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Szabo Z, Fabo C, Szarvas M, Matuz M, Oszlanyi A, Farkas A, Paroczai D, Lantos J, Furak J. Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years. J Clin Med 2023; 12:6457. [PMID: 37892595 PMCID: PMC10607362 DOI: 10.3390/jcm12206457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Non-intubated thoracic surgery has not achieved widespread acceptance despite its potential to improve postoperative outcomes. To ensure airway safety, our institute has developed a technique combining spontaneous ventilation with double-lumen tube intubation (SVI). This study aimed to verify the feasibility and limitations of this SVI technique. METHODS For the SVI method, anesthesia induction involves fentanyl and propofol target-controlled infusion, with mivacurium administration. Bispectral index monitoring was used to ensure the optimal depth of anesthesia. Short-term muscle relaxation facilitated double-lumen tube intubation and early surgical steps. Chest opening preceded local infiltration, followed by a vagal nerve blockade to prevent the cough reflex and a paravertebral blockade for pain relief. Subsequently, the muscle relaxant was ceased. The patient underwent spontaneous breathing without coughing during surgical manipulation. RESULTS Between 10 March 2020 and 28 October 2022, 141 SVI surgeries were performed. Spontaneous respiration with positive end-expiratory pressure was sufficient in 65.96% (93/141) of cases, whereas 31.21% (44/141) required pressure support ventilation. Only 2.84% (4/141) of cases reversed to conventional anesthetic management, owing to technical or surgical difficulties. Results of the 141 cases: The mean maximal carbon dioxide pressure was 59.01 (34.4-92.9) mmHg, and the mean lowest oxygen saturation was 93.96% (81-100%). The mean one-lung, mechanical and spontaneous one-lung ventilation time was 74.88 (20-140), 17.55 (0-115) and 57.73 (0-130) min, respectively. CONCLUSIONS Spontaneous ventilation with double-lumen tube intubation is safe and feasible for thoracic surgery. The mechanical one-lung ventilation time was reduced by 76.5%, and the rate of anesthetic conversion to relaxation was low (2.8%).
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Affiliation(s)
- Zsolt Szabo
- Doctoral School of Multidisciplinary Medicine, University of Szeged, H-6720 Szeged, Hungary
| | - Csongor Fabo
- Department of Anesthesiology and Intensive Therapy, University of Szeged, H-6720 Szeged, Hungary
| | - Matyas Szarvas
- Department of Anesthesiology and Intensive Therapy, University of Szeged, H-6720 Szeged, Hungary
| | - Maria Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, H-6720 Szeged, Hungary
| | - Adam Oszlanyi
- Department of Anesthesiology and Intensive Therapy, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, Hungary
| | - Attila Farkas
- Department of Thoracic Surgery, Markusovszky University Teaching Hospital, H-9700 Szombathely, Hungary
| | - Dora Paroczai
- Department of Medical Microbiology, University of Szeged, H-6720 Szeged, Hungary
| | - Judit Lantos
- Department of Neurology, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, Hungary
| | - Jozsef Furak
- Department of Surgery, University of Szeged, H-6720 Szeged, Hungary
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Chuang JH, Chen PH, Lu TP, Hung WT, Liao HC, Tsai TM, Lin MW, Chen KC, Hsu HH, Chen JS. Uniportal versus multiportal nonintubated thoracoscopic anatomical resection for lung cancer: A propensity-matched analysis. J Formos Med Assoc 2023; 122:947-954. [PMID: 37169655 DOI: 10.1016/j.jfma.2023.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/22/2023] [Accepted: 04/18/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND/PURPOSE No studies have compared between uniportal and multiportal nonintubated thoracoscopic anatomical resection for non-small cell lung cancer (NSCLC). We aimed to compare short- and long-term postoperative outcomes concerning these two methods. METHODS Our retrospective dataset comprised patients with NSCLC who underwent uniportal or multiportal nonintubated thoracoscopic anatomical resection between January 2011 and December 2019. The primary outcome was recurrence-free survival. Propensity scores were matched according to age, sex, body mass index, pulmonary function, tumor size, cancer stage, and surgical method. RESULTS In total, 1130 such patients underwent nonintubated video-assisted thoracoscopic surgery (VATS), and 490 consecutive patients with stage I-III NSCLC underwent nonintubated anatomical resection, including lobectomy and segmentectomy (uniportal, n = 158 [32.3%]; multiportal, n = 331 [67.7%]). The uniportal group had fewer dissected lymph nodes and lymph node stations. In paired group analysis, the uniportal group had shorter operation durations (99.8 vs. 138.2 min; P < 0.001), lower intensive care unit (ICU) admission rates and ICU admission intervals (7.0% vs. 27.8%; P < 0.001), and shorter postoperative hospital stays (4.1 days vs. 5.2 days; P < 0.001). The most common postoperative complication was prolonged air leaks. No surgical mortality was observed. The multiportal group had higher complication rates for grades ≥ II NSCLC; however, this difference was not significant (4.4% vs. 1.3%, respectively; P = 0.09). CONCLUSION Nonintubated uniportal VATS for anatomical resection had better results for some perioperative outcomes than multiportal VATS. Oncological outcomes such as recurrence-free and overall survival remained uncompromised, despite fewer dissected lymph nodes.
