Fei Cui1, Xiaoyong Shen2, Yang Xue3, Minwei Bao4, Wenshu Chen5, Yu Qi6, Zheng Ma7, Jun Yin8, Raymond Fryrear9, Chad Eckert9 and Sanjoy Roy9*
1The First Affiliated Hospital of Guangzhou Medical University, China
2Huadong Hospital, Affiliate of Fudan University, China
3Sichuan Province People’s Hospital, China
4Shanghai Pulmonary Hospital, China
5Fujian Province Hospital, China
6The First Affiliated Hospital of Zhengzhou University, China
7Chongqing General Hospital, China
8Zhongshan Hospital Fudan University, China
9Johnson & Johnson Medical Devices Company, USA
Background: VATS lobectomies have been shown to offer benefits over open thoracotomies in
terms of clinical and economic outcomes for patients and hospitals. New innovation in stapling
technology is expected to deliver improved clinical and economic outcomes in VATS procedures.
This study documents comparative evidence between major brands of staplers, and an aggregate
qualitative reaction from practicing thoracic surgeons in China in terms of utility of such evidence
in informing surgical choice in China.
Methods: Brief summaries of published pre-clinical and real-world database studies were presented
to a group of thoracic surgeons on-site in Shanghai. The evidence focused on comparing two major
stapler brands on device stability, bleeding complications, air leaks, and procedure economics.
Surgeons’ anonymized reactions to the presented evidence were captured through instant polls
conducted using an on-line polling software. Following a simplified Delphi Consensus development
methodology, absolute proportions of surgeon responses were calculated, with an a priori threshold
of 80% used as a general consensus position.
Results: Based on their review of the evidence, surgeons most agreed that a stapler does have a role
to play in the outcomes of VATS lobectomies. Based on multiple corroborating studies, surgeons
agreed that stapler choice does influence bleeding and air leak outcomes in lung surgery. Cost of
staplers was mentioned as a barrier for adoption owing to lack of understanding of downstream
value of higher priced technology - and further building the economic value proposition was
Conclusion: The presented evidence was found to be informative for clinical decision making.
Additional guidance was sought regarding cartridge/ reload selection, which would positively
affect the quality and cost of minimally invasive thoracic surgery. Observation of similar benefits
associated with latest powered and tissue-specific staplers across patients and geographies helps
build further confidence in their utility in China.
VATS, Thoracic Surgery; Stapler; Bleeding; Air Leak
Cui F, Shen X, Xue Y, Bao M, Chen W, Qi Y, et al. Evidence of the Impact of Stapler Choice on Clinical and Economic Outcomes in Video-Assisted Thoracoscopic Surgeries (VATS): APerspective from Thoracic Surgeons in China. World J Surg Surgical Res. 2020; 3: 1220..