Leakage pressures of partial and total lung lobectomies performed with thoracoabdominal staplers in cadaveric dogs.

Abstract

Objective: To compare leakage pressures of stapled partial and total lung lobectomies using thoracoabdominal (TA) staplers in canine cadaveric specimens.

Study design: Ex vivo experimental study.

Sample population: A total of 29 lung lobes from six canine cadavers.

Methods: Lower respiratory tracts were harvested from canine cadavers >15 kg. Lung lobes were randomized to groups: total lobectomy with a TA30-V3 (TL-30), partial lobectomy with two TA30-V3 cartridges in a wedge configuration (PL-30), and partial lobectomy with a TA60-3.5 mm (PL-60). The leakage pressure (pressure at which air bubbles were first seen from submerged tissue) was assessed, and groups were compared.

Results: All nine PL-30 and all nine PL-60 sites leaked at median pressures of 10 cm H₂O (range 10-15) and 18 cm H₂O (range 10-20), respectively. Only 1/11 TL-30 site leaked during testing at a pressure of 22 cm H₂O. PL-30 and PL-60 sites were more likely to leak at 20 (OR: 437; 95% CI: 7.9-24 171; p = .003) and 30 (OR: 133; 95% CI: 4.8-3674.2; p = .003) cm H₂O compared to TL-30 sites, and the leakage pressure was greater for TL-30 as compared to PL-30 (marginal effect: -46.14; 95% CI: -55.9 to -36.38; p < .001) and PL-60 (marginal effect: -41.2; 95% CI: -51.73 to -30.67; p < .001) sites. PL-60 leakage pressures were greater than those of PL-30 (marginal effect: 4.94; 95% CI: 1.43-8.44; p = .006).

Conclusion: In canine cadaveric lung, total lobectomies with a TA30-V3 were less likely to leak at physiological pressures than partial lobectomies with either TA30-V3 or TA60-3.5 mm staplers.

Clinical significance: These results suggest a greater potential risk for air leakage at physiologically relevant pressures following partial as compared to total lobectomies with the TA stapling devices and techniques used commonly in veterinary surgery.