Discussion
Despite standardized use of endoscopic staplers
that are accepted as safe devices, some unexpected
incidents may occur.[
5-
7] Understanding the safety issues and possible problems regarding the use of endoscopic
devices is of utmost importance. We successfully
managed two stapling device problems that occurred
in the same patient. First problem was a totally opened
lower pulmonary vein that was successfully repaired,
while the second was the dislocation of a metallic
element of the stapler. The metallic piece was removed
using the same (uniportal) approach. The stapling
device was regular, undamaged, and used for the first
time. This broken metallic part which fell into the
pleural space was confirmed to be fixed to the body
of the device. This information was approved by the
manufacturer and the device was delivered to them
for further technical investigation. According to the
literature and the manufacturer's feedback, such a
complication had never been reported. After falling
into the pleural space, the object may have been either
hidden in a distal point of the cavity and moved to
its place during repositioning the patient in operating
room or covered with a small clot which hid it on the
thoracic wall.
Explorative visualization as well as counting
surgical instruments and gauzes are routinely
performed before closure in each VATS as a surgical
principle. Methodologies including Six Sigma that
strive to achieve perfect quality[8] may be adopted
as a quality principle for surgeries to prevent such
structural problems.[8,9]
This case should remind us about the importance
of double-checking the integrity of the used stapling
devices during surgery. All team members in the
operating room including the circulating nurse should
be aware of the necessity to check such details to
prevent any event that may require an additional
surgery.
Declaration of conflicting interests
The authors declared no conflicts of interest with respect to
the authorship and/or publication of this article.
Funding
The authors received no financial support for the research
and/or authorship of this article.