Single-port thoracoscopic lung wedge resection using the Endo GIA Radial Reload

The Radial Stapler Facilitates Lung-Conserving Wedge Resections

OBJECTIVE

To test whether use of the radial stapler facilitates lung-conserving wedge resections compared to the linear stapler.

METHODS

A video-assisted thoracoscopic simulation lab was established to compare wedge resections performed only with linear staplers to wedge resections performed with the option of a radial stapler. Preserved sheep lungs were used. The target was a 0.5 cm mark on an ovoid surface of the lung equidistant from all edges. Seven fully trained cardiothoracic surgeons participated. They were instructed to obtain at least a 1 cm margin in all directions from the mark. The surgeons were allowed to work from only 2 preassigned ports. Each resected specimen was weighed. The resection margin was the shortest distance measured from the edge of the mark to the staple line. The mass-to-margin ratio was defined as the mass of the specimen divided by the length of the margin. The results were analyzed using a t-test for 2 independent means.

RESULTS

The 17 radial resections demonstrated a significantly better mass-to-margin ratio (3.31 [SD = 1.19]) compared to the 11 linear resections (4.75 [SD = 1.32], t[26] = 3, P = 0.006).

CONCLUSIONS

In a thoracoscopic simulation, the option of a radial stapler allowed for a better mass-to-margin resection of a small target from a broad surface of the lung than a linear stapler-only option.

Novel laparoscopic cornual resection of interstitial pregnancy using the Endo GIA™ Universal Stapler (Medtronic): A series of 12 cases

BACKGROUND

The maternal mortality of interstitial pregnancy is five times greater than that of other ectopic gestations due to potential haemorrhage. Minimal access surgical techniques usually comprise cornual resection and cornuostomy, requiring laparoscopic suturing skills.

AIM

To describe a case series using a laparoscopic automatic stapling device with reloadable cartridges to resect the cornu, enabling surgeons less familiar with intracorporeal suturing to avoid laparotomy when managing interstitial pregnancy.

MATERIALS AND METHODS

Twelve cases of laparoscopic cornual resections for interstitial pregnancies with the Endo GIA™ Universal Stapler (Medtronic) were collected prospectively over eight years. Outcome measures include human chorionic gonadotropin beta subunit (hβCG) levels, successful laparoscopic completion, estimated blood loss, intra-and post-operative complications and length of stay.

RESULTS

Median age and gestation at surgery were 31 years (range: 20-44) and eight weeks (range: 5-12), respectively. All involved live interstitial gestations, and 4/12 cases had significant haemoperitoneum at laparoscopy. The median blood loss was 300 mL (range 100-3500), and five women had blood loss >500 mL. The median serum hβCG level was 6429 IU/L (range: 1800-58690), and the median ectopic size was 4 cm (range 2-6). All cases were completed laparoscopically with no intra- or post-operative complications, although two women required blood transfusions. Median length of stay was 40 h. Further pregnancies could only be followed in 2/12 cases due to the migratory nature of our local population.

CONCLUSION

We describe a case series of 12 laparoscopic cornual resections for interstitial pregnancies using Endo GIA™ Universal Stapler, which simultaneously staples and transects the tissues, thus minimising the need for laparoscopic intracorporeal suturing.

Single-port thoracoscopic wedge resection using the Endo GIA Radial Reload: outcome of 15 cases

Background

We previously described the technique for single-port thoracoscopic lung wedge resection using the Endo GIA^TM Radial Reload surgical stapler. The GIA Radial Reload has a curved cut line that is perpendicular to the direction of instrument insertion, facilitating the approach to the lung tissue behind the lesion. Herein, we report the outcomes of 15 cases using this procedure.

Methods

Between August 2016 and February 2018, 15 patients underwent single-port thoracoscopic wedge resection using the Endo GIA Radial Reload. Single-port thoracoscopic surgery was performed through 3-5-cm incisions. For the first stapler, we used a GIA Radial Reload cartridge. For the second and subsequent staplers, we used the GIA Radial Reload cartridge or a straight cartridge based on the direction of the cut.

Results

In one patient, we extended the incision up to 7 cm and performed video-assisted thoracotomy because the lesion was too small to find. In the other 14 patients, the procedure was completed through a 3-5-cm port. In one patient, we added a suture for air leakage detected intraoperatively. Postoperative air leakage occurred in two patients. These three patients had emphysema based on computed tomography. In the remaining 12 patients, no air leakage was found and the chest tube was removed on postoperative day 1.

Conclusions

This procedure is suitable for resecting small nodules, because palpation with two fingers is easy. The GIA Radial Reload cartridge may not be a good choice for emphysematous lung, because air leakage sometimes occurs.