Slow-firing mode reduces stump oozing during pulmonary vessel stapling

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.
• 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.