Utility of the powered stapler for radical pulmonary resection: a propensity score-matched analysis
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ORIGINAL ARTICLE
Utility of the powered stapler for radical pulmonary resection: a propensity score‑matched analysis Wataru Shigeeda1 · Hiroyuki Deguchi1 · Makoto Tomoyasu1 · Satoshi Kudo1 · Yuka Kaneko1 · Hironaga Kanno1 · Hajime Saito1 Received: 13 April 2020 / Accepted: 13 August 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose Anatomical pulmonary resection, such as lobectomy, is a common procedure. Staplers play an important role in dividing an incomplete interlobular fissure, especially in thoracoscopic surgery. This study evaluates the effectiveness of a powered stapler for reducing the need for intraoperative fibrin glue and the incidence of air leakage after radical pulmonary resection. Methods The subjects of this retrospective study were 478 patients who underwent radical pulmonary resection. Propensity score analysis generated two matched pairs of 177 patients treated using powered and manual staplers, respectively. Results The need for fibrin glue intraoperatively during radical pulmonary resection was significantly less in the poweredstapler group (47.5%) than in the manual-stapler group (58.8%, p = 0.033). The incidence of postoperative air leakage following radical pulmonary resection was also significantly lower in the powered-stapler group (2.8%) than in the manualstapler group (10.7%, p = 0.003). Logistic regression analysis identified use of the powered stapler as a factor independently associated with both non-use of fibrin glue intraoperatively (odds ratio, 0.63; p = 0.040) and no postoperative air leakage (odds ratio, 0.26; p = 0.010). Conclusion Using a powered stapler to divide the incomplete interlobular fissure decreased the need for additional intraoperative management using fibrin glue and reduced postoperative air leakage in radical pulmonary resection. Keywords Powered stapler · Pulmonary resection · Blood product · Postoperative air leakage
Introduction Recent remarkable advances in medical technology have made radical pulmonary resection easier to perform as video-assisted thoracoscopic surgery (VATS) lobectomy, pneumonectomy, segmentectomy, and pulmonary wedge resection. The many advantages of VATS are well reported and include a shorter duration of chest tube placement [1–3], lower complication rates [1–4], shorter hospital stay [1–4], and improved patient-reported outcomes, such as less Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00595-020-02154-9) contains supplementary material, which is available to authorized users. * Wataru Shigeeda shigeeda@iwate‑med.ac.jp 1
Department of Thoracic Surgery, School of Medicine, Iwate Medical University, 2‑1‑1, Idaidori, Yahaba, Shiwa, Iwate 028‑3695, Japan
postoperative pain and earlier recovery to preoperative activity level [1, 3]. There have also been major advances in the development of medical devices related to thoracoscopic surgical systems, especially in staplers. Staplers are indispensable in VATS for transection of the pulmonary arteries, pulmonary ve
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