Bovine pericardial patch for preventing vascular oozing in video-assisted thoracoscopic surgery for lung cancer: A prospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Kongchen ¹ , NING Lu ² , LI Zhen ² , LIANG Qichen ¹ , WANG He ¹ , HE Baoyu ³ ,  ZHANG Ziteng ^2,4

1. Jining Medical College and College of Clinical Medicine, Jining, 272000, Shandong, P. R. China;
2. Department of Thoracic Surgery, Affiliated Hospital of Jining Medical College, Jining, 272000, P. R. China;
3. Department of Laboratory Medicine, Affiliated Hospital of Jining Medical College, Jining, 272000, P. R. China;
4. Department of Thoracic Surgery, Qinghai Red Cross Hospital, Qinghai, 810000, P. R. China;

Corresponding?author：

ZHANG Ziteng, Email: zitengzhang1353@163.com

Keywords：

Video-assisted thoracoscopic surgery; non-small cell lung cancer; bovine pericardial patch; oozing; clinical application

DOI：

10.7507/1007-4848.202509091

Video：

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Objective To evaluate the clinical efficacy of bovine pericardial patch in reinforcing pulmonary vascular stumps during video-assisted thoracoscopic radical resection for lung cancer, and to analyze its application value and cost-effectiveness based on vascular diameter. Methods A prospective cohort study was conducted by analyzing clinical data of 200 patients with non-small cell lung cancer who underwent video-assisted thoracic surgery (VATS) lobectomy performed by a single surgeon at Affiliated Hospital of Jining Medical College between May 2024 and May 2025. Patients were divided into an experimental group (reinforced with bovine pericardial patch) and a control group (treated solely with stapler) according to intraoperative management of vascular stumps. Both groups were further stratified into three subgroups based on target vessel diameter: <2 mm, 2-5 mm, and >5 mm. Perioperative outcomes including intraoperative blood loss, postoperative drainage volume (24-hour and total), chest tube duration, hospital stay, operation time, and hospitalization costs were compared between groups. Results The experimental group (n=100) comprised 41 males and 59 females with a median age of 60 (52, 66) years, while the control group (n=100) included 37 males and 63 females with a median age of 61 (53, 68) years. No statistical differences were observed in baseline characteristics between groups (P>0.05). Overall analysis demonstrated that the experimental group exhibited significantly reduced intraoperative blood loss [10 (10, 20) mL vs. 13 (10, 20) mL, P=0.015], shorter chest tube duration [3 (2, 3) days vs. 3 (3, 4) days, P<0.001], hospital stay [7 (6, 8) days vs. 8 (7, 9) days, P<0.001], operation time [56.0 (44.3, 72.8) minutes vs. 74.5 (55.0, 106.5) minutes, P<0.001], and lower total drainage volume [250.0 (172.5, 400.0) mL vs. 400.0 (202.5, 647.5) mL, P=0.001] compared to controls. However, no significant differences were found in 24-hour drainage volume [70 (50, 100) mL vs. 100 (50, 150) mL, P=0.066] or hospitalization costs [32,186.76 (30,098.56, 35,428.41) yuan vs. 33,400.02 (29,704.48, 38,323.72) yuan, P=0.434]. Stratified analysis revealed that the bovine pericardial patch showed superior performance in the 2-5 mm subgroup, where all perioperative parameters and hospitalization costs were significantly improved in the experimental group (P<0.05). Conversely, for vessels measuring <2 mm or >5 mm, the experimental group incurred higher hospitalization costs (P<0.05). Conclusion Bovine pericardial patch effectively reduces pulmonary vascular bleeding during VATS lobectomy and accelerates postoperative recovery. Its clinical benefits are most pronounced and economically advantageous when applied to vessels with diameters of 2-5 mm. Selective use of bovine pericardial patch based on vascular diameter can optimize both clinical outcomes and healthcare economic efficiency.

