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Tsuboshima K, Kurihara M, Seyama K. Current opinion and comparison of surgical procedures for the treatment of primary spontaneous pneumothorax. Expert Rev Respir Med 2021; 16:161-171. [PMID: 34821193 DOI: 10.1080/17476348.2022.2011218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Although three-port video-assisted thoracoscopic surgery (VATS) is the standard radical treatment for primary spontaneous pneumothorax (PSP), several issues need to be addressed as the postoperative recurrence rate remains relatively high. Although bullectomy is effective in preventing the postoperative recurrence of PSP, recurrent pneumothorax often occurs, requiring additional methods such as pleural covering with absorbable mesh sheets, surgical chemical pleurodesis, pleural abrasion, or pleurectomy. In addition, minimally invasive approaches that exceed three-port VATS are required according to the social demand. These approaches, such as uniportal VATS, reduced port surgery, and needlescopic surgery, have cosmetic merits, lower postoperative pain, and similar surgical results as three-port VATS. AREAS COVERED We focused on conventional and novel treatments for PSP in this article. EXPERT OPINION Effective methods that prevent postoperative recurrence and minimally invasive approaches will become popular in the near future.
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Affiliation(s)
- Kenji Tsuboshima
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Masatoshi Kurihara
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Kuniaki Seyama
- The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan.,Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
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2
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Lai J, Situ D, Xie M, Yu P, Wang J, Long H, Lai R. Continuous Paravertebral Analgesia versus Continuous Epidural Analgesia after Video-Assisted Thoracoscopic Lobectomy for Lung Cancer: A Randomized Controlled Trial. Ann Thorac Cardiovasc Surg 2021; 27:297-303. [PMID: 33597333 PMCID: PMC8560537 DOI: 10.5761/atcs.oa.20-00283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Whether continuous thoracic epidural analgesia (TEA) and continuous paravertebral block (PVB) have similar analgesic effects in patients undergoing video- assisted thoracic surgery (VATS) lobectomy was compared in this study. Methods: In all, 86 patients undergoing VATS lobectomy were enrolled in the prospective, randomized clinical trial. Group E received TEA. Group P received PVB. The primary endpoint was postoperative 24-hour visual rating scale (VAS) on coughing. Side effects and postoperative complications were also analyzed. Results: Pain scores at rest or on coughing at 24 and 48 h postoperatively were significantly lower in group E than in group P (P <0.05). At 24 h postoperatively, more patients in group E suffered from vomiting (32.6% vs 11.6%, P = 0.019), dizziness (55.8% vs 12.9%, P = 0.009), pruritus (27.9% vs 2.3%, P = 0.002), and hypotension (32.6% vs 4.7%, P = 0.002) than those in group P. Patients in group E were more satisfied (P = 0.047). Four patients in group P and two patients in group E suffered from pulmonary complications (P >0.05). The length of hospital and intensive care unit (ICU) stays were not significantly different. Conclusions: Though TEA has more adverse events than PVB, it may be superior to PVB in patients undergoing VATS lobectomy.
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Affiliation(s)
- Jielan Lai
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Dongrong Situ
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Lung Cancer Research Institute, Sun Yat-sen University, Guangzhou, China.,Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Manxiu Xie
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ping Yu
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Junchao Wang
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hao Long
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Lung Cancer Research Institute, Sun Yat-sen University, Guangzhou, China.,Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Renchun Lai
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Guangzhou, China
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3
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Cattoni M, Rotolo N, Mastromarino MG, Cardillo G, Nosotti M, Mendogni P, Rizzi A, Raveglia F, Siciliani A, Rendina EA, Cagini L, Matricardi A, Filosso PL, Passone E, Margaritora S, Vita ML, Bertoglio P, Viti A, Dominioni L, Imperatori A. Chronic chest pain and paresthesia after video-assisted thoracoscopy for primary pneumothorax. J Thorac Dis 2021; 13:613-620. [PMID: 33717534 PMCID: PMC7947510 DOI: 10.21037/jtd-20-2860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background This study aims to identify clinical and surgical risk factors for chronic chest pain and paresthesia after video thoracoscopic surgery for primary spontaneous pneumothorax. Methods We retrospectively collected the data of 1,178 consecutive patients <40-years-old undergoing video thoracoscopic surgery for primary spontaneous pneumothorax in 9 Italian centers in 2007–2017. Cases with <2-month follow-up were excluded, leaving 920 patients [80% male; median age: 21 (IQR, 18–27) years] for statistical analysis. The following risk factors for chronic chest pain and chronic paresthesia were assessed by univariable and multivariable Cox regression model: age, gender, cannabis smoking, video thoracoscopy ports number, pleurodesis technique (partial pleurectomy/pleural electrocauterization/pleural abrasion/talc poudrage), chest tube size (24/28 F), postoperative chest tube stay. Results Blebs/bullae resection with pleurodesis was performed in 732 (80%) cases; pleurodesis alone in 188 (20%). During a median follow-up of 68 (IQR: 42–95) months, chronic chest pain developed in 8% of patients, chronic chest paresthesia in 22%; 0.5% of patients regularly assumed painkillers. Chronic chest pain was independently associated with partial pleurectomy/pleura abrasion (P<0.001) and postoperative chest tube stay (P=0.019). Chronic chest paresthesia was independently associated with pleurodesis by partial pleurectomy (P<0.001), chest tube stay (P=0.035) and 28 F chest tube (P<0.001). Conclusions After video thoracoscopic surgery for primary spontaneous pneumothorax, the incidence of chronic chest pain and paresthesia was significantly lower when pleurodesis was performed by pleural electrocauterization or talc poudrage, and chest tube was removed early. A 24 F chest tube was associated with lower risk of chronic chest paresthesia.
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Affiliation(s)
- Maria Cattoni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Regional Hospital San Camillo-Forlanini, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Rizzi
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milan, Italy
| | - Federico Raveglia
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milan, Italy
| | | | | | - Lucio Cagini
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Alberto Matricardi
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Pier Luigi Filosso
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Erika Passone
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS, Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella,Verona, Italy
| | - Andrea Viti
- Division of Thoracic Surgery, IRCCS, Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella,Verona, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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4
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Sihoe ADL. Video-assisted thoracoscopic surgery as the gold standard for lung cancer surgery. Respirology 2020; 25 Suppl 2:49-60. [PMID: 32734596 DOI: 10.1111/resp.13920] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/20/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022]
Abstract
Surgical resection remains the only effective means of cure in the vast majority of patients with early-stage lung cancer. It can be performed via a traditional open approach (particularly thoracotomy) or a minimally invasive approach. VATS is 'keyhole' surgery in the chest, and was first used for lung cancer resection in the early 1990s. Since then, a large volume of evolving clinical evidence has confirmed that VATS lung cancer resection offered proven safety and feasibility, better patient-reported post-operative outcomes, less surgical trauma as quantified by objective outcome measures and equivalent or better survival than open surgery. This has firmly established VATS as the surgical approach of choice for early-stage lung cancer today. Although impressive new non-surgical lung cancer therapies have emerged in recent years, VATS is also being constantly rejuvenated by the development of 'next generation' VATS techniques, the refinement of VATS sublobar resection for selected patients, the utilization of bespoke post-operative recovery programmes for VATS and the synthesis of VATS into multi-modality lung cancer therapy. There is little doubt that VATS will remain as the gold standard for lung cancer surgery for the foreseeable future.
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Affiliation(s)
- Alan D L Sihoe
- Gleneagles Hong Kong Hospital, Hong Kong SAR, China.,International Medical Centre, Hong Kong SAR, China
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5
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Asghar Nawaz M, Apparau D, Zacharias J, Shackcloth M. Approach to pneumothorax surgery: a national survey of current UK practice. Asian Cardiovasc Thorac Ann 2019; 27:180-186. [PMID: 30661376 DOI: 10.1177/0218492319825943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pneumothorax is a common condition with various management options. We aimed to determine the current surgical practice in the United Kingdom. METHOD An online questionnaire regarding surgical strategy was sent to all consultants who were members of the Society for Cardiothoracic Surgery (80 thoracic). RESULTS Fifty-six consultants, mainly thoracic, responded to the survey. Video-assisted thoracoscopic surgery was unanimously the preferred approach, the majority (59%) using 3 ports. Regarding the timing of surgery, 53 (95%) surgeons would intervene at first presentation with persistent air leak and/or lung collapse, 41 (73%) for a first bilateral pneumothorax, 22 (39%) only for recurrent pneumothorax, and 18 (32%) for the first computed tomography evidence of bullae. Apical bullectomy + pleurectomy was the preferred technique for 26 (46%) surgeons, and apical bullectomy + apical pleurectomy + pleural abrasion was the choice for 13 (23%). Some surgeons were concerned about talc and avoid it. The majority (70%) used a single apical drain with or without 24-48 h suction. Regarding chest radiography, the response was variable but 48% performed immediate postoperative and/or daily chest radiographs. Currently, most surgeons (59%) use digital drains and feel it monitors air leaks better. The perceived chronic pain (1%-3%) and recurrence rates (0%-3%) were stated by 59% and 86%, respectively. CONCLUSION There is variability in the surgical management of pneumothorax among surgeons across the UK, but they all use video-assisted thoracoscopic surgery as the intervention of choice for pneumothorax surgery, and there is a shift towards early surgical intervention.
