Division of the intersegmental plane during thoracoscopic segmentectomy: is stapling an issue?

Abstract

Background: Stapling is becoming the method of choice for dividing the intersegmental plane during thoracoscopic segmentectomies. The technique however is controversial as it can impair re-expansion of preserved segments. We have analyzed the morbidity and lung re-expansion on a series of 175 thoracoscopic segmentectomies. Methods: A total of 175 patients underwent a thoracoscopic anatomic segmentectomy. Ten patients were excluded due to conversion into thoracotomy. There were 89 females (54%) and 76 males (46%). Mean age was 63 years (range, 18-83 years). Indications for segmentectomy were as follows: primary lung cancer (n=100, 61%), metastases (n=27, 16%), benign non-infectious lesions (n=20, 12%) and benign infectious lesions (n=18, 11%). The intersegmental plane was divided with an endostapler in all patients. Lung re-expansion assessment included chest roentgenograms at discharge and at one-month consultation. Results: The overall complication rate was 17%. There were 0.6% major complications and 16% minor complications. The average duration of drainage was 3 days (range, 1-13 days) and average length of stay was 5.7 days (range, 2-22 days). At discharge and at 1-month follow-up chest radiography, incomplete lung re-expansion was observed in 12 (7.4%) and 4 patients (2.8%) respectively. Patients who underwent upper lobe segmentectomy had significantly more incomplete re-expansion at discharge and at 1-month follow-up.On univariate analysis, mean drainage duration was significantly longer in patients who underwent upper segmentectomy (mean 3.7 days; range, 1-13) than those who underwent lower segmentectomy (mean 2.7 days; range, 1-5). Conclusions: Although stapling of the intersegmental plane most likely slightly impairs lung re-expansion, clinical and radiological consequences are minimal.

Clinical outcome and risk factors for complications after pulmonary segmentectomy by video-assisted thoracoscopic surgery: results of an initial experience

“…This finding is a bit higher than in other studies (17-35%) and is mainly due to the higher incidence of pneumonia (16)(17)(18)(19)(20). The higher incidence of pneumonia (17%) in our study as compared to other studies (1.8-8.6%) (16)(17)(18)(19) could be explained by the broad pneumonia diagnostic criteria we used. In our initial experience, the operating time and the complication rate did not decrease over the 3-year study period.…”

Efficacy of the Segment-Counting Method in Predicting Lung Function and Volume Following Stapler-Based Thoracoscopic Segmentectomy

“…17,18) The other approach, a stapling procedure, involves dividing lung parenchyma by assuming intersegmental planes using automatic suture instruments. 8,19) Some previous studies have compared lobectomy and segmentectomy on the basis of LF values and 3D lung volumetry findings. These studies evaluated LF before and after operations by scintigraphy or residual volumes based on 3D volumetry.…”

“…5) In contrast, it has also been determined that when lung parenchyma is separated with staples, postoperative atelectasis and peri-staple hematomas may occur. 6,7) Further, the tucking up of parenchymal tissue with sturdy staples may lead to insufficient postoperative lung expansion, 8,9) which may interfere with the postoperative recovery of pulmonary function and volume. However, there is limited evidence regarding the postoperative LF and volume following thoracoscopic surgery by using staplers, as opposed to open surgery.…”

Full thoracoscopic segmentectomies for lung cancer: rational of a multiportal fissure-based approach

“…By thoracoscopy, the surgeon cannot use his/her hand and the limited space associated with the lack of distance do not allow perfect exposure of the anatomy. This is why, in almost all recent series, the intersegmental plane is stapled, despite certain disadvantages of stapling, in particular possible plication of the parenchyma (23). Stapling does not obviate the need for precise marking of the segmental boundaries.…”