The Use of 8-mm Powered Articulation Endostapler for Sublobar Resection in Children. Preliminary Case Series

Video-assisted thoracoscopic surgery (VATS) is considered the treatment of choice in children with subpleural bullous lesions, in which endoscopic staplers are routinely used. Recently, a new generation of electronically powered stapling systems was developed. Our aim is to compare the use of a new 8-mm electronic endostapler with a 12-mm nonelectronic conventional device in thoracoscopic sublobar resection in children. We performed a retrospective single-center study in patients under 18 years who underwent VATS sublobar resection of subpleural bullae in our institution between January 2022 and December 2023. They were divided into two groups according to the type of endostapler used (8 mm electronic or 12 mm non-electronic). Demographic, clinical, intraoperative and postoperative outcomes were analyzed. We included 8 patients (4 in each group), with a median age of 13.2 years (interquartile range [IQR]: 10.7-15.4 years), without demographic or clinical differences between them. Median surgery time was 42 minutes (IQR 35-55 minutes) in the 8-mm electronic group compared with 53 minutes (IQR 45-65 minutes) in the 12-mm group. There were no intraoperative complications and no reconversions to open surgery. Median length of drainage therapy did not show significant differences between them (3 days in both groups; P = .512). No postoperative complications were reported. Preliminary results of the 8-mm electronic endostapler appear to be comparable with the conventional mechanical stapler. Advantages include smaller incisions, as well as one-handed, push-button operation, which eliminates the manual firing force and possibly enables more precise resection. Further studies are still needed.