Intraoperative Assessment of Anatomical Resection Margin Using a Novel Asymmetric Linear Stapler: An Initial Single Institution Experience.

OBJECTIVES

Intraoperative assessment of resection margins during pulmonary resection is limited by tissue compression and distortion caused by conventional staplers, which hinder direct pathological evaluation of the anatomical resection margin. We report our initial clinical experience with a novel asymmetric linear stapler (NALS) designed to provide direct access to the specimen-side anatomical resection margin for intraoperative histologic assessment.

METHODS

We retrospectively reviewed patients who underwent pulmonary resection using the NALS between July 2024 and December 2025. Intraoperative frozen-section examination was performed for parenchymal and/or bronchial margins when malignancy was suspected or confirmed. Margin status, margin distance, and frozen-permanent pathological concordance were analysed descriptively.

RESULTS

Among 226 patients who underwent pulmonary resection using the NALS, 206 resection margins (144 parenchymal and 62 bronchial) were evaluated. Intraoperative frozen-section examination identified margin positivity in 12 margins (5.8%). Residual tumour was confirmed on permanent pathology in 4 of 8 parenchymal frozen-positive margins, whereas all bronchial frozen-positive margins showed benign or reactive changes. No false-negative frozen-section findings were identified. Among negative margins with available measurements, 66.7% of parenchymal margins and 84.5% of bronchial margins measured at least 10 mm.

CONCLUSIONS

In this initial experience, intraoperative margin assessment using the NALS was feasible and enabled structured evaluation of the anatomical resection margin during pulmonary resection. Because no control group using conventional staplers was included, these findings should be interpreted as a feasibility assessment rather than evidence of superiority over standard stapling devices. Further multicentre studies with controlled comparisons and long-term oncologic follow-up are warranted.