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Affiliation(s)
| | - Denish Apparau
- 1 Manchester University NHS Foundation Trust, Manchester, UK
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6
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Uniportal Subxiphoid Video-Assisted Thoracoscopic Anatomical Segmentectomy: Technique and Results. Ann Thorac Surg 2018; 106:1519-1524. [DOI: 10.1016/j.athoracsur.2018.06.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
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Abstract
Thoracic surgery has evolved throughout the decades. The difficulty of accessing the intrathoracic organs through the bony rib-cage has been a challenge for thoracic surgeons. In the past, large incisions stretching across the chest, such as posterolateral thoracotomies with rib spreading was the standard approach to access the lungs. These methods cause large amounts of trauma to the patient, with high rates of mortality and morbidity. However, with the advances in technology and the improvements in surgical technique, thoracic surgery has progressed to minimise trauma to the patient while still maintaining oncological and surgical principles. State-of-the-art technology, combined with wide variety of old and new surgical techniques give the thoracic surgeon a formidable armamentarium. Although there has been a focus on reducing the number and size of surgical wounds, considerations other than surgical approach can reduce the trauma suffered by the patient. Preservation of pulmonary function via organ preservation and anaesthetic techniques to further minimise the systemic inflammation such as non-intubated anaesthesia have also been shown to improve patient outcomes. This article aims to review the recent advances in minimally invasive thoracic surgery.
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Affiliation(s)
- Max K H Wong
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China
| | - Alva K Y Sit
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China
| | - Timmy W K Au
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China
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8
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Lee CY, Narm KS, Lee JG, Paik HC, Chung KY, Shin HY, Yeom HY, Kim DJ. A prospective randomized trial of continuous paravertebral infusion versus intravenous patient-controlled analgesia after thoracoscopic lobectomy for lung cancer. J Thorac Dis 2018; 10:3814-3823. [PMID: 30069382 DOI: 10.21037/jtd.2018.05.161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Shik Narm
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Young Chung
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ha Young Yeom
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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9
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Caronia FP, Arrigo E, Failla AV, Sgalambro F, Giannone G, Lo Monte AI, Cajozzo M, Santini M, Fiorelli A. Uniportal thoracoscopy combined with laparoscopy as minimally invasive treatment of esophageal cancer. J Thorac Dis 2018; 10:E265-E269. [PMID: 29850166 DOI: 10.21037/jtd.2018.03.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 67-year-old man was referred to our attention for management of esophageal adenocarcinoma, localized at the level of the esophagogastric junction and obstructed the 1/3 of the esophageal lumen. Due to the extension of the disease (T3N1M0-Stage IIIA), the patient underwent neo-adjuvant chemo-radiation therapy and he was then scheduled for a minimally invasive surgical procedure including laparoscopic gastroplasty, uniportal thoracoscopic esophageal dissection and intrathoracic end-to-end esophago-gastric anastomosis. No intraoperative and post-operative complications were seen. The patient was discharged in post-operative day 9. Pathological study confirmed the diagnosis of adenocarcinoma (T2N1M0-Stage IIB) and he underwent adjuvant chemotherapy. At the time of present paper, patient is alive and well without signs of recurrence or metastasis. Our minimally approach compared to standard open procedure would help reduce post-operative pain and favours early return to normal activity. However, future experiences with a control group are required before our strategy can be widely used.
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Affiliation(s)
| | - Ettore Arrigo
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
| | | | - Francesco Sgalambro
- Anaesthesiology Unit, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
| | - Giorgio Giannone
- General Surgery Unit, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
| | | | - Massimo Cajozzo
- Thoracic Surgery Unit, Università degli Studi di Palermo, Palermo, Italy
| | - Mario Santini
- Thoracic Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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10
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Tamburini N, Bollini G, Volta CA, Cavallesco G, Maniscalco P, Spadaro S, Qurantotto F, Ragazzi R. Capsaicin patch for persistent postoperative pain after thoracoscopic surgery, report of two cases. J Vis Surg 2018; 4:51. [PMID: 29682461 DOI: 10.21037/jovs.2018.02.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/06/2018] [Indexed: 01/18/2023]
Abstract
Effective postoperative pain control after thoracic surgery is a significant clinical issue because it reduces pulmonary complications and accelerates the pace of recovery. Persistent postoperative pain syndrome is a recognized and frequent complication after thoracoscopic surgery. The capsaicin 8% patch contains a high concentration of synthetic capsaicin approved for treatment of peripheral neuropathic pain in adults. Little clinical data exist on the use of capsaicin patch in thoracic persistent postoperative pain syndrome. This report included two patients who were evaluated after receiving capsaicin for thoracic surgery. Satisfactory pain relief was achieved in both cases without side effects.
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Affiliation(s)
- Nicola Tamburini
- Department of Morfology, Experimental Medicine and Surgery, Section Chirurgia 1, Section of Anaesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Giacomo Bollini
- Department of Morphology, Experimental Medicine and Surgery, Section of Anaesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Carlo Alberto Volta
- Department of Morphology, Experimental Medicine and Surgery, Section of Anaesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Giorgio Cavallesco
- Department of Morfology, Experimental Medicine and Surgery, Section Chirurgia 1, Section of Anaesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Pio Maniscalco
- Department of Morfology, Experimental Medicine and Surgery, Section Chirurgia 1, Section of Anaesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Savino Spadaro
- Department of Morphology, Experimental Medicine and Surgery, Section of Anaesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Francesco Qurantotto
- Department of Morfology, Experimental Medicine and Surgery, Section Chirurgia 1, Section of Anaesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Riccardo Ragazzi
- Department of Morphology, Experimental Medicine and Surgery, Section of Anaesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
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11
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Masmoudi H, Etienne H, Sylvestre R, Evrard D, Ouede R, Le Roux M, Giol M, Assouad J. Three Hundred Fifty-One Patients With Pneumothorax Undergoing Uniportal (Single Port) Video-Assisted Thoracic Surgery. Ann Thorac Surg 2017; 104:254-260. [PMID: 28410634 DOI: 10.1016/j.athoracsur.2017.01.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 01/01/2017] [Accepted: 01/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) is usually performed using three ports. Uniportal VATS has not yet been widely developed. We report our single institution experience in uniportal VATS for the surgical management of 351 patients with pneumothorax. METHODS Between November 2009 and February 2016, we conducted a study in 351 patients treated for pneumothorax using uniportal VATS. Resection of apical bullae associated with partial pleurectomy, pleural abrasion, or talc effusion was performed. RESULTS The mean age was 29.6 ± 10.1 years. Surgical indications were mainly persistence or recurrence of pneumothorax. Sixty-seven patients (19%) presented with complications. At the 30-day control, 60.1% of patients were asymptomatic; 85% of patients were satisfied with the single small scar. The recurrence rate was 3.6% at 24 ± 13 months. CONCLUSIONS Uniportal VATS is feasible, safe, and reproducible in the treatment of pneumothorax. Morbidity is similar to multiport VATS. The recurrence rate is comparable with best results after multiport VATS or thoracotomy. Patients were satisfied with the single small scar.
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Affiliation(s)
- Hicham Masmoudi
- Department of Thoracic Surgery, Tenon Hospital, Paris, France.
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | | | - Diane Evrard
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | - Raphaël Ouede
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | | | - Mihaela Giol
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
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12
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Jeon HW, Kim YD. Does 11.5 mm guided single port surgery has clinical advantage than multi-port thoracoscopic surgery in spontaneous pneumothorax? J Thorac Dis 2016; 8:2924-2930. [PMID: 27867569 DOI: 10.21037/jtd.2016.10.56] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) has been widely used for spontaneous pneumothorax (SP). In recent years, thoracic surgeons have attempted single incision or single port surgery with the development of surgical technology and skills. Theoretically, single port surgery is expected to provide benefits such as less pain and early recovery. The purpose of this study was to determine the benefits of single port surgery in SP. METHODS The 107 patients with SP who underwent surgery, between July 2013 and May 2015, were reviewed retrospectively. The patients with secondary pneumothorax, who underwent open procedures and lacking of medical records were excluded. Visual analog scale (VAS), paresthesia and clinical outcomes were reviewed in 86 patients (46 patients: three-port, 40 patients: 11.5 mm guided single-port). RESULTS The mean age was 23.4 years in three-port and 22.4 in single-port (P=0.247). The height and body weight were not significantly difference between two groups. The mean operation time was 39 minutes (mins) in the three-port and 37.3 mins in the single port without statistical difference (P=0.204). The pain score in the single port surgery was significantly lower after postoperative day (POD) 1 (P=0.028). However chest tube duration time was significantly shorter in the single port group (P<0.001). After exclusion of the patients with chest tube removal within postoperative 1 day, the pain score was not significantly different at the POD 1 between two groups (P=0.176). The pain score between two groups were not different at 1 week after discharge. CONCLUSIONS The pain score reduction was found 1 day after operation in the single port group. However, the chest tube duration time was significantly shorter in the single port group and the pain score was not different at 1 week after discharge. Considering young age in primary SP, the benefit of single port surgery in SP was minimal.
