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Takamori S, Takenaka T, Shimokawa M, Hashinokuchi A, Matsudo K, Nagano T, Kohno M, Miura N, Yoshizumi T. Maximum resistance pressure at the time of lung tissue rupture after porcine lung transection using automatic linear staplers with different reinforcement methods. Surg Today 2024:10.1007/s00595-024-02858-2. [PMID: 38691222 DOI: 10.1007/s00595-024-02858-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/08/2024] [Indexed: 05/03/2024]
Abstract
PURPOSES Polyglycolic acid (PGA) sheets, fibrin glue, and staple line reinforcement are frequently used to prevent air leakage during lung resection. However, the optimal staple-line reinforcement method remains unclear. METHODS Cranial lung lobes of pigs were used to evaluate different staple line reinforcement methods (n = 6). Ventilator-assisted manometry was used to measure the maximum resistance pressure at the time of rupture of the lung tissue after stapling. RESULTS The mean maximum resistance pressures at the time of lung tissue rupture after using the stapler alone, stapler with PGA sheet and fibrin glue, and stapler with reinforcement were 38.0 cmH2O, 51.3 cmH2O, and 62.7 cmH2O, respectively. A significant increase in the maximum resistance pressure was observed with stapler reinforcement (P < 0.001), while the differences between the other groups were not statistically significant (P = 0.055, P = 0.111). A histological assessment revealed disruption of alveolar structures near the needle-stitching site in the stapler alone, and in the stapler with PGA sheet and fibrin glue groups. Pleural rupture near the staple line was observed in the stapler with reinforcement group. CONCLUSIONS The maximum resistance pressure before air leakage was significantly higher when using a stapler with reinforcement than when using a stapler alone.
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Affiliation(s)
- Shinkichi Takamori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Faculty of Medicine, Department of Thoracic and Breast Surgery, Oita University, Oita, Japan
| | - Tomoyoshi Takenaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Asato Hashinokuchi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kyoto Matsudo
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Taichi Nagano
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Mikihiro Kohno
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Naoko Miura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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da Silva PHS, Lopes CEB, Stallmach LB, Ferreira LDO, Pimentel PAB, Giuliano A, Freitas PMC, Horta RDS. Comparison of Different Pneumorrhaphy Methods after Partial Pulmonary Lobectomy in Dogs. Animals (Basel) 2023; 13:2732. [PMID: 37684995 PMCID: PMC10486489 DOI: 10.3390/ani13172732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Pulmonary loborraphy can be performed using manual sutures and staples, although other methods, such as tissue adhesives, are also cited in the veterinary literature. Although the surgery is well tolerated in the canine species, failure in pulmonary aerostasis is still a reality since all the methods described so far eventually lead to air leakage after the use of the partial lobectomy technique in the lungs. Within this context, the aim of this research was to compare the effectiveness of different hermetic sealing methods after partial lobectomy of the right caudal lung lobe (RCLL) in dogs. 30 cadavers models were divided in 6 groups: G1-cobbler suture associated with simple continuous; G2-overlapping continuous suture associated with simple continuous suture; G3-Ford interlocking suture; G4-Stapling device; G5-Tissue glue (cyanoacrylate). After performing the sealing techniques, the lungs were submerged in water and inflated with oxygen at positive ventilatory pressures at physiological (up to 14.7 mmHg, which is equivalent to up to 20 cmH2O) and supraphysiological levels (above 14.7 mmHg) to evaluate the performance of the sealing methods. At physiological ventilatory pressure levels, there was no difference between groups. Sealing with surgical glue was superior to interlocking sutures and stapling devices at supraphysiological levels of ventilatory pressure.
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Affiliation(s)
- Paloma Helena Sanches da Silva
- Department of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (P.H.S.d.S.); (C.E.B.L.); (L.B.S.); (L.d.O.F.); (P.A.B.P.); (P.M.C.F.)
| | - Carlos Eduardo Bastos Lopes
- Department of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (P.H.S.d.S.); (C.E.B.L.); (L.B.S.); (L.d.O.F.); (P.A.B.P.); (P.M.C.F.)
| | - Larissa Bueno Stallmach
- Department of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (P.H.S.d.S.); (C.E.B.L.); (L.B.S.); (L.d.O.F.); (P.A.B.P.); (P.M.C.F.)
