title: The advantages of selecting cartridges with a 1.8 mm height for pulmonary stapling.
abstract: OBJECTIVE
  The purpose of this study was to retrospectively analyze the complications arising from stapling of the pulmonary parenchyma and to determine the most appropriate cartridges to use for pulmonary stapling.
  
  
  METHODS
  A retrospective multi-institutional review was conducted by the Central Japan Lung Cancer Surgery Study Group. We analyzed both Echelon™ (EC) and EndoGIA™ (EGIA) staplers in this study. The stapling cartridges were classified into 3 colors according to the height of the ß loops: green (2.0 mm), gold (1.8 mm), and blue (1.5 mm).
  
  
  RESULTS
  Stapling of the pulmonary parenchyma was performed 9016 times. The total number of complications related to stapling was 61 (0.68 %). These complications were mainly caused by stapler-tissue thickness mismatch (n = 30, 49.2 %) and tissue fragility (n = 27, 44.3 %). The number and rate of complications of the different cartridges were 19 and 0.63 % for EGIA blue, 25 and 0.94 % for EGIA green, 1 and 0.067 % for EC gold, 12 and 0.98 % for EC blue, and 4 and 0.64 % for EC green, respectively. Complications associated with stapling using EC gold cartridges occurred less frequently than with the other cartridges (p = 0.0022).
  
  
  CONCLUSIONS
  The gold cartridge appears to cause the least complications and may therefore be the most appropriate cartridge for stapling the pulmonary parenchyma among the tested staplers.
authors.affiliation: Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan. motoki@med.nagoya-cu.ac.jp.
authors.forename: Motoki
authors.initials: M
authors.lastname: Yano
authors.affiliation: Department of Thoracic Surgery, Kariya Toyota General Hospital, Kariya, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Thoracic Surgery, Aichi Cancer Center Aichi Hospital, Okazaki, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Uchida
authors.affiliation: Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Moriyama
authors.affiliation: Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Haneda
authors.affiliation: Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Okuda
authors.affiliation: Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Nakanishi
mesh_terms: D006046:Gold; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D008168:Lung / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D013528:Surgical Staplers / Q000009:adverse effects*; D017792:Surgical Stapling / Q000009:adverse effects* / Q000379:methods*; D019616:Thoracic Surgical Procedures / Q000379:methods*
chemical_list: D006046:Gold
keywords: Cartridge; Complication; Lung; Stapling; Thoracic surgery