Application of “suction-guided stapling” during uniportal thoracoscopic major lung resection

Igai, Hitoshi; Furusawa, Shinya; Ohsawa, Fumi; Yazawa, Tomohiro; Matsuura, Natsumi; Kamiyoshihara, Mitsuhiro

doi:10.1007/s11748-021-01748-5

Cited by 5 publications

(7 citation statements)

References 4 publications

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“…When a stapling is performed for a pulmonary artery, sufficient exposure to allow for mobilization is important to achieve a safe stapling. For division of pulmonary vein or bronchus, we consider "suction guided stapling" to be very useful, as we have reported in previous studies [21][22][23] .…”

Section: Discussionmentioning

confidence: 99%

Controlling bleeding during uniportal thoracoscopic major pulmonary resection

Igai¹,

Kamiyoshihara²,

Matsuura³

et al. 2022

MIS

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Aim: In uniportal thoracoscopic major pulmonary resection, it is important to appropriately manage significant vessel injury, to ensure patient safety and minimize conversion to thoracotomy. We analyzed cases of significant vessel injury and investigated efficacy of an algorithm to manage bleeding during thoracoscopic uniportal major pulmonary resection. Methods: A total of 169 patients underwent “uniportal thoracoscopic major pulmonary resection” (lobectomy or segmentectomy) at our department between February 2019 and April 2021. These patients were classified into groups with (group A, n = 8) and without (group B, n = 161) intraoperative massive bleeding. Patient characteristics and perioperative results were compared between the two groups. Patients with significant vessel injury and conversion to thoracotomy were analyzed in detail. Results: Group B had significantly less blood loss (A: 197 ± 173 g; B: 42 ± 74 g, P < 0.0001) and shorter-duration postoperative drainage (A: 2.6 ± 1.8 days; B: 1.6 ± 1.3 days, P = 0.036). There were no group differences in any other factors. The most frequently injured vessel in group A was the pulmonary artery (75%). Emergent conversion was required in four cases (cases 7, 76, 128, and 133; 2.4%) due to intraoperative bleeding. No patient developed catastrophic bleeding or required an intraoperative transfusion. Conclusion: We managed significant vessel injury appropriately during uniportal thoracoscopic major pulmonary resection using the troubleshooting algorithm. The algorithm for the uniportal approach was considered effective and easy to apply even by less-experienced surgeons.

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Section: Discussionmentioning

confidence: 99%

Controlling bleeding during uniportal thoracoscopic major pulmonary resection

Igai¹,

Kamiyoshihara²,

Matsuura³

et al. 2022

MIS

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“…We highly recommend our “suction‐guided stapling” method for division of the pulmonary vein and bronchi. 7 The space required for smooth stapling is created using only a long, curved suction device. This greatly aids uniportal surgery because the number of surgical instruments that can be inserted is limited.…”

Section: Discussionmentioning

confidence: 99%

“…Stapler insertion is also difficult (for the same reason). We highly recommend our “suction‐guided stapling” method for division of the pulmonary vein and bronchi 7 . The space required for smooth stapling is created using only a long, curved suction device.…”

Section: Discussionmentioning

confidence: 99%

Uniportal thoracoscopic left posterior basal segmentectomy using a posterior approach

2022

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Posterior basal (S10) segmentectomy is one of the most challenging (and uncommon) types of pulmonary segmentectomy. Here, we present two key tips for facilitating a uniportal operation. The first is a full understanding of the relative locations of the pulmonary vessels and bronchi (as revealed by preoperative three‐dimensional computed tomography/broncho‐angiography), and the other is the use of “suction‐guided stapling” to dissect and divide the peripheral pulmonary vessels and bronchi. We describe the successful postoperative course of a patient who was so treated.

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“…We consider that a uniportal, thoracoscopic anterior approach ensures safe dissection of the lower bronchus, because a good anterior operative view of the lower lobe pulmonary artery and bronchus is available. We usually employ suction-guided stapling to avoid injury to the lower lobe pulmonary artery that might be caused by mis-insertion of a stapler ( 10 , 11 ). We encountered no instances of significant, intraoperative vessel injury using the fissureless technique; this technique is safe.…”

Section: Discussionmentioning

confidence: 99%

“…Then the lower bronchus was carefully encircled and divided. We used a suction-guided technique to avoid injury to the pulmonary artery behind the bronchus that might have been caused by mis-insertion of a forceps or stapler ( 10 , 11 ). Next, the branches of the lower lobe pulmonary arteries were divided.…”

Section: Methodsmentioning

confidence: 99%

A dense fissure is not a contra-indication for uniportal thoracoscopic lobectomy

Igai¹,

Matsuura²,

Numajiri³

et al. 2022

J Thorac Dis

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Background: A dense fissure is a main cause of a postoperative prolonged air leak (PAL). Such a fissure, if exposed, sometimes incidentally injures the pulmonary artery. We investigated whether uniportal thoracoscopic lobectomy which is considered technically more difficult than the conventional multiportal approach was appropriate for patients with dense fissures.Methods: From February 2019 to January 2022, 140 patients with primary lung cancer underwent uniportal thoracoscopic lobectomy with ≥ ND2a-1 lymphadenectomy. Patients were divided into those with dense (n=22) and separated (n=118) fissures. All dense fissures were treated using a fissureless technique without exposure of the pulmonary artery. We compared the characteristics and perioperative results of the two groups. We used multivariate analysis to identify factors predictive of PAL.Results: Although dense fissures were significantly associated with right upper lobectomies, the other patient characteristics and perioperative results were similar between the two groups. No significant pulmonary artery injuries occurred in the fissureless group. In subgroup analyses of right upper lobectomy patients, we found no other significant between-group differences in patient characteristics or perioperative results. In multivariate analyses, right upper lobectomy (odds ratio: 0.046, 95% confidence interval: 0.0044-0.49, P=0.011) or smoking index (odds ratio: 1.03, 95% confidence interval: 1-1.07, P=0.048) was the factor predictive of PAL.Conclusions: A dense fissure is not a contraindication for uniportal thoracoscopic lobectomy using the fissureless technique, which is thus safe.

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Application of “suction-guided stapling” during uniportal thoracoscopic major lung resection

Cited by 5 publications

References 4 publications

Controlling bleeding during uniportal thoracoscopic major pulmonary resection

Controlling bleeding during uniportal thoracoscopic major pulmonary resection

Uniportal thoracoscopic left posterior basal segmentectomy using a posterior approach

A dense fissure is not a contra-indication for uniportal thoracoscopic lobectomy

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