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It Turns Out Stapler Choice Matters in Lung Cancer Surgery

2018/6/28 10:48:23 Views:605
Video-assisted lobectomies performed withpowered staplers resulted in nearly half as many patient bleeding complicationsas those conducted with manual staplers, according to a recent study.
 
Patients treated with powered staplers werereleased from the hospital one day earlier than those whose surgeons usedmanual staplers. The retrospective study, funded by powered-stapler makerEthicon, also indicated shortened hospital stays and 10% lower costs among thepatients treated with the powered devices, most of which were manufactured byEthicon, part of Johnson & Johnson. Most of the manual devices were made byMedtronic, according to the study, which appears in thejournal Advances in Therapy.
 
A lobectomy is a surgical procedure inwhich an entire lobe of the lung is removed due to cancer, infection, chronicobstructive pulmonary disease or benign tumors. Between 2% and 10% percent oflobectomies result in bleeding complications, according to a previous study ofvideo-assisted thoracic surgery and robotic lobectomy published in the Annalsof Thoracic Surgery in 2014, and an Ethicon analysis of nearly 27,000lobectomies captured in the Premier Perspective database for the period of2008-2014.
 
Most of the patients included in the studywere operated on using Ethicon’s Echelon Flex powered staplers. Their rate ofbleeding complications was 8.5% compared with manual stapler patients, at 16%.Hospital stays averaged 4.9 days for the powered-stapler group versus 5.9 daysfor the manual-stapler group. Total adjusted hospital costs were about 9%higher for procedures performed with manual staplers ($26,052 vs. $23,841).Outcomes including discharge status, operating room time and hospitalreadmissions were not different between the two groups. 

For the study, researchers evaluatedhospital discharge data of more than 3,550 thoracic patients from more than 700hospitals that contribute to the Premier Healthcare Database, one of thelargest statistically-certified hospital databases in the world. Patients hadVATS lobectomy procedures with either powered staplers (659 patients) or manualstaplers (3,100 patients) between January 2012 and September 2016. Nearly allof the powered staplers used in the study, were Ethicon’s Echelon Flex whilemore than 74% of the manual staplers were made by Medtronic, with the balancebeing manufactured by Ethicon.
 
One of the most important steps in lungsurgery and particularly lobectomy is the cutting of blood vessels, which couldlead to catastrophic outcomes if not done properly, according to Sanjoy Roy,director of health economics and market access at Ethicon, and a co-author ofthe study. The company didn’t set out to find fault with its competitors, butrather to study how powered staplers performed compared with manual devices,regardless of manufacturer, Roy added.
 
The company had previously studied theoutcomes of powered-stapler bariatric procedures, but no one had done a similarstudy on lung surgery patients.
 
“This is a startup for a journey into thethoracic space for Ethicon,” Roy said. “This validates our assumption or ourexpectation of our technologies at least offering some incremental value to thepatients, to the hospitals, and to the healthcare systems. I’m super excitedabout where we are right now.”

The big question that the studydid not answer is why the powered staplers led to better outcomes. It might betissue-gripping technology that the powered staplers have, but the company doesnot have specific evidence of this, added Roy.

“This gives us impetus, encouragement tocontinue to dig deeper,” he said.