Stapling Techniques in Pulmonary Surgery

Abstract

There are only a few reports in the veterinary literature describing the use of stapling equipment and techniques for pulmonary surgery. These reports indicate that complications associated with these procedures are minimal. Although pulmonary lobectomy procedures originally described independent isolation and ligation of the hilar vessels, it became apparent that, with the use of the smaller staples, especially the ones designed for vascular use, this was unnecessary. Therefore, en bloc hilar stapling is the procedure of choice. This makes the surgical procedure extremely quick to perform. Similarly, there is no indication to routinely oversew staple lines when performing a partial lobectomy. This is a tedious procedure and may actually increase the chance of air leakage. If point areas of leakage do occur, these can be independently occluded either with sutures or individual vascular clips. Selecting the correct size of TA stapler and staples to create the correct length of staple line is critical. It is important that all the tissue to be ligated lie comfortably within the staple line. It is better to use a stapler that is too long and collect the extra staples on a sponge than to use one that is too short that results in leakage from nonstapled tissue. In general, the 4.8-mm staples should not be used for pulmonary surgery in the dog and cat. They do not compress the tissue enough to prevent leakage. For most complete lobectomies, where the hilus of the lung can be adequately isolated, the TA 30 V3 is the stapler of choice. When performing a partial lobectomy, a longer stapler is often required. If a TA 55 or TA 90 is necessary, it should be used with 3.5-mm staples. Even though stapling techniques have made pulmonary surgical procedures safe, easy, and quick to perform, they are not totally free of problems and complications. Experience in the use of the equipment is essential, as is good surgical judgment as to when to use or not to use these techniques. The absence of reported clinical complications, either short- or long-term, attests to the success of these techniques.