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Affiliation(s)
- Jen-Hao Chuang
- Department of Surgical Oncology, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Pei-Hsing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, HsinChu County, Taiwan; Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Tzu-Pin Lu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Wan-Ting Hung
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan; Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsien-Chi Liao
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Traumatology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Tung-Ming Tsai
- Department of Surgical Oncology, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Mong-Wei Lin
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Ke-Cheng Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Jin-Shing Chen
- Department of Surgical Oncology, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei City, Taiwan; Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan; Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
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Fan Q, Luo J, Zhou Q, Zhang Y, Zhang X, Li J, Jiang L, Lan L. Esketamine opioid-free intravenous anesthesia versus opioid intravenous anesthesia in spontaneous ventilation video-assisted thoracic surgery: a randomized controlled trial. Front Oncol 2023; 13:1145953. [PMID: 37324000 PMCID: PMC10266098 DOI: 10.3389/fonc.2023.1145953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/17/2023] [Indexed: 06/17/2023] Open
Abstract
Background Opioid-free anesthesia (OFA) provides adequate analgesia and can reduce postoperative opioid consumption, but its efficacy in spontaneous ventilation video-assisted thoracic surgery (SV-VATS) has not been demonstrated. We aimed to investigate the hypothesis that OFA could provide the same perioperative pain control as opioid anesthesia (OA), maintain safe and stable respiration and hemodynamics during surgery, and improve postoperative recovery. Methods Sixty eligible patients (OFA group: n=30; OA group: n=30) treated between September 15, 2022, and December 15, 2022, at The First Hospital of Guangzhou Medical University were included. They were randomized to receive standard balanced OFA with esketamine or OA with remifentanil combined with sufentanil. The primary outcome was the pain numeric rating score (NRS) at postoperative 24 h, and the secondary outcomes were intraoperative respiratory and hemodynamic data, opioid consumption, vasoactive drug dosage, and recovery in the post-anesthesia care unit and ward. Results There was no significant difference in the postoperative pain scores and recovery quality between the two groups. The OFA group had a significantly lower dose of phenylephrine (P=0.001) and a lower incidence of hypotension (P=0.004) during surgery. The OFA group resumed spontaneous respiration faster (P<0.001) and had a higher quality of lung collapse (P=0.02). However, the total doses of propofol and dexmetomidine were higher (P=0.03 and P=0.02), and the time to consciousness was longer (P=0.039) in the OFA group. Conclusions OFA provides the same level of postoperative pain control as OA, but it is more advantageous in maintaining circulatory and respiratory stability and improving the quality of pulmonary collapse in SV-VATS.
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Affiliation(s)
- Qisen Fan
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jinhui Luo
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qianling Zhou
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yaoliang Zhang
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Zhang
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiayang Li
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Long Jiang
- National Clinical Research Center for Respiratory Disease and Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lan Lan
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Lin WY, Lin FS, Shih CC, Sung YJ, Chen AY, Piao YC, Chen JS, Cheng YJ. Comparisons on the intraoperative desaturation and postoperative outcomes in non-intubated video-assisted thoracic surgery with supraglottic airway devices or high-flow nasal oxygen: A retrospective study. J Formos Med Assoc 2023; 122:309-316. [PMID: 36463081 DOI: 10.1016/j.jfma.2022.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 11/03/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Few studies have compared intraoperative oxygenation and perioperative outcomes between non-intubated video-assisted thoracic surgery (NIVATS) with supraglottic airway devices (SADs) and NIVATS with high flow nasal oxygenation (HFNO). The aim of this retrospective study was to compare the intraoperative desaturation rate and postoperative outcomes between NIVATS with SADs and NIVATS with HFNO. METHODS Data regarding NIVATS performed for lung cancer from January 2020 to December 2021 were collected. Intraoperative anesthetic results, post-anesthetic adverse effects, and surgical outcomes for patients who received SAD or HFNO were analyzed using propensity score-matched and unmatched analysis. RESULTS In total, 199 patients with i-gel™ and 95 patients with HFNO were included. Significantly more female patients (91.6 vs. 82.4%, p = 0.0378) and fewer wedge resections (78.9 vs. 85.4%, p = 0.0258) were observed in the HFNO group. Among 250 patients who underwent NIVATS wedge resections under total intravenous anesthesia, those who received HFNO had a significantly higher desaturation event rate (19.8% vs. 7.9% in i-gel™ group; p = 0.0063), lower nadir SPO2 (94.0% vs. 96.1% in i-gel™ group; p = 0.0012), and longer hospitalization (4.0 ± 0.8 vs. 3.6 ± 0.6 in i-gel™ group; p < 0.0001). However, propensity score matching analysis revealed no significant between-group difference in the desaturation rate. A log-rank test revealed that smoking (p = 0.0005) and HFNO (p = 0.0074) were associated with intraoperative desaturation. CONCLUSION The rate of SAD use in NIVATS was twice the rate of HFNO use, especially for wedge resections. There is uncertain airway patency and limited flow through HFNO during one-lung ventilation, whereas SADs like i-gel™ presented a significantly less intraoperative desaturation rate over time and similar postoperative outcomes.
