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

Figures & data

Table 1 Evaluation of Intraoperative Bleeding After Endoscopic Stapler Use in Pulmonary Artery Transection

p value <0.0001^a	Patients n (%) N=239	Bleeding Cases^b n (%) N=24	Closed Anvil Jaw Space, µm
Group 1: ECHELON FLEX™ PVS (PVE35A)	82 (34.3)	0 (0.0)	–
ECHELON ENDOPATH™ 35mm Vascular Reloads (VASECR35)	82 (34.3)	0 (0.0)	0.636
Group 2: Endo-GIA™ iDrive™ Ultra Powered Handle 1 (IDRVULTRA1)	94 (39.3)	17 (70.8)	-
Gray cartridge (Endo-GIA™ 45mm Curved Tip Articulating Vascular Reload [EGIA45CTAV])	61 (25.5)	15 (62.5)	0.106
White cartridge (Endo-GIA-II white cartridge 45)	4 (1.7)	2 (8.3)	0.212
Tan cartridge (Endo-GIA™ 45mm Curved Tip Articulating Vascular/Medium Reload with Tri-Staple™ Technology [EGIA45])	29 (12.1)	0 (0.0)	0.530
Group 3: Endo-GIA™ Ultra Universal Stapler XL (EGIAUXL)/ECHELON FLEX™ ENDOPATH^®	63 (26.4)	7 (29.2)	-
Endo-GIA™ Ultra Universal Stapler XL (EGIAUXL) - gray cartridge (Endo-GIA™ 45mm Curved Tip Articulating Vascular Reload [EGIA45CTAV])	25 (10.5)	4 (16.7)	0.424
Endo-GIA™ Ultra Universal Stapler XL (EGIAUXL) - white cartridge (Endo-GIA-II white cartridge 45)	8 (3.3)	2 (8.3)	0.212
Endo-GIA™ Ultra Universal Stapler XL (EGIAUXL) - tan cartridge (Endo-GIA™ 45mm Curved Tip Articulating Vascular/Medium Reload with Tri-Staple™ Technology [EGIA45CTAVM])	17 (7.1)	0 (0.0)	0.530
ECHELON FLEX™ ENDOPATH^® - white cartridge (Endoscopic Linear Cutter Reloads [ECR45W])	13 (5.4)	1 (4.2)	0.212

Notes: ^aFisher Exact test. ^b2 bleeding cases were from thoracotomy, 10 bleeding cases were from video-assisted thoracoscopic surgery. Groups 1 and 2 are powered staplers, Group 3 are manual staplers. ECHELON staplers are manufactured by Ethicon, Endo-GIA™ staplers are manufactured by Medtronic.

Figure 1 (A) Comparison of powered endoscopic staplers (B) comparison of jaw angles and (C) histological findings after pulmonary arterial stapling. Histological sections of pulmonary artery tissue adjacent to the area of stapling were stained with Elastica van Gieson stain (X200). In (C) the pulmonary artery section is from stapling with the Endo-GIA™ iDrive™ plus gray cartridge. White arrows indicate the ruptured medial layer.

Abbreviation: PVS, powered vascular stapler.