated perioperative factors and recurrence-free survival after surgery in the two groups.

RESULTS

Nine patients in Group B developed postoperative recurrences. In contrast, there was no postoperative recurrence in Group A. According to the Kaplan-Meier curves, the 2-year recurrence-free survival rates of the patients were 100% and 90.3%, in Group A and Group B, respectively. The log-rank test showed a significant difference between the two groups (p = 0.031).

CONCLUSION

Low-voltage coagulation for the margin of a staple line plus coverage with a polyglycolic acid sheet is a useful option as an additional technique after bullectomy for primary spontaneous pneumothorax to prevent a postoperative recurrence.

Low-voltage coagulation, polyglycolic acid sheets, and fibrin glue to control air leaks in lung surgery

OBJECTIVE

We evaluated the efficacy of low-voltage coagulation (LVC) with polyglycolic acid (PGA) sheets (Neoveil, GUNZE Ltd., Japan) and fibrin glue to control intraoperative alveolar air leaks after lung surgery.

METHODS

We included 176 patients with non-small cell lung cancer who underwent thoracoscopic lobectomies. When alveolar air leak was confirmed after lung resection, we applied LVC system to the pleural defect followed by layers of PGA sheets and fibrin glue (n = 40). We then analyzed postoperative air leaks (rate of occurrence and duration time).

RESULTS

73% of patients (29/40 cases) experienced no postoperative air leaks. Although 11 patients experienced air leaks after surgery, there were no prolonged air leaks (>7 days) (resolution time, 3.5 ± 1.4 days; range, 2-6 days). Two patients required drainage for late-onset air leaks, but their conditions improved without further treatment. There were no further adverse events.

CONCLUSIONS

The use of LVC with PGA sheets and fibrin glue following pulmonary resection efficiently prevented both intraoperative air leaks and prolonged air leaks after lung surgery.