Resection and stapling technique for wide-based giant bullae in video-assisted thoracic surgery using a new end-stapler.

In video-assisted thoracic surgery (VATS), stapling resection for wide-based giant bullae requires a large-volume reduction of normal lung parenchyma and is technically difficult because of the lack of holding and stapling ability of the end stapler for the thick lung parenchyma. A new end-stapler device, the Echelon 60 Endopath stapler (60-mm stapling), has a long, strong anvil and a wide jaw aperture and is able to easily hold thick lung parenchyma. This device is able to divide with precise stapling over a long incision. In VATS management for two recent cases of broad-based giant bullae, this new device was used instead of suture closure and easily achieved stapled closure after excision of the bulla wall. This method prevents large-volume reduction of normal lung and enables an easy, fast, and reliable suture along a precise stapling line.