Electrocautery vs. Stapler in Comparing Safety for Segmentectomy of Lung Cancer: A Meta-Analysis

Abstract

Background: Electrocautery and staplers are regarded as the two most common surgical instruments for dissecting the intersegmental plane in segmentectomy. We performed a meta-analysis to compare electrocautery and staplers in terms of their safety and effects.Methods: A systematic search strategy was performed using PubMed, and the retrieval time was up to April 1, 2020. Odds ratio (OR) and mean differences (MDs) with 95% CI were applied to determine the effectiveness of dichotomous or continuous variables, respectively.Results: Six studies including 385 patients were included. The electrocautery had a higher incidence rate of postoperative complication [OR= 1.92, 95% CI (1.12, 3.28), P = 0.02)] and air leak [OR: 3.91, 95% CI (1.64, 9.35), P = 0.002)]. No significant difference was found in the comparison of surgery time, blood loss, and duration of tube days or hospitality days.Conclusions: Our study indicated that patients under segmentectomy were associated with better safety by using stapler than electrocautery in the reduction of postoperative complications.

Application of microwave surgical instrument to lung segmentectomy for small-sized lung cancer

“… 6 However, the use of surgical staplers, electrocautery, or other energy devices for dissection of the intersegmental plane remains controversial. 15 , 16 , 17 , 18 , 19 In a previous prospective study, the degree of pulmonary function preservation did not change in a comparison of intersegmental dissection using surgical staplers or electrocautery, and the surgical stapler group required more staple cartridges. However, the medical costs remained the same because of increased complications in the electrocautery group.…”

Asia expert consensus on segmentectomy in non–small cell lung cancer: A modified Delphi study

“…An SLR comparing electrocautery versus stapler in segmentectomy reported that electrocautery resulted in a greater incidence rate of air leaks. 20 Experts agreed that compared with staplers, the use of energy devices alone (eg, electrocautery, ultrasonic scalpel) may result in a greater rate of postoperative air leaks. Energy devices may result in some heat damage to lung tissues, which may give rise to postoperative complications such as air leaks.…”

“…Energy devices may result in some heat damage to lung tissues, which may give rise to postoperative complications such as air leaks. 20 …”

Division of the intersegmental demarcation using the “modified hand‐tearing method” is safe and feasible in thoracoscopic anatomical segmentectomy

“…The uniform, solid coagulation layer caused by sealing may also be unfavorable for recognization of the ISD. Compared with stapling, the inferiority of energy devices mainly include more complex procedures, increased risk of air leakage; 22–25 and dependence on clear and persistent ISD. Therefore, an appropriate combination is believed to be better than alone 9,11 …”