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Helping a Leader in Cardiothoracic Surgery

Case Study:

Helping a leader in cardiothoracic surgery build the case for updating EU guidance about surgical sealant management


The Client

Our client is a world-leader in the development and supply of medical and surgical devices, with a strong focus on innovation, both in terms of technology and its application.

Their leadership is demonstrated by co-collaboration with surgical experts, ongoing education and encouraging dialogues within the markets that they work.


Prolonged air leak (PAL) is the most common post-operative complication following lung resection, affects 70% of patients, and the most important determinant of post-operative length of hospital stay.

PAL is associated with pain, reduced mobility, increased risk of further complications, prolonged hospital stay, re-operation, and unplanned costs.

The use of surgical sealants is one of the methods available to reduce the occurrence of intraoperative air leaks.  However, there was insufficient expert guidance to support consistent use in appropriate circumstances.


Following initial literature review conducted by Triducive, it was established that surgical sealants are able to both reduce postoperative air leaks and time to chest drain removal yet no guidance existed to support appropriate, consistent use.

A modified Delphi approach was designed to inform the development of future guidelines by understanding expert opinion in the following areas:

  • Burden of PAL
  • Patient selection
  • Use of Surgical Sealants & expected outcomes
  • Good practice principles with sealant use



Triducive began working on this project and together with the client team, designed a modified Delphi approach which aimed to create:


Our Process

Step 1

A multi-disciplinary group of experts from across the EU were facilitated to pinpoint the challenges to optimal surgery and then define a set of statements that described ‘ideal’ practice.

Step 2

A structured online survey was developed and disseminated across other EU-based cardiothoracic surgeons. The online survey tested the strength of agreement that existed in relation to all the statements developed.

Step 3

Following structured review of the results by the steering group, a sub-set of the survey statements were then ratified by the professional body to define realistic surgical standards.

Step 4

A second facilitated review of the full dataset by the steering group led to the development of a core set of recommendations that reflected the results achieved.  This was informed and substantiated by the consensus achieved for using sealants in selected patients to improve efficiency in healthcare provision.

Step 5

A manuscript capable of peer-reviewed publication was developed and provided as draft for the steering group to adapt and finalise.  Triducive supported the authors to take ownership of the draft and to submit to European Journal of Cardio-Thoracic Surgery for peer review.

Outcomes & next steps




Responses achieved



Peer-agreed expert recommendations

Published in a high impact peer-reviewed journal with endorsement from the professional body

Provided a strong platform for the client to engage with key surgical decision makers to encourage changes to become formalised in European guidelines

Following submission, the manuscript was accepted for publication by European Journal of Cardio-Thoracic Surgery and subsequently published. The client have since worked with Triducive and other partners to develop a range of campaign activities based on this to drive:

  • Triducive and other partners to develop a range of campaign activities based on this to drive:
  • Awareness of the burden of air leaks in cardiothoracic surgery
  • Evidence for using lung sealants appropriately
  • Educational content and activities to share expert opinion
  • A platform to inform guidelines across the EU of the optimal use of sealants in lung surgery


“This will add to the evidence base that will inform future practice across the the EU”
Cardiothoracic surgeon, Italy

“A great support to transform future surgery across the EU”
Chair, ETST

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