Lasers for Pulmonary Resections

Abstract Objective: Our goal is to evaluate the effectiveness and safety of lasers compared with mechanical staplers in pulmonary resections using a qualitative and systematic manner. Summary of background data: Laser technique is effective in pulmonary resections among patients with pulmonary disease. However, systematic review of this technique need to be made toascertain its key role in thoracosurgery domain. Methods: For randomized controlled trials (RCTs) published in Medline, Web of Science, Cochrane Controlled Trials Register (CCTR), and clinical trial databases from June 1979 to October 2022, we identified and synthesized three studes to compare the efficacy and safety of lasers and mechanical staplers in pulmonary resections based on selection criteria. Two reviewers independently assessed trial bias and extracted data to make a using a qualitative systematic review. Results: The three RCTs were obtained using surgery approach of video-assisted thoracoscopic surgery (VATS). The operating time of the laser group was longer than that of the staple group in Marulli study (WMD = 12.00 min, 95% CI -11.66 to 35.66 for McKenna, WMD = 39.00 min, 95% CI 21.82 to 56.18 for Marulli and WMD = 2.00 min, 95% CI -15.10 to 19.10 for Scanagatta), while the hospital stay of the laser group was comparative with that of the staple group (WMD = -2.00d, 95% CI -7.36 to 3.36 for McKenna, WMD = -3.00d, 95% CI -6.29 to 0.29 for Marulli and WMD = 0.00d 95% CI -1.69 to 1.69 for Scanagatta). Risk ratio (95%CI), expressed as the persistent air leaks of the laser group vs the staple group, was RR = 0.68 (95%CI 0.38 to 1.22) for McKenna, RR = 0.67 (95%CI 0.12 to 3.61) for Marulli, RR = 1.07 (95%CI 0.53 to 2.16) for Scanagatta, respectively and expressed as pneumothorax, RR = 7.09 (95%CI 0.90 to 55.95) for McKenna, RR = 0.33 (95%CI 0.01 to 7.76) for Marulli, RR = 6.28 (95%CI 0.34 to 117.39) for Scanagatta, respectively. At the 6th month follow-up, the mean postoperative forced expiratory volume in 1 second of the staple group was significantly improved compared with that of the laser group. The clinical symptoms and dyspnea index were improved by more than one grade 8 of 33 (24%) patients in the laser group and 26 of 39 (66%) patients in the staple group (p = 0.003). Conclusions: The lasers are effective and comparable with mechanical stapler technique in pulmonary resections except for the improved for dyspnea index.