Methods for Dissecting Intersegmental Planes in Segmentectomy: A Randomized Controlled Trial.

ABSTRACT Background The perioperative outcomes of using stapling devices versus electrocautery to dissect intersegmental planes in patients undergoing segmentectomy for small pulmonary lesions is still unclear. The aim of this randomized controlled trial (RCT) was to compare the perioperative outcomes of these two methods. Methods A single-center, prospective, participant-blinded, randomized controlled trial (NCT03192904) was conducted with a preplanned sample size of 136. The primary outcome was the incidence of postoperative complications. Secondary outcomes included duration of surgery, blood loss during surgery, first day drainage volume, duration of drainage, postoperative hospital stay, loss of lung function and medical costs. Results The trial was stopped early due to a marked difference in the primary outcome between groups at a scheduled interim check of the data after recruiting 70 patients. The incidence of postoperative complications (e.g., air leakage etc.) was higher in the electrocautery group than in the stapler device group (11/32, 34.4% vs. 2/33, 6.1%, p = 0.004). There were no differences in surgery duration, blood loss during surgery, first day drainage volume, duration of drainage, postoperative hospital stays, loss of lung function, or total medical cost, although the per-patient cost of medical materials was higher in the stapler device group (4214.6 ± 1185.4 USD vs 3260.1 ± 852.6 USD, p Conclusions Among patients undergoing segmentectomy, the use of stapler devices to divide intersegmental planes decreased postoperative complications without further compromising lung function or increasing economic burden.