Determination of initial airtightness after anatomical laser segmentectomy in an ex vivo model

Abstract

If a pulmonary pathology can be removed by anatomical segmentectomy, the need for lobectomy is obviated. The procedure is considered oncologically equivalent and saves healthy lung tissue. In every segmentectomy, lung parenchyma must be transected in the intersegmental plane. Using an ex vivo model based on porcine lung, three transection techniques (monopolar cutter + suture, stapler, and Nd:YAG laser) are to be compared with respect to their initial airtightness. At an inspiratory ventilation pressure of 25 mbar, all three preparations were airtight. Upon further increase in ventilation pressure up to 40 mbar, the laser group performed best in terms of airtightness. Since thanks to its use of a laser fibre, this technique is particularly suitable for minimally invasive surgery; it should be further evaluated clinically for this indication in the future.

Keywords: Airtightness; Laser fibre; Monopolar cutter; Nd:YAG laser; Segmental resection; Segmentectomy; Stapler; VATS.

Fig 1

a Marked atelectatic segment of the lower lobe after clamping out of the segmental bronchus. b Segmentectomy through the use of a laser fibre (800 μm). The laser fibre is handled with a fibre holder (own photo)

Fig 2

a Illustration of the experimental setup. b Quantitative determination of the air leakage by collecting the escaping air through a funnel (own photo)

Fig. 3

Airtightness of the resection areas in groups 1 to 3, graded up to a maximum p_ins = 40 mbar

Fig. 4

Relative airtightness of groups 1 to 3 with increasing inspiratory ventilation pressure