Evaluation of a new ultrasonic device for surgical dissection in lung lobectomy and lymphadenectomy for lung cancer

Objective To assess and compare surgical electric hook vs Harmonic ACE Plus® impact on short-term postoperative outcomes after video-assisted thoracoscopic (VATS) lung lobectomy and lymphadenectomy for non-small cell lung cancer (NSCLC). Materials and methods We prospectively collected data of 120 consecutive patients [60% male; median age: 71 (62-76 IQR:) years] undergoing lung lobectomy and lymphadenectomy by VATS for NSCLC in our Center from October 1st 2016 to July 31th 2019. Patients were divided in two groups based on the device used for tissue dissection: the electric hook (Group A) in 68 cases and the Harmonic ACE Plus® (Group B) in 52. Multivariable analysis by binary logistic regression was performed in order to test the energy device as possible risk factor for pleural effusion volume at 48 hours after surgery and for postoperative chest tube duration. Results No intraoperative complications due to energy device were recorded in both groups. Chylothorax incidence was higher in Group A with no statistically significant difference between the two groups (3% vs 0%; p-value=0.50). Pleural effusion volume during the first 48 postoperative hours was significantly higher in Group B: 253 ml (IQR: 149-405) vs 408 (IQR: 294-508) ml (p-value<0.01). However, chest tube duration was similar in the two groups: 4 (IQR: 3-8) vs 5 (IQR: 4-8) days (p-value=0.39). At multivariable analysis energy device was not independently associated with pleural effusion volume at 48 hours after surgery and with postoperative chest tube duration. Conclusions Electric hook or Harmonic ACE Plus® use during VATS lobectomy for NSCLC is safe and leads to similar postoperative short-term outcomes.