Two Cases of Interrupted Pulmonary Artery Dissection Using the SureForm SmartFire Stapling System due to Activation...

Robot-assisted thoracoscopic surgery (RATS) is now widely performed worldwide, and the use of robotic staplers is increasingly common. In this report, we present two cases in which pulmonary artery transection was interrupted due to activation of the robotic stapler's safety mechanism, labeled "Tissue Too Thick to Continue." Although no superfluous tissue was apparent upon inspection, the transaction was halted mid-procedure in both cases. Potential causes for this interruption include inappropriate cartridge selection for the tissue thickness, a dropped staple, or insufficient detachment of tissue in a visually inaccessible area. Malfunction or interruption of an automatic stapling device during vascular transection can lead to serious complications. Therefore, we believe this safety system should assess tissue suitability before initiating transection. Here, we describe how we managed these intraoperative events and discuss possible factors contributing to robotic stapler malfunction.