Unveiling the benefits of stapler tractor dissociating segmental bronchus in lung segmentectomy: A retrospective cohort study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Bin ¹ , ZHENG Jianan ² , CHEN Liang ² , ZHU Quan ² ,  ZHU Jian ³ ,  WEN Wei ²

1. Department of Thoracic Surgery, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, 242400, Jiangsu, P. R. China;
2. Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan, 430070, P. R. China;
3. Department of Thoracic Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, P. R. China;

Corresponding author：

ZHU Jian, Email: wenwei@jsph.org.cn; WEN Wei, Email: zhujian0718@163.com

Keywords：

Lung segmentectomy; surgical technique; stapler; flat tube tractor; surgical quality evaluation; surgical video replay

DOI：

10.7507/1007-4848.202312080

Video：

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Objective To investigate the benefits of using a stapler tractor in the treatment of segmental bronchus during lung segmentectomy through detailed video replay analysis of surgical procedures. Methods We collected data from patients who underwent segmental resection performed by the same surgical team in the Department of Thoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, from November 1, 2020 to August 31, 2023. After excluding data that lacked analysis parameters, the remaining data were divided into four groups based on the methods used for dissociating segmental bronchus: stapler tractor group (group A), stapler with bronchial stretching group (group B), stapler only group (group C), and silk ligature group (group D). We then compared baseline data and videotaped surgical details across all groups. Surgical details included the success rate of one-time segmental bronchus dissociation and severance, the time taken for successful one-time dissociation and severance of the segmental bronchus, the incidence of bleeding during bronchus dissociation, the conversion rate to thoracotomy during surgery, and surgical outcomes such as total operative time, postoperative hospitalization days, postoperative thoracic drainage volume, and pulmonary air leakage rate. Results The study included 325 patients (203 in the group A, 62 in the group B, 29 in the group C, and 31 in group D). There was no statistically significant difference in baseline data among the four groups. However, significant differences were found in terms of total operation time, postoperative hospitalization days, intraoperative blood loss, segmental bronchial stump length, postoperative air leakage rate, hemorrhage rate during segmental bronchial dissociation, and conversion to thoracotomy rate among the four groups (P<0.05). Conclusions Using a stapler tractor for dissociating segmental bronchus in lung segmentectomy results in shorter operative time, less risk of intraoperative bleeding, and reduced surgical complications. This study provides valuable evaluation methodologies through the analysis of video replay surgical details, contributing to the improvement of lung segmentectomy quality.