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Affiliation(s)
- Wen-Ying Lin
- Department of Anesthesiology, National Taiwan University Cancer Center, No.57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City 106, Taiwan
| | - Feng-Sheng Lin
- Department of Anesthesiology, National Taiwan University Hospital, 7, Chung-Shan S Rd, Taipei City 10002, Taiwan
| | - Chung-Chih Shih
- Department of Anesthesiology, National Taiwan University Cancer Center, No.57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City 106, Taiwan
| | - Yi-Jung Sung
- Department of Anesthesiology, National Taiwan University Cancer Center, No.57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City 106, Taiwan
| | - An-Yu Chen
- Department of Anesthesiology, National Taiwan University Cancer Center, No.57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City 106, Taiwan
| | - Yu-Chin Piao
- Department of Anesthesiology, National Taiwan University Cancer Center, No.57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City 106, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Cancer Center, No.57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City 106, Taiwan.
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Liu Y, Liang L, Yang H. Airway management in "tubeless" spontaneous-ventilation video-assisted thoracoscopic tracheal surgery: a retrospective observational case series study. J Cardiothorac Surg 2023; 18:59. [PMID: 36737801 PMCID: PMC9898933 DOI: 10.1186/s13019-023-02157-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Surgeon and anesthetist share the airway in a simpler way in the resection and reconstruction phase of tracheal surgery in tubeless spontaneous-ventilation video-assisted thoracoscopic surgery (SV-VATS). Tubeless SV-VATS means stable spontaneous ventilation in the resection and reconstruction phase to anesthesiologist, and unobstructed surgical field to surgeon. What's the ideal airway management strategy during "Visual Field tubeless" SV-VATS for tracheal surgery is still an open question in the field. METHODS We retrospectively reviewed 33 patients without sleeve and carina resections during the study period (2018-2020) in our hospital. The initial management strategy for these patients was spontaneous ventilation for intrathoracic tracheal resection and reconstruction. We obtained and reviewed medical records from our institution's clinical medical records system to evaluate the airway management strategy and device failure rate for tracheal resection in Tubeless SV-VATS. RESULTS Between 2018 and 2020, SV-VATS was first attempted in the 33 patients who had intrathoracic tracheal surgery but without sleeve and carina resections. All patients underwent bronchoscopy (33/33) and 8 patients (8/33) received partial resection before surgery. During the surgery, the airway device comprised either a ProSeal laryngeal mask airway (ProSeal LMA) (n = 27) or single lumen endotracheal tube (n = 6). During the resection and reconstruction phase, Visual Field tubeless SV-VATS failed in 9 patients, and breathing support switched to plan B which is traditional ventilation of a single lumen endotracheal tube for cross field intubation (n = 4) and ProSeal LMA alongside a high-frequency catheter (high-frequency jet ventilation, HFJV) (n = 5) into the distal trachea ventilation. Preoperative respiratory failure or other ventilation-related complications were not observed in this cohort. CONCLUSION Base on current analysis either ProSeal LMA or endotracheal tube is an effective airway management strategy for tubeless SV-VATS with appropriate patient selection. It also provides breathing support conversion option when there's inadequate ventilation.
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Affiliation(s)
- Yuying Liu
- grid.470124.4Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Rd, Guangzhou, 510120 China
| | - Lixia Liang
- grid.470124.4Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Rd, Guangzhou, 510120 China
| | - Hanyu Yang
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Rd, Guangzhou, 510120, China.
