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Matsuoka S, Hara D, Nakamura D, Kumeda H, Miura K, Iwaya M, Eguchi T, Hamanaka K, Uehara T, Shimizu K. Long-term pulmonary repair in rat lungs after sublobar resection: electrocautery versus stapler methods. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02098-8. [PMID: 39466548 DOI: 10.1007/s11748-024-02098-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 10/15/2024] [Indexed: 10/30/2024]
Abstract
OBJECTIVE We investigated and compared the long-term (6-month) histologic changes in a rat model of sublobar resection created using electrocautery or stapler techniques. METHODS Nine-week-old male rats were anesthetized and intubated; thoracotomy with sublobar resection was performed in the right middle lobe using electrocautery or stapler techniques. Histological examination was performed at 2, 4, 8, 12, and 24 weeks post-surgery to assess long-term effects on lung tissue repair and morphologic changes. Lung expansion and alveolar epithelial cell proliferation were evaluated by measuring the mean linear intercept and counting the number of alveolar type I and II cells. RESULTS The electrocautery group showed signs of lung self-repair at the resected area over time, with inflammatory cell infiltration followed by growth of vessels and bronchioles. Mesothelial cells covered the resected area by 2 weeks; elastic fibers gradually connected from both sides by 24 weeks. Lung expansion, measured by mean linear intercept, was initially small below the electrocautery resection area at 2 weeks but recovered from 4 to 24 weeks. The stapler group showed persistently small mean linear intercept over time. In the electrocautery group, the number of alveolar type II cells was higher just below the resection than in other areas from 2 to 24 weeks, followed by alveolar type I cells (4 to 24 weeks). The stapler group showed a transient alveolar type II cell increase at 2 weeks. CONCLUSIONS Compared to the stapler technique, electrocautery may provide advantages for postoperative lung repair by promoting lung expansion and alveolar epithelial cell proliferation.
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Affiliation(s)
- Shunichiro Matsuoka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Daisuke Hara
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Daisuke Nakamura
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Hirotaka Kumeda
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Kentaro Miura
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Mai Iwaya
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takashi Eguchi
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Kazutoshi Hamanaka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
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Mimura T, Ishida M, Tadokoro K, Kamigaichi A, Hirai Y, Nishina M, Kagimoto A, Tsubokawa N, Yamashita Y. Application of microwave surgical instrument to lung segmentectomy for small-sized lung cancer. JTCVS Tech 2024; 24:186-196. [PMID: 38835577 PMCID: PMC11145393 DOI: 10.1016/j.xjtc.2024.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 06/06/2024] Open
Abstract
Objectives For lung segmentectomy of small lung cancers, we used a microwave surgical instrument for lung parenchymal dissection mainly at the pulmonary hilum, which is difficult to handle with surgical staplers. This technique facilitated the insertion of staples. Methods In total, 116 patients with cStage 0-1A3 non-small cell lung cancer who underwent lung segmentectomy were included in this study. We compared the perioperative factors of the group in which a microwave surgical instrument was used for dissection procedures, including lung parenchymal dissection at the pulmonary hilum, and peripheral intersegmental dissection was performed with surgical staplers (group M+S: N = 69), with those of the group in which parenchymal dissection was performed mainly with surgical staplers without using the microwave surgical instrument (group S: N = 47). Results Although more complex segmentectomies were performed in the M+S group (P = .001), the number of staple cartridges (7 staple cartridges vs 8 staple cartridges, P = .005), the surgical times (179 vs 221 minutes, P < .0001), and the blood loss (5 mL vs 30 mL, P = .012) were significantly lower in the M+S group. The duration of chest tube placement was significantly shorter in the M+S group (P = .019), and postoperative complications of grade 2 or greater were significantly lower in the M+S group (P = .049). Conclusions The effective use of the microwave surgical instrument combined with surgical staplers can simplify pulmonary hilar and intersegmental plane dissections not only for simple segmentectomy but also for complex segmentectomy, leading to favorable intraoperative and postoperative outcomes.
