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Deng J, Zeng Z, Zhang Z. Case report of non-tracheal intubation-an alternative for postpneumonectomy patients undergoing contralateral pulmonary resection. J Cardiothorac Surg 2023; 18:282. [PMID: 37817241 PMCID: PMC10565958 DOI: 10.1186/s13019-023-02386-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Surgery on the contralateral or other lungs after pneumonectomy on one side is highly challenging and complex. It is critical to creating conditions for fluent surgical maneuvers while ensuring adequate ventilation for a patient during such an operation in the same chest cavity that appears incompatible. CASE PRESENTATION We have reported herein the case of a patient who, following a left pneumonectomy, underwent a right upper pulmonary nodule wedge resection via video-assisted thoracoscopic surgery without requiring endotracheal intubation. We managed ventilation with a laryngeal mask airway under general anesthesia combined with a thoracic epidural block. The diseased lobe collapsed well for the surgical procedure during VATS without hypoxia, after which the resection was safely performed. CONCLUSIONS Non-tracheal intubation anesthesia can be a potentially attractive alternative for patients undergoing contralateral pulmonary resection after pneumonectomy.
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Affiliation(s)
- Jingdan Deng
- Department of Anesthesiology, Meizhou People's Hospital, 514031, Meizhou City, Guangdong Province, China.
| | - Zhiwen Zeng
- Department of Anesthesiology, Meizhou People's Hospital, 514031, Meizhou City, Guangdong Province, China
| | - Zizheng Zhang
- Department of thoracic surgery, Meizhou People's Hospital, 514031, Meizhou City, Guangdong Province, China
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Quantitative Measurement of Pneumothorax Using Artificial Intelligence Management Model and Clinical Application. Diagnostics (Basel) 2022; 12:diagnostics12081823. [PMID: 36010174 PMCID: PMC9406694 DOI: 10.3390/diagnostics12081823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/16/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
Artificial intelligence (AI) techniques can be a solution for delayed or misdiagnosed pneumothorax. This study developed, a deep-learning-based AI model to estimate the pneumothorax amount on a chest radiograph and applied it to a treatment algorithm developed by experienced thoracic surgeons. U-net performed semantic segmentation and classification of pneumothorax and non-pneumothorax areas. The pneumothorax amount was measured using chest computed tomography (volume ratio, gold standard) and chest radiographs (area ratio, true label) and calculated using the AI model (area ratio, predicted label). Each value was compared and analyzed based on clinical outcomes. The study included 96 patients, of which 67 comprised the training set and the others the test set. The AI model showed an accuracy of 97.8%, sensitivity of 69.2%, a negative predictive value of 99.1%, and a dice similarity coefficient of 61.8%. In the test set, the average amount of pneumothorax was 15%, 16%, and 13% in the gold standard, predicted, and true labels, respectively. The predicted label was not significantly different from the gold standard (p = 0.11) but inferior to the true label (difference in MAE: 3.03%). The amount of pneumothorax in thoracostomy patients was 21.6% in predicted cases and 18.5% in true cases.
