title: Adverse events of pulmonary vascular stapling in thoracic surgery.
abstract: OBJECTIVE
  The use of staplers for thoracic surgery has been widely accepted and regarded as a safe procedure. However, adverse events (AEs) of stapling are occasionally experienced. The aim of this retrospective study was to analyse the AEs of stapling in pulmonary vascular surgery.
  
  
  METHODS
  A retrospective multi-institutional review was conducted by the 29 institutions of the Central Japan Lung Cancer Surgery Study Group. All staplings of the pulmonary artery (PA) and vein in thoracic surgery were reviewed during the research period.
  
  
  RESULTS
  Stapling of the PA and vein was performed 3393 times. The total number of AEs related to stapling was nine (0.27%). Eight events occurred intraoperatively and one occurred immediately after the operation. Intraoperative AE occurred more frequently than postoperative AE. AE in the PA occurred more frequently than in the pulmonary vein. The intraoperative AEs were oozing (n=3), stapling failure (n=2), laceration of the peripheral vasculature at compression (n=2) and technical injury of the vasculature at insertion (n=1). The causes of AEs were reported to be tissue fragility (n=3), stapler rocking during stapling (n=2), stapler-tissue thickness mismatch (n=2) and technical failure (n=1). The only postoperative AE was staple line rupture of the PV stump. No relationship was seen between the incidence of AE and cartridge colours, compression types of staplers or numbers of staple lines.
  
  
  CONCLUSIONS
  Generally, stapling of the pulmonary vasculatures in recent thoracic surgery has been safe. Furthermore, the knowledge of the possible risks of pulmonary vascular stapling may help to decrease the AEs of stapling.
authors: Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. motoki@med.nagoya-cu.ac.jp
authors: Motoki
authors: M
authors: Yano
authors: Motoshi
authors: M
authors: Takao
authors: Takuji
authors: T
authors: Fujinaga
authors: Takaaki
authors: T
authors: Arimura
authors: Ichiro
authors: I
authors: Fukai
authors: Shinichiro
authors: S
authors: Ota
authors: Yushi
authors: Y
authors: Saito
authors: Katsuhiro
authors: K
authors: Okuda
mesh_terms: D016009:Chi-Square Distribution; D004867:Equipment Design; D006801:Humans; D007564:Japan; D011183:Postoperative Complications / Q000601:surgery; D011651:Pulmonary Artery / Q000601:surgery*; D011667:Pulmonary Veins / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000009:adverse effects* / Q000295:instrumentation; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Adverse event; Pulmonary artery; Pulmonary vein; Stapler; Stapling
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