title: Is bipolar thermofusion an acceptable option for unseparated interlobar fissure division in pulmonary lobectomy?
abstract: OBJECTIVE
  This study aimed to review the safety of a reusable sealing instrument, BiClamp(®), as an alternative to the mechanical stapler for interlobar fissure division in pulmonary lobectomy.
  
  
  METHODS
  A retrospective review was conducted of 95 patients who underwent pulmonary lobectomy performed by a single surgeon between November 2005 and March 2010. The patients were divided into two groups according to the period before and after introduction of the BiClamp(®): 29 patients who underwent fissure division with staples only (staple group) and 66 patients who underwent the same procedure mainly with the instrument (BiClamp(®) group).
  
  
  RESULTS
  There were 60 (63.2%) male and 35 (36.8%) female patients, with a mean ± SD age of 67.5 ± 10.8 years. Comparison of the characteristics of the two groups revealed that the BiClamp(®) group included significantly more cases of lobectomy by video-assisted thoracic surgery and far fewer completely lobulated lungs; 6 of 66 patients (9.1%) compared with 9 of 29 (31.0%) of the staple group. Except for 18 patients who underwent division using staples owing to thick parenchyma of the interlobar fissure, we attempted to divide the fissure of 42 patients in the BiClamp(®) group. Solo use of the BiClamp(®) was possible for 25 of 60 patients (41.7%) with an incomplete fissure. Eight patients (13.3%) needed one staple cartridge in combination with BiClamp(®), five (8.3%) needed two cartridges and four (6.7%) patients needed three (combined use). In most cases, except for right upper or middle lobectomy, the division of the interlobar fissure could be performed by sole use of the BiClamp(®). Incidence rates of prolonged air leakage and pneumonia were not significantly different between the two groups (respectively, 6.9 and 3.4% in the staple group vs 10.6 and 9.1% in the BiClamp(®) group).
  
  
  CONCLUSIONS
  The study results demonstrate that the division of the interlobar fissure in pulmonary lobectomy with BiClamp(®) is safe and feasible in most cases. While the results point out the limitation that division of the right upper or middle lobe may still be a challenge, they show the potential benefit of staple reduction. Less use of staples results in reduced medical costs and carbon dioxide emission, contributing to 'ecosurgery', which ultimately conserves the global environment.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan. sakuragi@cc.saga-u.ac.jp
authors.forename: Tohru
authors.initials: T
authors.lastname: Sakuragi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Takeda
authors.forename: Takashi
authors.initials: T
authors.lastname: Teishikata
authors.forename: Kyoka
authors.initials: K
authors.lastname: Sakoda
authors.forename: Shigeki
authors.initials: S
authors.lastname: Morita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004598:Electrosurgery / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D012189:Retrospective Studies; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000295:instrumentation*; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome
keywords: BiClamp®; Ecosurgery; Lobectomy; Lung; SOFT COAG