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West CT, Tiwari A, Matthews L, Drami I, Mai DVC, Jenkins JT, Yano H, West MA, Mirnezami AH. Eureka: objective assessment of the empty pelvis syndrome to measure volumetric changes in pelvic dead space following pelvic exenteration. Tech Coloproctol 2024; 28:74. [PMID: 38926191 PMCID: PMC11208191 DOI: 10.1007/s10151-024-02952-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/25/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Large tissue defects following pelvic exenteration (PE) fill with fluid and small bowel, leading to the empty pelvis syndrome (EPS). EPS causes a constellation of complications including pelvic sepsis and reduced quality of life. EPS remains poorly defined and cannot be objectively measured. Pathophysiology of EPS is multifactorial, with increased pelvic dead space potentially important. This study aims to describe methodology to objectively measure volumetric changes relating to EPS. METHODS The true pelvis is defined by the pelvic inlet and outlet. Within the true pelvis there is physiological pelvic dead space (PDS) between the peritoneal reflection and the inlet. This dead space is increased following PE and is defined as the exenteration pelvic dead space (EPD). EPD may be reduced with pelvic filling and the volume of filling is defined as the pelvic filling volume (PFV). PDS, EPD, and PFV were measured intraoperatively using a bladder syringe, and Archimedes' water displacement principle. RESULTS A patient undergoing total infralevator PE had a PDS of 50 ml. A rectus flap rendered the pelvic outlet watertight. EPD was then measured as 540 ml. Therefore there was a 10.8-fold increase in true pelvis dead space. An omentoplasty was placed into the EPD, displacing 130 ml; therefore, PFV as a percentage of EPD was 24.1%. CONCLUSIONS This is the first reported quantitative assessment of pathophysiological volumetric changes of pelvic dead space; these measurements may correlate to severity of EPS. PDS, EPD, and PFV should be amendable to assessment based on perioperative cross-sectional imaging, allowing for potential prediction of EPS-related outcomes.
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Affiliation(s)
- C T West
- Southampton Complex Cancer and Exenteration Team, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
| | - A Tiwari
- Southampton Complex Cancer and Exenteration Team, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - L Matthews
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - I Drami
- St Mark's Hospital & Academic Institute, London, UK
- Imperial College, London, UK
| | - D V C Mai
- St Mark's Hospital & Academic Institute, London, UK
- Imperial College, London, UK
| | - J T Jenkins
- St Mark's Hospital & Academic Institute, London, UK
- Imperial College, London, UK
| | - H Yano
- Southampton Complex Cancer and Exenteration Team, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M A West
- Southampton Complex Cancer and Exenteration Team, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - A H Mirnezami
- Southampton Complex Cancer and Exenteration Team, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Noro A, Natale G, Messina G, Leonardi B, Rainone A, Santini M, Fiorelli A. The Prediction of Fissure Integrity by Quantitative Computed Tomography Analysis. Thorac Cardiovasc Surg 2023; 71:573-581. [PMID: 35987193 DOI: 10.1055/s-0042-1755382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Incomplete interlobar fissure may increase the difficulty of thoracoscopic lobectomy. Herein, we compared the accuracy of visual versus quantitative analysis to predict fissure integrity in lung cancer patients undergoing thoracoscopic lobectomy and evaluated the effects of fissure integrity on surgical outcome. METHODS This was a single-center retrospective study including consecutive patients undergoing VATS (video-assisted thoracoscopic surgery) lobectomy for lung cancer. The target interlobar fissures were classified as complete or incomplete by visual and quantitative analysis. Using the intraoperative finding as the reference method, the diagnostic accuracy of the two methods to define fissure completeness (dependent variable) was calculated and statistically compared. Yet, we evaluated differences in postoperative outcomes between patients with complete and incomplete fissure integrity. RESULTS A total of 93 patients were included in the study; 33/93 (36%) presented complete fissure. Visual and quantitative analyses correctly identified complete fissure in 19/33 (57%) and 29/33 (88%) patients, respectively, and incomplete fissure in 56/60 (93%) and 58/60 (96%) patients, respectively. Quantitative analysis had better diagnostic accuracy than visual analysis (81 vs. 93%; p = 0.01). Patients with incomplete fissure compared with those with complete fissure had a higher conversion rate (6 vs. 13%; p = 0.43), higher persistent air leak rate (0/33 vs. 14/60; p = 0.03), and longer hospitalization (12.6 ± 3.8 vs. 7.1 ± 2.4 days; p = 0.01). CONCLUSION Quantitative analysis accurately predicted the fissures' integrity; it may be useful for selecting suitable cases for thoracoscopic lobectomy especially for surgeons with limited minimally invasive experience.
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Affiliation(s)
- Antonio Noro
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Gaetana Messina
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Beatrice Leonardi
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Anna Rainone
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
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Mei L, Liu W, Xiu Y, Tao S, Feng Y, Tan Q, Xu S, Xian L, Deng B. Multi-center experience in an optimized right upper lobectomy surgical procedure in China. Thorac Cancer 2022; 14:573-583. [PMID: 36567443 PMCID: PMC9968593 DOI: 10.1111/1759-7714.14781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND This multi-center study was aimed at retrospectively evaluating the feasibility, safety, clinical outcomes, and surgical learning curve of an optimized procedure for right upper lobectomy (RUL), which is challenging because of the anatomical structures and features of this lobe. METHODS This study included 45 RUL cases of robot-assisted thoracoscopy (RATS) in a pilot cohort and 187 RUL cases of video-assisted thoracoscopy (VATS) in three cohorts. A total of 121 and 111 patients underwent traditional and optimized RUL, respectively. The optimized surgical procedure was performed to consecutively transect the superior arterial trunk and bronchus, and finally disconnect the pulmonary vein and posterior ascending artery with interlobar fissures. Clinical and radiological data were reviewed retrospectively. RESULTS Optimized RUL can be performed successfully by RATS or VATS. The optimized procedure yielded better clinical outcomes than the traditional procedure, including shorter operation times, less blood loss, fewer complications, shorter hospital times, lower costs, and a lower likelihood of postoperative intermedius bronchial kinking. Additionally, for calcified interlobar lymph nodes, the optimized VATS group was less likely to be converted to thoracotomy than the traditional group. The skills required to perform optimized VATS RUL can be gained by surgeons after 12 to 15 cases. The two RUL procedures in the pilot cohort showed similar disease-free survival. CONCLUSIONS The optimized RUL was safe, economical, and feasible, with a short learning curve and satisfactory disease-free survival.
