![]() open surgery are commonly reported: (I) problems in selection between the 3.5 and 4.5 mm staple height due to difficulty in assessment of the thickness and resistance of lung tissue in the limited space setting (II) the relatively small jaw opening of endo-stapler can make loading of the tissue difficult, associated with friction and subsequent tearing of the tissue (III) difficulty in precisely positioning the stapler tip may result in excessive tissue traction ( 2). Several reasons for stapler-related problems in VATS vs. The second difference relates to the use of bronchial staplers-in open surgery TA staplers are usually used, whilst āVā-shaped endo-stapler jaws are most frequently used in VATS procedures. In this situation the most proximally invaded vessel is stapled the last, after having dealt with other vessels, so that the distal end can be freely cut without the unplanned blood loss. One major difference relates the disease stage-unlike the early stage lung cancer, being the usual indication for the use of endo-vascular staplers in VATS surgery, the use of vascular TA staplers in open surgery frequently represents the only possible option in presence of locally advanced tumours, like for example in presence of short main pulmonary artery stump or invaded extrapericardial part of the pulmonary vein. Nowadays, in addition to initially used āLā-shaped TA bronchial and vascular staplers, endo-staplers are being increasingly used during open surgery as well, mostly to reduce the operation time and improve surgical comfort. What are the differences in the use of staplers? The widespread use of VATS brought another type of problems, not strictly related to staplers, but more to difficulties in stapler positioning related to the limited space. With the widespread use of video-assisted thoracoscopic surgery (VATS), the focus switched towards adverse events (AEs) during vascular stapling. After the onset of lung volume reduction surgery (LVRS), most of the data related to the role of the stapler line reinforcement. mechanical suture of the bronchus in open surgery. The initial reports referred mostly to advantages and disadvantages of manual vs. The reports about the benefits of staplers followed a certain time trend. These changes, together with lung emphysema and tuberculosis, affect the efficiency of staplers as well. In addition, increases in lung tissue thickness are typical for lung cancer and pulmonary fibrosis. In thoracic surgery, some specificities of the lung tissue, whose peripheral and central areas vary greatly in content of solid (bronchi) and more plastic elements (alveoli), directly influence the stapling process. One of the key requirements for the use of staplers in surgery in general is the need to find a balance between adequate tissue compression time and the risk of increased tissue tearing and excessive tensile strength ( 1). How to prevent adverse events of vascular stapling in thoracic surgery: recommendations based on a clinical and experimental study. Email: on: Shimizu N, Tanaka Y, Okamoto T, et al. Clinic for Thoracic Surgery, University Hospital Basel, Spitalstrasse 21, Basel, Switzerland.
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