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Maximum resistance pressure at the time of lung tissue rupture after porcine lung transection using automatic linear staplers with different reinforcement methods

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Abstract

Purposes

Polyglycolic acid (PGA) sheets, fibrin glue, and staple line reinforcement are frequently used to prevent air leakage during lung resection. However, the optimal staple-line reinforcement method remains unclear.

Methods

Cranial lung lobes of pigs were used to evaluate different staple line reinforcement methods (n = 6). Ventilator-assisted manometry was used to measure the maximum resistance pressure at the time of rupture of the lung tissue after stapling.

Results

The mean maximum resistance pressures at the time of lung tissue rupture after using the stapler alone, stapler with PGA sheet and fibrin glue, and stapler with reinforcement were 38.0 cmH2O, 51.3 cmH2O, and 62.7 cmH2O, respectively. A significant increase in the maximum resistance pressure was observed with stapler reinforcement (P < 0.001), while the differences between the other groups were not statistically significant (P = 0.055, P = 0.111). A histological assessment revealed disruption of alveolar structures near the needle-stitching site in the stapler alone, and in the stapler with PGA sheet and fibrin glue groups. Pleural rupture near the staple line was observed in the stapler with reinforcement group.

Conclusions

The maximum resistance pressure before air leakage was significantly higher when using a stapler with reinforcement than when using a stapler alone.

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Acknowledgements

We thank Angela Morben, DVM, and ELS from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Funding

The costs of the staplers, polyglycolic acid sheets, fibrin glue, ECHELON ENDOPATH™ Staple Line Reinforcement (ECH60R), and porcine lungs were funded by Research Funding of the Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University.

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Authors and Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Shinkichi Takamori, Tomoyoshi Takenaka, Asato Hashinokuchi, Kyoto Matsudo, Taichi Nagano, Mikihiro Kohno, Naoko Miura & Tomoharu Yoshizumi

  2. Faculty of Medicine, Department of Thoracic and Breast Surgery, Oita University, Oita, Japan

    Shinkichi Takamori

  3. Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan

    Mototsugu Shimokawa

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  1. Shinkichi Takamori
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  2. Tomoyoshi Takenaka
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  3. Mototsugu Shimokawa
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  5. Kyoto Matsudo
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  9. Tomoharu Yoshizumi
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Correspondence to Tomoyoshi Takenaka.

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Conflict of interest

Shinkichi Takamori: no conflict of interest. Tomoyoshi Takenaka: no conflict of interest. Asato Hashinokuchi: no conflict of interest. Kyoto Matsudo: no conflict of interest. Taichi Nagano: no conflict of interest. Mikihiro Kohno: no conflict of interest. Naoko Miura: no conflict of interest. Tomoharu Yoshizumi: no conflict of interest.

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Takamori, S., Takenaka, T., Shimokawa, M. et al. Maximum resistance pressure at the time of lung tissue rupture after porcine lung transection using automatic linear staplers with different reinforcement methods. Surg Today (2024). https://doi.org/10.1007/s00595-024-02858-2

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