A Comparative Study of Endo Stapler and Ultrasonic Scalpel in 3-Port Video-Assisted Thoracoscopic Surgery (VATS) for Lung Cancer Resections

Prolonged air leaks are typical postoperative complications of thoracoscopic surgery for lung cancer. Postoperative pulmonary fistula is thought to arise from the site of staple-on-staple or pleural defect site that occurs during pulmonary parenchymal dissection by Endo stapler or ultrasonic scalpel, that is, interlobar or intersegmental formation. In this study, we analyzed the incidence of prolonged air leaks caused by Endo staplers or ultrasonic scalpels through propensity score matching. A case series analysis was conducted on 322 patients who underwent thoracoscopic surgery at our hospital. The primary endpoint was the difference in the incidence of prolonged air leaks between 83 patients in the Endo stapler group and the ultrasonic scalpel group after confounding adjustment by propensity score matching. Prolonged air leaks occurred in 62 (19.3%) of all patients. The emphysematous changes were extracted as a factor involved in the development of PAL. After propensity score matching, no significant difference in the incidence of prolonged air leak between the automatic suture device group and the ultrasonic scalpel group (14.5% vs 19.3%, p = 0.535) was found. Multiple logistic regression analysis using the presence or absence of prolonged air leaks as an outcome also showed no significant association between the use of the ultrasonic scalpel and the onset of prolonged air leak. Our findings suggest that using the ultrasonic scalpel with fibrin glue plus polyglycolic acid sheet on parenchymal stumps could be used for the prevention of prolonged air leaks without being significantly inferior to the Endo stapler.