Air leaks: Stapling affects porcine lungs biomechanics

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

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 cmH₂O; 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.

Comparative study of hydrophobically modified gelatin-based sealant with commercially available sealants

Air leakage is one of the major complications related to pulmonary surgeries. To reduce this complication, we developed a decyl group (C10)-modified Alaska pollock gelatin (ApGltn) (C10-ApGltn) sealant and evaluated its practical performance against commercially available sealants, Beriplast® and DuraSeal®. C10-ApGltn was synthesized by reductive amination of the amino groups in ApGltn with decanal. C10-ApGltn was crosslinked with a poly(ethylene glycol)-based crosslinker to form a tissue sealant. The crosslinking time of the C10-ApGltn sealant was fast enough for curing on tissue and application as a spray system. Although the percent swelling of C10-ApGltn and DuraSeal was significantly greater than Beriplast, C10-ApGltn and DuraSeal exhibited excellent tissue sealing properties on pleura tissue under a long-term moist condition. Additionally, C10-ApGltn and DuraSeal did not cause severe inflammatory responses in a rat subcutaneous example. Therefore, C10-ApGltn sealant had comparable tissue sealing properties to DuraSeal under a moist condition, indicating the potential of C10-ApGltn sealant for pulmonary surgeries.