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Affiliation(s)
- Long‐Yong Mei
- Department of Thoracic Surgery, Institute of Surgery Research, Daping HospitalArmy Medical UniversityChongqingChina
| | - Wen‐Zhou Liu
- Department of Thoracic and Cardiovascular SurgeryThe Second Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Yu‐Chi Xiu
- Department of Thoracic SurgeryGeneral Hospital of Northern Theater CommandShenyangChina
| | - Shao‐Lin Tao
- Department of Thoracic Surgery, Institute of Surgery Research, Daping HospitalArmy Medical UniversityChongqingChina
| | - Yong‐Geng Feng
- Department of Thoracic Surgery, Institute of Surgery Research, Daping HospitalArmy Medical UniversityChongqingChina
| | - Qun‐You Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping HospitalArmy Medical UniversityChongqingChina
| | - Shi‐Guang Xu
- Department of Thoracic SurgeryGeneral Hospital of Northern Theater CommandShenyangChina
| | - Lei Xian
- Department of Thoracic and Cardiovascular SurgeryThe Second Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Bo Deng
- Department of Thoracic Surgery, Institute of Surgery Research, Daping HospitalArmy Medical UniversityChongqingChina
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Hamilton DL. Is posterior femoral cutaneous nerve block clinically relevant in awake foot and ankle surgery? Comment on Br J Anaesth 2021; 126: e171-2. Br J Anaesth 2021; 128:e8-e10. [PMID: 34740437 DOI: 10.1016/j.bja.2021.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/18/2021] [Accepted: 09/19/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Duncan L Hamilton
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK; School of Medicine, University of Sunderland, Sunderland, UK.
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Affiliation(s)
- Justin L Garner
- Royal Brompton and Harefield NHS Foundation Trust, 4964, London, United Kingdom of Great Britain and Northern Ireland.,Chelsea and Westminster Hospital NHS Foundation Trust, 9762, London, United Kingdom of Great Britain and Northern Ireland.,Imperial College London National Heart and Lung Institute, 90897, London, United Kingdom of Great Britain and Northern Ireland;
| | - Sujal R Desai
- Royal Brompton and Harefield NHS Foundation Trust, 4964, Radiology, London, United Kingdom of Great Britain and Northern Ireland.,Imperial College London National Heart and Lung Institute, 90897, London, United Kingdom of Great Britain and Northern Ireland.,Margaret Turner-Warwick Centre for Fibrosing Lung Disease, London, United Kingdom of Great Britain and Northern Ireland
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Yurasakpong L, Yammine K, Limpanuparb T, Janta S, Chaiyamoon A, Kruepunga N, Meemon K, Suwannakhan A. The prevalence of the azygos lobe: A meta-analysis of 1,033,083 subjects. Clin Anat 2021; 34:872-883. [PMID: 33908686 DOI: 10.1002/ca.23737] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/22/2021] [Accepted: 03/11/2021] [Indexed: 12/15/2022]
Abstract
The azygos lobe (AL) is an accessory lobe of the right lung with prevalence between 0.4 and 1.2%. The aim of the present review is to provide a better estimate of the frequency of the AL and to examine its relationships with other variables such as population, diagnostic methods, and co-occurring illnesses. Studies published between 1899 and October 2020 were searched through three electronic databases; Google Scholar, PubMed, and JSTOR. Titles, abstracts, and full texts of the retrieved entries were screened to determine their appropriateness for inclusion. A total of 88 studies relating to 1,033,083 subjects met the inclusion criteria. A random-effects meta-analysis yielded an overall prevalence of 0.30% (95% CI: 0.0024-0.0035, I2 = 97.9%). Linear regression and subgroup analysis revealed a negative correlation (ρ = -0.540, p <0.001) between AL prevalence and sample size; studies with smaller sample sizes had higher prevalences. The AL prevalence in individuals with congenital pulmonary defects, 5.2% (95% CI: 0.0018-0.0086, I2 = 0%), was 17 times higher than the overall prevalence (z = 6.65, p <0.001), suggesting associations with other abnormalities and possibly a genetic predisposition. In addition to an evidence-based synthesis of AL prevalence, this study demonstrates publication bias and small-study effects in the anatomy literature. Awareness of the AL is crucial for radiologists when they interpret unusual radiological findings and for surgeons when they operate in the region.
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Affiliation(s)
| | - Kaissar Yammine
- Department of Orthopedic and Trauma Surgery, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon.,The Center for Evidence-Based Anatomy, Sports and Orthopedic Research, Lebanese American University, Byblos, Lebanon
| | | | - Sirorat Janta
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Arada Chaiyamoon
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nutmethee Kruepunga
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Krai Meemon
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Athikhun Suwannakhan
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
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