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Affiliation(s)
- Hyun Woo Jeon
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Young-Du Kim
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
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13
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Liu CY, Lin CS, Liu CC. Asian perspectives in thoracic surgery: clinical innovation in Taiwan. J Thorac Dis 2016; 8:S606-12. [PMID: 27651935 DOI: 10.21037/jtd.2016.08.64] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The development of minimally-invasive surgery of the thorax began in the 1990s, but not until the recent decade did we see dramatic improvements in patient care and refinement of technique. The current generation has witnessed the evolution from traditional thoracotomy, to a single-port, non-intubated thoracoscopic approach. The investigation of subxiphoid single-port, transumbilical approach, and natural orifice transluminal endoscopic surgery (NOTES) in animal model are also undergoing. In Taiwan, several talented young surgeons have vigorously devoted their ideas and innovations to this field, making the Taiwan surgical society vivid and prosperous. The desire to improve, and willingness to change are the foundation of those surgeons. Providing better patient care is their impetus to strive for improvement. This article provides an account of how minimally-invasive thoracic surgery has evolved in recent years, and what clinical innovations have been developed by the Taiwan surgical society.
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Affiliation(s)
- Chao-Yu Liu
- Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan;; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chen-Sung Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan;; Division of Thoracic Surgery, Feng-Yuan Hospital, Ministry of Health and Welfare, Taichung City, Taiwan
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, Department of Surgery, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan
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Shanthanna H, Aboutouk D, Poon E, Cheng J, Finley C, Paul J, Thabane L. A retrospective study of open thoracotomies versus thoracoscopic surgeries for persistent postthoracotomy pain. J Clin Anesth 2016; 35:215-220. [PMID: 27871525 DOI: 10.1016/j.jclinane.2016.07.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/01/2016] [Accepted: 07/08/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Persistent thoracotomy pain syndrome (PTPS) is a recognized complication and is considered to be less after video-assisted thoracoscopic surgery (VATS) compared with open thoracic surgery (OTS). The primary objective was to compare the incidence of PTPS at 6 months. Secondary objectives were to compare the incidence of neuropathic pain between VATS and OTS and to report perioperative factors associated with the development of PTPS. METHODS This historical cohort study involved patient contact by a questionnaire regarding the presence of PTPS and its type. Patient, surgical, and analgesia factors were collected from health records, acute pain, and thoracic surgery databases. The data were analyzed using a multivariable logistic regression analysis, with results reported as adjusted odds ratio (OR) (95% confidence interval; P value). RESULTS Of 308 patients, 130 returned their questionnaire, and 106 responses were analyzed. The incidence of PTPS was 35% and 54% with VATS and OTS respectively, with an adjusted OR, 0.33 (95% confidence interval, 0.13-0.86), P= .024. The percentage of neuropathic pain was 18% and 48%, with VATS and OTS respectively, with an adjusted OR, 0.18 (0.04-0.85), P= .031. The diagnosis of cancer and previous chronic pain history were observed to be significantly associated with PTPS. CONCLUSIONS Our study indicates that PTPS is significantly more common and has a higher chance of being neuropathic with OTS. Despite being relatively less traumatic, VATS still carries a significant potential for PTPS. A diagnosis of cancer and history of previous pain are highly predictive of its development.
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Affiliation(s)
- Harsha Shanthanna
- Department of Anesthesia, McMaster University & St. Joseph's Hospital, Hamilton, Ontario, Canada.
| | - Dina Aboutouk
- Department of Anesthesia, McMaster University & St. Joseph's Hospital, Hamilton, Ontario, Canada
| | - Eugenia Poon
- Department of Anesthesia, McMaster University & St. Joseph's Hospital, Hamilton, Ontario, Canada
| | - Ji Cheng
- McMaster University & The Research Institute, St Joseph's Hospital, Hamilton, Ontario, Canada
| | - Christian Finley
- Department of Surgery, McMaster University & Department of Thoracic Surgery, St Joseph's Hospital, Hamilton, Ontario, Canada
| | - James Paul
- Department of Anesthesia, McMaster University & St. Joseph's Hospital, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Anesthesia, McMaster University & St. Joseph's Hospital, Hamilton, Ontario, Canada; McMaster University & The Research Institute, St Joseph's Hospital, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Aresu G, Wu L, Lin L, Jiang G, Jiang L. The Shanghai Pulmonary Hospital subxiphoid approach for lobectomies. J Vis Surg 2016; 2:135. [PMID: 29078522 DOI: 10.21037/jovs.2016.07.09] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/28/2016] [Indexed: 11/06/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) has recognized benefits. However, patients undergoing VATS also complain acute and sometime chronic postoperative pain due to the damage of the intercostal bundles. Subxiphoid uniportal VATS has been presented as alternative approach that can completely avoid the intercostal nerve injury and further reduce the surgical outcome. The aim of this manuscript is to illustrate the Shanghai Pulmonary Hospital uniportal subxiphoid lobectomy surgical techniques.
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Affiliation(s)
- Giuseppe Aresu
- Department of Cardiothoracic Surgery, Santa Maria della Misericordia University Hospital, Udine 33100, Italy.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.,Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - Liang Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Lei Lin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Lei Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
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Vats Versus Axillary Minithoracotomy in the Management of the Second Episode of Spontaneous Pneumothorax: Cost–Benefit Analysis. World J Surg 2016; 40:2171-7. [DOI: 10.1007/s00268-016-3558-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang BY, Chang YC, Chang YC, Wang KM, Lin CH, Lin SH, Lin WC. Thoracoscopic surgery via a single-incision subxiphoid approach is associated with less postoperative pain than single-incision transthoracic or three-incision transthoracic approaches for spontaneous pneumothorax. J Thorac Dis 2016; 8:S272-8. [PMID: 27014474 DOI: 10.3978/j.issn.2072-1439.2016.02.33] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Comparison of the degree of postoperative pain associated with different thoracoscopic surgical techniques for spontaneous pneumothorax has never reported. In this study we compared perioperative outcomes and degrees of postoperative pain associated with single-incision subxiphoid thoracoscopic surgery, single-incision transthoracic thoracoscopic surgery and three-incision transthoracic thoracoscopic surgery for spontaneous pneumothorax. METHODS During the period August 2013 to September 2015, fifty-seven consecutive patients with spontaneous pneumothorax were treated via single-incision subxiphoid thoracoscopic surgery, single-incision transthoracic thoracoscopic surgery or three-incision transthoracic thoracoscopic surgery. Demographic data, operative time, operative blood loss, length of hospital stay, duration of chest tube drainage, postoperative complications, and numeric pain rating scale scores were collected from the medical records for analysis. RESULTS Among the 57 patients, 14 received single-incision subxiphoid thoracoscopic surgery, 26 underwent single-incision transthoracic surgery and 17 received three-incision thoracoscopic surgery. In all patients, surgeries were completed without the need for conversion to open surgery. Patients who underwent the single-incision subxiphoid procedure had significantly lower 1-, 8-, 24- and 32-hour postoperative pain scale scores than patients who underwent the other two procedures. The average and maximum pain scale scores during the first 24 hours were lowest in the single-incision subxiphoid group (P<0.0001). CONCLUSIONS Single-incision subxiphoid thoracoscopic surgery is associated with significantly lower postoperative pain intensity than transthoracic approaches and therefore may provide an alternative surgical technique for patients with spontaneous pneumothorax.
