A Case of Postoperative Pneumothorax due to a Dislodged Reinforced Staple Fragment After Thoracoscopic Segmentectomy: Recommendations for the Safe Use of Reinforced Staplers

A 70-year-old man underwent a video-assisted thoracoscopic S1 + 2 segmentectomy for suspected left upper lobe lung cancer. Despite an uneventful intraoperative procedure with no air leakage on intraoperative testing, a postoperative pneumothorax developed after the patient returned to the ward. Conservative management, including autologous blood pleurodesis was attempted; however, persistent air leakage necessitated reoperation on postoperative day five. Intraoperatively, the dislodged staple fragment was found embedded in the remaining left upper lobe, causing an air leak. This fragment likely originated from a malformed staple during the initial resection. The staple was removed, and the leak point was successfully repaired. This case demonstrates the rare but significant risk of postoperative pneumothorax caused by dislodged staple fragments. We emphasize the critical importance of meticulous staple-line assessment and careful intraoperative management when using staple-line reinforcement (SLR) materials. Surgeons must increase their awareness of these potential complications and implement preventive measures to ensure patient safety.