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Ritson et al: Ex vivo comparative evaluation of feline hilar lung lobectomy using linear stapler, pretied ligature loop, and double-shank titanium clips
Veterinary Surgery 7, 2025

🔍 Key Findings

  • No leakage occurred using pretied ligature loops (PLL) or double-shank (DS) titanium clips up to 40 cm H₂O airway pressure.
  • 1/10 stapled lobes leaked at supraphysiologic pressure (40 cm H₂O), but this was not statistically significant (p = .33).
  • All techniques sealed effectively under physiologic and supraphysiologic pressures in cadaveric feline lungs.
  • PLL and DS clips required less working space than staplers, making them more practical for small thoracic cavities.
  • DS titanium clips offer enhanced security due to dual shanks and tissue-gripping design, reducing clip slippage.
  • Leak testing was cyclic and submerged, simulating physiologic ventilation and allowing robust evaluation.
  • Stapling failure occurred along the staple line, highlighting risks of air leakage due to staple misalignment or poor hilar access.
  • PLL and DS clips may be cost-effective and efficient alternatives for open or minimally invasive feline lung lobectomy.

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← Articles

Ritson et al: Ex vivo comparative evaluation of feline hilar lung lobectomy using linear stapler, pretied ligature loop, and double-shank titanium clips
Veterinary Surgery 7, 2025

🔍 Key Findings

  • No leakage occurred using pretied ligature loops (PLL) or double-shank (DS) titanium clips up to 40 cm H₂O airway pressure.
  • 1/10 stapled lobes leaked at supraphysiologic pressure (40 cm H₂O), but this was not statistically significant (p = .33).
  • All techniques sealed effectively under physiologic and supraphysiologic pressures in cadaveric feline lungs.
  • PLL and DS clips required less working space than staplers, making them more practical for small thoracic cavities.
  • DS titanium clips offer enhanced security due to dual shanks and tissue-gripping design, reducing clip slippage.
  • Leak testing was cyclic and submerged, simulating physiologic ventilation and allowing robust evaluation.
  • Stapling failure occurred along the staple line, highlighting risks of air leakage due to staple misalignment or poor hilar access.
  • PLL and DS clips may be cost-effective and efficient alternatives for open or minimally invasive feline lung lobectomy.

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Multiple Choice Questions on this study

In Ritson 2025 et al., on feline hilar lobectomy sealants, what **pressure level** was used as the endpoint for leak testing?

A. 15 cm H₂O
B. 25 cm H₂O
C. 30 cm H₂O
D. 35 cm H₂O
E. 40 cm H₂O

Answer: 40 cm H₂O

Explanation: The endpoint was a supraphysiologic pressure of 40 cm H₂O to stress test device seal.
In Ritson 2025 et al., on feline hilar lobectomy sealants, how were devices evaluated for seal integrity?

A. Simulated coughing and breath holding
B. Direct hemostasis under pressure
C. Leakage under cyclical positive pressure ventilation
D. Computed tomography visualization
E. Manual compression of the bronchus

Answer: Leakage under cyclical positive pressure ventilation

Explanation: Bronchial stumps were tested with increasing pressures in submerged cyclic ventilation simulation.
In Ritson 2025 et al., on feline hilar lobectomy sealants, which of the following techniques demonstrated the **highest observed incidence of leakage** at 40 cm H₂O airway pressure?

A. Linear stapler
B. Pretied ligature loop
C. Double-shank titanium clip
D. All techniques had equal leakage incidence
E. Only PLL showed leakage

Answer: Linear stapler

Explanation: Only one leakage occurred in the stapler group, at 40 cm H₂O, while PLL and DS clips had no failures.
In Ritson 2025 et al., on feline hilar lobectomy sealants, what was the **design benefit** of the double-shank (DS) titanium clip?

A. Compression with reduced scissoring risk
B. Smaller than standard clips
C. Biodegradable over time
D. Reusable for multiple lobes
E. Requires no applier tool

Answer: Compression with reduced scissoring risk

Explanation: The DS clip's dual shanks prevent clip scissoring and improve tissue grip.
In Ritson 2025 et al., on feline hilar lobectomy sealants, what was the **main advantage** of PLL and DS clips over traditional staplers in cadaveric models?

A. Lower incidence of hemorrhage
B. Less technical expertise required
C. Higher burst pressure tolerance
D. Smaller working space requirements
E. Faster surgical time

Answer: Smaller working space requirements

Explanation: PLL and DS clips required less space, making them advantageous for feline thoracic cavities.

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