Initial Experience and Feasibility of Novel Asymmetric Linear Stapler in Pulmonary Resection: Single Center Experience

Background: Accurate resection margin assessment is crucial for achieving optimal oncologic outcomes in lung cancer surgery.Conventional linear staplers introduce significant tissue deformation, limiting the ability to assess true resection margins intraoperatively.The novel asymmetric linear stapler (NALS) has been developed to address these limitations by minimizing tissue compression and preserving margin integrity.This study presents our initial experience with NALS, evaluating its feasibility in achieving accurate intraoperative margin assessment.Methods: A retrospective study was conducted at Chungnam National University Hospital between July 2024 and February 2025.Patients who underwent pulmonary resection using NALS were included.Resection margins were evaluated intraoperatively using frozen section analysis and later confirmed via final pathological assessment.Margin positivity rates, tumor characteristics, and resection margin distances were analyzed.Results: A total of 87 patients underwent pulmonary resection using NALS.The mean resection margin distance was 13.413.8mm (interquartile range, 3.75-20 mm).Margin positivity was identified in 5.7% of cases (parenchymal: 5.5%, bronchial: 5.8%).Histopathologic examination confirmed that NALS preserved tissue integrity, allowing for reliable intraoperative assessment.Conclusion: NALS enables precise intraoperative margin assessment by preserving resection margin integrity, reducing tissue distortion, and potentially minimizing unnecessary lung parenchymal resection.This technique may optimize the balance between oncologic safety and lung function preservation, particularly in sublobar resection.Further multicenter studies and long-term follow-up are warranted to assess the impact of NALS on recurrence rates and survival outcomes.