Stapler stuck to the lung tissue during thoracoscopic lobectomy: a case report

Background: Staplers play a crucial role for thoracoscopic lobectomy, but their malfunction may be associated with post-operative morbidity and/or mortality. Case Description: Herein, we reported a case of stapler trouble during thoracoscopic left lower lobectomy. At the end of the operation, interlobar fissure was divided by stapler with 60 mm purple (3.5 mm) cartridge. After firing, the jaws did not open, and remained stuck to the lung tissue. A fissureless approach was performed and the interlobar fissure was divided at last using a stapler with 60 mm purple (3.5 mm) cartridge. After firing, the jaws did not open, and remained stuck to the lung tissue. All secondary maneuvers recommended from the manufacturer for opening the jaws were performed, but without success. An additional stapler with 60 mm purple (3.5 mm) cartridge was inserted through the anterior incision, and divided the tissue between the stuck stapler and the pulmonary artery. The tissue with the locked stapler was divided from the specimen using energy device, and taken out of the patient through the anterior incision. The specimen was then inserted within the endo-bag and retrieved through the anterior incision in a standard manner. Extended lymphadenectomy completed the procedure, and intraoperative sealing test revealed no air leakage. The postoperative course was unremarkable, and patient was discharged five days later. The actual follow-up showed no sign of recurrence. Conclusions: Our strategy may be useful for surgeons to deal an unpredicted similar situation that may occur either for stapler malfunction or for improper use