title: Thulium laser versus staplers for anatomic pulmonary resections with incomplete fissures: negative results of a randomized trial.
abstract: OBJECTIVE
  This randomized trial evaluated the feasibility and safety of thulium 2010-nm laser to perform anatomic lung resections in patients with incomplete fissures, as compared to mechanical staplers with or without sealants.
  
  
  METHODS
  Seventy-two patients scheduled for segmentectomy or lobectomy were enrolled. After intraoperative confirmation of the extent of resection and incomplete fissures (Craig type 2, 3 or 4), they were randomized and allocated to one of the following arms: laser resection by thulium (group A) or standard resection with mechanical staplers with or without sealants (group B). The primary endpoints of the study included analysis of intraoperative and postoperative course, and costs.
  
  
  RESULTS
  Thirty-eight patients were assigned to group A (32 lobectomies, 6 segmentectomies) and 34 to group B (31 lobectomies, 3 segmentectomies). No 30-day mortality was observed. Median operative times were 145.0 minutes (group A) and 142.5 minutes (group B, P = 0.83). The median time to drainage removal was 5 days (group A) and 4 days (group B), while the median length of hospital stay was the same (7 days). Prolonged air leaks >7 days were observed in 12 patients of group A (32%) and 10 patients of group B (29%, P = 0.46). Unpredictable late pneumothorax occurred in 3 patients of group A (2 readmissions, need for 1 repeat thoracotomy). Cost analysis demonstrated an intraoperative advantage for group A (mean 807 ± 212 euro) versus group B (mean 1,047+/-276 euro, P <0.0001), but the differences in total costs could be due to chance (P = 0.83).
  
  
  CONCLUSIONS
  The use of laser to complete fissures can lead to late pneumothorax, even in the absence of postoperative air leaks. Moreover, the use of laser to complete fissures did not prove to reduce overall costs. Trial Registration Identification Number: 41/10 (IRB00001457 - FWA00001798 - IORG0001063).
authors: Paolo
authors: P
authors: Scanagatta
authors: Simone
authors: S
authors: Furia
authors: Andrea
authors: A
authors: Billè
authors: Leonardo
authors: L
authors: Duranti
authors: Lara
authors: L
authors: Girelli
authors: Luca Domenico
authors: LD
authors: Tavecchio
authors: Francesco
authors: F
authors: Leo
authors: Riccardo
authors: R
authors: Giovannetti
authors: Giuseppe
authors: G
authors: Pelosi
authors: Luca
authors: L
authors: Porcu
authors: Ugo
authors: U
authors: Pastorino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D053685:Laser Therapy / Q000009:adverse effects* / Q000191:economics; D008175:Lung Neoplasms / Q000191:economics / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D061214:Patient Safety; D011013:Pneumonectomy / Q000191:economics / Q000379:methods*; D011030:Pneumothorax / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D013528:Surgical Staplers / Q000191:economics; D013932:Thulium / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D013932:Thulium