Ex vivo comparative evaluation of feline hilar lung lobectomy using linear stapler, pretied ligature loop, and double-shank titanium clips.

Abstract

Objective: To compare the seal performance of a linear vascular stapler, pretied ligature loop (PLL), and double-shank (DS) titanium clip for total lung lobectomy in a feline cadaveric model under physiologic and supraphysiologic airway pressures.

Study design: Ex vivo experimental randomized study.

Sample population: Thirty cadaveric feline lung lobes.

Methods: Thirty lung lobes from five fresh feline cadavers, humanely euthanized for reasons unrelated to this study, were randomized into three groups to undergo hilar lung lobectomy using a linear vascular stapler, PLL, or DS titanium clips. After lobectomy, each bronchial stump was submerged in water, and the peak inspiratory airway pressure was increased up to 40 cm H₂O. Bursting pressure was compared across the techniques.

Results: No air leaks were observed in the PLL or DS titanium clip groups. One bronchial stump (1/10) in the linear vascular stapler group leaked at the supraphysiologic pressure of 40 cm H₂O. There was no difference in leakage incidence among the groups (p = .33).

Conclusion: Linear vascular stapler, PLL, or DS titanium clips were comparable and effective devices for sealing the hilar lung lobectomy site at physiologic and supraphysiologic airway pressure in feline cadavers. The PLL and DS titanium clips were relatively easy to use, required less working space, and may represent an equally effective and more cost-efficient alternative to traditional stapling devices in open and minimally invasive feline pulmonary lobectomy.