[Assessment of 7 years of automatic suturing in pulmonary surgery]

In 738 patients, the stapler-suturing methods were used in 2 main areas of concern: closure of the major hilar broncho-vascular structures (for smaller pulmonary vessels, we use absorbable ligating clips: Absolok from Ethicon and Polysurgiclip from USSC), suture of the lung parenchyma. Regarding pedicular sutures, our rate of bronchial fistula is 1,0% (or 4,4% if only pneumonectomies are taken into account: 1,4 on the left and 7,7 on the right). These rates are compared with those gathered from the literature, with emphasis on the right main bronchus. Regarding parenchymal sutures, we place TA and GIA on collapsed parenchyma for achieving a wide range of either intralobar or translobar procedures. We lay emphasis on: the conventional segmentectomies with stapling of the intersegmental surface, and the newer and more economical "non réglées" transsegmental resections in which the surgeon is anymore limited by segmental frontiers. The control of blood and air leakage from the cut surface is quite satisfactory, reducing significanthy the postoperative morbidity. For both major pedicular structures and fragile lung parenchyma, the stapler-suturing methods are very reliable and provide a quicker, simpler, safer, easier and more economical surgery in lung resections.