Manual slow firing mode of SigniaTM Stapling System can achieve less staple line bleeding from pulmonary artery

Background: Staple line (SL) bleeding from the pulmonary artery (PA) can interfere with subsequent surgical procedures and prolong operative time. SL bleeding is associated with staple malformation and vessel wall damage. The manual slow firing mode (MSFM) is a function of Covidien's powered stapler Signia™, which performs firing at a continuous slow speed, whereas the conventional stapling mode adjusts the stapling speed based on tissue thickness. The slow-speed stapling of the PAs may help prevent staple malformation and vessel wall damage, thereby contributing to the reduction in SL bleeding. This study aimed to evaluate the effects of MSFM on PA dissection. Methods: Of the 433 anatomical lung resections performed at our institution between November 2020 and November 2024, patients who underwent anatomical lung resection using the Signia™ small diameter reload with a gray 30 mm cartridge were included. PA dissection was classified into the conventional normal mode (NM) and MSFM; the frequency of SL bleeding was evaluated using each mode. SL bleeding was defined as bleeding/oozing that persisted for at least 15 s without any intervention or after the required compression for ≥5 s. We also evaluated SL bleeding in small-diameter (<7 mm), which could be safely dissected using an energy device, and in large-diameter vessels (≥7 mm). Results: Among the 82 patients, the total number of dissected pulmonary arteries was 84 and 87 in the NM and MSFM groups, respectively. The median (range) diameter was 6.6 (range, 2.1-14.1) mm in the NM and 6.3 (range, 2.3-14.2) mm in the MSFM groups (P=0.59). SL bleeding was significantly lower in the MSFM group [11.5% (10/87)] than in the NM group [26.2% (22/84)] (P=0.01). SL bleeding in the small vessels was 19.1% (9/47) in the NM group and 10.2% (5/49) in the MSFM group, with no significant difference (P=0.26). In contrast, for large vessels, SL bleeding was significantly lower in the MSFM group [13.2% (5/38)] compared with the NM group [35.1% (13/37)] (P=0.03). Conclusions: MSFM could reduce SL bleeding from large-diameter PAs and might contribute to improved intraoperative safety.