A Comparative Effectiveness Study of Two Narrow-Profile Staplers Used in Video-assisted Thoracoscopic Lobectomy

Purpose: The objective of this study was to evaluate and compare the effectiveness of a narrow-profile, small-diameter reload to a powered vascular stapler when used during VATs lobectomy. Patients and Methods: This was a retrospective, observational cohort study comparing outcomes after VATs lobectomy procedures in which either the Echelon Flex™ powered vascular stapler (PVS) or a Signia™ small-diameter reload (SDR) was used to transect pulmonary vasculature. Data from adult patients (≥ 18 years of age) who had lung cancer and underwent elective, primary VATs lobectomy in the 3 years between 2021 and 2023 were extracted from the PINC AI healthcare database. Two patient groups (PVS vs SDR) were propensity-score matched using a 1:1 nearest neighbor matching scheme with a caliper of 0.2 to adjust the baseline patient characteristic imbalance. Two sensitivity analyses were performed using multivariable regression models and propensity score inverse probability weighting. Results: Of 558 (34.1% SDR and 65.9% PVS) eligible inpatient cases, 68.5% age ≥ 65, 58.2% were female, 59.0% were married, 79.8% White, 68.5% were Medicare, 73.5% had comorbidity ≥ 3. One hundred and ninety pairs were matched. The incidence rate of blood transfusion was significantly higher in the PVS group than in the SDR group (PVS vs SDR: 6.4% vs 0.5% for matched pairs, difference: 5.8%, 95% confidence interval (CI) 2.2%– 9.5%, p = 0.002). The incidence rate of bleeding was not significantly different between the groups and no conversions were observed. Intensive care unit visits and length of stay were higher in the PVS group. Sensitivity analyses results were consistent with these findings. Conclusion: The narrow-profile SDR was an effective and beneficial tool for division and ligation during VATs lobectomy and is associated with fewer blood transfusions compared to PVS. Plain Language Summary: PLS Title : Comparing the performance of two surgical staplers during minimally invasive lung surgery. Surgical staplers are used for many kinds of surgeries. Some staplers are better for certain uses, depending on their design. In this article, we analyzed patient records from a US hospital-based, service-level, all-payer healthcare claims to help understand how two different surgical staplers performed in preventing bleeding during lobectomy (a type of lung surgery). One is called the “powered vascular stapler” (PVS) and the other is a “small-diameter reload” (SDR). We looked at lung cancer patients who underwent lobectomy in the years 2021 and 2023. Both staplers were effective tools during surgery. However, patients who had a procedure using the SDR stapler were less likely to need a blood transfusion compared to those where the PVS stapler was used. This suggests that patients in the SDR group may have lost less blood during surgery. Therefore, the SDR stapler might be a more suitable tool for minimally invasive lobectomy. Keywords: video-assisted thoracoscopic surgery, minimally invasive surgery, thoracic surgery, lobectomy, surgical stapler, small-diameter reload, blood transfusion