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Affiliation(s)
- Bing-Yen Wang
- 1 Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua and Chung Shan Medical University, Taichung, Taiwan ; 2 School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; 3 Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan ; 4 Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan ; 5 Division of Thoracic Surgery, Department of Surgery, Shin Kong Memorial Wu Ho-Su Hospital, Taipei, Taiwan ; 6 Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, and Chung Shan Medical University, Taichung, Taiwan ; 7 Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Yin-Chun Chang
- 1 Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua and Chung Shan Medical University, Taichung, Taiwan ; 2 School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; 3 Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan ; 4 Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan ; 5 Division of Thoracic Surgery, Department of Surgery, Shin Kong Memorial Wu Ho-Su Hospital, Taipei, Taiwan ; 6 Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, and Chung Shan Medical University, Taichung, Taiwan ; 7 Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Yih-Chen Chang
- 1 Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua and Chung Shan Medical University, Taichung, Taiwan ; 2 School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; 3 Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan ; 4 Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan ; 5 Division of Thoracic Surgery, Department of Surgery, Shin Kong Memorial Wu Ho-Su Hospital, Taipei, Taiwan ; 6 Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, and Chung Shan Medical University, Taichung, Taiwan ; 7 Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Kung-Min Wang
- 1 Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua and Chung Shan Medical University, Taichung, Taiwan ; 2 School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; 3 Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan ; 4 Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan ; 5 Division of Thoracic Surgery, Department of Surgery, Shin Kong Memorial Wu Ho-Su Hospital, Taipei, Taiwan ; 6 Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, and Chung Shan Medical University, Taichung, Taiwan ; 7 Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Ching-Hsiung Lin
- 1 Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua and Chung Shan Medical University, Taichung, Taiwan ; 2 School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; 3 Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan ; 4 Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan ; 5 Division of Thoracic Surgery, Department of Surgery, Shin Kong Memorial Wu Ho-Su Hospital, Taipei, Taiwan ; 6 Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, and Chung Shan Medical University, Taichung, Taiwan ; 7 Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Sheng-Hao Lin
- 1 Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua and Chung Shan Medical University, Taichung, Taiwan ; 2 School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; 3 Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan ; 4 Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan ; 5 Division of Thoracic Surgery, Department of Surgery, Shin Kong Memorial Wu Ho-Su Hospital, Taipei, Taiwan ; 6 Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, and Chung Shan Medical University, Taichung, Taiwan ; 7 Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Wei-Cheng Lin
- 1 Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua and Chung Shan Medical University, Taichung, Taiwan ; 2 School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; 3 Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan ; 4 Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan ; 5 Division of Thoracic Surgery, Department of Surgery, Shin Kong Memorial Wu Ho-Su Hospital, Taipei, Taiwan ; 6 Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, and Chung Shan Medical University, Taichung, Taiwan ; 7 Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
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Lee SH, Lee CY, Lee JG, Kim N, Lee HM, Oh YJ. Intraoperative Dexmedetomidine Improves the Quality of Recovery and Postoperative Pulmonary Function in Patients Undergoing Video-assisted Thoracoscopic Surgery: A CONSORT-Prospective, Randomized, Controlled Trial. Medicine (Baltimore) 2016; 95:e2854. [PMID: 26886651 PMCID: PMC4998651 DOI: 10.1097/md.0000000000002854] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Video-assisted thoracoscopic surgery (VATS) has been known to be a stressful event for patients, and dexmedetomidine is known to attenuate surgery-induced sympathetic responses and potentiate analgesia in perioperative periods. The present was designed to evaluate the effects of intraoperative dexmedetomidine administration on the quality of recovery (QoR) and pulmonary function after VATS. Patients with lung cancer undergoing VATS were randomized to Dex group (loading of 1.0 μg/kg for 20 minutes before the termination of surgery, n = 50) or Control group (comparable volume of normal saline, n = 50). The QoR-40 questionnaire assesses postoperative recovery and validates the overall surgical and general anesthesia outcomes. The QoR-40 scores, forced expiratory volume for 1 second (FEV1) on postoperative day (POD) 1 and 2, and emergence agitation were evaluated. The global QoR-40 score (162.3 ± 17.8 vs 153.3 ± 18.7, P = 0.016 on POD 1; 174.3 ± 16.0 vs 166.8 ± 16.7, P = 0.028 on POD 2) and FEV1 (2.1 ± 0.4 vs 1.9 ± 0.5 L, P = 0.034 on POD 1; 2.2 ± 0.5 vs 2.0 ± 0.4 L, P = 0.030 on POD 2) were significantly higher in the Dex group compared with the Control group on POD1 and POD 2. The score of emergence agitation was lower in the Dex group compared with the Control group (3 [2-5] vs 5 [3-7], P < 0.001). The number of patients indicating severe emergence agitation was shorter in the Dex group than Control group (0 [0%] vs 7 [14%], P = 0.048). The length of hospital stay was significantly shorter (6.7 [3-9] vs 8.4 [4-9] days, P = 0.045) in the Dex group compared with the Control group. Intraoperative dexmedetomidine administration improved QoR, postoperative pulmonary function, and emergence agitation in patients undergoing VATS. Consequently, intraoperative dexmedetomidine administration could improve postoperative outcomes and reduced the length of hospital stay in patients undergoing VATS.
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Affiliation(s)
- Su Hyun Lee
- From the Department of Anesthesiology and Pain Medicine (SHL, NK, HML, YJO); Anesthesia and Pain Research Institute (SHL, NK, YJO); Department of Thoracic and Cardiovascular Surgery (CYL, JGL), Yonsei University College of Medicine, Seoul, Korea
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Qin SL, Huang JB, Yang YL, Xian L. Uniportal versus three-port video-assisted thoracoscopic surgery for spontaneous pneumothorax: a meta-analysis. J Thorac Dis 2016; 7:2274-87. [PMID: 26793349 DOI: 10.3978/j.issn.2072-1439.2015.12.56] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Whether or not uniportal video-assisted thoracoscopic surgery (VATS) is beneficial for spontaneous pneumothorax remains inconclusive. This meta-analysis aimed to summarize the available evidence to assess the feasibility and advantages of uniportal VATS for the treatment of spontaneous pneumothorax compared with three-port VATS. METHODS Eligible publications were identified by searching the Cochrane Library, PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data databases and CQVIP. Odds ratios (OR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated to compare dichotomous and continuous variables, respectively. RESULTS This meta-analysis was based on 17 studies and included a total of 988 patients with spontaneous pneumothorax. No death was reported during the perioperative period. Compared with three-port VATS groups, there was a statistically significant difference in uniportal VATS groups regarding postoperative hospital stay (SMD= -0.58; 95% CI: -1.04 to -0.12; P=0.01), paresthesia (OR=0.13; 95% CI: 0.07 to 0.24; P<0.00001), visual analogue pain score (VAS) at 24 hours (h) (SMD= -0.87; 95% CI: -1.07 to -0.68; P<0.00001), VAS at 72 h (SMD= -0.49; 95% CI: -0.68 to -0.30; P<0.00001), and patients satisfaction scale (PSS) at 24 h (SMD= -0.81; 95% CI: -1.21 to -0.41; P<0.0001), PSS at 48 h (SMD= -0.69; 95% CI: -1.08 to -0.29; P=0.0007). However there was no statistically significant difference on the recurrence (OR=0.79; 95% CI: 0.42 to 1.46; P=0.45), operative time (SMD= -0.23; 95% CI: -0.21 to 0.67; P=0.31), length of postoperative drainage (SMD= -0.17; 95% CI: -0.40 to -0.07; P=0.16), VAS at 48 h (SMD= -0.40; 95% CI: -1.47 to 0.67; P=0.46), and PSS at 72 h (SMD= -0.13; 95% CI: -0.52 to -0.25; P=0.50). CONCLUSIONS The results for mortality, recurrence, operative time, and length of postoperative drainage were similar between uniportal and three-port VATS. Uniportal VATS resulted in reduction in postoperative pain and paresthesia as well as an improvement in patients' satisfaction. This meta-analysis indicated that using uniportal VATS to treat spontaneous pneumothorax was safe and feasible, and it may be a better alternative procedure because of its advantage in reducing postoperative pain and paresthesia.
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Affiliation(s)
- Shi-Lei Qin
- 1 Department of Cardiothoracic Surgery, the First Affiliated Hospital of GuangXi Medical University, Nanning 530021, China ; 2 Class 3 in Grade 2009 of GuangXi Medical University, Nanning 530021, China
| | - Jin-Bo Huang
- 1 Department of Cardiothoracic Surgery, the First Affiliated Hospital of GuangXi Medical University, Nanning 530021, China ; 2 Class 3 in Grade 2009 of GuangXi Medical University, Nanning 530021, China
| | - Yan-Long Yang
- 1 Department of Cardiothoracic Surgery, the First Affiliated Hospital of GuangXi Medical University, Nanning 530021, China ; 2 Class 3 in Grade 2009 of GuangXi Medical University, Nanning 530021, China
| | - Lei Xian
- 1 Department of Cardiothoracic Surgery, the First Affiliated Hospital of GuangXi Medical University, Nanning 530021, China ; 2 Class 3 in Grade 2009 of GuangXi Medical University, Nanning 530021, China
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Tschopp JM, Bintcliffe O, Astoul P, Canalis E, Driesen P, Janssen J, Krasnik M, Maskell N, Van Schil P, Tonia T, Waller DA, Marquette CH, Cardillo G. ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax. Eur Respir J 2015; 46:321-35. [PMID: 26113675 DOI: 10.1183/09031936.00219214] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/17/2015] [Indexed: 12/15/2022]
Abstract
Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons to produce a comprehensive review of available scientific evidence.Smoking remains the main risk factor of PSP. Routine smoking cessation is advised. More prospective data are required to better define the PSP population and incidence of recurrence. In first episodes of PSP, treatment approach is driven by symptoms rather than PSP size. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of PSP recurrence includes pleurodesis. Talc poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc is available. Video-assisted thoracic surgery is preferred to thoracotomy as a surgical approach.In first episodes of PSP, aspiration is required only in symptomatic patients. After a persistent or recurrent PSP, definitive treatment including pleurodesis is undertaken. Future randomised controlled trials comparing different strategies are required.
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Affiliation(s)
- Jean-Marie Tschopp
- Centre Valaisan de Pneumologie, Dept of Internal Medicine RSV, Montana, Switzerland Task Force Chairs
| | - Oliver Bintcliffe
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Philippe Astoul
- Dept of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hospital North Aix-Marseille University, Marseille, France
| | - Emilio Canalis
- Dept of Surgery, University of Rovira I Virgili, Tarragona, Spain
| | | | - Julius Janssen
- Dept of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marc Krasnik
- Dept of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Nicholas Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul Van Schil
- Dept of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Thomy Tonia
- Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | - David A Waller
- Dept of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Charles-Hugo Marquette
- Hospital Pasteur CHU Nice and Institute for Research on Cancer and Ageing, University of Nice Sophia Antipolis, Nice, France
| | - Giuseppe Cardillo
- Dept of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy Task Force Chairs
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Li S, Cui F, Liu J, Xu X, Shao W, Yin W, Chen H, He J. Nonintubated uniportal video-assisted thoracoscopic surgery for primary spontaneous pneumothorax. Chin J Cancer Res 2015; 27:197-202. [PMID: 25937782 DOI: 10.3978/j.issn.1000-9604.2015.03.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/01/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The objective of the current study was to evaluate the feasibility and safety of nonintubated uniportal video-assisted thoracoscopic surgery (VATS) for the management of primary spontaneous pneumothorax (PSP). METHODS From November 2011 to June 2013, 32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidural anaesthesia and sedation without endotracheal intubation. An incision 2 cm in length was made at the 6(th) intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a soft incision protector. Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy. Data were collected within a minimum follow-up period of 10 months. RESULTS The average time of surgery was 49.0 min (range, 33-65 min). No complications were recorded. The postoperative feeding time was 6 h. The mean postoperative chest tube drainage and hospital stay were 19.3 h and 41.6 h, respectively. The postoperative pain was mild for 30 patients (93.75%) and moderate for two patients (6.25%). No recurrences of pneumothorax were observed at follow-up. CONCLUSIONS The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible, but may also be a safe and less invasive alternative for select patients in the management of PSP. This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases. Further work and development of instruments are needed to define the applications and advantages of this technique.