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Affiliation(s)
- Takeshi Mimura
- Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan, Kure, Hiroshima, Japan
| | - Masayuki Ishida
- Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan, Kure, Hiroshima, Japan
| | - Kazuki Tadokoro
- Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan, Kure, Hiroshima, Japan
| | - Atsushi Kamigaichi
- Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan, Kure, Hiroshima, Japan
| | - Yuya Hirai
- Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan, Kure, Hiroshima, Japan
| | - Mai Nishina
- Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan, Kure, Hiroshima, Japan
| | - Atsushi Kagimoto
- Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan, Kure, Hiroshima, Japan
| | - Norifumi Tsubokawa
- Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan, Kure, Hiroshima, Japan
| | - Yoshinori Yamashita
- Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan, Kure, Hiroshima, Japan
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Marra A, Yankulov A. The role of new staplers in reducing the incidence of air leak. J Thorac Dis 2023; 15:893-900. [PMID: 36910065 PMCID: PMC9992581 DOI: 10.21037/jtd-22-192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/12/2022] [Indexed: 11/06/2022]
Abstract
Surgical staplers play an important role in the contemporary minimally invasive thoracic surgery including resection of lung tissue. However, staple line failure resulting in postoperative air leaks is a common complication after lung surgery, that if persist more than five days are defined as prolonged air leaks (PALs). PALs are associated with increased length of stay, patient morbidity and mortality, and hospital costs. To reduce the incidence of PALs, stapler devices underwent in the last years ongoing development aimed at improving device-to-tissue interaction. This clinical practice review explores the most important aspects of the evolution of surgical staplers, based on the review of the available literature. Modern staple cartridges entail small bumps to engage tissue and minimize tissue movement during compression and firing. Staplers with graduated staple heights are advocated to generate less stress on tissue during compression and clamping, thus affording greater perfusion into the staple line. However, air leaks may occur from an appropriate staple line with complete pleural coverage and perfusion due to enlarged staple canals after lung inflation, particularly in case of emphysema. To buttress staple line, thus prevent air leaks in high-risk patients, several types of tissue coverage (bovine pericardium, polytetrafluoroethylene, knitted calcium alginate, bioabsorbable polyglycolic acid) have been successfully developed in the last years. Finally, the most advanced stapler technology is represented by the new energy powered staplers, able to eliminate the manual firing force, monitor tissue compression during firing, and making automatic adjustments to optimize the staple line.
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Affiliation(s)
- Alessandro Marra
- Department of Thoracic Surgery, Lung Centre, Rems-Murr-Klinikum Winnenden, Winnenden/Stuttgart, Germany
| | - Aleksandar Yankulov
- Department of Thoracic Surgery, Lung Centre, Rems-Murr-Klinikum Winnenden, Winnenden/Stuttgart, Germany
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Feng Z, Hu B, Yu S, Guo C, Peng Z. Division of the intersegmental demarcation using the "modified hand-tearing method" is safe and feasible in thoracoscopic anatomical segmentectomy. Thorac Cancer 2022; 13:2732-2740. [PMID: 36184304 PMCID: PMC9527171 DOI: 10.1111/1759-7714.14607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The accurate and safe division of the intersegmental demarcation (ISD) is critical and challenging during thoracoscopic anatomical segmentectomy. Here, we provide an improved technique which emphasizes the application of an electric hook and blunt division of ISD. The technique is termed as the "modified hand-tearing method" (MHT method) with combined application of an electric hook and staplers. The study aimed to review the outcomes of patients who underwent thoracoscopic anatomical segmentectomy, with or without the MHT method in our institute and assess its feasibility and safety. In addition, we compared the feasibility between video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) using the MHT method. METHODS From 2018 July to 2021 June, we retrospectively analyzed 701 patients who underwent segmentectomy. Using propensity score matching, data of two well-matched pairs of 276 cases in the MHT method and non-MHT method groups, and two well-matched pairs of 40 cases in the VATS and RATS subgroups were obtained. The clinical and perioperative characteristics of patients were compared between groups. RESULTS Compared with the non-MHT method group, the MHT method group had shorter operation time and shorter postoperative hospital stay. Period of chest tube drainage and postoperative total drainage and postoperative complications had no between-group difference. Compared with VATS, the RATS subgroup had less intraoperative bleeding and shorter postoperative hospital stay. CONCLUSION Division of ISD using the MHT method has advantages in precision and ease of operation, so it has the potential to become a feasible and effective method for thoracoscopic anatomical segmentectomy.
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Affiliation(s)
- Zhen Feng
- Department of Thoracic SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Benchuang Hu
- Department of Thoracic SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Shuliang Yu
- Department of OncologyThe First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan HospitalJinanChina
| | - Chenran Guo
- Department of Thoracic SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Zhongmin Peng
- Department of Thoracic SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanChina
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