Clin Surg | Volume 3, Issue 1 | Research Article | Open Access

The Efficiency and Safety of Variable-Height Staple Technology in Pulmonary Resections

Hiroyuki Ito* and Haruhiko Nakayama

Department of Thoracic Surgery, Kanagawa Cancer Center, Japan

*Correspondance to: Hiroyuki Ito 

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Objectives: Mechanical suturing devices are commonly used for resection of the pulmonary parenchyma. We evaluated a new variable-height staple, Tri-Staple, in a prospective single arm study.Method: Sixty patients with lung tumor who underwent resection of the pulmonary parenchyma with the Tri-Staple between October 2011 and February 2012 were assessed for various outcomes, including the incidence of prolonged pulmonary fistula, incidence and severity of air leaks from the site of resection with the mechanical suturing device, and duration of drain placement. Patients who had preoperative imaging evidence of severe emphysema, pulmonary fibrosis, or adhesion and those who were expected to have pleural adhesion were excluded.Results: A total of 172 cartridges were used: eight Tan (Camel) Reloads, 104 Purple Reloads, and 60 Black Reloads. The median number of cartridges used per patient was 2.87 (1 to 13). Prolonged pulmonary fistula occurred in 1.7% (1/60) of patients. Of all staple firings, 8.1% (14/172) were associated with intra operative air leaks. The location of the air leak was the staple holes in nine patients (64.3%, 9/14) and the visceral pleura outside of the staple line in five patients (35.7%, 5/14). No air leaks were observed at the stumps or staple line overlapping sites. The middle to the tip of the staple line was associated with more air leaks, but with no significant difference between the sections of the staple line. Analysis by cartridge size showed a trend toward a lower incidence of air leaks with the cartridge intended for thick tissues. No cartridge caused poor staple formation. The median time to the resolution of air leaks was 0 days (0 to 10 days), the duration of drain placement was 2.3 days (0 to 11), and the only adverse event observed during the study was reoperation for prolonged pulmonary fistula.Conclusion: Pulmonary resection with the Tri-Staple was associated with a low incidence of prolonged pulmonary fistula and intra operative air leaks, demonstrating that it is feasible in terms of safety and efficiency. When it is difficult to decide which cartridge to use, selecting higher staple heights may reduce the risk of air leaks.


Surgery; Operative procedures; Pulmonary resection; Mechanical suturing device


Ito H, Nakayama H. The Efficiency and Safety of Variable-Height Staple Technology in Pulmonary Resections. Clin Surg. 2018; 3: 2091.

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