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

Yoshio Tsunezuka, Nobuhiro Tanaka, Hideki Fujimori Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, JapanCorrespondence: Yoshio TsunezukaDepartment of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kuratsukihigashi 2-1, Kanazawa 920-8530, Jap...

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Autores principales:	Tsunezuka Y, Tanaka N, Fujimori H
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	surgery stapler pulmonary artery bleeding Medical technology R855-855.5
Acceso en línea:	https://doaj.org/article/5d49c9b645824cf79e4e4a324dd90a8d
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spelling	oai:doaj.org-article:5d49c9b645824cf79e4e4a324dd90a8d2021-12-02T08:41:02ZThe Impact of Endoscopic Stapler Selection on Bleeding at the Vascular Stump in Pulmonary Artery Transection1179-1470https://doaj.org/article/5d49c9b645824cf79e4e4a324dd90a8d2020-02-01T00:00:00Zhttps://www.dovepress.com/the-impact-of-endoscopic-stapler-selection-on-bleeding-at-the-vascular-peer-reviewed-article-MDERhttps://doaj.org/toc/1179-1470Yoshio Tsunezuka, Nobuhiro Tanaka, Hideki Fujimori Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, JapanCorrespondence: Yoshio TsunezukaDepartment of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kuratsukihigashi 2-1, Kanazawa 920-8530, JapanTel +81-76-237-8211Fax +81-76-238-2337Email tsuney@nifty.comObjective: 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 FLEXTM Powered Vascular Stapler (PVS), Group 2 – Medtronic Endo-GIATM iDriveTM 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 FLEXTM PVS and Endo-GIATM iDriveTM with gray cartridge combinations had the greatest and smallest closed anvil jaw gaps (> 0.63 μm and < 0.15 μm, respectively); Endo-GIATM iDriveTM gray cartridge combinations resulted in ruptures of inner and middle membranes of the pulmonary artery. No ruptures were observed using the ECHELON FLEXTM 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 FLEXTM PVS and tan cartridges for pulmonary artery stapling may help to prevent tissue damage and intraoperative bleeding.Keywords: surgery, stapler, pulmonary artery, bleedingTsunezuka YTanaka NFujimori HDove Medical Pressarticlesurgerystaplerpulmonary arterybleedingMedical technologyR855-855.5ENMedical Devices: Evidence and Research, Vol Volume 13, Pp 41-47 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	surgery stapler pulmonary artery bleeding Medical technology R855-855.5
spellingShingle	surgery stapler pulmonary artery bleeding Medical technology R855-855.5 Tsunezuka Y Tanaka N Fujimori H The Impact of Endoscopic Stapler Selection on Bleeding at the Vascular Stump in Pulmonary Artery Transection
description	Yoshio Tsunezuka, Nobuhiro Tanaka, Hideki Fujimori Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, JapanCorrespondence: Yoshio TsunezukaDepartment of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kuratsukihigashi 2-1, Kanazawa 920-8530, JapanTel +81-76-237-8211Fax +81-76-238-2337Email tsuney@nifty.comObjective: 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 FLEXTM Powered Vascular Stapler (PVS), Group 2 – Medtronic Endo-GIATM iDriveTM 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 FLEXTM PVS and Endo-GIATM iDriveTM with gray cartridge combinations had the greatest and smallest closed anvil jaw gaps (> 0.63 μm and < 0.15 μm, respectively); Endo-GIATM iDriveTM gray cartridge combinations resulted in ruptures of inner and middle membranes of the pulmonary artery. No ruptures were observed using the ECHELON FLEXTM 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 FLEXTM PVS and tan cartridges for pulmonary artery stapling may help to prevent tissue damage and intraoperative bleeding.Keywords: surgery, stapler, pulmonary artery, bleeding
format	article
author	Tsunezuka Y Tanaka N Fujimori H
author_facet	Tsunezuka Y Tanaka N Fujimori H
author_sort	Tsunezuka Y
title	The Impact of Endoscopic Stapler Selection on Bleeding at the Vascular Stump in Pulmonary Artery Transection
title_short	The Impact of Endoscopic Stapler Selection on Bleeding at the Vascular Stump in Pulmonary Artery Transection
title_full	The Impact of Endoscopic Stapler Selection on Bleeding at the Vascular Stump in Pulmonary Artery Transection
title_fullStr	The Impact of Endoscopic Stapler Selection on Bleeding at the Vascular Stump in Pulmonary Artery Transection
title_full_unstemmed	The Impact of Endoscopic Stapler Selection on Bleeding at the Vascular Stump in Pulmonary Artery Transection
title_sort	impact of endoscopic stapler selection on bleeding at the vascular stump in pulmonary artery transection
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/5d49c9b645824cf79e4e4a324dd90a8d
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The Impact of Endoscopic Stapler Selection on Bleeding at the Vascular Stump in Pulmonary Artery Transection

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