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Affiliation(s)
- Shuben Li
- 1 The First Clinical College, Southern Medical University, Guangzhou 510515, China ; 2 Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Fei Cui
- 1 The First Clinical College, Southern Medical University, Guangzhou 510515, China ; 2 Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jun Liu
- 1 The First Clinical College, Southern Medical University, Guangzhou 510515, China ; 2 Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xin Xu
- 1 The First Clinical College, Southern Medical University, Guangzhou 510515, China ; 2 Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Wenlong Shao
- 1 The First Clinical College, Southern Medical University, Guangzhou 510515, China ; 2 Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Weiqiang Yin
- 1 The First Clinical College, Southern Medical University, Guangzhou 510515, China ; 2 Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Hanzhang Chen
- 1 The First Clinical College, Southern Medical University, Guangzhou 510515, China ; 2 Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jianxing He
- 1 The First Clinical College, Southern Medical University, Guangzhou 510515, China ; 2 Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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Komplikationen in der Therapie des Spontanpneumothorax. Chirurg 2015; 86:444-52. [DOI: 10.1007/s00104-014-2866-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sihoe ADL, Yu PSY, Yeung JWL. Primary pneumothorax: Should surgery be offered after the first episode? World J Respirol 2015; 5:47-57. [DOI: 10.5320/wjr.v5.i1.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 01/01/2015] [Accepted: 02/02/2015] [Indexed: 02/06/2023] Open
Abstract
Surgery is the recommended and most effective means of preventing the recurrence of primary spontaneous pneumothorax (PSP). However, the conventional belief amongst most clinicians is that surgery should not be routinely offered to patients with an uncomplicated first episode of PSP. The view that surgery should be reserved for recurrent episodes of ipsilateral PSP is based on an apprehension regarding traumatic thoracic surgery combined with a perception that recurrences after a single episode of PSP are unlikely. Modern advances in minimally invasive thoracic surgery have now dramatically reduced the morbidity of PSP surgery. Such surgery is now safe, effective and causes minimal indisposition for patients. On the other hand, modern clinical data suggests that recurrence rate of PSP is perhaps much higher than previously assumed, with more than half of patients experiencing a second episode within several years of the first. With such new appreciations of the current situation, it is appropriate to now consider offering surgery to patients even after the first episode of PSP.
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Imperatori A, Rotolo N, Spagnoletti M, Festi L, Berizzi F, Di Natale D, Nardecchia E, Dominioni L. Risk factors for postoperative recurrence of spontaneous pneumothorax treated by video-assisted thoracoscopic surgery†. Interact Cardiovasc Thorac Surg 2015; 20:647-51; discussion 651-2. [PMID: 25690457 DOI: 10.1093/icvts/ivv022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 01/14/2015] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Over the past two decades, video-assisted thoracoscopic blebectomy and pleurodesis have been used as a safe and reliable option for treatment of spontaneous pneumothorax. The aim of this study is to evaluate the long-term outcome of video-assisted thoracoscopic surgery (VATS) treatment of spontaneous pneumothorax in young patients, and to identify risk factors for postoperative recurrence. METHODS We retrospectively analysed the outcome of VATS treatment of spontaneous pneumothorax in our institution in 150 consecutive young patients (age ≤ 40 years) in the years 1997-2010. Treatment consisted of stapling blebectomy and partial parietal pleurectomy. After excluding 16 patients lost to follow-up, in 134 cases [110 men, 24 women; mean age, 25 ± 7 standard deviation years; median follow-up, 79 months (range: 36-187 months)], we evaluated postoperative complications, focusing on pneumothorax recurrence, thoracic dysaesthesia and chronic chest pain. Risk factors for postoperative pneumothorax recurrence were analysed by logistic regression. RESULTS Of 134 treated patients, 3 (2.2%) required early reoperation (2 for bleeding; 1 for persistent air leaks). Postoperative (90-day) mortality was nil. Ipsilateral pneumothorax recurred in 8 cases (6.0%) [median time of recurrence, 43 months (range: 1-71 months)]. At univariate analysis, the recurrence rate was significantly higher in women (4/24) than in men (4/110; P = 0.026) and in patients with >7-day postoperative air leaks (P = 0.021). Multivariate analysis confirmed that pneumothorax recurrence correlated independently with prolonged air leaks (P = 0.037) and with female gender (P = 0.045). Chronic chest wall dysaesthesia was reported by 13 patients (9.7%). In 3 patients, (2.2%) chronic thoracic pain (analogical score >4) was recorded, but only 1 patient required analgesics more than once a month. CONCLUSIONS VATS blebectomy and parietal pleurectomy is a safe procedure for treatment of spontaneous pneumothorax in young patients, with a 6% long-term recurrence rate in our experience. Postoperative recurrence significantly correlates with female gender and with prolonged air leakage after surgery.
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Affiliation(s)
- Andrea Imperatori
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Marco Spagnoletti
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Luigi Festi
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Fabio Berizzi
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Davide Di Natale
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Elisa Nardecchia
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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Łochowski MP, Kozak J. Video-assisted thoracic surgery complications. Wideochir Inne Tech Maloinwazyjne 2014; 9:495-500. [PMID: 25561984 PMCID: PMC4280410 DOI: 10.5114/wiitm.2014.44250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 04/12/2014] [Accepted: 05/02/2014] [Indexed: 12/04/2022] Open
Abstract
Video-assisted thoracic surgery (VATS) is a miniinvasive technique commonly applied worldwide. Indications for VATS are very broad and include the diagnosis of mediastinal, lung and pleural diseases, as well as large resection procedures such as pneumonectomy. The most frequent complication is prolonged postoperative air leak. The other significant complications are bleeding, infections, postoperative pain and recurrence at the port site. Different complications of VATS procedures can occur with variable frequency in various diseases. Despite the large number of their types, such complications are rare and can be avoided through the proper selection of patients and an appropriate surgical technique.
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Affiliation(s)
| | - Józef Kozak
- Department of Thoracic Surgery, Medical University of Lodz, Lodz, Poland
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Sihoe ADL. The evolution of minimally invasive thoracic surgery: implications for the practice of uniportal thoracoscopic surgery. J Thorac Dis 2014; 6:S604-17. [PMID: 25379198 DOI: 10.3978/j.issn.2072-1439.2014.08.52] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/24/2014] [Indexed: 11/14/2022]
Abstract
The history of Minimally Invasive Surgery in the thorax is one of evolution, not revolution. The concept of video-assisted thoracic surgery (VATS) to greatly reduce the trauma of chest operations was born over two decades ago. Since then, it has undergone a series of step-wise modifications and improvement. The original practice of three access ports in a 'baseball diamond' pattern was modified to suit operational needs, and gradually developed into 'next generation' approaches, including Needlescopic and 2-port VATS. The logical, incremental progression has culminated in the Uniportal VATS approach which has stirred considerable interest within the field of Thoracic Surgery in recent years. This measured, evolutionary process has significant implications on how the surgeon should approach, master and realize the full potential of the Uniportal technique. This article gives a précis of the evolutionary history of minimally invasive thoracic surgery, and highlights the lessons it provides about its future.
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Affiliation(s)
- Alan D L Sihoe
- Division of Cardiothoracic Surgery, Department of Surgery, The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong 999077, China
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Chen TP, Yen-Chu, Wu YC, Yeh CJ, Liu CY, Hsieh MJ, Yuan HC, Ko PJ, Liu YH. Transumbilical Thoracoscopy Versus Conventional Thoracoscopy for Lung Wedge Resection: Safety and Efficacy in a Live Canine Model. Surg Innov 2014; 22:568-76. [PMID: 25294791 DOI: 10.1177/1553350614552733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Transumbilical single-port surgery has been associated with less postoperative pain and offers better cosmetic outcomes than conventional 3-port laparoscopic surgery. This study compares the safety and efficacy of transumbilical thoracoscopy and conventional thoracoscopy for lung wedge resection. METHODS The animals (n = 16) were randomly assigned to the transumbilical thoracoscopic approach group (n = 8) or conventional thoracoscopic approach group (n = 8). Transumbilical lung resection was performed via an umbilical incision and a diaphragmatic incision. In the conventional thoracoscopic group, lung resection was completed through a thoracic incision. For both procedures, we compared the surgical outcomes, for example, operating time and operative complications; physiologic parameters, for example, respiratory rate and body temperature; inflammatory parameters, for example, white blood cell count; and pulmonary parameters, for example, arterial blood gas levels. The animals were euthanized 2 weeks after the surgery for gross and histologic evaluations. RESULTS The lung wedge resection was successfully performed in all animals. There was no significant difference in the mean operating times or complications between the transumbilical and the conventional thoracoscopic approach groups. With regard to the physiologic impact of the surgeries, the transumbilical approach was associated with significant elevations in body temperature on postoperative day 1, when compared with the standard thoracoscopic approach. CONCLUSIONS This study suggests that both approaches for performing lung wedge resection were comparable in efficacy and postoperative complications.
