Computer-controlled stapling system for lung surgery.

Abstract

PURPOSE: Current disposable hand-actuated staplers may pose reliability problems, especially with respect to the measurement of tissue thickness. We have evaluated a newly developed stapler with a computer-controlled placement of staples. DESCRIPTION: The SurgAssist system (Power Medical Interventions, New Hope, PA) is comprised of a console that houses a computer, a remote control unit, a flexible shaft, and a cartridge. The remote control unit has two uses: (1) controlling the accurate placement of the cartridge by orientating the tip of the flexible shaft, and (2) controlling the closure of the stapler and the firing. Each cartridge contains a programmed electronic device that triggers the activation of the appropriate program in the main microprocessor. The compression level on the tissue is determined by the computer. EVALUATION: The system was used in a consecutive series of 38 patients, 26 times during open lung surgery and 12 times during video-assisted thoracic surgery. The following open procedures were performed: three pneumonectomies, 15 lobectomies, three segmentectomies, and five wedge resections. The following video-assisted thoracic surgery procedures were performed: eight wedge resections and four bullectomies for pneumothorax. There was no stapling failure and no complication related to the use of the stapler. During video-assisted thoracic surgery, some ergonomic problems were encountered that will be overcome by redesign. CONCLUSIONS: The computer-controlled stapling system may significantly improve tissue approximation during open and video-assisted thoracic surgery.