Non-powered stapler linked to fewer postoperative air leaks than powered stapler in severe emphysema LVRS

OBJECTIVES: This study aimed to assess whether the use of the non-powered AEON Endostapler during lung resection in patients with severe lung emphysema reduces the duration of postoperative air leak, as measured by the air leak volume over time, in comparison to the Echelon Flex Powered Plus Stapler. METHODS: A total of 32 lung volume reduction surgeries were performed on 19 patients, stratified by side of the operation. These procedures were randomly assigned to utilize either the non-powered or the powered stapler. Postoperative air leak was monitored using a digital recording system. The time to air leak closure, the incidence and severity of air leaks, and the duration of chest tube placement were evaluated. RESULTS: Immediate postoperative air leaks were observed in 6 of 17 procedures (35.3%) using the non-powered stapler and in 9 of 15 procedures (60%) performed with the powered stapler. The median time to closure of the air leak was also considerably shorter in the non-powered procedures: 14.3 hours [6.7, 116] compared to 93.2 hours [2.1, 159] for the powered treatments. Cox regression analysis yielded a hazard ratio of 1.6 (95% CI, 0.73-3.3) for a faster air leak closure with the non-powered stapler (P = .25). CONCLUSIONS: Both stapler systems are feasible for use in patients with severe lung emphysema. However, our results show an earlier air leak closure and a lower incidence of postoperative air leaks with the use of a non-powered stapler. CLINICAL REGISTRATION NUMBER: https://clinicaltrials.gov/study/NCT05628415? term=LVRS&rank=9, 28.11.2022.