A Comparative Effectiveness Study of Two Narrow-Profile Staplers Used in Video-assisted Thoracoscopic Lobectomy

The objective of this study was to evaluate and compare the effectiveness of a narrow-profile, small-diameter reload to a powered vascular stapler when used during VATs lobectomy.

This was a retrospective, observational cohort study comparing outcomes after VATs lobectomy procedures in which either the Echelon Flex™ powered vascular stapler (PVS) or a Signia™ small-diameter reload (SDR) was used to transect pulmonary vasculature. Data from adult patients (≥18 years of age) who had lung cancer and underwent elective, primary VATs lobectomy in the 3 years between 2021 and 2023 were extracted from the PINC AI healthcare database. Two patient groups (PVS vs SDR) were propensity-score matched using a 1:1 nearest neighbor matching scheme with a caliper of 0.2 to adjust the baseline patient characteristic imbalance. Two sensitivity analyses were performed using multivariable regression models and propensity score inverse probability weighting.

Of 558 (34.1% SDR and 65.9% PVS) eligible inpatient cases, 68.5% age ≥65, 58.2% were female, 59.0% were married, 79.8% White, 68.5% were Medicare, 73.5% had comorbidity ≥3. One hundred and ninety pairs were matched. The incidence rate of blood transfusion was significantly higher in the PVS group than in the SDR group (PVS vs SDR: 6.4% vs 0.5% for matched pairs, difference: 5.8%, 95% confidence interval (CI) 2.2%-9.5%, p = 0.002). The incidence rate of bleeding was not significantly different between the groups and no conversions were observed. Intensive care unit visits and length of stay were higher in the PVS group. Sensitivity analyses results were consistent with these findings.

The narrow-profile SDR was an effective and beneficial tool for division and ligation during VATs lobectomy and is associated with fewer blood transfusions compared to PVS.