Division of the intersegmental plane during thoracoscopic segmentectomy: is stapling an issue?

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Surgical Oncology

Background:

• Thoracoscopic segmentectomy is increasingly used for lung resections.
• Endostapler use for intersegmental plane division is common but debated.
• Potential for impaired lung re-expansion is a concern with stapling.

Purpose of the Study:

• To evaluate morbidity and lung re-expansion after thoracoscopic segmentectomy using endostaplers.
• To assess the clinical and radiological impact of stapling the intersegmental plane.

Main Methods:

• Retrospective analysis of 175 thoracoscopic anatomic segmentectomies.
• Endostapler used for all intersegmental plane divisions.
• Chest radiography assessed lung re-expansion at discharge and 1-month follow-up.

Main Results:

• Overall complication rate was 17% (0.6% major, 16% minor).
• Incomplete lung re-expansion observed in 7.4% at discharge and 2.8% at 1 month.
• Upper lobe segmentectomies showed more incomplete re-expansion and longer drainage duration.

Conclusions:

• Endostapling of the intersegmental plane may minimally impair lung re-expansion.
• Clinical and radiological consequences of stapling appear minimal.
• Thoracoscopic segmentectomy with stapling is a viable procedure with low morbidity.