1.	Siegel RL, Kratzer TB, Giaquinto AN, et al. Cancer statistics, 2025. CA Cancer J Clin, 2025, 75(1): 10-45.
2.	Ma J, Li X, Zhao S, et al. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for lung lobectomy or segmentectomy in patients with non-small cell lung cancer: a meta-analysis. BMC Cancer, 2021, 21(1): 498.
3.	Boukansa S, Benbrahim Z, Gamrani S, et al. Correlation of epidermal growth factor receptor mutation with major histologic subtype of lung adenocarcinoma according to IASLC/ATS/ERS classification. Cancer Control, 2022, 29: 10732748221084930.
4.	孫大強, 陳平雁, 劉倫旭, 等. 11958例Ⅰ~ⅢA期非小細胞肺癌手術患者不同隨訪方式5年生存率比較的多中心真實世界研究. 中國胸心血管外科臨床雜志, 2021, 28(6): 615-622.Sun DQ, Chen PY, Liu LX, et al. Comparison of 5-year survival rates of different follow-up methods in 11, 958 patients with stage Ⅰ-ⅢA non-small cell lung cancer after surgery: a multicenter real-world study. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(6): 615-622.
5.	李盛輝, 任怡久, 蘇杭, 等. 胸腔鏡肺部手術中切割閉合吻合器應用評價進展. 中國胸心血管外科臨床雜志, 2025, 32(5): 709-713.Li SH, Ren YJ, Su H, et al. Progress in the evaluation of cutting staplers in thoracoscopic lung surgery. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(5): 709-713.
6.	Tsunezuka Y, Tanaka N, Fujimori H. The impact of endoscopic stapler selection on bleeding at the vascular stump in pulmonary artery transection. Med Devices (Auckl), 2020, 13: 41-47.
7.	Gossot D, Merlusca G, Tudor A, et al. Pitfalls related to the use of endostaplers during video-assisted thoracic surgery. Surg Endosc, 2008, 23(1): 189-192.
8.	Cerfolio RJ, Bryant AS, Skylizard L, et al. Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms. J Thorac Cardiovasc Surg, 2011, 142(4): 740-746.
9.	Suzuki J, Shiono S, Watanabe H, et al. Rupture of the staple suture site after stapling the right inferior pulmonary vein with double rows of staples: a case report. Gen Thorac Cardiovasc Surg Cases, 2025, 4(1): 5.
10.	Motoyama H, Yamashina A, Chihara K. Sudden hemothorax following lobectomy caused by staple. Interact Cardiovasc Thorac Surg, 2009, 9(1): 117-118.
11.	Yano M, Sano M, Kani H, et al. Adverse events of stapling in thoracic surgery: relations between an incidence of adverse events and a stapling volume. Ann Thorac Cardiovasc Surg, 2014, 20(4): 320-324.
12.	Reinders Folmer EI, Verhofstad N, Zeebregts CJ, et al. Performance of the BioIntegral bovine pericardial graft in vascular infections: VASCular No-REact Graft Against INfection Study. Ann Vasc Surg, 2023, 95: 116-124.
13.	Zhang D, Zhu GJ, Wei XY, et al. Repair of coronary artery ostium with a ring-shaped bovine pericardial patch. Interact Cardiovasc Thorac Surg, 2022, 35(5): ivac260.
14.	Ahn JS, Mo H, Ahn S, et al. Outcomes of vein reconstruction using bovine pericardial patch. Vascular, 2022, 31(2): 292-297.
15.	Iop L, Palmosi T, Dal Sasso E, et al. Bioengineered tissue solutions for repair, correction and reconstruction in cardiovascular surgery. J Thorac Dis, 2018, 10(S20): S2390-S2411.
16.	Marra A, Yankulov A. The role of new staplers in reducing the incidence of air leak. J Thorac Dis, 2023, 15(2): 893-900.
17.	Aprile V, Bacchin D, Calabro F, et al. Intraoperative prevention and conservative management of postoperative prolonged air leak after lung resection: a systematic review. J Thorac Dis, 2023, 15(2): 878-892.
18.	Araki Y, Konishi Y, Terada T, et al. Pericardial sandwich technique for end-to-end anastomosis of artificial graft. Ann Thorac Surg, 2018, 106(5): e269-e271.
19.	Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg, 2010, 139(2): 366-378.
20.	Paul S, Sedrakyan A, Chiu YL, et al. Outcomes after lobectomy using thoracoscopy vs. thoracotomy: a comparative effectiveness analysis utilizing the Nationwide Inpatient Sample database. Eur J Cardiothorac Surg, 2013, 43(4): 813-817.
21.	Guo C, Mei J, Ma L, et al. Handling vascular bleeding without conversion during video-assisted thoracoscopic surgery major pulmonary resection. Ann Transl Med, 2018, 6(18): 363.
22.	Liu L, Mei J, He J, et al. International expert consensus on the management of bleeding during VATS lung surgery. Ann Transl Med, 2019, 7(23): 712.
23.	Yilmaz M, Turkcan BS, Ecevit AN, et al. Comparative outcome analysis of direct anastomosis and bovine pericardial patch augmentation techniques in arch reconstruction for paediatric patients. Cardiol Young, 2025, 35(4): 763-769.

