Comparative Study For The Effectiveness Of VATS Wedge Resection For Peripheral Pulmonary Nodules Using Clamp And Saw Technique Augmented By Tissue Sealants

Introduction: The video-assisted thoracoscopic surgery (VATS) has become progressively popular as a minimally invasive method for pulmonary resection surgery [1]. As a result, multiple technologies have been developed parallel to this technique to overcome the limitations for limited access and reduce the postoperative air leak. This included the wide use of staplers because of their convenience and quickness. However, using staplers are not devoid of complication. The purpose of the current study is to evaluate the effectiveness of VATS wedge resection using non-crushing clamp and continuous absorbable sutures augmented by tissue sealants for resection of peripheral pulmonary nodules and spotlights on the technical aspects to enhance safety and efficacy. Patient and methods: We conducted retrospective observational comparative study on a cohort of patients who underwent wedge resection using VATS for solitary or multiple peripheral pulmonary nodules. Patients were divided into two main groups. Group A included patients who had VATS wedge resection using staplers’ technique. Group B included patients who had VATS wedge resection with clamp and saw technique. Results: A total of 134 patients were included. 75 patients were excluded since they did not meet the selection criteria. The remaining 59 patients were divided between the two groups. Group A included 27 while Group B included 32 patients. There were 33 males (55.9%) and 26 females (44.1%). There were no significant differences in patient characteristics between both groups. Lung nodules had a mean maximal transverse diameter of 22.1±7.2mm (range 14.9–29.3mm). The mean distance from the pleura to superficial nodule margins was 12.0±3.1mm (range: 8.9–25.1mm). Univariate regression analysis was conducted on patients’ characteristics, nodule size and depth, comorbidities included smoking history and preoperative FEV1, and resection technique used. The results showed that neither of the variables was risk factor for development of the complications. However, the multivariate Logistic regression analysis of the results showed that stapler use in deeper nodules were among the influencing factor of postoperative complication (P < 0.05). This variable along with the other variables with P < 0.2 in univariate regression were further included in multivariate logistic regression. The final results demonstrated nodule depth (OR 4.07, 95% CI 2.05–14.66, P = 0.0.31) and stapler use (OR 2.17, 95% CI 2.11–7.13, P = 0.043) were risk factors for postoperative complications. Conclusion: in clinical practice, it is necessary to choose the appropriate treatment according to the patients’ individual situation. The clamp and saw technique augmented by surgical sealants for wedge resection of peripheral pulmonary nodule would be a substitute for staplers with similar air leak incidence, durations and severity. Keywords: Clamp and saw technique, wedge resection, VATS wedge resection.