Staplers versus hand-sewing for pulmonary lobectomy: randomized controlled trial

Abstract

Background: Division of the parenchymal lung for lobectomy is performed in patients who have an incomplete fissure. A stapler device can reduce postoperative air leak, but it is expensive.

Objective: to investigate the advantage of using a stapler, in terms of postoperative air leak and cost, compared to hand-sewn techniques.

Method: A Non-blinded randomized controlled trial was conducted in Chiang Mai University Hospital, Thailand, from November 15, 2011 to September 30, 2012. Fifty-three adult patients were randomized to undergo a hand-sewn technique (27 patients) or stapler closure (26 patients).

Results: Postoperative air leak in the stapler group was less than that in the hand-sewn group (7.7% vs. 29.6%, p = 0.044), and the duration of air leak in the stapler group was significantly shorter than that in the hand-sewn group (1.0 vs. 13.4 days, p = 0.032). The cost of treatment was not significantly different between groups; however, the total cost in the stapler group was less than that in the hand-sewn group (mean difference 4454 Thai baht (US$144.75).

Conclusion: A stapler reduces postoperative air leaks and the duration of air leaks. Furthermore, the total cost of treatment was comparable. Therefore, using staples may provide substantial financial benefits.

Trial registration: ClinicalTrials.gov NCT01575314.

Keywords: Cost-consequence analysis; Lobectomy; Lung neoplasms; Surgical stapling.