1. Siegel RL, Kratzer TB, Giaquinto AN, et al. Cancer statistics, 2025. CA Cancer J Clin, 2025, 75(1): 10-45.
2. Ma J, Li X, Zhao S, et al. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for lung lobectomy or segmentectomy in patients with non-small cell lung cancer: a meta-analysis. BMC Cancer, 2021, 21(1): 498.
3. Boukansa S, Benbrahim Z, Gamrani S, et al. Correlation of epidermal growth factor receptor mutation with major histologic subtype of lung adenocarcinoma according to IASLC/ATS/ERS classification. Cancer Control, 2022, 29: 10732748221084930.
4. 孫大強, 陳平雁, 劉倫旭, 等. 11958例Ⅰ~ⅢA期非小細胞肺癌手術患者不同隨訪方式5年生存率比較的多中心真實世界研究. 中國胸心血管外科臨床雜志, 2021, 28(6): 615-622.Sun DQ, Chen PY, Liu LX, et al. Comparison of 5-year survival rates of different follow-up methods in 11, 958 patients with stage Ⅰ-ⅢA non-small cell lung cancer after surgery: a multicenter real-world study. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(6): 615-622.
5. 李盛輝, 任怡久, 蘇杭, 等. 胸腔鏡肺部手術中切割閉合吻合器應用評價進展. 中國胸心血管外科臨床雜志, 2025, 32(5): 709-713.Li SH, Ren YJ, Su H, et al. Progress in the evaluation of cutting staplers in thoracoscopic lung surgery. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(5): 709-713.
6. Tsunezuka Y, Tanaka N, Fujimori H. The impact of endoscopic stapler selection on bleeding at the vascular stump in pulmonary artery transection. Med Devices (Auckl), 2020, 13: 41-47.
7. Gossot D, Merlusca G, Tudor A, et al. Pitfalls related to the use of endostaplers during video-assisted thoracic surgery. Surg Endosc, 2008, 23(1): 189-192.
8. Cerfolio RJ, Bryant AS, Skylizard L, et al. Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms. J Thorac Cardiovasc Surg, 2011, 142(4): 740-746.
9. Suzuki J, Shiono S, Watanabe H, et al. Rupture of the staple suture site after stapling the right inferior pulmonary vein with double rows of staples: a case report. Gen Thorac Cardiovasc Surg Cases, 2025, 4(1): 5.
10. Motoyama H, Yamashina A, Chihara K. Sudden hemothorax following lobectomy caused by staple. Interact Cardiovasc Thorac Surg, 2009, 9(1): 117-118.
11. Yano M, Sano M, Kani H, et al. Adverse events of stapling in thoracic surgery: relations between an incidence of adverse events and a stapling volume. Ann Thorac Cardiovasc Surg, 2014, 20(4): 320-324.
12. Reinders Folmer EI, Verhofstad N, Zeebregts CJ, et al. Performance of the BioIntegral bovine pericardial graft in vascular infections: VASCular No-REact Graft Against INfection Study. Ann Vasc Surg, 2023, 95: 116-124.
13. Zhang D, Zhu GJ, Wei XY, et al. Repair of coronary artery ostium with a ring-shaped bovine pericardial patch. Interact Cardiovasc Thorac Surg, 2022, 35(5): ivac260.
14. Ahn JS, Mo H, Ahn S, et al. Outcomes of vein reconstruction using bovine pericardial patch. Vascular, 2022, 31(2): 292-297.
15. Iop L, Palmosi T, Dal Sasso E, et al. Bioengineered tissue solutions for repair, correction and reconstruction in cardiovascular surgery. J Thorac Dis, 2018, 10(S20): S2390-S2411.
16. Marra A, Yankulov A. The role of new staplers in reducing the incidence of air leak. J Thorac Dis, 2023, 15(2): 893-900.
17. Aprile V, Bacchin D, Calabro F, et al. Intraoperative prevention and conservative management of postoperative prolonged air leak after lung resection: a systematic review. J Thorac Dis, 2023, 15(2): 878-892.
18. Araki Y, Konishi Y, Terada T, et al. Pericardial sandwich technique for end-to-end anastomosis of artificial graft. Ann Thorac Surg, 2018, 106(5): e269-e271.
19. Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg, 2010, 139(2): 366-378.
20. Paul S, Sedrakyan A, Chiu YL, et al. Outcomes after lobectomy using thoracoscopy vs. thoracotomy: a comparative effectiveness analysis utilizing the Nationwide Inpatient Sample database. Eur J Cardiothorac Surg, 2013, 43(4): 813-817.
21. Guo C, Mei J, Ma L, et al. Handling vascular bleeding without conversion during video-assisted thoracoscopic surgery major pulmonary resection. Ann Transl Med, 2018, 6(18): 363.
22. Liu L, Mei J, He J, et al. International expert consensus on the management of bleeding during VATS lung surgery. Ann Transl Med, 2019, 7(23): 712.
23. Yilmaz M, Turkcan BS, Ecevit AN, et al. Comparative outcome analysis of direct anastomosis and bovine pericardial patch augmentation techniques in arch reconstruction for paediatric patients. Cardiol Young, 2025, 35(4): 763-769.

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