title: Late onset postoperative pulmonary fistula following a pulmonary segmentectomy using electrocautery or a harmonic scalpel.
abstract: OBJECTIVE
  The purpose of this study is to retrospectively examine the postoperative pulmonary fistula as a complication after the use of either electrocautery or a harmonic scalpel without stapling devices.
  
  
  METHODS
  The subjects of this study consisted of 28 patients who received a segmentectomy for a pulmonary malignant tumor, 25 cases of lung cancer and 3 of metastatic lung tumor. The electrocautery was used in 17 patients (EC group) and the harmonic scalpel in 11 (HS group). The levels of postoperative air leakage and postoperative complications were examined among the two groups retrospectively. The histological findings of the cut surface of the segmentectomy by electrocautery and harmonic scalpel were also examined.
  
  
  RESULTS
  Hemostasis and air leakage both were well controlled during the operation, and the postoperative drainage period was short. No major postoperative complications occurred, and all patients began walking in the early postoperative days. However, 1 to 3 postoperative months after discharge, 8 patients showed late onset of a pulmonary fistula, 3 of the 17 (18%) in the EC group and 5 of the 11 (45%) in the HS group. The histological findings of the cut surface of the segmentectomy showed that most of the layer of coagulation necrosis by the harmonic scalpel measured 2 mm thick, and it was denser than that cut from electrocautery. The lumen of the bronchus markedly decreased in size, but it remained, as it also did under the effects of electrocautery.
  
  
  CONCLUSIONS
  In the months following the operation, the incidence of the late onset of a pulmonary fistula was higher when the harmonic scalpel was used. It was believed that the small bronchial stump could not tolerate the airway pressure because the thick coagulation necrosis delayed healing of the postoperative wound. It was necessary to ligate the stump of a small bronchus, even though the stump had been temporally closed by coagulation necrosis with the electrocautery or harmonic scalpel during the operation.
authors.affiliation: Department of Chest Surgery, Toho University Medical Center Omori Hospital, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan.
authors.forename: Keigo
authors.initials: K
authors.lastname: Takagi
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Hata
authors.forename: Shuichi
authors.initials: S
authors.lastname: Sasamoto
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Tamaki
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Fukumori
authors.forename: Hajime
authors.initials: H
authors.lastname: Otsuka
authors.forename: Chiyoko
authors.initials: C
authors.lastname: Hasegawa
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Shibuya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004564:Electrocoagulation / Q000009:adverse effects*; D004867:Equipment Design; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D008026:Ligation; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D016156:Respiratory Tract Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies; D013525:Surgical Instruments; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014945:Wound Healing