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Affiliation(s)
- Tzu-Ping Chen
- Department of Surgery, Chang Gung Memorial Hospital at Keelung, Chang Gung University, Taiwan, ROC
| | - Yen-Chu
- Chang Gung Memorial Hospital at Linko, Chang Gung University, Taiwan, ROC
| | - Yi-Cheng Wu
- Chang Gung Memorial Hospital at Linko, Chang Gung University, Taiwan, ROC
| | - Chi-Ju Yeh
- Chang Gung Memorial Hospital at Linko, Chang Gung University, Taiwan, ROC
| | - Chien-Ying Liu
- Chang Gung Memorial Hospital at Linko, Chang Gung University, Taiwan, ROC
| | - Ming-Ju Hsieh
- Chang Gung Memorial Hospital at Linko, Chang Gung University, Taiwan, ROC
| | - Hsu-Chia Yuan
- Chang Gung Memorial Hospital at Linko, Chang Gung University, Taiwan, ROC
| | - Po-Jen Ko
- Chang Gung Memorial Hospital at Linko, Chang Gung University, Taiwan, ROC
| | - Yun-Hen Liu
- Chang Gung Memorial Hospital at Linko, Chang Gung University, Taiwan, ROC
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Snyder CW, Walford NE, Danielson PD, Chandler NM. A simple thoracoscopic plication technique for diaphragmatic eventration in neonates and infants: technical details and initial results. Pediatr Surg Int 2014; 30:1013-6. [PMID: 25139157 DOI: 10.1007/s00383-014-3580-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Existing minimal-access surgical approaches for correction of symptomatic diaphragmatic eventration may be technically difficult in neonates and infants. We report technical details and initial outcomes of a novel, simple thoracoscopic repair technique. METHODS The technique uses one 3-mm camera port, a 3-mm instrument incision without a port, and an 18-gauge spinal needle, which is passed through the chest wall into the pleural space. The excess diaphragm is first plicated over the needle, after which a non-absorbable suture is passed through the needle and tied extracorporeally. The needle is passed repeatedly until the desired degree of tension is achieved. A retrospective review was performed for all patients undergoing repair by this technique. RESULTS Nine patients have undergone thoracoscopic plication at a median age of 3 months (range 0.2-13.2 mos.) and a median weight of 4.5 kg (range 2.3-8.2 kg). No organ injuries or conversions to thoracotomy occurred. Median operative time was 60 min. Patients repaired beyond the neonatal period were extubated in the operating room. There were two post-operative pneumothoraces. No recurrences have been seen at a mean follow-up of 17 months. CONCLUSION This technique of thoracoscopic diaphragm plication is safe, effective, and technically straightforward in neonates and infants.
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Affiliation(s)
- Christopher W Snyder
- Division of Pediatric Surgery, All Children's Hospital, John Hopkins University School of Medicine, St. Petersburg, FL, USA,
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Sihoe ADL, Hsin MKY, Yu PSY. Needlescopic video-assisted thoracic surgery pleurodesis for primary pneumothorax. Multimed Man Cardiothorac Surg 2014; 2014:mmu012. [PMID: 24969616 DOI: 10.1093/mmcts/mmu012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Conventional video-assisted thoracic surgery (VATS) is already well established as the approach of choice for definitive surgical management for primary pneumothorax. However, VATS itself is a constantly evolving technique. The needlescopic VATS (nVATS) approach uses the existing chest drain wound as a working port and adds only two 3-mm ports to provide equally effective pleurodesis as conventional VATS. Staple resection of bullae or blebs plus complete mechanical parietal pleural abrasion is achievable using nVATS. By potentially reducing morbidity for the individual patient, the nVATS approach may lower thresholds for surgical candidacy-even for first episodes of primary pneumothorax.
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Affiliation(s)
- Alan D L Sihoe
- Division of Cardiothoracic Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Michael K Y Hsin
- Division of Cardiothoracic Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Peter S Y Yu
- Division of Cardiothoracic Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
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Li C, Xu C, Ma H, Ni B, Chen J, Chen T, Zhang H, Zhao J. Video-assisted thoracoscopic lobectomy with a single utility port is feasible in the treatment of elderly patients with peripheral lung cancer. Thorac Cancer 2014; 5:219-24. [PMID: 26767004 DOI: 10.1111/1759-7714.12081] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/10/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Video-assisted thoracoscopic (VATS) lobectomy with a single utility port has emerged as a new technology in recent years. The aim of this study is to review the technology in the treatment of elderly patients with peripheral lung cancer. METHODS We retrospectively analyzed the clinical data of 21 elderly patients with peripheral lung cancer who underwent single utility port VATS lobectomy from February 2011 to February 2013 in the First Affiliated Hospital of Soochow University (VATS group). The clinical outcomes and postoperative complications were then compared to data from 32 elderly patients who underwent lobectomy by thoracotomy (TL group). RESULTS No mortality occurred during the postoperative period in either group. There was no statistical difference in surgery duration, the quantity of lymph node dissection or intraoperative blood loss between the VATS and TL groups. However, significant differences existed in the postoperative hospital stay (6.19 ± 1.69 days vs. 8.22 ± 2.55 days), time to first activity out of bed (20.57 ± 7.72 hours vs. 26.81 ± 9.27 hours), chest drainage duration (4.24 ± 1.04 days vs. 5.22 ± 1.29 days), and total postoperative drainage volume (642.86 ± 158.18 mL vs. 787.81 ± 211.55 mL) between the VATS and TL groups (P <0.05). The percentage of patients with no complications in the VATS group (85.71%) is significantly higher when compared with the TL group (56.25%, P <0.05). CONCLUSION VATS lobectomy with a single utility port is a safe and feasible surgical procedure for selected elderly patients with peripheral lung cancer.
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Affiliation(s)
- Chang Li
- Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Soochow University, Medical College of Soochow University Suzhou, China; Soochow University Laboratory of Cancer Molecular Genetics, Medical College of Soochow University Suzhou, China; Suzhou Key Laboratory for Cancer Molecular Genetics Suzhou, China
| | - Chun Xu
- Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Soochow University, Medical College of Soochow University Suzhou, China
| | - Haitao Ma
- Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Soochow University, Medical College of Soochow University Suzhou, China
| | - Bin Ni
- Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Soochow University, Medical College of Soochow University Suzhou, China
| | - Jun Chen
- Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Soochow University, Medical College of Soochow University Suzhou, China
| | - Tengfei Chen
- Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Soochow University, Medical College of Soochow University Suzhou, China
| | - Hongtao Zhang
- Soochow University Laboratory of Cancer Molecular Genetics, Medical College of Soochow University Suzhou, China; Suzhou Key Laboratory for Cancer Molecular Genetics Suzhou, China
| | - Jun Zhao
- Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Soochow University, Medical College of Soochow University Suzhou, China; Soochow University Laboratory of Cancer Molecular Genetics, Medical College of Soochow University Suzhou, China; Suzhou Key Laboratory for Cancer Molecular Genetics Suzhou, China
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Igai H, Kamiyoshihara M, Ibe T, Kawatani N, Shimizu K. Single-incision thoracoscopic surgery for spontaneous pneumothorax using multi-degrees of freedom forceps. Ann Thorac Cardiovasc Surg 2014; 20:974-9. [PMID: 24492179 DOI: 10.5761/atcs.oa.13-00278] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The objective of this study was to assess the perioperative results of a single-incision approach using multi-DOF forceps for spontaneous pneumothorax, in comparison with the traditional 3-port approach. METHODS Between May 2012 and June 2013, 44 patients with spontaneous pneumothorax underwent SITS, and their clinical characteristics and perioperative results were evaluated. We then compared those who had undergone SITS (SITS group) with those who had undergone traditional 3-port surgery before the study period (3-port group). RESULTS The two groups were similar in terms of mean patient age and pneumothorax laterality (p = 0.81, 0.38), but the proportion of male patients was higher in the 3-port group than in the SITS group (p = 0.0026). Operation time in the SITS group (52.4 min) was longer than in the 3-port group (35.9 min, p <0.0001). The duration of postoperative drainage and hospital stay did not differ significantly between the groups (p = 0.19, 0.075). Although 14 of the 56 SITS patients (25%) showed mild adhesion in the pleural cavity, none required conversion to a 3-port approach. The bullous region in two or three lobes was resected in 23 patients (41%). CONCLUSIONS SITS using multi-DOF forceps is a useful approach for treatment of spontaneous pneumothorax in selected patients.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan
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Thoracoscopic and laparoscopic plication of the hemidiaphragm is effective in the management of diaphragmatic eventration. Pediatr Surg Int 2014; 30:19-24. [PMID: 24100524 DOI: 10.1007/s00383-013-3418-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Diaphragmatic plication by minimally invasive surgery is thought to allow for a quick recovery and has been performed on small children. Here, we report our experience with different plication procedures to discuss how to choose among these different plication procedures in endoscopic surgery for pediatric patients with diaphragmatic eventration. PATIENTS AND METHODS We retrospectively analyzed clinical data of 27 pediatric patients (21 boys, 6 girls; median age: 12.7 months, range 2 months-3 years) admitted to our hospital between November 2008 and July 2013. Three different plication procedures were used: the "reefing the mainsail" technique (8 patients), "invaginating the diaphragmatic dome" technique (10 patients), and "pleating" technique (9 patients). Indications included ventilator dependency (7.41 %), respiratory distress (22.22 %), chronic lung lobe collapse (11.11 %), persistent atelectasis with recurrent pneumonias (18.52 %), and asymptomatic severe eventration (40.74 %). RESULTS Descending distance of diaphragm after surgery ranged from 1 to 4.5 intercostal spaces (mean distance: 2.65 intercostal spaces). All patients recovered well postoperatively, except for one patient with a pneumothorax. Two patients who required respiratory support before the operation no longer required it within 7 d after surgery. Follow-up ranged from 1 to 35 months. Clinical results were satisfactory with obvious improvement in symptoms and a slight re-elevation within a distance of one intercostal space. CONCLUSION For pediatric patients with diaphragmatic eventration, different endoscopic surgeries and plication procedures all yielded satisfactory results. We believe that the choice of one procedure over the other depends only on the surgeon's experience.
