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Slow Stapler Firing May Reduce Intraoperative Staple-Line Air Leakage During Pulmonary Resection: A Retrospective
Ryohei Miyazaki1, Masaya Tamura1, Naoki Furukawa1
1Department of Thoracic Surgery, Kochi Medical School, Kochi University, Nankoku, JPN.
Cureus
|June 29, 2026
Summary
Slower stapler firing during pulmonary resection may reduce air leaks from the staple line. This study suggests a link between faster stapler speed and increased air leakage in thoracic surgery patients.
Area of Science:
- Thoracic Surgery
- Surgical Technology
- Pulmonary Medicine
Background:
- Air leakage post-pulmonary resection is a common complication in thoracic surgery.
- This complication leads to prolonged chest drainage and increased healthcare costs.
- The impact of linear stapler firing speed on intraoperative air leakage is not well understood.
Purpose of the Study:
- To investigate the association between stapler firing speed and intraoperative air leakage during pulmonary resection.
- To determine if slower stapler firing reduces the incidence of staple-line air leaks.
Main Methods:
- Retrospective single-center study of 232 patients undergoing pulmonary resection for non-small cell lung cancer.
- Patients categorized into fast (6-10 seconds) and slow (≥20 seconds) stapler firing modes.
- Propensity score matching used to adjust for baseline differences; surgical videos reviewed for air leaks.
Main Results:
- After matching, 83 pairs were analyzed; staple-line air leak incidence was lower in the slow mode group (10.8%) vs. fast mode (22.9%).
- Multivariable analysis indicated fast stapler firing was significantly associated with intraoperative air leakage (OR 3.19).
- Smoking history and Goddard score were also associated with air leakage.
Conclusions:
- Slower stapler firing may be associated with reduced intraoperative staple-line air leakage in pulmonary resections.
- Findings are hypothesis-generating due to study limitations, including device heterogeneity and retrospective design.
- Further research is needed to confirm the effect of firing speed, separating it from device-specific factors.