The stapler, cartridges and extracted pig arteries were kindly provided by Ethicon Endo-Surgery, Cincinnati, OH, USA. The authors declare that they have no competing interests.
JO: Study proposal, experimental design, data collection, statistics, clinical investigation, clinical review, and manuscript drafting. HK: Supervision, general support and advising; JU: Department chair. All authors read and approved the final manuscript.
Video-assisted thoracoscopic surgery (VATS) lobectomy is increasingly used for pulmonary sequestration; however, there are few descriptions of safe handling of the aberrant artery. Here we clarify the safe handling of an aberrant artery using a clinical review and an experimental model.
We retrospectively reviewed the records of patients who underwent lobectomy for pulmonary sequestration with aberrant arteries at the Nippon Medical School between January 2008 and December 2010. This was supplemented by an experimental pressure test using vessels obtained from pigs.
We identified four patients with aberrant arteries that were successfully occluded via either stapling. In the experimental model, we divided pig vessels into small-diameter (S) and large-diameter (L) groups. The 1.0-mm-high staples were stronger in the S group than in the L group (p = 0.028). In the L group, the 2.0-mm-high staples were stronger than the 1.0-mm staples (p = 0.015). Leakage from the staple line was associated with a poorer B-shape of inserted staples.
The techniques described in this report are useful in successful minimally invasive transection of an aberrant artery (other than very thin vessels) when resecting a pulmonary sequestration by stapler only. A detailed investigation should be performed to determine the most appropriate stapler or cartridge.
Shigeo K, Takashi M, Atsuhisa I, Hiroshi O, Tsukasa T, Kazuo T. Intralobar pulmonary sequestration supplied by multiple anomalous arteries: report of a case. Surg Today. 2001;31:701–4. CrossRef
- Safe transection of aberrant arteries associated with pulmonary sequestrations
- BioMed Central
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