The powered vascular staple (PVS) versus conventional powered linier cutter (PLC) for the application of bronchial transection in thoracoscopic anatomic segmentectomy

Ying Ji, Bin Qiu, Shugeng Gao


Background: Recent studies indicated that thoracoscopic anatomical segmentectomy (TAS) is widely adopted in early non-small cell lung cancer. Considering the slender segmental bronchi and the narrow space around segmental bronchi, it is easier to treat segmental bronchi with powered vascular stapler (PVS), which was designed to have a narrower anvil and a beak like tip. However, the safety and feasibility of PVS in stapling segmental bronchi are not yet clear.
Methods: We retrospectively compared the perioperative features of segmental bronchial closure treated with PVS and powered linier cutter (PLC) in thoracoscopic anatomic segmentectomy performed by a single surgeon and evaluated the safety and feasibility of PVS for the segmental or subsegmental bronchus.
Results: Between April 2018 and April 2019, a total of 162 patients who underwent anatomic segmentectomy were analyzed (PVS n=75 and PLC n=87). No bronchopleural fistula (BPF) occurred in 162 patients. Intraoperative blood loss in PVS group (15.2±8.91 mL) was significantly lower than that in PLC group (25.29±24.06 mL) (P<0.05). The operative time of PVS group was similar to the PLC group (P>0.05). There was no significant difference between the two groups in postoperative drainage and chest tube duration (all P>0.05). In terms of postoperative complications, the incidence of hemoptysis in PVS group was similar to PLC group (P>0.05). Two cases of subcutaneous emphysema occurred in PVS group, one case of pulmonary air leakage (>3 days) and one case of subcutaneous emphysema occurred in PLC group. Besides, all the surgeons (100%) slight agree or strongly agree that PVS is easier to pass through the segmental bronchus.
Conclusions: PVS is a smoother and easier instrument and has the same effectiveness and security as PLC. It leads to reduced operation difficulty and potential intraoperative complications.