The Impact of Endoscopic Stapler Selection on Bleeding at the Vascular Stump in Pulmonary Artery Transection

Abstract

Objective

To assess bleeding following transection of the pulmonary artery with powered and manual endoscopic staplers.

Methods

Cases of video-assisted and open-chest thoracic surgical procedures for non-small cell lung cancer at Ishikawa Prefectural Central Hospital were reviewed between 2012 and 2018. Three stapler groups were assessed: Group 1 – Ethicon ECHELON FLEX^TM Powered Vascular Stapler (PVS), Group 2 – Medtronic Endo-GIA^TM iDrive^TM powered stapler, Group 3 – Ethicon and Medtronic manual staplers.

Results

Of 239 patients, 82 cases (34.3%) were Group 1, 94 cases (39.3%) were Group 2 and 63 cases (26.4%) were Group 3. Mean age was 68.3 years (range 36–88 years), and most patients received video-assisted right upper lobectomy (82.8%). Bleeding occurred in 24 cases: 17 (70.8%) in Group 2 and 7 (29.2%) cases in Group 3. No bleeding occurred in Group 1. The loaded ECHELON FLEX^TM PVS and Endo-GIA^TM iDrive^TM with gray cartridge combinations had the greatest and smallest closed anvil jaw gaps (>0.63 µm and <0.15 µm, respectively); Endo-GIA^TM iDrive^TM gray cartridge combinations resulted in ruptures of inner and middle membranes of the pulmonary artery. No ruptures were observed using the ECHELON FLEX^TM PVS.

Conclusion

An excessively narrow gap between cartridge and anvil may damage the blood vessel wall and lead to bleeding following transection. This study provides preliminary evidence that the use of the ECHELON FLEX^TM PVS and tan cartridges for pulmonary artery stapling may help to prevent tissue damage and intraoperative bleeding.

Keywords:

• surgery
• stapler
• pulmonary artery
• bleeding

Acknowledgments

The authors acknowledge Ruth Le Fevre, PhD, Costello Medical Singapore Pte Ltd, Singapore, and Simon Foulcer, PhD, Costello Medical, UK, for writing and editorial assistance. All costs associated with development of this article were funded by Medical Device Business Services Inc.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

Third-party writing assistance for this article, provided by Ruth Le Fevre, PhD, Costello Medical, Singapore, and Simon Foulcer, PhD, Costello Medical, UK, was funded by Medical Device Business Services Inc.