Computer assisted stapling of tissues (CAST) is a new technology in evolution. It provides the surgeon with more ability to carry out procedures when minimal access is used for major surgical procedures. Preservation of the chest wall mechanics is a major factor in patient recovery following pulmonary resection (PR). The posterolateral muscle dividing thoracotomy, the ‘standard ‘approach for major PR is associated with decreased pulmonary function and late muscle atrophy. The alternate approach of VATS for PR has major limitation including it is restricted to small tumors, inadequate mediastinal lymphadenectomy and tumor implantation at port sites. A totally muscle sparing lateral thoracotomy (MATS) is another approach that does not have the above limitations. The purpose of this report is to give our experience with CAST to divide lung parenchyma and to secure the vascular and bronchial structures during PR employing MATS.
One hundred consecutive patients undergoing major PR using the CAST, forms the basis of this report. All patients underwent MATS, sparing both latissimus dorsi and serratus anterior muscles. The data were collected prospectively for analysis.
The procedures included 77 lobectomies, 5 pnuemonectomies and 18 major wedge or segmental resections. The median numbers of staples used were 5(range 1-13). Major malfunctions were encountered in 4 instances. Dislodgement of the cartridge from the cable occurred after successful deployment of the staples in two instances and in one instance an incomplete staple formation on a vessel requiring additional suture placement and one bronchial stapling failed requiring suture closure.
We conclude that CAST for PR is feasible. The resection of lung is made simpler, particularly of the bronchial and vascular structures. The use of this new technology is advantageous when MATS is performed for lung resections.
The technology is a significant advancement in currently available techniques for pulmonary resection. This will allow wider use of complete muscle sparing thoracotomy as a standard of practice for lung resection in the future.
Wickii Vigneswaran, Consultant fee, speaker bureau, advisory committee, etc. Advisory committee, Power Medical Interventions.