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Slow-firing mode reduces stump oozing during pulmonary vessel stapling.

Takuya Kohama¹, Masayuki Tanahashi¹, Haruhiro Yukiue²

¹Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan.

Journal of Thoracic Disease

|December 11, 2025

Summary

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Using a slow-firing mode for powered staplers significantly reduced bleeding from pulmonary vessel stumps during thoracic surgery. This simple adjustment can improve staple-line security and reduce complications in patients undergoing pulmonary resections.

Area of Science:

Thoracic Surgery
Surgical Technology
Vascular Surgery

Background:

Central vascular stump oozing is a persistent challenge in thoracic surgery following pulmonary vessel stapling.
Optimal firing speed for powered staplers to minimize bleeding is not well-established.
This study investigates the efficacy of slow-firing mode versus fast-firing mode in reducing intraoperative stump oozing.

Purpose of the Study:

To evaluate if slow-firing mode reduces intraoperative stump oozing compared to default fast-firing mode during pulmonary vessel stapling.
To identify factors influencing stump oozing during powered stapling.
To assess the impact of firing speed on hemostatic intervention needs and stapling time.

Main Methods:

A retrospective two-center cohort study analyzed 276 pulmonary vessel stapling events using a powered stapler with adjustable firing speed.

Keywords:

Pulmonary vessel stapling powered stapler technique slow-firing mode stump oozing

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Patients were divided into slow-firing (168 events) and fast-firing (108 events) groups.

Inverse probability of treatment weighting (IPTW) and multivariable logistic regression adjusted for confounders like vessel type, diameter, and mechanical stress.

Main Results:

The overall incidence of stump oozing was 23.2%.
Slow-firing mode showed a significantly lower incidence of oozing (17.9%) compared to fast-firing mode (31.5%; P=0.01).
After IPTW adjustment, slow-firing mode was independently associated with reduced oozing risk (OR, 0.51; P=0.03), with pulmonary artery stapling, lifting, and traction identified as risk factors.

Conclusions:

Slow-firing mode significantly decreases prolonged stump oozing from central vascular stumps, especially during pulmonary artery transection.
This finding suggests slow-firing mode is a practical strategy to enhance staple-line security.
Further validation in prospective studies is recommended to confirm these benefits.