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2.	Gonzalez M, Karenovics W, Bédat B, et al. Performance of prolonged air leak scoring systems in patients undergoing video-assisted thoracoscopic surgery segmentectomy. Eur J Cardiothorac Surg, 2022, 62(3): ezac100.
3.	Cannone G, Verzeletti V, Busetto A, et al. Three-Dimensional Imaging-Guided Lung Anatomic Segmentectomy: A Single-Center Preliminary Experiment. Medicina (Kaunas). 2023, 59(12): 2079.
4.	Aokage K, Suzuki K, Saji H, et al. Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): a multicentre, single-arm, confirmatory, phase 3 trial. Lancet Respir Med. 2023, 11(6): 540-549.
5.	黄晶晶, 陈志鹏, 卞承禹, 等. 以肺亚段为解剖单元的肺结节手术策略及临床结果的单中心回顾性分析. 中国胸心血管外科临床杂志, 2022, 29(1): 36-43.
6.	陈亮, 王俊, 吴卫兵, 等. 胸腔镜精准肺段切除术技术流程和质量控制. 中国胸心血管外科临床杂志, 2019, 26(1): 21-28.
7.	Gómez Hernández MT, Rivas Duarte C, et al. Usefulness of near-infrared fluorescence for identifying the segmental bronchus in minimally invasive segmentectomy. Cir Esp (Engl Ed), 2023, 101(1): 51-54.
8.	吴卫兵, 陈亮, 朱全, 张右江, 邵永丰. 直线切割缝合器引导管在全胸腔镜肺叶、肺段切除中的应用. 中国胸心血管外科临床杂志, 2012, 19(6): 638-641.
9.	Igaki T, Kitaguchi D, Matsuzaki H, et al. Automatic Surgical Skill Assessment System Based on Concordance of Standardized Surgical Field Development Using Artificial Intelligence. JAMA Surg. 2023, 158(8): e231131.
10.	Chhabra KR, Thumma JR, Varban OA, et al. Associations Between Video Evaluations of Surgical Technique and Outcomes of Laparoscopic Sleeve Gastrectomy. JAMA Surg. 2021, 156(2): e205532.
11.	Bowyer MW, Andreatta PB, Armstrong JH, et al. A novel paradigm for surgical skills training and assessment of competency. JAMA Surg, 2021, 156(12): 1103-1109.
12.	Schlick CJR, Bilimoria KY, Stulberg JJ, et al. Video-based feedback for the improvement of surgical technique: A platform for remote review and improvement of surgical technique. JAMA Surg, 2020, 155(11): 1078-1079.
13.	Curtis NJ, Foster JD, Miskovic D, et al. Association of surgical skill assessment with clinical outcomes in cancer surgery. JAMA Surg, 2020, 155(7): 590-598.
14.	Jung JP, Zenati MS, Dhir M, et al. Use of video review to investigate technical factors that may be associated with delayed gastric emptying after pancreaticoduodenectomy. JAMA Surg, 2018, 153(10): 918-927.
15.	朱健, 郗二平, 朱豫, 等. 320排CT在肺占位性病变诊断中的应用价值. 华南国防医学杂志, 2020, 34(5): 333-336,350.
16.	Liao W, Xu X, Li Z, et al. Three-dimensional imaging anatomical research and clinical implications of V1+2 d in the left upper lung. Thorac Cancer, 2023. doi: 10.1111/1759-7714.15186. Epub ahead of print.
17.	Wu WB, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
18.	徐文正, 李志华, 潘相龙, 等. 3D指导锥式肺段切除术治疗肺实质深部早期肺癌的肿瘤学疗效研究. 中国胸心血管外科临床杂志: 1-9 [2023-12-14]. http://kns.cnki.net/kcms/detail/51.1492.R.20230117.1258.012.html.
19.	Wang J, Xu X, Wen W, et al. Technique for tailoring complex demarcation in lung segmentectomy. Thorac Cancer, 2018, 9(11): 1562-1564.
20.	He Z, Wu W, Chen L. A 'true segmentectomy' cannot be overemphasized especially in the complex setting. Interdiscip Cardiovasc Thorac Surg, 2023, 36(5): ivad075.
21.	Xie B, Sun X, Qin Y, et al. Short-term outcomes of typical versus atypical lung segmentectomy by minimally invasive surgeries. Thorac Cancer, 2019, 10(9): 1812-1818.
22.	Mimura T, Yamashita Y, Kagimoto A, et al. Safety of a novel microwave surgical instrument for lung parenchyma dissection during segmentectomy. Ann Thorac Surg, 2020, 109(6): 1692-1699.
23.	Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
24.	Oizumi H, Kato H, Endoh M, et al. Management of bronchial stumps in anatomic lung segmentectomy. Ann Thorac Surg, 2016, 101(6): 2120-2124.
25.	Majeed FA, Raza A, Imtiaz T, et al. Pediculated intercostal muscle flaps in bronchiactasis resectional surgery for bronchial stump reinforcement. J Coll Physicians Surg Pak, 2020, 30(2): 197-200.
26.	Schlick CJR, Bilimoria KY, Stulberg JJ. Video-based feedback for the improvement of surgical technique: A platform for remote review and improvement of surgical technique. JAMA Surg, 2020, 155(11): 1078-1079.

