A new study, presented at the 55th Annual Meeting of the Society of Thoracic Surgeons (STS), has discovered a significant differences between technologies of surgical stapler based on impact they have on rate of air leaks, one of the most common complications related to lobectomies, a type of thoracic surgery for treating lung cancer.
For the first time, the research team was able to directly see, monitor, and measure the prolonged air leaks in the staple-line from nearly 110 sets of surgically cut and stapled porcine lungs, with the use of a Physiologic Lung Model (PLM) that facilitates intraoperative as well as postoperative breathing.
The researchers created staple lines of different heights with Endo GIA reinforced reload with Tri-Staple Technology by Medtronic which had over twice the rate of staple-line air leaks under the conditions of modelled physiologic breathing. To deploy uniform heights of closed staple lines, surgeons use a Surgical Stapler system such as ECHELON FLEX GST System, developed by Ethicon.
Apart from discovering higher rates of air leaks associated with graduated staple lines, researchers found that natural breathing or postoperative conditions, as triggered with negative pressure ventilation, were associated with higher air leaks magnitude and incidence compared to positive pressure ventilation, which was used to mimic the conditions of ventilator-assisted breathing during surgery.
Lead study author Seth D. Force said that breathing modality and staple design are the key variable that could impact staple-line air leaks, one of the biggest challenges faced in thoracic surgery.
The new study suggest that under intraoperative as well as postoperative ventilation, lungs-associated staple line behave in different manner, which may entail considerations of a variety of staple design and more attentive testing of future surgical stapler.
On the basis of their findings, the team hypothesized that graduated staple lines in the lungs’ thinner tissue regions do not compress the tissue enough to prevent air leaks, which have observed in about 25% of lobectomies, leading to higher costs, long-term hospitalizations, and even increasing the risk of in-hospital mortality. Stapler design differences and the way each of them exerts force on tissue at the time stapling may also give rise to air leaks, the researchers said.