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Response of Diseased Lung Tissue to Compression
Jennifer Whiffen, MS, Jennifer Mangum, Thomas A. D'Amico, MD, Jennifer Broom, MS, Elizabeth Contini, Andrew Miesse, MS, Dwight Bronson, MS.
Covidien, Surgical Solutions, North Haven, CT, USA.
OBJECTIVE:
The objective of the current study was to examine the compressibility of lung parenchyma using two stapling strategies in patients undergoing resection for lung cancer or lung volume reduction for emphysema.
METHODS:
Parenchymal tissue excised during resection for lung cancer or for emphysema was immediately compressed between platens simulating an endoscopic stapler’s anvil and cartridge; resulting force-displacement curves were recorded. Testing was performed on tissue adjacent to the staple line and compressed to a final thickness of 1 mm at two rates, simulating slow and fast instrument firing. Load displacement curves and maximum force values were used to evaluate the tissue response to compression. Further examination of resulting force data revealed the peak force required to compress tissue to specific heights that correlate to closed staple heights found in endoscopic staplers.
RESULTS:
For both loading rates, the tissue from patients with lung cancer (n=49) required a greater force to compress to 1mm thickness than the tissue from patients with emphysema (n=26). While the oncologic tissue required greater force to compress, the rate of loading had a greater impact on the response of the emphysematous tissue. The force required to compress the tissue to 2mm was 1.8 and 3.0 times greater at the fast rate vs. the slow rate for oncologic and emphysematous tissue, respectively. Further compression to 1mm resulted in a smaller difference between the loading rates in the disease states, 1.3 and 1.6 times greater for oncologic and emphysematous tissue, respectively.
CONCLUSIONS:
Results from the current study demonstrates how the disease state affects the tissue’s response to compressive loading and how this response may influence stapler performance.The study showed that the maximum load measured was directly related to the rate of compression and tissue disease state. Study demonstrated how lung tissue responds to loading Surgical stapling of these tissue types may benefit from slower more deliberate firing. 
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