Curved cutter stapler for the application of bronchial sutures in anatomic pulmonary resections: the clinical experience of 139 cases.
OBJECTIVE
One of the fundamental steps in an anatomical pulmonary resection is the main and lobar bronchus suture. Nowadays, two different types of staplers are on the market: the linear TA stapler for open surgery (Tyco Healthcare Group LP, Norwalk, CT, USA), which is based on a 'guillotine' mechanism, sewing, but not cutting the bronchus, and the endoscopic linear stapler which both cuts and sews. This study aimed to fill the void in the use of an instrument used to staple and cut at the same time in 'open' thoracic surgery, eliminating the need for a scalpel: the curved cutter stapler (Contour Curved Cutter Stapler; Ethicon Endo-Surgery, Inc., Cincinnati, OH, USA).


METHODS
Between May 2009 and March 2011, the Contour Curved Stapler (Ethicon) was used for the bronchus in 139 cases of non-small cell lung carcinoma (NSCLC)-29 females and 110 males ranging between 48 and 85 years (average 71.1)-and comprising 115 lobectomies (8 bilobectomies) and 24 pneumonectomies (8 on the right lung, 16 on the left lung).


RESULTS
All patients underwent a bronchoscopic check-up 30 days after they were discharged: in all cases, the bronchial stump was clearly within normal limits. No cases of bronchopleural fistulas were observed in the 139 patients.


CONCLUSIONS
On the basis of this study, the curved cutter stapler showed to be a satisfactory device for securing the bronchus during an anatomic resection (whether lobar or main), in 'open' thoracic surgery. However, even though there were no cases of fistula, we consider that our data is still too limited to be statistically significant.
Department of Thoracic Surgery, San Paolo Hospital, Bari, Italy. paolosardelli@gmail.com
Paolo
P
Sardelli
Barbara
B
Barrettara
Marco Luigi
ML
Cisternino
Gaetano
G
Napoli
Angelo
A
Lacitignola
Stefania
S
Quitadamo
D000368:Aged; D000369:Aged, 80 and over; D001980:Bronchi / Q000601:surgery*; D001983:Bronchial Fistula / Q000209:etiology / Q000517:prevention & control; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000209:etiology / Q000517:prevention & control; D011013:Pneumonectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000517:prevention & control; D013528:Surgical Staplers; D017792:Surgical Stapling