Abstract： Objective To investigate the application of a silicone guiding tube for endoscopic linear stapling device in complete video-assisted thoracoscopic lobectomy and segmentectomy，so as to improve the safety and efficiency of manipulating the endoscopic linear stapling device. Methods We retrospectively analyzed clinical data of 178 patients with peripheral non-small cell lung caner and 26 patients with benign lung lesions who underwent surgical resection in First Affiliated Hospital of Nanjing Medical University from October 2009 to December 2011. There were 85 males and 119 females with their average age of 62±11 years. A total of 172 patients underwent complete video-assisted thoracoscopic lobectomy and 32 patients underwent segmentectomy. We designed a silicone guiding tube to facilitate the use of endoscopic linear stapling device. With the help of the tube， a1l pulmonary arteries， veins， bronchus and interlobar fissure involved were managed with endoscopic linear stapling devices. Results Three patients （1.47%）underwent conversion to thoracotomy because of dense lymph node adhesion， and all other complete video-assisted thoracoscopic surgeries were successfully performed. There was no blood vessel injury， severe postoperative complications or perioperative death. The use rate of the tube was 95.6% （303/317）， 66.9% （115/172）， 22.7% （39/172） and 78.5% （255/325） in pulmonary arteries， veins， bronchus and interlobar fissure stapling for lobectomy respectively， and 94.4% （34/36）， 77.3% （17/22）， 25.0% （8/32）， 33.1% （45/136） in pulmonary arteries， veins， bronchus and interlobar fissure stapling for segmentectomy respectively. For lobectomy， a total of 986 staples were used with an average of 5.7 staples for each patient， the average operative time was 192.5±54.0 min and average intraoperative blood loss was 118.1±104.1 ml. For segmentectomy， a total of 226 staples were used with an average of 7.1 staples for each patient， the average operative time was 193.7±37.4 min and average intraoperative blood loss was 60.9±78.0 ml. Conclusion Using a silicone guiding tube can facilitate the application of endoscopic linear stapling device， shorten the learning curve of complete video-assisted thoracoscopic lobectomy and segmentectomy， and improve the safety， convenience and economical efficiency of endoscopic linear stapling device.
Objective To investigate the application and techni ques of endoscop ic linear stapling device in complete video-assisted thoracoscopic lobectomy, a n d to improve the safety and quality of the operation. Methods From September 2006 to January 2008,sixty consecutive complete video-assisted thoracoscopic lo b ectomies were performed. The patients include 30 men and 30 women with average a ge of 59.8 years old. Eight patients suffered from benign lung lesions, and 52 p atients suffered from primary lung cancers or other pulmonary malignancy. The op erations were performed under general anesthesia with doublelumen intubation a nd complete thoracoscopy.The procedures include 12 right upper lobectomies, 10 right middle lobectomies, 14 right lower lobectomies, 8 left upper lobectomies a nd 16 left lower lobectomies. All arteries, veins, bronchus involved were manag ed with endoscopic linear stapling devices. Results All the pr ocedures were successful with one conversion case（1.67%） due to tense lymph no des adhesion, no severe complications, as active bleeding, continuous air leak, foreign body reac tion or operation related death occured. Endoscopic linear stapling devices were used for stapling in 381 different procedures with average of 6.35 per case, am ong which 124 (2.06 per case)were for pulmonary arteries, 66(1.10 per case) for pulmonary veins, 60 for lobar bronchus and 131 for interlobar fissures.A period of 11.3 months (2-18 months) follow-up of all patients shows no dela yed bleeding, bronchialpleural fistula, pyothorax or pneumonia. Concl usion The application of endoscopic linear stapling device is one of th e major difficulty in complete video-assisted thoracoscopic lobectomy. Careful manipulation under some specific principles is the key for the security of the operation.
目的 探讨胃大部切除术中应用直线型切割缝合器的临床经验及优点。方法 总结直线型切割缝合器的使用方法，并比较分析传统胃大部切除术和采用直线型切割缝合器行胃大部切除术的手术时间和术后并发症。结果 使用直线型切割缝合器使手术时间缩短60～120 min (P=0.000)，术后出血并发症明显减少(P=0.024)。结论 应用直线型切割缝合器行胃大部切除术可以缩短手术时间和减少术后出血的发生。
目的评价将直线切割缝合器应用于脾切除贲门周围血管离断术中的安全性及效果。 方法前瞻性收集2013年6月至2014年5月期间于笔者所在医院行脾切除贲门周围血管离断术的46例肝炎后肝硬变继发门静脉高压症患者的临床资料，根据脾切除贲门周围血管离断术中直线切割缝合器的应用情况分为对照组18例（术中未使用直线切割缝合器）和观察组28例（术中使用直线切割缝合器），比较2组患者的疗效指标。 结果2组患者均顺利完成手术，无围手术期死亡及肝性脑病发生。对照组患者的手术时间、术中出血量、术中输血比例及术后24 h引流量均长于（或大于）观察组（P＜0.05），而2组患者的术后住院时间比较差异无统计学意义（P＞0.05）。术后所有患者均获访，随访时间为4 d～10个月，平均4个月。随访期间所有患者均无消化道再出血发生，脾功能亢进得到完全纠正，生活质量满意。 结论将直线切割缝合器应用于脾切除贲门周围血管离断术是安全而有效的，其简化了手术操作，减少了手术创伤，值得临床推广应用。
ObjectiveTo investigate the safety and feasibility of thoracoscopic lobectomy without mechanical suture.MethodsThe data of 28 consecutive patients (a non-mechanical suture group, 16 males and 12 females at age of 61.23±11.10 years) who underwent non-mechanical suture anatomic thoracoscopic lobectomy performed by the same surgeon from March 2015 to March 2018 were analyzed retrospectively, and 28 patients (18 males and 10 females at age of 59.45±13.39 years) who underwent completely anatomic thoracoscopic lobectomy with endoscopic stapler (a mechanical suture group) in the same period were matched. The clinical effectiveness of the two groups was compared.ResultsThe operation time between the non-mechanical suture group (136.30±53.46 min) and the mechanical suture group (109.63±44.61 min) showed a statistical difference (P<0.05). While in term of intraoperative bleeding volume (65.00 ml vs. 50.00 ml), postoperative thoracic drainage time (3.73 days vs. 3.56 days), thoracic drainage volume (538.60 ml vs. 563.70 ml), postoperative hospital stay (5.58 days vs. 5.35 days) and postoperative complication rate (5/28 vs. 6/28), there was no statistical difference between the two groups. Hospitalization expense was significantly different between the two groups (35 438.30 yuan vs. 51 693.60 yuan).ConclusionNon-mechanical suture thoracoscopic anatomic lobectomy is safe and feasible, and can significantly reduce the medical cost but prolong the operation time.
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 segmentectomy performed by the same surgical team in the Department of Thoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, from November 2020 to August 2023. After excluding data that lacked analysis parameters, the remaining patients were divided into four groups based on the methods used for dissociating segmental bronchus: a stapler tractor group (group A), a stapler with bronchial stretching group (group B), a stapler only group (group C), and a silk ligature group (group D). Then, we 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 the 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). ConclusionUsing a stapler tractor for dissociating segmental bronchus in lung segmentectomy results in shorter operative time, less risk of intraoperative bleeding, and less surgical complications. This study provides valuable evaluation methodologies through the analysis of video replay surgical details, contributing to the improvement of lung segmentectomy quality.