Efficacy of Non-Powered Stapler in Lung Volume Reduction Surgery of Severe Lung Emphysema: A Prospective Randomized Single-Blinded Monocentric Study

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Efficacy of Non-Powered Stapler in Lung Volume Reduction Surgery of Severe Lung Emphysema: A Prospective Randomized Single-Blinded Monocentric Study

Eric Francis Macharia-Nimietz, Makhmudbek Mallaev, Paulius Gecas, Jovan Vujic, Urs Simmen, Aljaz Hojski, Michael Tamm, Didier Lardinois
Department of Thoracic Surgery, University Hospital Basel, Basel, Switzerland

Interdisciplinary CardioVascular and Thoracic Surgery (ICVTS), March 2026

35.3% vs. 60%
Immediate air leak (AEON vs. Echelon)
14.3 vs. 93.2 hrs
Median time to air leak closure
RCT
Prospective randomized design
Key finding: Prospective RCT in severe emphysema (GOLD III/IV). AEON (non-powered) showed lower incidence of immediate postoperative air leak (35.3% vs. 60%) and substantially shorter median time to air leak closure (14.3 vs. 93.2 hours) compared to Echelon Flex Powered Plus Stapler in lung volume reduction surgery.

Abstract

Objectives: This study aimed to assess whether the use of the non-powered AEON Endostapler during lung resection in patients with severe lung emphysema reduces the duration of postoperative air leak, as measured by the air leak volume over time, in comparison to the Echelon Flex Powered Plus Stapler.

Methods: A total of 32 lung volume reduction surgeries were performed on 19 patients, stratified by side of the operation. These procedures were randomly assigned to utilize either the non-powered or the powered stapler. Postoperative air leak was monitored using a digital recording system. The time to air leak closure, the incidence, and severity of air leaks, as well as the duration of chest tube placement were evaluated.

Results: Immediate postoperative air leaks were observed in 6 of 17 procedures (35.3%) using the non-powered stapler and in 9 of 15 procedures (60%) performed with the powered stapler. The median time to closure of the air leak was also considerably shorter in the non-powered procedures: 14.3 hours [6.7, 116] compared to 93.2 hours [2.1, 159] for the powered treatments. Cox regression analysis yielded a Hazard ratio of 1.6 (95% CI: 0.73-3.3) for a faster air leak closure with the non-powered stapler (P = 0.25).

Conclusions: Both stapler systems are feasible for use in patients with severe lung emphysema. However, our results show an earlier air leak closure and a lower incidence of postoperative air leak with the use of the non-powered stapler.

Box Plot of Time to Air Leak Closure

Box Plot of Time to Air Leak Closure
Source: Interdisciplinary CardioVascular and Thoracic Surgery (ICVTS), March 2026

Kaplan–Meier Cumulative Event Curves for Time to Air Leak Closure.
Source: Interdisciplinary CardioVascular and Thoracic Surgery (ICVTS), March 2026

*Abstract text reproduced from the original publication with attribution to the authors and publisher. All rights remain with the respective copyright holders. Reproduced here for informational and educational purposes in accordance with applicable open-access licensing or fair use principles. For the definitive version, refer to the original publication via the link provided.

Clinical Relevance: Prolonged air leak is reported in up to 60-75% of patients after lung surgery in the presence of severe emphysema, making it one of the most significant complications in lung volume reduction surgery. This prospective randomized trial from a European academic center provides the first controlled comparison of AEON against a powered stapler specifically in this high-risk patient population. The finding that a non-powered stapler achieved lower air leak incidence and faster closure time in emphysematous tissue is particularly relevant for thoracic surgeons managing COPD GOLD III and IV patients, where staple line integrity in fragile, hyperinflated parenchyma is critical.
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