The Impact of Endoscopic Linear Stapling Device Stability in Thoracic Surgery: A Delphi Panel Approach

Objectives: To develop consensus statements outlining the impact of endoscopic linear stapling device stability on potential complications of thoracic surgery and the stress/concern of thoracic surgeons. Methods: Eight thoracic surgeons representing 8 countries participated in a Delphi panel process using 2 anonymous surveys. The first included binary, multiple-response, and Likert scale-type questions, which were converted into affirmative statements for survey 2 if an adequate number of respondents answered similarly. Consensus was defined a priori when ≥70% agreed with the affirmative statement in survey 2. Results: All panelists completed both surveys. Panelists unanimously agreed that: 1) an endoscopic linear stapling device with improved stability would result in less stress/concern for critical firings, surgeries where a fellow is trained, and robot-assisted surgeries requiring an assistant; 2) reduced unintentional tissue/structure damage and reduced tension on tissue being fired upon may result from use of an endoscopic linear stapling device that provides improvement in stability; and 3) endoscopic linear stapling device stability had more clinical importance in video-assisted thoracic surgery compared to open thoracic surgery. Conclusions: Improved endoscopic linear stapling device stability is a critical component of thoracic surgery likely to result in more frequent positive surgical outcomes when compared to a device with greater instability.