Significance of staple height on air leak after wedge resection for pulmonary malignant tumor.

Abstract

<h4>Background</h4>Cartridge color selection generally depends on the surgeon's preference, based on the lung parenchyma thickness and location of tumor or presence of underlying lung diseases. We hypothesize that air leaks in pulmonary wedge resection occur due to injury to the visceral pleura around the staple line when the lung expands. Therefore, selecting black cartridge, the one with the largest staple height may be reasonable to avoid occurrence of air leaks. We aimed to clarify the impact of cartridge selection on the occurrence of air leak in pulmonary resection with a stapling device.<h4>Methods</h4>We retrospectively reviewed 145 patients who underwent thoracoscopic pulmonary wedge resection for pulmonary malignant tumors using Tri-Staple™. A black cartridge alone was used in 118 patients, and a purple cartridge (alone or in combination with black or camel cartridge) was used in 27 patients. The presence or absence of air leak from the stapling site was visually observed during an intraoperative water seal test. We also evaluated the leak threshold of the stapled line of the black and purple cartridges with <i>ex vivo</i> porcine lungs (six samples for each cartridge).<h4>Results</h4>Overall, 12 patients (10.1%) in the black cartridge group and eight (29.6%) in the purple cartridge group developed air leaks (P=0.01). Adjustment by the propensity score for patient background indicated that the purple cartridge might be a risk factor for intraoperative air leak (P=0.08). According to the experimental study, the leak threshold of the lungs when excised using black cartridge was significantly higher than that when excised using purple cartridge (80.0±16.7 <i>vs.</i> 49.7±22.8 cmH₂O, P=0.03).<h4>Conclusions</h4>Our clinical and experimental data suggest that selecting black cartridge is better than purple cartridge to avoid occurrence of air leak in pulmonary wedge resection for pulmonary malignant tumors.