Author of

• 12068

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  O13 - Limited Resections (ID 101)

  • Event: WCLC 2013
  • Type: Oral Abstract Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:G.M. Wright, K. Kernstine
  • Coordinates: 10/29/2013, 10:30 - 12:00, Bayside 204 A+B, Level 2

  • 12074

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    O13.06 - Vio-soft-coagulation for repair of air leak from dissected intersegmental plane during thoracoscopic segmentectomy (ID 949)

    11:25 - 11:35  |  Author(s): M. Miyajima
    • Abstract
    • Presentation
    • Slides

    Background
    The VIO soft-coagulation system is a new device for tissue coagulation. This system regulates the temperature rise below boiling point without generating sparks, which is high enough to denature protein. The purposes of this study are to evaluate the effect of intersegmental air leak repair by the use of Vio-soft coagulation mode (ERBE Elektromedizin GmbH, Germany) during thoracoscopic segmentectomy and to show how to use the device.

    Methods
    Between 2007 and 2013, we have performed 162 thoracoscopic segmentectomies for early stage primary lung cancer (In this period, 805 thoracoscopic lobectomies have been performed.). Among these patients, 36 underwent anatomical intersegmental plane dissection only using electrocautery without any staplers. Inclusion criteria for thoracoscopic segmentectomy are as follows: 1) c-stage IA peripheral non-small cell carcinoma, 2) No prior chemotherapy or radiation therapy, and 3) Confirmation of N0 status by intraoperative frozen examination. Furthermore, indication criteria for anatomical intersegmental plane dissection using electrocautery followed by any sealing to repair air leak from dissected intersegmental plane include the above-mentioned criteria and as follows: 1) Non-emphysematous lung, and 2) No pleural adhesion. In this series, we divided the intersegmental plane along the intersegmental vein and inflation-deflation demarcation line with an electrocautery (monopolar coagulation mode, 80W) and vessel sealing system. Soft coagulation was set at Effect 5 and 80W for divided intersegmental sealing. The massive air leak from the divided intersegmental plane was repaired with suture pneumorrhaphy or bronchiororraphy before the coagulation. These patients were assigned into two groups: group A consisted of 19 patients with air leak repair using Vio-soft coagulation system and group B consisted of 21 patients not subjected to the system.

    Results
    There was no case of conversion to thoracotomy. The mean operative time was 229 + 73 vs 238 + 48 min (group A vs group B; P=0.69), and accordingly, the mean intraoperative blood loss was 104 + 112 vs 115 + 115 ml (P=0.77). Total number of endostapler cartridges was 1.3 vs 1.4 (P=0.99). Of course, the cartridge number used for intersegmental division was zero in both groups. Most importantly, the fibrin sealant was used in 5 patients (26.3%) vs13 patients (61.9%) to repair air leak from intersegmental division (P=0.031). There were no major postoperative complications in both groups. There were one cases of prolonged air leak in group A and one (requiring redo surgery) in group B (P>0.99). The median chest tube duration and postoperative stay were 2.0 + 1.7 (range 1-8 days) vs 2.4 + 0.8 days (range 2-5 days) (P=0.41) and 7.9 + 1.9 vs 7.9 + 2.3 days (P>0.99), respectively.

    Conclusion
    The VIO soft-coagulation system is safe and feasible for repair of dissected intersegmental plane in patients during thoracoscopic segmentectomy. It enables reduction in the use of fibrin sealant and number of endostapler cartridges in this procedure without any postoperative increased air leak problem.

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