| | - Lucas de Oliveira Ferreira
- Department of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (P.H.S.d.S.); (C.E.B.L.); (L.B.S.); (L.d.O.F.); (P.A.B.P.); (P.M.C.F.)
| | - Pedro Antônio Bronhara Pimentel
- Department of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (P.H.S.d.S.); (C.E.B.L.); (L.B.S.); (L.d.O.F.); (P.A.B.P.); (P.M.C.F.)
| | - Antonio Giuliano
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Patrícia Maria Coletto Freitas
- Department of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (P.H.S.d.S.); (C.E.B.L.); (L.B.S.); (L.d.O.F.); (P.A.B.P.); (P.M.C.F.)
| | - Rodrigo dos Santos Horta
- Department of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (P.H.S.d.S.); (C.E.B.L.); (L.B.S.); (L.d.O.F.); (P.A.B.P.); (P.M.C.F.)
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Bressler EM, Chu NQ, Sabatelle RC, Mahvi DA, Korunes-Miller JT, Nagashima F, Ichinose F, Liu R, Grinstaff MW, Colson YL, Raut CP. Doxorubicin-Loaded Polymeric Meshes Prevent Local Recurrence after Sarcoma Resection While Avoiding Cardiotoxicity. Cancer Res 2022; 82:4474-4484. [PMID: 36169924 PMCID: PMC9948765 DOI: 10.1158/0008-5472.can-22-0734] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/04/2022] [Accepted: 09/23/2022] [Indexed: 01/27/2023]
Abstract
Surgery is the only potentially curative treatment for localized soft-tissue sarcomas. However, for sarcomas arising in the retroperitoneum, locoregional recurrence rates are 35% to 59% despite resection. Doxorubicin (DOX) is the standard first-line systemic chemotherapy for advanced soft-tissue sarcoma, yet its intravenous administration yields limited clinical efficacy and results in dose-limiting cardiotoxicity. We report the fabrication and optimization of a novel electrospun poly(caprolactone) (PCL) surgical mesh coated with layers of a hydrophobic polymer (poly(glycerol monostearate-co-caprolactone), PGC-C18), which delivers DOX directly to the operative bed following sarcoma resection. In xenograft models of liposarcoma and chondrosarcoma, DOX-loaded meshes (DoM) increased overall survival 4-fold compared with systemically administered DOX and prevented local recurrence in all but one animal. Importantly, mice implanted with DoMs exhibited preserved cardiac function, whereas mice receiving an equivalent dose systemically displayed a 23% decrease from baseline in both cardiac output and ejection fraction 20 days after administration. Collectively, this work demonstrates a feasible therapeutic approach to simultaneously prevent post-surgical tumor recurrence and minimize cardiotoxicity in soft-tissue sarcoma. SIGNIFICANCE A proof-of-principle study in animal models shows that a novel local drug delivery approach can prevent tumor recurrence as well as drug-related adverse events following surgical resection of soft-tissue sarcomas.
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Affiliation(s)
- Eric M. Bressler
- Department of Biomedical Engineering, Boston University, Boston, MA 02114
| | - Ngoc-Quynh Chu
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115
| | | | - David A. Mahvi
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115
| | | | - Fumiaki Nagashima
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115
| | - Fumito Ichinose
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115
| | - Rong Liu
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115
| | - Mark W. Grinstaff
- Department of Biomedical Engineering, Boston University, Boston, MA 02114,Department of Chemistry, Boston University, Boston, MA 02114,Co-corresponding authors Mark W. Grinstaff, Room 519, 590 Commonwealth Ave, Boston MA, Boston, MA 02215, Tel: 718-358-3429, ; Yolonda L. Colson, Massachusetts General Hospital, 55 Fruit Street, Founders 7, Boston, MA 02114, Office: 617-726-5600, ; Chandrajit P. Raut, Brigham and Women's Hospital · , 75 Francis St, Boston, MA 02115, Tel: 617-632-5982,
| | - Yolonda L. Colson
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115,Co-corresponding authors Mark W. Grinstaff, Room 519, 590 Commonwealth Ave, Boston MA, Boston, MA 02215, Tel: 718-358-3429, ; Yolonda L. Colson, Massachusetts General Hospital, 55 Fruit Street, Founders 7, Boston, MA 02114, Office: 617-726-5600, ; Chandrajit P. Raut, Brigham and Women's Hospital · , 75 Francis St, Boston, MA 02115, Tel: 617-632-5982,
| | - Chandrajit P. Raut
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115,Co-corresponding authors Mark W. Grinstaff, Room 519, 590 Commonwealth Ave, Boston MA, Boston, MA 02215, Tel: 718-358-3429, ; Yolonda L. Colson, Massachusetts General Hospital, 55 Fruit Street, Founders 7, Boston, MA 02114, Office: 617-726-5600, ; Chandrajit P. Raut, Brigham and Women's Hospital · , 75 Francis St, Boston, MA 02115, Tel: 617-632-5982,
