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Khandhar SJ, Desai NP, Anselme S, Shersher DD, Seder CW, Sanchez PG. A real-world study evaluating the safety and utility of a two-row stapler reload on pulmonary vasculature. J Thorac Dis 2024; 16:3753-3763. [PMID: 38983164 PMCID: PMC11228709 DOI: 10.21037/jtd-24-179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/11/2024] [Indexed: 07/11/2024]
Abstract
Background Endoscopic staplers are common surgical devices used for the ligation and division of vasculature in thoracic procedures. When a stapler ligates and divides pulmonary vasculature, potentially catastrophic intraoperative bleeding at the staple-line may occur. The aim of this study was to confirm the safety and discuss the utility of a two-row stapler reload, by assessing the incidence of clinically necessary intraoperative hemostatic intervention when applied to pulmonary vasculature in real-world applications. Methods This study was designed as a prospective non-comparative registry study conducted in seven centers across the United States, to confirm the safety and performance of Signia™ Small Diameter Reloads (SDR) when used for indicated thoracic surgical procedures. The primary endpoint was the incidence of hemostatic intervention related to the ligation and division of pulmonary arteries and veins. A five-point Likert scale scored hemostasis of each SDR staple-line. Secondary endpoints included the incidence of device-related only adverse events (AEs), device deficiencies, and procedure-related hospital readmission up to and including 30 days post operation. Results SDR was fired 302 times across pulmonary vasculature in 120 subjects. Three firings required clinically necessary hemostatic intervention for an intervention rate of 0.99% (3 of 302 firings). Moreover, 97.5% (117 of 120 subjects) had intact SDR staple-lines regardless of surgical access or stapler handle preference. Only 4 (3.3%) thoracoscopic and robotic procedures converted to open, but none were due to SDR staple-lines. There was no statistically significant difference between the Likert score of transected arteries compared to veins (P=0.61). There were no device deficiencies or device-only related AEs reported. Conclusions In this study, the two-row stapler reloads demonstrated favorable safety and efficacy profiles when fired across hilar vessels in the thoracic space with a 99% hemostatic rate, independent of surgical access and stapler handle preference.
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Affiliation(s)
- Sandeep J. Khandhar
- Division of Thoracic Surgery, Virginia Cancer Specialists, Inova Fairfax Hospital, Fairfax, VA, USA
| | - Neetha P. Desai
- Clinical Research and Medical Sciences, Medtronic, North Haven, CT, USA
| | | | - David D. Shersher
- Division of Thoracic Surgery, Cooper University Hospital, Camden, NJ, USA
- Division of Thoracic Surgery, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Christopher W. Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Pablo G. Sanchez
- Department of Thoracic Surgery, University of Pittsburgh Physicians, Pittsburgh, PA, USA
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Gamberini G, Maglio S, Mariani A, Mazzotta AD, Forgione A, Marescaux J, Melfi F, Tognarelli S, Menciassi A. Design and preliminary validation of a high-fidelity vascular simulator for robot-assisted manipulation. Sci Rep 2024; 14:4779. [PMID: 38413654 PMCID: PMC10899586 DOI: 10.1038/s41598-024-55351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
The number of robot-assisted minimally invasive surgeries is increasing annually, together with the need for dedicated and effective training. Surgeons need to learn how to address the novel control modalities of surgical instruments and the loss of haptic feedback, which is a common feature of most surgical robots. High-fidelity physical simulation has proved to be a valid training tool, and it might help in fulfilling these learning needs. In this regard, a high-fidelity sensorized simulator of vascular structures was designed, fabricated and preliminarily validated. The main objective of the simulator is to train novices in robotic surgery to correctly perform vascular resection procedures without applying excessive strain to tissues. The vessel simulator was integrated with soft strain sensors to quantify and objectively assess manipulation skills and to provide real-time feedback to the trainee during a training session. Additionally, a portable and user-friendly training task board was produced to replicate anatomical constraints. The simulator was characterized in terms of its mechanical properties, demonstrating its realism with respect to human tissues. Its face, content and construct validity, together with its usability, were assessed by implementing a training scenario with 13 clinicians, and the results were generally positive.
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Affiliation(s)
- Giulia Gamberini
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy.
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy.
