Abstract： Objective To investigate the application of a silicone guiding tube for endoscopic linear stapling device in complete video-assisted thoracoscopic lobectomy and segmentectomy，so as to improve the safety and efficiency of manipulating the endoscopic linear stapling device. Methods We retrospectively analyzed clinical data of 178 patients with peripheral non-small cell lung caner and 26 patients with benign lung lesions who underwent surgical resection in First Affiliated Hospital of Nanjing Medical University from October 2009 to December 2011. There were 85 males and 119 females with their average age of 62±11 years. A total of 172 patients underwent complete video-assisted thoracoscopic lobectomy and 32 patients underwent segmentectomy. We designed a silicone guiding tube to facilitate the use of endoscopic linear stapling device. With the help of the tube， a1l pulmonary arteries， veins， bronchus and interlobar fissure involved were managed with endoscopic linear stapling devices. Results Three patients （1.47%）underwent conversion to thoracotomy because of dense lymph node adhesion， and all other complete video-assisted thoracoscopic surgeries were successfully performed. There was no blood vessel injury， severe postoperative complications or perioperative death. The use rate of the tube was 95.6% （303/317）， 66.9% （115/172）， 22.7% （39/172） and 78.5% （255/325） in pulmonary arteries， veins， bronchus and interlobar fissure stapling for lobectomy respectively， and 94.4% （34/36）， 77.3% （17/22）， 25.0% （8/32）， 33.1% （45/136） in pulmonary arteries， veins， bronchus and interlobar fissure stapling for segmentectomy respectively. For lobectomy， a total of 986 staples were used with an average of 5.7 staples for each patient， the average operative time was 192.5±54.0 min and average intraoperative blood loss was 118.1±104.1 ml. For segmentectomy， a total of 226 staples were used with an average of 7.1 staples for each patient， the average operative time was 193.7±37.4 min and average intraoperative blood loss was 60.9±78.0 ml. Conclusion Using a silicone guiding tube can facilitate the application of endoscopic linear stapling device， shorten the learning curve of complete video-assisted thoracoscopic lobectomy and segmentectomy， and improve the safety， convenience and economical efficiency of endoscopic linear stapling device.
Citation：
WU Weibing,CHEN Liang,ZHU Quan,ZHANG Shijiang,SHAO Yongfeng.. Application of A Silicone Guiding Tube for Endoscopic Linear Stapling Device in Complete Video-Assisted ThoracoscopicLobectomy and Segmentectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(6): 638-641. doi:
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Roviaro GC， Varoli F， Vergani C， et al. State of the art in thoracospic surgery：a personal experience of 2000 video thoracoscopic procedures and an overview of the literature. Surg Endosc， 2002， 16 （6）：881-892.
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Belgers EH， Siebenga J， Bosch AM， et al. Complete video-assisted thoracoscopic surgery lobectomy and its learning curve. A single center study introducing the technique in The Netherlands.Interact Cardiovasc Thorac Surg， 2010， 10 （2）：176-180.
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Solaini L， Prusciano F， Bagioni P， et al. Video-assisted thoracic surgery major pulmonary resections. Present experience.Eur J Cardiothorac Surg， 2001， 20 （3）：437-442.
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Szwerc MF， Landreneau RJ， Santos RS， et al. Minithoracotomy combined with mechanically stapled bronchial and vascular ligation for anatomical lung resection. Ann Thorac Surg， 2004， 77 （6）：1904-1909.
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McKenna RJ Jr， Houck W， Fuller CB. Video-assisted thoracic surgery lobectomy：experience with 1，100 cases. Ann Thorac Surg， 2006， 81 （2）：421-425.
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Gossot D， Merlusca G， Tudor A， et al. Pitfalls related to the use of endostaplers during video-assisted thoracic surgery. Surg Endosc， 2009， 23 （1）：189-192.
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Complications MR， Learning curves for video-assisted thoracic surgery lobectomy. Thorac Surg Clin， 2008， 18 （3）：275-280.
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赵辉，王俊， 刘军， 等. 胸腔镜肺叶切除术治疗早期肺癌的学习曲线. 中华胸心血管外科杂志， 2009， 25 （1）：23-25．.
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蒲强， 刘伦旭， 车国卫， 等. 单向式全胸腔镜肺癌切除术的学习曲线分析. 中华外科杂志， 2010， 48 （15）：1161-1165．.