1. Ginsberg RJ, Rubinstein L. The comparison of limited resection to lobectomy for T1N0 non-small cell lung cancer. LCSG 821. Chest, 1994, 106(6 Suppl): 318S-319S.
2. Gonzalez M, Karenovics W, Bédat B, et al. Performance of prolonged air leak scoring systems in patients undergoing video-assisted thoracoscopic surgery segmentectomy. Eur J Cardiothorac Surg, 2022, 62(3): ezac100.
3. Cannone G, Verzeletti V, Busetto A, et al. Three-Dimensional Imaging-Guided Lung Anatomic Segmentectomy: A Single-Center Preliminary Experiment. Medicina (Kaunas). 2023, 59(12): 2079.
4. Aokage K, Suzuki K, Saji H, et al. Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): a multicentre, single-arm, confirmatory, phase 3 trial. Lancet Respir Med. 2023, 11(6): 540-549.
5. 黄晶晶, 陈志鹏, 卞承禹, 等. 以肺亚段为解剖单元的肺结节手术策略及临床结果的单中心回顾性分析. 中国胸心血管外科临床杂志, 2022, 29(1): 36-43.
6. 陈亮, 王俊, 吴卫兵, 等. 胸腔镜精准肺段切除术技术流程和质量控制. 中国胸心血管外科临床杂志, 2019, 26(1): 21-28.
7. Gómez Hernández MT, Rivas Duarte C, et al. Usefulness of near-infrared fluorescence for identifying the segmental bronchus in minimally invasive segmentectomy. Cir Esp (Engl Ed), 2023, 101(1): 51-54.
8. 吴卫兵, 陈亮, 朱全, 张右江, 邵永丰. 直线切割缝合器引导管在全胸腔镜肺叶、肺段切除中的应用. 中国胸心血管外科临床杂志, 2012, 19(6): 638-641.
9. Igaki T, Kitaguchi D, Matsuzaki H, et al. Automatic Surgical Skill Assessment System Based on Concordance of Standardized Surgical Field Development Using Artificial Intelligence. JAMA Surg. 2023, 158(8): e231131.
10. Chhabra KR, Thumma JR, Varban OA, et al. Associations Between Video Evaluations of Surgical Technique and Outcomes of Laparoscopic Sleeve Gastrectomy. JAMA Surg. 2021, 156(2): e205532.
11. Bowyer MW, Andreatta PB, Armstrong JH, et al. A novel paradigm for surgical skills training and assessment of competency. JAMA Surg, 2021, 156(12): 1103-1109.
12. Schlick CJR, Bilimoria KY, Stulberg JJ, et al. Video-based feedback for the improvement of surgical technique: A platform for remote review and improvement of surgical technique. JAMA Surg, 2020, 155(11): 1078-1079.
13. Curtis NJ, Foster JD, Miskovic D, et al. Association of surgical skill assessment with clinical outcomes in cancer surgery. JAMA Surg, 2020, 155(7): 590-598.
14. Jung JP, Zenati MS, Dhir M, et al. Use of video review to investigate technical factors that may be associated with delayed gastric emptying after pancreaticoduodenectomy. JAMA Surg, 2018, 153(10): 918-927.
15. 朱健, 郗二平, 朱豫, 等. 320排CT在肺占位性病变诊断中的应用价值. 华南国防医学杂志, 2020, 34(5): 333-336,350.
16. Liao W, Xu X, Li Z, et al. Three-dimensional imaging anatomical research and clinical implications of V1+2 d in the left upper lung. Thorac Cancer, 2023. doi: 10.1111/1759-7714.15186. Epub ahead of print.
17. Wu WB, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
18. 徐文正, 李志华, 潘相龙, 等. 3D指导锥式肺段切除术治疗肺实质深部早期肺癌的肿瘤学疗效研究. 中国胸心血管外科临床杂志: 1-9 [2023-12-14]. http://kns.cnki.net/kcms/detail/51.1492.R.20230117.1258.012.html.
19. Wang J, Xu X, Wen W, et al. Technique for tailoring complex demarcation in lung segmentectomy. Thorac Cancer, 2018, 9(11): 1562-1564.
20. He Z, Wu W, Chen L. A 'true segmentectomy' cannot be overemphasized especially in the complex setting. Interdiscip Cardiovasc Thorac Surg, 2023, 36(5): ivad075.
21. Xie B, Sun X, Qin Y, et al. Short-term outcomes of typical versus atypical lung segmentectomy by minimally invasive surgeries. Thorac Cancer, 2019, 10(9): 1812-1818.
22. Mimura T, Yamashita Y, Kagimoto A, et al. Safety of a novel microwave surgical instrument for lung parenchyma dissection during segmentectomy. Ann Thorac Surg, 2020, 109(6): 1692-1699.
23. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
24. Oizumi H, Kato H, Endoh M, et al. Management of bronchial stumps in anatomic lung segmentectomy. Ann Thorac Surg, 2016, 101(6): 2120-2124.
25. Majeed FA, Raza A, Imtiaz T, et al. Pediculated intercostal muscle flaps in bronchiactasis resectional surgery for bronchial stump reinforcement. J Coll Physicians Surg Pak, 2020, 30(2): 197-200.
26. Schlick CJR, Bilimoria KY, Stulberg JJ. Video-based feedback for the improvement of surgical technique: A platform for remote review and improvement of surgical technique. JAMA Surg, 2020, 155(11): 1078-1079.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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