- The Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Sabina Maglio
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy
- The Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Andrea Mariani
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alessandro Dario Mazzotta
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy
- The Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Surgery, Madre Giuseppina Vannini Hospital, Istituto Figlie Di San Camillo, Rome, Italy
| | - Antonello Forgione
- IRCAD France, Institut de recherche contre les cancers de l'appareil digestif, Strabourg Cedex, France
| | - Jacques Marescaux
- IRCAD France, Institut de recherche contre les cancers de l'appareil digestif, Strabourg Cedex, France
| | | | - Selene Tognarelli
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy
- The Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Arianna Menciassi
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy
- The Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
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Gajić D, Wojtyś M, Wójcik N, Maciąg B, Kiełbowski K, Wójcik J, Grodzki T. Examination of resistance of various methods of pulmonary vessel occlusion to hydrostatic pressure. Indian J Thorac Cardiovasc Surg 2023; 39:484-488. [PMID: 37609616 PMCID: PMC10441956 DOI: 10.1007/s12055-023-01505-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 08/24/2023] Open
Abstract
Objective The aim of this study was to compare pressure resistance of the most common methods of vessel occlusion during thoracic surgical procedures: ligations, clips, and vascular endostaplers. Methods Pulmonary vessels were obtained during routine thoracic surgeries. A ball-tipped cannula was inserted through an opening in the side wall and secured with a linen ligature from slipping out. Subsequently, saline was infused into the vessel. We recorded the pressure on which a leakage occurred. Results A total of 65 vessels, divided between 3 groups, were enrolled in the study. In the endostaplers group, median bursting pressures were 262.5 mmHg and 300 mmHg for arteries and veins, respectively. In the case of clips, it was over 750 mmHg in both types of the vessels. The same results were observed in the ligation group. Minimal bursting pressures in endostapler occlusion were 187.5 mmHg and 225 mmHg in arteries and veins, respectively. In the case of clips, it was 600 mmHg for arteries and 675 mmHg for veins. A total of 525 mmHg (arteries) and 750 mmHg (veins) were the minimal leaking values observed in vessels occluded with ligations. Comparative analysis showed statistically significant differences in endostapler-clips and endostapler-ligations pairs (p < 0.001). There were no differences between clips and ligations. Conclusions The examined methods are capable of occluding pulmonary vessels under physiological conditions. Furthermore, ligations and clips are resistant to pressures highly exceeding physiological values.
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Affiliation(s)
- Darko Gajić
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Małgorzata Wojtyś
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Norbert Wójcik
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Bogumił Maciąg
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Kajetan Kiełbowski
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Janusz Wójcik
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Tomasz Grodzki
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
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DeForge TL, Singh A, Appleby R, Yiew XT, Bersenas AM. Outcomes following combined median sternotomy and ventral midline laparotomy for bicavitary penetrating wooden foreign bodies. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2023; 64:839-843. [PMID: 37663025 PMCID: PMC10426240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Combined abdominal and thoracic pathology caused by extra-gastrointestinal migration of an ingested wooden foreign body (WFB) is an uncommon but serious injury. Presenting clinical signs are typically nonspecific and, in the absence of observed WFB ingestion, diagnosis is challenging. Treatment requires concurrent abdominal and thoracic surgical exploration to remove the WFB and address injuries caused by its migration. This case series describes perioperative characteristics and outcomes in 4 dogs following combined median sternotomy and ventral midline laparotomy (CMSVML) for bicavitary penetrating WFBs. Key clinical message: Treatment of bicavitary penetrating WFBs with CMSVML provided postoperative outcomes similar to those in previous reports; however, high-grade complications and prolonged hospitalization were commonly encountered.
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Affiliation(s)
- Teagan L DeForge
- Department of Clinical Sciences, Ontario Veterinary College, University of Guelph, 28 College Avenue West, Guelph, Ontario N1G 2W1
| | - Ameet Singh
- Department of Clinical Sciences, Ontario Veterinary College, University of Guelph, 28 College Avenue West, Guelph, Ontario N1G 2W1
| | - Ryan Appleby
- Department of Clinical Sciences, Ontario Veterinary College, University of Guelph, 28 College Avenue West, Guelph, Ontario N1G 2W1
| | - Xiu Ting Yiew
- Department of Clinical Sciences, Ontario Veterinary College, University of Guelph, 28 College Avenue West, Guelph, Ontario N1G 2W1
| | - Alexa M Bersenas
- Department of Clinical Sciences, Ontario Veterinary College, University of Guelph, 28 College Avenue West, Guelph, Ontario N1G 2W1
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Aprile V, Bacchin D, Marrama E, Korasidis S, Mastromarino MG, Palmiero G, Ambrogi MC, Lucchi M. Cold coagulation in thoracoscopic treatment of primary pneumothorax: a comparison with apicectomy. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 36:7034454. [PMID: 36856744 PMCID: PMC9976768 DOI: 10.1093/icvts/ivad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/17/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
OBJECTIVES Primary spontaneous pneumothorax is a common disease, whose surgical treatment is still enigmatic in terms of timing and technique. Herein, we reported our experience with the parenchymal-sparing technique via cold coagulation (CC), in comparison to stapler apicectomy (SA). METHODS We retrospectively collected data of all patients with apical blebs or <2 cm bullae treated with minimally invasive surgery for recurrent or persistent spontaneous pneumothorax, from 2010 to 2020. Two different surgical techniques were used: SA and the parenchymal-sparing CC of the apex. Perioperative and long-term results were analysed and compared. RESULTS Out of 177 patients enrolled, 77 patients (CC group) underwent cold-coagulation of the apex while 100 patients (SA group) were treated with SA. Two groups were comparable in terms of age, surgical indication, intraoperative findings and affected side. CC group had a mean operative time of 43.2 min (standard deviation ± 19.5), shorter than SA group with 49.3 min (standard deviation ± 20.1, P-value: 0.050). Complication rate was significantly different between 2 groups, 5 (7%) and 16 (16%), for the CC and SA groups, respectively (P: 0.048), even if not in terms of prolonged postoperative air leak (P: 0.16). During the follow-up, 13 homolateral recurrences were reported: 2 (3%) in group CC and 11 (11%) in group SA; with a significant difference (P: 0.044). All reinterventions (postoperative prolonged air leak and recurrences) required an SA. CONCLUSIONS Parenchymal-sparing technique through CC of apical blebs and bullae is an effective treatment for primary spontaneous pneumothorax and guarantees a good immediate lung sealing, despite stapling still represents the choice treatment in complex cases.