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Goto H, Mun M, Mori S, Samejima J, Matsuura Y, Nakao M, Uehara H, Nakagawa K, Okumura S. Thoracoscopic partial lung resection following pneumonectomy: a report of three cases. J Cardiothorac Surg 2019; 14:183. [PMID: 31684981 PMCID: PMC6827206 DOI: 10.1186/s13019-019-1008-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/23/2019] [Indexed: 11/22/2022] Open
Abstract
Background The prognosis of patients who undergo unilateral pneumonectomy and subsequently develop a contralateral pulmonary tumor can be improved by tumor resection. Thus, surgery is a treatment option if the patient’s pulmonary function and performance status are satisfactory. To date, there have been only few cases reporting thoracoscopic lung resection for pulmonary tumor after contralateral pneumonectomy because of the difficulty in respiratory management during surgery. Thoracoscopic surgery requires the maintenance of the operative field to allow the lung to collapse, and in partial lung resection we need to identify tumor localization. The identification of a tumor lesion just inferior to the pleura is easy; however, the identification of a tumor lesion in the deep parts is difficult. The tumor in the deep part of the lung segments can be easily located if the tumor-affected lobe is allowed to completely collapse. Therefore, ventilation technique should be modified according to the tumor localization. Case presentation Here, we report three cases of thoracoscopic partial lung resections for pulmonary tumors that developed after contralateral pneumonectomy. Intermittent manual ventilation using a tracheal tube was performed in two cases with a lesion just inferior of the pleura. The tumors in both patients were resected using automatic suturing devices while arresting manual ventilation. The affected lobe was allowed to collapse using a bronchial blocker in one of the cases with a lesion in the deep part. Furthermore, she had contralateral pneumothorax with bullae on the right upper and lower lobes of the lung. The tumor in the deep part of the lung segment and ruptured bullae were easily located and resected using automatic suturing devices. The hemodynamic status of the patients was stable, and the intra- and postoperative courses were uneventful. Conclusions Our cases demonstrate that thoracoscopic lung resection after contralateral pneumonectomy can be performed if intermittent manual ventilation is utilized when the tumor is located just inferior to the pleura and if selective double ventilation using an intrabronchial blocker is utilized when the tumor is located in the deep part.
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Affiliation(s)
- Hidenori Goto
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-8-31, Ariake, Koto, Tokyo, Tokyo, 135-8550, Japan.
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-8-31, Ariake, Koto, Tokyo, Tokyo, 135-8550, Japan
| | - Shohei Mori
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-8-31, Ariake, Koto, Tokyo, Tokyo, 135-8550, Japan
| | - Joji Samejima
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-8-31, Ariake, Koto, Tokyo, Tokyo, 135-8550, Japan
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-8-31, Ariake, Koto, Tokyo, Tokyo, 135-8550, Japan
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-8-31, Ariake, Koto, Tokyo, Tokyo, 135-8550, Japan
| | - Hirohumi Uehara
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-8-31, Ariake, Koto, Tokyo, Tokyo, 135-8550, Japan
| | - Ken Nakagawa
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-8-31, Ariake, Koto, Tokyo, Tokyo, 135-8550, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-8-31, Ariake, Koto, Tokyo, Tokyo, 135-8550, Japan
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Contralateral Traumatic Hemopneumothorax. Case Rep Emerg Med 2018; 2018:4328704. [PMID: 30729046 PMCID: PMC6313992 DOI: 10.1155/2018/4328704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/26/2018] [Indexed: 12/03/2022] Open
Abstract
Pneumothorax is the entry of air into the virtual space between the visceral and the parietal pleurae, which can occur spontaneously or to a greater extent in a traumatic way. In daily clinical practice it is frequent to find injuries that generate traumatic pneumothorax that is ipsilateral to the lesion. However, there are case reports of contralateral pneumothorax that occurred in procedures such as insertion of pacemakers, or in cases of pneumonectomy. The following is the case report of a 37-year-old man who was admitted with a sharp wound to the right paravertebral region who developed a left haemopneumothorax due to a tangential course of the injuring agent. Adequate clinical judgment was followed, and several imaging studies were carried out, leading to the diagnosis of traumatic pneumothorax that was contralateral to the described injury.
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Migliore M, Borrata F, Nardini M, Criscione A, Calvo D, Gangemi M, Scalieri F. Awake uniportal video-assisted thoracic surgery for complications after pneumonectomy. Future Oncol 2016; 12:51-54. [PMID: 27744718 DOI: 10.2217/fon-2016-0362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Since 1998, we started a clinical program for awake video-assisted thoracic surgery in our unit using four-step local anesthesia and sedation. Throughout the years, we experienced several difficult cases, three of them had complications postpneumonectomy. The aim of this paper is to report these three cases.
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Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Catania, Italy
| | - Francesco Borrata
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Catania, Italy
| | - Marco Nardini
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Catania, Italy
| | - Alessandra Criscione
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Catania, Italy
| | - Damiano Calvo
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Catania, Italy
| | - Mariapia Gangemi
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Catania, Italy
| | - Francesco Scalieri
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Catania, Italy
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