title: Staplers versus hand-sewing for pulmonary lobectomy: randomized controlled trial.
abstract: BACKGROUND
  Division of the parenchymal lung for lobectomy is performed in patients who have an incomplete fissure. A stapler device can reduce postoperative air leak, but it is expensive.
  
  
  OBJECTIVE
  to investigate the advantage of using a stapler, in terms of postoperative air leak and cost, compared to hand-sewn techniques.
  
  
  METHODS
  A Non-blinded randomized controlled trial was conducted in Chiang Mai University Hospital, Thailand, from November 15, 2011 to September 30, 2012. Fifty-three adult patients were randomized to undergo a hand-sewn technique (27 patients) or stapler closure (26 patients).
  
  
  RESULTS
  Postoperative air leak in the stapler group was less than that in the hand-sewn group (7.7% vs. 29.6%, p = 0.044), and the duration of air leak in the stapler group was significantly shorter than that in the hand-sewn group (1.0 vs. 13.4 days, p = 0.032). The cost of treatment was not significantly different between groups; however, the total cost in the stapler group was less than that in the hand-sewn group (mean difference 4454 Thai baht (US$144.75).
  
  
  CONCLUSIONS
  A stapler reduces postoperative air leaks and the duration of air leaks. Furthermore, the total cost of treatment was comparable. Therefore, using staples may provide substantial financial benefits.
authors.affiliation: Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital, Chaing Mai, Thailand.
authors.forename: Apichat
authors.initials: A
authors.lastname: Tantraworasin
authors.forename: Somcharean
authors.initials: S
authors.lastname: Seateang
authors.forename: Nutchanart
authors.initials: N
authors.lastname: Bunchungmongkol
mesh_terms: D000328:Adult; D000368:Aged; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D057239:Early Termination of Clinical Trials; D005260:Female; D017721:Hospital Costs; D006785:Hospitals, University; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D011030:Pneumothorax / Q000209:etiology / Q000517:prevention & control; D013528:Surgical Staplers / Q000191:economics; D017792:Surgical Stapling / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D013536:Suture Techniques / Q000009:adverse effects / Q000191:economics; D013785:Thailand; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cost-consequence analysis; Lobectomy; Lung neoplasms; Surgical stapling