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Wen CT, Chu Y, Yeh CJ, Liu CY, Yuan HC, Ko PJ, Liu YH, Liu HP. Feasibility and safety of endoscopic transumbilical thoracic surgical lung biopsy: a survival study in a canine model. J Surg Res 2013; 183:47-55. [DOI: 10.1016/j.jss.2012.11.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 11/22/2012] [Accepted: 11/30/2012] [Indexed: 12/26/2022]
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Transoral endoscopic surgery versus conventional thoracoscopic surgery for thoracic intervention: safety and efficacy in a canine survival model. Surg Endosc 2013; 27:2428-35. [PMID: 23355155 DOI: 10.1007/s00464-012-2753-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 12/04/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Transoral endoscopic surgery has been shown to be feasible and safe in both humans and animal models. The purpose of this study was to evaluate the safety and efficacy of transoral and conventional thoracoscopy for thoracic exploration, surgical lung biopsy, and pericardial window creation. METHODS The animals (n = 20) were randomly assigned to the transoral endoscopic approach group (n = 10) or conventional thoracoscopic approach group (n = 10). Transoral thoracoscopy was performed with a flexible bronchoscope via an incision over the vestibulum oris. In conventional thoracoscopy, access to the thoracic cavity was obtained through a thoracic incision. Surgical outcomes (body weight, operating time, operative complications, and time to resumption of normal diet), physiologic parameters (respiratory rate, body temperature), inflammatory parameters [white blood cell (WBC) counts and C-reactive protein (CRP)], and pulmonary parameters (arterial blood gases) were compared for both procedures. RESULTS The surgical lung biopsy and pericardial window creation were successfully performed in all animals except one animal in the transoral group. There was no significant difference in operating times between the groups. The increase in WBC in the transoral thoracoscopy group was significantly smaller on postoperative day 1 than in the conventional thoracoscopy group (p = 0.0029). The transoral group had an earlier return to preoperative body temperature (p = 0.041) and respiratory rate (p = 0.045) on day 7. With respect to pulmonary parameters, there was no significant difference in blood pH, pCO2, or PaCO2 between the transoral and transthoracic groups. All animals survived without complications 14 days after surgery. CONCLUSIONS This study demonstrated that the transoral approach was comparable to conventional thoracoscopic surgery for lung biopsy and pericardial window creation in terms of safety and efficacy.
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Lee JH, Yang WD, Han SY, Noh JI, Cho SH, Kim SH, Chae WS, Jin HC. Effect of Epidural Magnesium on the Incidence of Chronic Postoperative Pain After Video-Assisted Thoracic Surgery. J Cardiothorac Vasc Anesth 2012; 26:1055-9. [DOI: 10.1053/j.jvca.2012.06.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Indexed: 11/11/2022]
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One-port (uniportal) video-assisted thoracic surgical resections—A clear advance. J Thorac Cardiovasc Surg 2012; 144:S27-31. [PMID: 22743172 DOI: 10.1016/j.jtcvs.2012.06.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 03/23/2012] [Accepted: 06/05/2012] [Indexed: 11/23/2022]
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Boley TM, Reid AJ, Manning BT, Markwell SJ, Vassileva CM, Hazelrigg SR. Sternotomy or bilateral thoracoscopy: pain and postoperative complications after lung-volume reduction surgery. Eur J Cardiothorac Surg 2012; 41:14-8. [PMID: 21601469 DOI: 10.1016/j.ejcts.2011.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Video-assisted thoracoscopic surgery (VATS) and median sternotomy (MS) are two approaches in lung-volume reduction surgery (LVRS). This study focused on the two surgical approaches with regard to postoperative pain. METHODS In this prospective, non-randomized study, pain was measured preoperatively and postoperatively using the visual analog scale (VAS) and the brief pain inventory (BPI). Incentive spirometry (IS) assessed restriction of the thoracic cage due to pain. Factors associated with treatment complications, medication usage, hospital stay, operating times, and chest-tube duration differences were examined between groups. RESULTS Of 85 patients undergoing LVRS, 23 patients underwent reduction via MS and 62 patients via bilateral VATS. VAS scores revealed no difference in postoperative pain except for VAS scores on days 6 (PM) and 7 (PM). BPI scores yielded higher scores in the VATS group on postoperative day (POD) 1 in the reactive dimension, but no other overall differences. MS patients receiving tramadol consumed a higher mean amount than VATS patients on POD 5 and POD 6. IS change from baseline to postoperative were similar between groups, and increased pain correlated with decreased IS scores on POD 1. Chest-tube duration, complications, and pain medication were similar between groups. CONCLUSIONS Bilateral VATS and MS offer similar outcomes with regard to postoperative pain and complications. These results suggest that the choice of LVRS operative approach should be dependent on disease presentation, surgeon expertise, and patient preference, not based upon differences in perceived postoperative pain between MS and bilateral VATS.
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Affiliation(s)
- Theresa M Boley
- Southern Illinois University School of Medicine, Division of Cardiothoracic Surgery, 701 N, First Street, Springfield, IL 62794-9638, USA.
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Foroulis CN, Anastasiadis K, Charokopos N, Antonitsis P, Antonitisis P, Halvatzoulis HV, Karapanagiotidis GT, Grosomanidis V, Papakonstantinou C. A modified two-port thoracoscopic technique versus axillary minithoracotomy for the treatment of recurrent spontaneous pneumothorax: a prospective randomized study. Surg Endosc 2011; 26:607-14. [PMID: 21562918 DOI: 10.1007/s00464-011-1734-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 04/26/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Currently, most thoracic surgeons perform surgical pleurodesis for recurrent spontaneous pneumothorax (RSP) by video-assisted thoracic surgery (VATS). However, the superiority of VATS over axillary minithoracotomy is not been established in prospective studies to date. A modified two-port VATS technique and axillary minithoracotomy were prospectively evaluated for possible differences in the short- and long-term outcome for patients. METHODS In this study, 66 consecutive patients underwent surgical pleurodesis for RSP through either a modified two-port VATS procedure (group A, 33 patients) or axillary minithoracotomy (group B, 33 patients). According to the study design (NCT01192217), the patients were randomly assigned to the two groups, which were similar in terms of age and body mass index. One-lung ventilation time, histology of the available lung parenchyma specimens, early postoperative complications, length of chest tube drainage and hospital stay, recurrence rate, and a score for patient satisfaction with treatment based on the sum of postoperative pain, dependent-arm mobilization, and return to full activity subscores were evaluated. The follow-up period varied from 3 to 53 months (median, 30 months). RESULTS The one-lung ventilation and operating times were significantly longer (p < 0.001) in group A than in group B. The overall detection of blebs, bulla, or both was 51.5% in group A and 63.8% in group B. The recurrence rate, complication rate, postoperative chest tube drainage duration, postoperative hospital stay, and incidence of chronic pain did not differ between the two groups. The score for patient satisfaction with treatment was significantly higher in group A than in group B (p < 0.001) according the subscores for better dependent-arm mobilization and return to full activity. CONCLUSIONS Axillary minithoracotomy and VATS are equally effective for the treatment of RSP, although the rate for resection of blebs, bulla, or both is higher with the axillary minithoracotomy procedure. Although VATS is more time consuming, it offers to the patient more satisfaction with treatment.
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Affiliation(s)
- Christophoros N Foroulis
- Department of Thoracic and Cardiovascular Surgery, Aristotle University Medical School, AHEPA University Hospital, Stilponos Kiriakidi Street, 54636, Thessaloniki, Greece.
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Prasad R, Arthur LG, Timmapuri SJ, Schwartz MZ, Fairbanks TJ, Mendelson KG, Thatch K, Moront ML. Early Experience with Single-Incision Thoracoscopic Surgery in the Pediatric Population. J Laparoendosc Adv Surg Tech A 2011; 21:189-92. [DOI: 10.1089/lap.2010.0150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rajeev Prasad
- Department of Pediatric Surgery, St. Christopher's Hospital for Children/Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - L. Grier Arthur
- Department of Pediatric Surgery, St. Christopher's Hospital for Children/Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Shaheen J. Timmapuri
- Department of Pediatric Surgery, St. Christopher's Hospital for Children/Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Marshall Z. Schwartz
- Department of Pediatric Surgery, St. Christopher's Hospital for Children/Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Timothy J. Fairbanks
- Department of Pediatric Surgery, St. Christopher's Hospital for Children/Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Kim G. Mendelson
- Department of Pediatric Surgery, St. Christopher's Hospital for Children/Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Keith Thatch
- Department of Pediatric Surgery, St. Christopher's Hospital for Children/Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Matthew L. Moront
- Department of Pediatric Surgery, St. Christopher's Hospital for Children/Drexel University College of Medicine, Philadelphia, Pennsylvania
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Neustein SM, McCormick PJ. Postoperative analgesia after minimally invasive thoracoscopy: What should we do? Can J Anaesth 2011; 58:423-5, 425-7. [DOI: 10.1007/s12630-011-9475-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 02/14/2011] [Indexed: 11/25/2022] Open
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Bilateral video-assisted thoracoscopic thymectomy has a surgical extent similar to that of transsternal extended thymectomy with more favorable early surgical outcomes for myasthenia gravis patients. Surg Endosc 2010; 25:849-54. [DOI: 10.1007/s00464-010-1280-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
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Abstract
Chest pain from respiratory causes is a common complaint and may indicate the presence of a serious or even life-threatening pathologic condition. Most chest pains are the result of irritation or inflammation of the parietal pleura, as the visceral pleura is insensate, although pain may arise from direct malignant invasion or trauma to the chest wall. Rapid recognition with appropriate understanding of the anatomy and physiology of chest pain from respiratory causes is vital to ensure timely and appropriate therapy.