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Deguchi H, Tomoyasu M, Shigeeda W, Kaneko Y, Kanno H, Saito H. Reduction of air leakage using linear staple device with bioabsorbable polyglycolic acid felt for pulmonary lobectomy. Gen Thorac Cardiovasc Surg 2019; 68:266-272. [DOI: 10.1007/s11748-019-01207-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022]
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Shigeeda W, Deguchi H, Tomoyasu M, Kaneko Y, Kanno H, Tanita T, Saito H. The utility of the Stapler with PGA sheet for pulmonary wedge resection: a propensity score-matched analysis. J Thorac Dis 2019; 11:1546-1553. [PMID: 31179098 DOI: 10.21037/jtd.2019.03.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Air leakage is a common complication after pulmonary wedge resection. The aim of this study was to evaluate the effect of staple line reinforcement in reducing air leakage after pulmonary wedge resection. Methods A retrospective analysis was performed on patients who underwent pulmonary wedge resection. The patients were classified into 2 groups; the Stapler with polyglycolic acid sheet was used for the reinforced and the Stapler without polyglycolic acid sheet was used for the non-reinforced group. The patients were matched one-to-one based on a propensity score that comprised several patient characteristics. A propensity score-matched analysis was performed to compare patient outcomes. Results A total of 291 patients who met the inclusion criteria were investigated. There were 165 in the reinforced group and 126 patients in the non-reinforced group. Propensity score analysis generated 104 matched pairs of patients in both the reinforced and the non-reinforced groups. The rate of non-placement of chest tube was significantly higher in the reinforced group than in the non-reinforced group (61.5% vs. 36.5%; P<0.001). The rate of postoperative air leakage was higher in the non-reinforced group than in the reinforced group (13.5% vs. 1.9%, P<0.001). On logistic regression analysis, not using the reinforcement device was one of the independent factors related to pulmonary air leakage after pulmonary wedge resection (OR: 8.58, P<0.001). Conclusions The use of the Stapler with polyglycolic acid sheet during pulmonary wedge resection increased the rate of intraoperative chest tube removal and reduced the rate of postoperative air leakage.
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Affiliation(s)
- Wataru Shigeeda
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Hiroyuki Deguchi
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Makoto Tomoyasu
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Yuka Kaneko
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Hironaga Kanno
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Tatsuo Tanita
- Natori Mori Hospital, Tohoku Medical and Pharmaceutical University, Miyagi, Japan
| | - Hajime Saito
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
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Evaluation of the necessity for chest drain placement following thoracoscopic wedge resection. Surg Today 2016; 47:606-610. [PMID: 27688029 PMCID: PMC5378738 DOI: 10.1007/s00595-016-1414-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 08/09/2016] [Indexed: 11/02/2022]
Abstract
PURPOSE To evaluate the outcomes of patients who underwent thoracoscopic wedge resection without chest drain placement. METHODS The subjects of this retrospective study were 89 patients, who underwent thoracoscopic wedge resection at our hospital between January, 2013 and July, 2015. A total of 45 patients whose underlying condition did not meet the following criteria were assigned to the "chest drain placement group" (group A): peripheral lesions, healthy lung parenchyma, no intraoperative air leaks, hemorrhage or effusion accumulation, and no pleural adhesion. The other 44 patients whose underlying condition met the criteria were assigned to the "no chest drain placement group" (group B). Patient characteristics, specimen data, and postoperative conditions were analyzed and compared between the groups. RESULTS Group A patients had poorer forced expiratory volume in one second (FEV1) values, less normal spirometric results, significantly higher resected lung volume, a greater maximum tumor-pleura distance, and a larger maximum tumor size. They also had a longer postoperative hospital stay. There was no difference between the two groups in postoperative complications. CONCLUSIONS Avoiding chest drain placement after a thoracoscopic wedge resection appears to be safe and beneficial for patients who have small peripheral lesions and healthy lung parenchyma.
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