Computer-Controlled Stapling System for Lung Surgery

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.