Suzuki Mikito, Imoto Tomohiro, Shimizu Reiko, Nakagawa Kazuo
Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan.
J Thorac Dis. 2025 Jul 31;17(7):4948-4956. doi: 10.21037/jtd-2025-549. Epub 2025 Jul 28.
Staple line (SL) bleeding from the pulmonary artery (PA) can interfere with subsequent surgical procedures and prolong operative time. SL bleeding is associated with staple malformation and vessel wall damage. The manual slow firing mode (MSFM) is a function of Covidien's powered stapler Signia™, which performs firing at a continuous slow speed, whereas the conventional stapling mode adjusts the stapling speed based on tissue thickness. The slow-speed stapling of the PAs may help prevent staple malformation and vessel wall damage, thereby contributing to the reduction in SL bleeding. This study aimed to evaluate the effects of MSFM on PA dissection.
Of the 433 anatomical lung resections performed at our institution between November 2020 and November 2024, patients who underwent anatomical lung resection using the Signia™ small diameter reload with a gray 30 mm cartridge were included. PA dissection was classified into the conventional normal mode (NM) and MSFM; the frequency of SL bleeding was evaluated using each mode. SL bleeding was defined as bleeding/oozing that persisted for at least 15 s without any intervention or after the required compression for ≥5 s. We also evaluated SL bleeding in small-diameter (<7 mm), which could be safely dissected using an energy device, and in large-diameter vessels (≥7 mm).
Among the 82 patients, the total number of dissected pulmonary arteries was 84 and 87 in the NM and MSFM groups, respectively. The median (range) diameter was 6.6 (range, 2.1-14.1) mm in the NM and 6.3 (range, 2.3-14.2) mm in the MSFM groups (P=0.59). SL bleeding was significantly lower in the MSFM group [11.5% (10/87)] than in the NM group [26.2% (22/84)] (P=0.01). SL bleeding in the small vessels was 19.1% (9/47) in the NM group and 10.2% (5/49) in the MSFM group, with no significant difference (P=0.26). In contrast, for large vessels, SL bleeding was significantly lower in the MSFM group [13.2% (5/38)] compared with the NM group [35.1% (13/37)] (P=0.03).
MSFM could reduce SL bleeding from large-diameter PAs and might contribute to improved intraoperative safety.
肺动脉（PA）吻合钉线（SL）出血会干扰后续手术操作并延长手术时间。SL出血与吻合钉畸形和血管壁损伤有关。手动慢速发射模式（MSFM）是柯惠动力吻合器Signia™的一项功能，其以连续慢速进行发射，而传统吻合模式则根据组织厚度调整吻合速度。肺动脉的慢速吻合可能有助于防止吻合钉畸形和血管壁损伤，从而减少SL出血。本研究旨在评估MSFM对肺动脉解剖的影响。
在2020年11月至2024年11月期间于本机构进行的433例解剖性肺切除术中，纳入使用配有灰色30mm钉仓的Signia™小直径再装填器进行解剖性肺切除的患者。肺动脉解剖分为传统正常模式（NM）和MSFM；使用每种模式评估SL出血的频率。SL出血定义为在无任何干预的情况下持续至少15秒或在所需压迫≥5秒后仍存在的出血/渗血。我们还评估了可使用能量装置安全解剖的小直径（<7mm）和大直径血管（≥7mm）中的SL出血情况。
在82例患者中，NM组和MSFM组分别解剖了84条和87条肺动脉。NM组的中位数（范围）直径为6.6（范围2.1 - 14.1）mm，MSFM组为6.3（范围2.3 - 14.2）mm（P = 0.59）。MSFM组的SL出血率[11.5%（10/87）]显著低于NM组[26.2%（22/84）]（P = 0.01）。小血管中的SL出血在NM组为19.1%（9/47），在MSFM组为10.2%（5/49），无显著差异（P = 0.26）。相比之下，对于大血管，MSFM组的SL出血率[13.2%（5/38）]显著低于NM组[35.1%（13/37）]（P = 0.03）。
MSFM可减少大直径肺动脉的SL出血，并可能有助于提高术中安全性。