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Affiliation(s)
- Vittorio Aprile
- Corresponding author. Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy. Tel: +39 050995227; e-mail: (V. Aprile)
| | - Diana Bacchin
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Elena Marrama
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | | | | | - Marcello Carlo Ambrogi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy,Unit of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Marco Lucchi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy,Unit of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
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Skrzypczak P, Roszak M, Kasprzyk M, Dyszkiewicz W, Kamiński M, Gabryel P, Piwkowski C. The technique of stump closure has no impact on post-pneumonectomy bronchopleural fistula in the non-small cell lung cancer-a cross-sectional study. J Thorac Dis 2022; 14:3343-3351. [PMID: 36245618 PMCID: PMC9562551 DOI: 10.21037/jtd-22-240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022]
Abstract
Background Pneumonectomy is a high-risk radical resection procedure, with bronchopleural fistula (BPF) being its most challenging and severe complication. This study aimed to assess the surgical risk factors and the impact of the bronchial stump closure technique on the incidence of the BPF. Methods This is a single-center, cross-sectional study of the medical records of 455 post-pneumonectomy patients operated due to non-small cell lung cancer (NSCLC) in 2006-2017. We analyzed the following variables and their influence on the occurrence of the BPF: operation side, surgical techniques (i.e., manual suture or the stapler), stump buttressing, the extension of pneumonectomy, comorbidities, and postoperative complications. Results BPF occurred in 7.47% of post-pneumonectomy patients. BPF was more prevalent in right-sided pneumonectomy versus left-sided (10.98% vs. 5.32%; P=0.026). The use of a stapler or manual suture was not associated with the incidence of the BPF (7.96% vs.7.09%, P=0.72). There were no significant differences in the occurrence of BPF among bronchial stump buttressing with the parietal pleura (P=0.80), intercostal muscle flap (IMF) (P=0.46), and pericardial fat pad (P=0.88). When comparing data from 2006-2012 with those from 2013-2017, we found a steady decrease in the number of performed stump reinforcements, but this was not associated with a higher risk of BPF. Conclusions The method used for stump closure, additional tissue buttressing of the bronchial stump and year of the surgery had no significant impact on the occurrence of BPF. Only right-sided pneumonectomy was associated with higher BPF occurrence.
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Affiliation(s)
- Piotr Skrzypczak
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Magdalena Roszak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznań, Poland
| | - Mariusz Kasprzyk
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Wojciech Dyszkiewicz
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Mikołaj Kamiński
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Piotr Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznań, Poland
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Matsui H, Murakawa T. Potential surgical challenge: Hooking the staple stump. JTCVS Tech 2021; 11:76-77. [PMID: 35169745 PMCID: PMC8828788 DOI: 10.1016/j.xjtc.2021.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/26/2021] [Indexed: 11/12/2022] Open
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Somashekhar SP, Shivaram HV, Abhaham SJ, Dalvi A, Kumar A, Gode D, Misra S, Jain SK, Prasad CRK, Pillarisetti RR. ASI's Consensus Guidelines: ABCs of What to Do and What Not During the COVID-19 Pandemic. Indian J Surg 2020; 82:240-250. [PMID: 32837070 PMCID: PMC7280171 DOI: 10.1007/s12262-020-02452-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- S. P. Somashekhar
- Department of Surgical Oncology, Manipal Hospitals, Bengaluru, Karnataka India
| | - H. V. Shivaram
- Department of Surgery and allied Specialties, Aster CM hospital, Bengaluru, Karnataka India
| | | | - Abhay Dalvi
- The Association of Surgeons of India, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra India
| | - Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Dilip Gode
- Datta Meghe Institute Medical Sciences, Nagpur, Maharashtra India
| | - Shiva Misra
- Shivani Hospital & IVF, Utter Pradesh, Kanpur, India
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