Effect of cutting technique at the intersegmental plane during segmentectomy on expansion of the preserved segment: Comparison between staplers and scissors in ex vivo pig lung

Objective: Cutting the intersegmental plane by using a stapler during segmentectomy might interfere with the expansion of the preserved lung due to visceral pleura caught in a staple line, especially in a large regional segmentectomy, such as left upper division or basal segmentectomy. We compared the preserved lung volume after segmentectomy among the methods using stapler, sharp dissection, and their combination for cutting the intersegmental plane in ex vivo pig lungs. We also examined a covering effect of polyglycolic acid mesh and fibrin glue. Methods: To assume a large regional segmentectomy in clinical practice, segments of the left caudal lobe except the lateral segment 2 (L2 segment) were resected, and the lung volume of the preserved L2 segment was measured. The intersegmental plane was cut by the following three methods: (1) stapler (n=8); (2) scissors (n=8); and (3) the combined method, that is, cutting the shallow lung tissue with scissors and the deep one with stapler (n=8). The opened intersegmental plane was covered with polyglycolic acid mesh and fibrin glue. The air leakage was checked by injecting air through the bronchus at pressures of up to 30cmH ₂O. Thereafter, normal saline was injected through the bronchus at pressures of 10, 20, and 30cmH ₂O, to measure lung volumes by the volume-displacement method. Results: Polyglycolic acid mesh and fibrin glue prevented air leakage completely at up to 30cmH ₂O. At the saline injection pressures of 10, 20, and 30cmH ₂O, the mean volumes of L2 segment were 72±14, 96±14, and 109±26ml with the stapler; 86±11, 117±19, and 135±39ml with scissors; and 98±10, 140±20, and 155±40ml with the combined methods, respectively. The volume of the preserved L2 segment was significantly lower with the stapler method than with either the scissors or combined method at each pressure (p<0.01). The difference was not significant between the scissors and combined methods. Conclusions: Coverage with polyglycolic acid mesh and fibrin glue prevented air leakage from the opened intersegmental plane. The stapler interferes with the expansion of preserved lung in comparison to scissors or combined methods in a large regional segmentectomy.