&lt;italic&gt;Ex Vivo&lt;/italic&gt; Modeling of Perioperative Air Leaks in Porcine Lungs

Klassen, Charles; Eckert, Chad E.; Wong, Jordan B; Guyette, Jacques P.; Harris, Jason L.; Thompson, Suzanne; Wudel, L. James; Ott, Harald C.

doi:10.1109/tbme.2018.2819625

Cited by 10 publications

(12 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Air leaks have a significant impact on clinical outcomes in patients following thoracic surgical procedures,1–6,11 but limitations in current preclinical models and clinical studies hinder the understanding of the impact of breathing modality and stapler design on these leaks 6. Our study utilizes a previously described model capable of isolating and quantifying air leaks under simulated perioperative ventilation modalities to evaluate site-specific air leaks in excised lungs 18. To the best of our knowledge, this is the first known effort toward understanding the impact of ventilation modality on air leaks attributed specifically to staple lines.…”

Section: Discussionmentioning

confidence: 99%

“…A previously described ex vivo porcine lung model was used to investigate differences in air leak occurrence and air leak rates between two different breathing modalities: PPV meant to mimic intraoperative ventilation and NPV meant to mimic postoperative/natural breathing conditions 18. In the context of this model, NPV refers to the transpulmonary pressure approximating what occurs under natural breathing generated by subatmospheric intrapleural pressure, not negative pressure ventilators (eg, “iron lungs”).…”

Section: Methodsmentioning

confidence: 99%

“…Ex vivo models can address some of the concerns, but current models rely solely on positive pressure ventilation (PPV) or require small animal lungs not suitable for surgical device studies. To address these limitations, a novel physiologic lung model was developed that enables direct visualization, isolation, collection, and quantification of site-specific air leaks while accommodating a range of intraoperative and postoperative breathing modalities 18. An initial study with pinhole pleural defects in porcine lungs showed a substantial increase in leak rate upon transition from positive to negative pressure ventilation (NPV), but how staple-line-related air leaks behave under such conditions remains in question 18.…”

Section: Introductionmentioning

confidence: 99%

“…To address these limitations, a novel physiologic lung model was developed that enables direct visualization, isolation, collection, and quantification of site-specific air leaks while accommodating a range of intraoperative and postoperative breathing modalities 18. An initial study with pinhole pleural defects in porcine lungs showed a substantial increase in leak rate upon transition from positive to negative pressure ventilation (NPV), but how staple-line-related air leaks behave under such conditions remains in question 18. In this work, we sought to evaluate the impact of breathing modality and stapler design on staple-line-specific air leaks using a physiologic lung model.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Preclinical quantification of air leaks in a physiologic lung model: effects of ventilation modality and staple design

Eckert¹,

Harris²,

Wong³

et al. 2018

MDER

Self Cite

View full text Add to dashboard Cite

PurposeThoracic air leaks are a common complication following pulmonary resections. Limitations in clinical studies and preclinical models have hindered efforts to understand the pathophysiology of air leaks. With an emphasis on staple-line specific air leaks, we hypothesize that ventilation modality – intraoperative positive pressure vs postoperative negative pressure – and stapler design may play a role in air leaks.MethodsUsing a novel physiologic lung model, air leaks associated with graduated and uniform staple designs were evaluated under positive and negative pressure ventilation, simulating perioperative breathing in porcine lungs. Air leak incidence, air leak volume, and air leak rate were captured along with ventilation pressure and tidal volume.ResultsIn all cases, negative pressure ventilation was associated with a higher occurrence of leaks when compared to positive pressure ventilation. Lungs leaked more air and at a faster rate under negative pressure ventilation compared to positive pressure ventilation. Graduated staple designs were associated with higher occurrence of leaks as well as larger leak rates when compared to uniform staples. Tissue thickness was not associated with differences in air leaks when tested with appropriate staple heights.ConclusionUsing a novel lung model to investigate the pathophysiology of air leaks, we have identified breathing modality and staple design as two important variables that may impact air leaks. This work will help guide device design and drive future studies in human tissue, and it may help inform clinical practice to ultimately improve patient outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Preclinical quantification of air leaks in a physiologic lung model: effects of ventilation modality and staple design

Eckert¹,

Harris²,

Wong³

et al. 2018

MDER

Self Cite

View full text Add to dashboard Cite

show abstract

“…Finally, short time post-operative air leaks supposedly originate from biomechanical causes, suggesting that they are related to staple and mechanical parameters such as pressure and volume [22]. Considering the field of air leaks after lung surgery, there are very few published fundamental research studies investigating the biomechanics of the problem [7], [8], [23], [24]. Recently, Digital Image Correlation (DIC) has been a technique of choice for accurately measuring the strain on the surface of biological materials [24]- [26].…”

Section: Introductionmentioning

confidence: 99%

Air leaks: stapling affects porcine lungs biomechanics

Bonnet¹,

Tabiai²,

Rakovich

et al. 2021

Preprint

View full text Add to dashboard Cite

During thoracic operations, surgical staplers resect cancerous tumors and seal the spared lung. However, post-operative air leaks are undesirable clinical consequences: staple legs wound lung tissue. Subsequent to this trauma, air leaks from lung tissue into the pleural space. This affects the lung's physiology and patients' recovery. The objective is to biomechanically and visually characterize porcine lung tissue with and without staples in order to gain knowledge on air leakage following pulmonary resection. Therefore, a syringe pump filled with air inflates and deflates eleven porcine lungs cyclically without exceeding 10 cmH2O of pressure. Cameras capture stereo-images of the deformed lung surface at regular intervals while a microcontroller simultaneously records the alveolar pressure and the volume of air pumped. The raw images are then used to compute tri-dimensional displacements and strains with the Digital Image Correlation method (DIC). Air bubbles originated at staple holes of inner row from exposed porcine lung tissue due to torn pleural on costal surface. Compared during inflation, left upper or lower lobe resections have similar compliance (slope of the pressure vs volume curve), which are 9% lower than healthy lung compliance. However, lower lobes statistically burst at lower pressures than upper lobes (p-value<0.046) in ex vivo conditions confirming previous clinical in vivo studies. In parallel, the lung deformed mostly in the vicinity of staple holes and presented maximum shear strain near the observed leak location. To conclude, a novel technique DIC provided concrete evidence of the post-operative air leaks biomechanics. Further studies could investigate causal relationships between the mechanical parameters and the development of an air leak.

show abstract