# Staple Formations in Bronchial Closure with Equal-Height Staples to Those with Graduated-Height Staples Using Motorized Staplers

## TL;DR

This study compares staple formation completeness in bronchial closure using two types of motorized staplers, finding that graduated-height staples perform better, especially in calcified bronchi.

## Contribution

The study provides empirical evidence on the performance of graduated-height versus equal-height staples in bronchial closure using motorized staplers.

## Key findings

- Graduated-height staples showed a higher incidence of staple scores above the median compared to equal-height staples.
- Graduated-height staples had a higher rate of complete staple formation, particularly in calcified bronchi.
- No bronchopleural fistula was observed in any patients during the study period.

## Abstract

Purpose: Motorized automatic staplers are used for bronchial closure following pulmonary resection. This study aimed to compare the completeness of staple formation in bronchial closure using 2 commonly adopted staple cartridges with motorized automatic staplers as follows: graduated-height staples (GHS) and equal-height staples (EHS).

Methods: This prospective observational study included 103 patients (105 bronchial stumps) undergoing pulmonary resections for lung cancer. Resected bronchi were embedded in paraffin, X-rays were taken, and staple formations were scored on a 0–4 scale, with a score of 4 indicating complete staple formation. Stump scores represented the average score of all staples per bronchial stump.

Results: The GHS exhibited a higher incidence of staple scores above the median (3.91) than that of the EHS (37/59 [62.7%] vs. 19/46 [41.3%], respectively; p = 0.033). Additionally, the GHS had a higher rate of complete staple formation than that in the EHS (84.7% vs. 75.1%; p <0.0001). This difference was more evident in calcified bronchi (84.2% vs. 57.6%, respectively; p <0.0001). No bronchopleural fistula was observed in any patients during the year.

Conclusion: Staple formations were generally more complete in the GHS than in the EHS. This difference was particularly notable in calcified bronchi.