Thank you for sharing your thoughts on what patient characteristics may increase the risk of air leaks. While not all leaks will be due to the stapling and buttress technologies, staple line security and hemostasis are essential to avoid stapling related intra-operative leaks. You mentioned you use a buttress as a method to reduce leaks. Certainly, the evidence supports the use of a buttress to reduce the risk of leaks and that is why J&J Medtech have launched an innovative and easy to use buttress material that has been demonstrated to reduce links in two clinical trials.^1,2 The ECHELON ENDOPATH™  Staple line reinforcement, otherwise known as SLR is a simple to use buttress made from the same trusted VICRYL™ and PDS™ materials that have been used for decades in suture materials. The evidence to support the use of SLR spans across bench top, pre-clinical and clinical evidence.^1,2,3,4 I want to focus particularly on the two clinical studies that have demonstrated that ECHELON™ SLR reduces PALs.^1,2 An independent study in Japan recruited 48 patients who underwent a thoracic lobectomy and used ECHELON™ SLR during the procedure. This data was then compared with historical control data in an exploratory study. The ECHELON™ SLR group demonstrated a 6.3% PAL rate while the historical group demonstrated a 28.5% PAL rate.1 In addition, the ECHELON™ SLR group had a significantly shorter indwelling chest drainage time and length of hospital stay.¹ A US study included 131 patients undergoing pulmonary resection in a single arm multi-centre prospective trial. The buttress was used on lung parenchyma but not on the bronchi or vessels. 5 patients (3.8%) treated with ECHELON™ SLR experienced PALs.² However, the surgeons reported these AEs were either not related or unlikely related to the device. No patients experienced an empyema.² This demonstrates that the use of ECHELON™ SLR can result in lower PAL rates than the reported rates in the literature of 5-19%.5 In addition, all the surgeons involved in the study reported they found ECHELON™ SLR easier to use than other available buttresses.² This ease of use is a result of the simple 4 step application process which allows ECHELON™ SLR to stay securely attached to the staple reload, yet still gently release onto tissue.^*3,4 And best of all it has no strings. I would be happy to share these papers with you to review. Would you be interested in trailing ECHELON™ SLR in 5-10 cases to see the results for yourself?