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J Thorac Cardiovasc Surg 1995;109:1252
© 1995 Mosby, Inc.

BRIEF COMMUNICATIONS

Malfunctioning of vascular staple cutter during thoracoscopic lobectomy

Anthony P. C. Yim, MD, Jonathan K. S. Ho, MD


Hong Kong

From the Cardiothoracic Unit, Department of Surgery, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.

McKenna Go 1 recently reported his experience with video-assisted thoracoscopic lobectomy on 45 patients with no mortality or major complications. Advances in video-assisted thoracoscopic surgery have forced us to rely more and more on mechanical devices, particularly endoscopic staple cutters. They are reliable but not infallible. We would like to report a bad experience that we had with the vascular stapler (Multifire Endo-GIA 30V stapler, United States Surgical Corporation, Norwalk, Conn.). We have used this device many times previously without problems.

The mishaps occurred when we were performing a right upper lobectomy and we used the stapler to transect the superior pulmonary vein. It was the second load of cartridge for that particular stapler. The staple-cutter transected the vein but failed to staple. Fortunately we were able to immediately place a sponge stick through the minithoracotomy to slow down the bleeding and give enough time for extension of the minithoracotomy. The patient lost about 700 ml of blood and made an otherwise uneventful recovery. Examination of the stapling device and discussion with the manufacturer afterward revealed that slight pressure on the release mechanism on the shaft of the stapler (Fig. 1) during insertion could lead to slight misalignment between the anvil and the loading unit. Because we do not routinely use instruments ports for thoracoscopic lobectomy, pressure from the rib during insertion on the shaft could be the reason for the malfunctioning of the stapler as a result of malalignment, which would allow transection with the blade without proper stapling.



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  		Fig. 1. Close-up view of the endo-GIA stapler showing the release mechanism, which could cause misalignment if external pressure is applied during its insertion into the chest.

 
Although the true merits of thoracoscopic lobectomy remain to be defined, the safety of the patient should always be the primary concern. It is imperative that both the surgical and the nursing teams be familiar with the functioning of the staplers. The anvil must be carefully cleaned after use each time, because unused staples and blood clot can hinder proper firing during the next application. We now routinely insert the stapler through a 11.5 cm trocar port. Further advance in video-assisted thoracic surgery will depend on refinement of instrumentation.

Footnotes

J THORAC CARDIOVASC SURG 1995;109:1252 Back

References

  1. McKenna RJ. Lobectomy by video-assisted thoracic surgery with mediastinal node sampling for lung cancer. J THORAC CARDIOVASC SURG 1994;107:879-82.[Abstract/Free Full Text]



This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
A. P. C. Yim and H.-P. Liu
Complications and Failures of Video-Assisted Thoracic Surgery: Experience From Two Centers in Asia
Ann. Thorac. Surg., February 1, 1996; 61(2): 538 - 541.
[Abstract] [Full Text]

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