title: A prospective randomized trial comparing stapler and laser techniques for interlobar fissure completion during pulmonary lobectomy.
abstract: Alveolar air leaks, often resulting from lung tissue traumatization during dissection of fissures, still remain a challenging problem in lung surgery. Several tools and techniques have been used to reduce air leakage, but none was judged ideal. This prospective, randomized trial was designed to evaluate the feasibility, safety, and effectiveness of completion of fissures during pulmonary lobectomy by using a laser system. A standard stapler technique was used for comparison; the primary goal was to reach at least a comparable result. Forty-four patients were enrolled, 22 were treated with standard technique by using staplers (S) and 22 underwent laser (L) dissection. Randomization to one of the two groups was intraoperative after evaluating the presence of incomplete fissure (grade 3-4 following Craig's classification). A Thulium laser 2010 nm (Cyber TM, Quanta System, Italy) was used at power of 40 W. Outcome primary measures were the evaluation and duration of intra- and postoperative air leaks, the rate of complications, and the hospital stay. Air leaks (2.1 ± 4.2 vs 3.6 ± 7.2 days; p = 0.98) and chest tube duration (6.4 ± 4.2 vs 7.5 ± 6.3 days, p = 0.44) were lower in L compared with S group even if these were not statistically significant. Complications (36.4 vs 77.3 %; p = 0.006), hospital stay (6.9 ± 3.8 vs 9.9 ± 6.9 days; p = 0.03), hospitalization costs (5,650 vs 8,147 euros; p = 0.01), and procedure costs (77 % of difference; p < 0.0001) were significantly lower for L group, while operative time was longer (197 ± 34 vs 158 ± 41 min; p = 0.004). The use of laser dissection to prevent postoperative air leaks is effective and comparable with stapler technique. Aero-haemostatic laser properties (by sealing of small blood vessels and checking air leaks) allow a safe application during pulmonary lobectomy in interlobar fissure completion avoiding stapler use.
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Via Giustiniani, 1, 35100, Padua, Italy. beppemarulli@libero.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marulli
authors.forename: Andrea
authors.initials: A
authors.lastname: Droghetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Chiara
authors.forename: Francesca
authors.initials: F
authors.lastname: Calabrese
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rebusso
authors.forename: Egle
authors.initials: E
authors.lastname: Perissinotto
authors.forename: Giovanni
authors.initials: G
authors.lastname: Muriana
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
mesh_terms: D000368:Aged; D015505:Chest Tubes; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D017792:Surgical Stapling / Q000191:economics / Q000379:methods*; D013932:Thulium; D016896:Treatment Outcome
chemical_list: D013932:Thulium