The best site for bronchial stapling in left and right upper lobectomies: a comparative study

Area of Science:

• Thoracic Surgery
• Surgical Technique Optimization
• Pulmonary Medicine

Background:

• Bronchial stump complications can occur after lobectomy.
• The precise placement of bronchial staples may influence postoperative outcomes.
• Understanding residual bronchial anatomy post-stapling is crucial for patient recovery.

Purpose of the Study:

• To investigate the relationship between bronchial staple positioning and residual bronchus deformity (DRB) after upper lobectomy.
• To determine the optimal staple line location to prevent postoperative cough associated with DRB.
• To evaluate the impact of residual cartilaginous rings at the stump (RCRS) on DRB and cough.

Main Methods:

• Retrospective analysis of 40 patients undergoing left upper lobectomy (LUL) or right upper lobectomy (RUL) with bronchial stapling.
• Assessment of staple positioning relative to the upper lobe bronchus (ULB) entrance (2 vs. 3-4 bronchial rings).
• Postoperative bronchoscopic evaluation for residual cartilaginous rings at the stump (RCRS) and deformity of the residual bronchus (DRB), correlated with cough symptoms.

Main Results:

• Stapling 2 bronchial rings (BR) from the ULB entrance resulted in no RCRS and a high incidence of DRB (86% in LUL) and severe cough.
• Stapling 3-4 BR from the ULB entrance resulted in 1-2 RCRS, significantly reducing DRB (10% with one RCRS) and cough.
• DRB was strongly associated with the absence of RCRS (p < 0.01) and occurred less frequently with one or two RCRS.

Conclusions:

• Bronchial staple placement 3-4 BR distal to the left ULB entrance is recommended for LUL.
• This technique minimizes DRB and associated severe cough by preserving 1-2 RCRS.
• Optimizing staple line location is critical for preventing bronchial stump complications and improving patient quality of life post-lobectomy.