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Affiliation(s)
- Fraser J H Brims
- Respiratory Department, Portsmouth Hospitals NHS Trust, Portsmouth, UK; Respiratory Department, Sir Charles Gairdner Hospital, Perth, Australia
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44
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Chou SH, Li HP, Lee JY, Lee YL, Kao EL, Huang MF, Lin TE. Needlescopic Video-assisted Thoracic Surgery for Primary Spontaneous Pneumothorax. MINIM INVASIV THER 2009; 18:221-4. [DOI: 10.1080/13645700802649425] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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45
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Chang Y, Chou S, Kao E, Chuang H, Li H, Lee J, Huang M. Video‐assisted extrathoracic bleb excision: An ultra‐minithoracotomy for primary spontaneous pneumothorax. MINIM INVASIV THER 2009; 16:323-7. [DOI: 10.1080/13645700701702200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Liu YH, Chao YK, Wu YC, Hsieh MJ, Wu CY, Lu MS, Liu CY, Ko PJ, Liu HP. Bullae ablation in primary spontaneous pneumothorax. World J Surg 2009; 33:938-42. [PMID: 19234740 DOI: 10.1007/s00268-009-9928-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The benefit of bullae ablation for the management of primary spontaneous pneumothorax (PSP) has been established. However, various modalities for bullae ablation have been reported from different centers. OBJECTIVE The present study aimed to assess whether endoloop ligation of bullae was as effective as staple bullectomy for preventing the recurrence of pneumothorax. METHODS Between January 1993 and December 2003, 226 patients (203 men and 23 women) with PSP were recorded and retrospectively reviewed. One hundred thirty (57.5%) patients were treated with endoloop ligation of bullae and the other 96 (42.5%) were treated with staple bullectomy. Mechanical abrasion was performed in all patients after bullae ablation. RESULTS The recurrence rate of pneumothorax was 6.2% (8 patients) in the endoloop ligation group and 17.7% (17 patients) in the staple bullectomy group (p = 0.006). The postoperative complication rate was 14.6 and 20.8% in the endoloop ligation and staple bullectomy groups, respectively (p = 0.221). The long-term chest discomfort rate after endoloop ligation and staple bullectomy was 14.6 and 13.5%, respectively (p = 0.819) CONCLUSIONS Endoloop ligation of bullae is as effective as mechanical staple bullectomy for the management of bullae in primary spontaneous pneumothorax.
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Affiliation(s)
- Yun-Hen Liu
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Shing Street, Guei-Shan Shiang, Tao-Yuan, 333, Taiwan, ROC
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Orki A, Demirhan R, Ciftci H, Coskun T, Kutlu CA, Arman B. Videothoracoscopic approach to recurrence primary spontaneous pneumothorax: using of electrocoagulation in small bulla/blebs. Indian J Surg 2009; 71:19-22. [PMID: 23133103 DOI: 10.1007/s12262-009-0005-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Accepted: 12/31/2008] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of electrocoagulation of bullae/blebs and apical pleurectomy via videothoracoscopic approach. METHODS We reviewed 42 patients who underwent Videoassisted thoracoscopy (VATS) procedure for recurrence primary spontaneous pneumothorax (PSP) from 200022006. There were 30 male and 12 female patients with a median age of 30 years. The percentage of pneumothorax was calculated median of 60% (British Thoracic Society Guideline - 2003). Thirty-two (76.2%) bullae/blebs were observed with the median diameter of 15 mm (5-30). RESULTS Bulla ablation via cauterisation and apical pleurectomy was performed in 32 patients. Ten patients underwent only apical pleurectomy/abrasion because in this group there was not any either bulla or bleb could be found. The median duration of drainage time was 3 days. There was no mortality and complications occurred in five (11.9%) patients. Only two (4.76%) recurrence occurred during the 52 months (5 to 76) median follow-up period. CONCLUSION Videothoracoscopic bulla ablation with apical pleurectomy is a safe method for recurrence PSP. Especially, if the bulla or bleb is smaller than 20 mm the ablation via cauterisation reduces the expenses of VATS procedure by avoiding the use of stapler devices.
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Affiliation(s)
- Alpay Orki
- Department of Thoracic Surgery, Maltepe University, Istanbul, Turkey
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Chang PC, Chou SH, Kao EL, Cheng YJ, Chuang HY, Liu CK, Lai CL, Huang MF. Bilateral Video-Assisted Thoracoscopic Thymectomy vs. Extended Transsternal Thymectomy in Myasthenia Gravis: A Prospective Study. Eur Surg Res 2008; 37:199-203. [PMID: 16260868 DOI: 10.1159/000087863] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2005] [Indexed: 11/19/2022]
Abstract
The optimal approach to thymectomy remains controversial. This study is designed to prospectively compare the results between bilateral video-assisted thoracoscopic thymectomy (BVTx) and extended transsternal thymectomy (ETTx) in patients with myasthenia gravis (MG) without thymoma. Fifteen patients who had undergone BVTx and 16 patients who had undergone ETTx were compared for age, gender, severity of disease, preoperative duration of disease, operative time, intraoperative blood loss, postoperative complications, hospital stay, duration of chest tube drainage, thymic histopathology, pain perception by visual analog scale (VAS), remission and improvement rate, period of follow-up, and activities of daily living (ADL). Fisher's exact test, t test and paired t test were used for statistical analysis. BVTx had longer operative time and less intraoperative blood loss than that of the ETTx. Their remission rates and their degree of postoperative ADL improvement were not significantly different. However, the lowering of VAS was significantly greater in the sternotomy group at 3 months. All other parameters were not significantly different. No mortality was noted in the series. We consider BVTx as an effective alternative procedure to the transsternal approach for patients with nonthymomatous MG. As more and more people care about cosmetics, BVTx could become the future trend.
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Affiliation(s)
- P C Chang
- Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
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Residual apical space following surgery for pneumothorax increases the risk of recurrence. Eur J Cardiothorac Surg 2008; 34:169-73. [DOI: 10.1016/j.ejcts.2008.03.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 03/25/2008] [Accepted: 03/31/2008] [Indexed: 11/17/2022] Open
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Hutter J, Reich-Weinberger S, Hitzl W, Stein HJ. Sequels 10 years after thoracoscopic procedures for benign disease. Eur J Cardiothorac Surg 2007; 32:409-11. [PMID: 17587591 DOI: 10.1016/j.ejcts.2007.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Revised: 04/28/2007] [Accepted: 05/23/2007] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Video-assisted thoracic surgery (VATS) is recognized to be as effective as open thoracic surgery for a variety of diagnostic and therapeutic conditions, but with significantly less morbidity. Chronic postoperative pain (CPP) is defined as persisting more than 2 months after the procedure. CPP and other neurological sensations like dysesthesia or numbness are found frequently, but little is known about the outcome of those patients many years after the primary procedure. METHODS In 1999 we retrospectively investigated a group of 46 (31.9%) out of 144 patients who were identified with sequels at a mean of 32 months after a VATS procedure. Now at 123 months postoperation we reinvestigated those patients for ongoing sequels. RESULTS Out of 46 patients, 36 were still alive and could be reached for an interview. Eighteen patients (50%) were now free from symptoms while 18 patients (50%) still suffered from sequels. From the group of 144 patients operated on, sequels were now present in 18 patients (12.5% at 123 months vs 31.4% at 32 months, p=0.0002). Pain was present in 17 patients (11.8% vs 20.1%, p=0.11), in 3 patients (2.1% vs 18.1%, p<0.000001) even at rest, and in 4 patients (2.7% vs 12.5%, p=0.0002) only at exercise. Ten patients (6.9% vs 28.5%, p=0.096) suffered from pain occasionally, e.g. because of changing weather. Painkillers were taken only by one patient (0.7% vs 16.6%, p<0.0001) occasionally, and the sequels impacted the life of one female patient (0.7% vs 13.2%, p<0.0001) badly. Numbness was present in 16.9% versus 1.3% (p=0.0013) of patients. CONCLUSION Early postoperative sequels are frequently found in VATS procedures, but patients with pain even after years have a nearly 50% chance to eliminate their problems. In addition, numbness and dysesthesia seem to disappear almost completely several years after the procedure.
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Affiliation(s)
- Jörg Hutter
- Department of Surgery, Paracelsus Private Medical University, Müllnerhauptstr 48, 5020 Salzburg, Austria.
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