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Gharagozloo F， Margolis M， Tempesta B. Robot-assisted thoracoscopic lobectomy for early-stage lung cancer. Ann Thorac Surg， 2008， 85 （6）：1880-1885.
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Asamura H， Suzuki K， Kondo H， et al. Mechanical vascular division in lung resection. Eur J Cardiothorac Surg， 2002， 21 （5）：879-882.
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刘彦国， 王俊， 李运， 等. 内镜用直线切割缝合器在全胸腔镜肺叶切除术中的应用. 中国胸心血管外科临床杂志， 2008， 15 （5）：321-324．.
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吴卫兵， 陈亮， 朱全， 等. 自行研制的腔镜直线切割缝合器引导管在胸腔镜肺叶切除中的应用. 南京医科大学学报：自然科学版，2011， 31 （12）：1831-1833．.
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Ito N， Suda T， Inoue T， et al. Use of a soft silicone tube guide for an automatic suture device in video-assisted lung lobectomy. J Thorac Cardiovasc Surg， 2005， 130 （3）：931-932.
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| 15. |
Gossot D. Technical tricks to facilitate totally endoscopic major pulmonary resections. Ann Thorac Surg， 2008， 86 （1）：323-326.
|
- 1. Roviaro GC， Varoli F， Vergani C， et al. State of the art in thoracospic surgery：a personal experience of 2000 video thoracoscopic procedures and an overview of the literature. Surg Endosc， 2002， 16 （6）：881-892.
- 2. Belgers EH， Siebenga J， Bosch AM， et al. Complete video-assisted thoracoscopic surgery lobectomy and its learning curve. A single center study introducing the technique in The Netherlands.Interact Cardiovasc Thorac Surg， 2010， 10 （2）：176-180.
- 3. Solaini L， Prusciano F， Bagioni P， et al. Video-assisted thoracic surgery major pulmonary resections. Present experience.Eur J Cardiothorac Surg， 2001， 20 （3）：437-442.
- 4. Szwerc MF， Landreneau RJ， Santos RS， et al. Minithoracotomy combined with mechanically stapled bronchial and vascular ligation for anatomical lung resection. Ann Thorac Surg， 2004， 77 （6）：1904-1909.
- 5. McKenna RJ Jr， Houck W， Fuller CB. Video-assisted thoracic surgery lobectomy：experience with 1，100 cases. Ann Thorac Surg， 2006， 81 （2）：421-425.
- 6. Gossot D， Merlusca G， Tudor A， et al. Pitfalls related to the use of endostaplers during video-assisted thoracic surgery. Surg Endosc， 2009， 23 （1）：189-192.
- 7. Complications MR， Learning curves for video-assisted thoracic surgery lobectomy. Thorac Surg Clin， 2008， 18 （3）：275-280.
- 8. 赵辉，王俊， 刘军， 等. 胸腔镜肺叶切除术治疗早期肺癌的学习曲线. 中华胸心血管外科杂志， 2009， 25 （1）：23-25．.
- 9. 蒲强， 刘伦旭， 车国卫， 等. 单向式全胸腔镜肺癌切除术的学习曲线分析. 中华外科杂志， 2010， 48 （15）：1161-1165．.
- 10. Gharagozloo F， Margolis M， Tempesta B. Robot-assisted thoracoscopic lobectomy for early-stage lung cancer. Ann Thorac Surg， 2008， 85 （6）：1880-1885.
- 11. Asamura H， Suzuki K， Kondo H， et al. Mechanical vascular division in lung resection. Eur J Cardiothorac Surg， 2002， 21 （5）：879-882.
- 12. 刘彦国， 王俊， 李运， 等. 内镜用直线切割缝合器在全胸腔镜肺叶切除术中的应用. 中国胸心血管外科临床杂志， 2008， 15 （5）：321-324．.
- 13. 吴卫兵， 陈亮， 朱全， 等. 自行研制的腔镜直线切割缝合器引导管在胸腔镜肺叶切除中的应用. 南京医科大学学报：自然科学版，2011， 31 （12）：1831-1833．.
- 14. Ito N， Suda T， Inoue T， et al. Use of a soft silicone tube guide for an automatic suture device in video-assisted lung lobectomy. J Thorac Cardiovasc Surg， 2005， 130 （3）：931-932.
- 15. Gossot D. Technical tricks to facilitate totally endoscopic major pulmonary resections. Ann Thorac Surg， 2008， 86 （1）：323-326.