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[The perioperative role of high-flow cannula oxygen (HFNO)]. Rev Mal Respir 2023; 40:61-77. [PMID: 36496314 DOI: 10.1016/j.rmr.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
High-flow nasal cannula oxygen (HFNO) is commonly used during the perioperative period. Its numerous physiological benefits, satisfactory tolerance and ease of use have led to its widespread application in intensive care and post-anesthesia care units. HFNO is also used in the operating theater in multiple indications: as oxygen supplementation (associated with pressurization) prior to orotracheal intubation; in digestive and bronchial endoscopies, especially in patients at risk of hypoxemia; and in intraoperative surgery requiring spontaneous ventilation (ENT, thoracic surgery…). During the postoperative period, HFNO can be used in a curative strategy for respiratory failure or in a prophylactic strategy to prevent reintubation. In a curative approach, HFNO seems of interest following cardiac or thoracic surgery but has not been evaluated in respiratory failure subsequent to abdominal surgery, in which case noninvasive ventilation remains the gold standard. The risk of respiratory complications depends on type of surgery and on patient comorbidities. As prophylaxis, HFNO is currently preferred to conventional oxygen therapy after cardiac or thoracic surgery, especially in patients at high risk of respiratory complications. For the clinician, it is important to acknowledge the limits of HFNO and to closely monitor patients receiving HFNO, the objective being to avoid delays in intubation that could lead to increased mortality.
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Defosse JM, Wappler F, Schieren M. [Anaesthetic Management of Non-intubated Video-assisted Thoracic Surgery]. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:405-416. [PMID: 35728591 DOI: 10.1055/a-1497-9883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Non-intubated thoracic surgery is currently gaining popularity. In select patients and in experienced centres, non-intubated approaches may enable patients to safely undergo thoracic surgical procedures, who would otherwise be considered at high risk from general anaesthesia. While non-intubated techniques have been widely adopted for minor surgical procedures, its role in major thoracic surgery is a topic of controversial debate.This article discusses disadvantages of intubated anaesthetic approaches and advantages of non-intubated thoracic surgery as well as the anaesthetic management. This includes surgical and anaesthetic criteria for patient selection, suitable regional anaesthetic techniques, concepts for sedation and maintenance of airway patency as well as the management of perioperative complications.Non-intubated thoracic surgery has the potential to reduce postoperative morbidity and hospital length of stay. Successful non-intubated management depends on a standardised and well-trained interdisciplinary approach, especially regarding patient selection and perioperative complications.
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Chen PH, Chuang JH, Lu TP, Hung WT, Liao HC, Tsai TM, Lin MW, Chen KC, Hsu HH, Chen JS. Non-Intubated Versus Intubated Video-Assisted Thoracic Surgery in Patients Aged 75 Years and Older: A Propensity Matching Study. Front Surg 2022; 9:880007. [PMID: 35586501 PMCID: PMC9108723 DOI: 10.3389/fsurg.2022.880007] [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: 02/20/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction In most developed countries, lung cancer is associated with the highest mortality rate among all cancers. The number of elderly patients with lung cancer is increasing, reflecting the global increase in aging population. Patients with impaired lung or cardiac function are at a high risk during intubated general anesthesia, which may preclude them from surgical lung cancer treatment. We evaluated the safety and survival of non-intubated video-assisted thoracoscopic surgery (VATS) versus those of intubated thoracoscopic surgery for surgical resection for lung cancer in older patients. Methods Patients aged ≥75 years who underwent non-intubated and intubated VATS resection with pathologically confirmed non-small cell lung cancer, using a combination of thoracic epidural anesthesia or intercostal nerve block and intra-thoracic vagal block with target-controlled sedation, from January 2011 to December 2019 were included. Ultimately, 79 non-intubated patients were matched to 158 patients based on age, sex, body mass index, family history, comorbidity index, pulmonary function (forced expiratory volume in one second/ forced vital capacity [%]), and disease stage. The endpoints were overall survival and recurrence progression survival. Results All patients had malignant lung lesions. Data regarding conversion data and the postoperative result were collected. Both groups had comparable preoperative demographic and cancer staging profiles. The anesthetic duration in the non-intubated group was shorter than that in the intubated group, which showed a significantly higher mean number of lymph nodes harvested (intubated vs non-intubated, 8.3 vs. 6.4) and lymph stations dissected (3.0 vs. 2.6). Intensive care unit (ICU) admission rate and postoperative ICU stay were significantly longer in the intubated group. The complication rate was higher and hospital stay were longer in the intubated group, but these differences were not significant (12% vs. 7.6%; p = .07, respectively). Conclusions In the elderly, non-intubated thoracoscopic surgery provides similar survival results as the intubated approach, although fewer lymph nodes are harvested. Non-intubated surgery may serve as an alternative to intubated general anesthesia in managing lung cancer in carefully selected elderly patients with a high risk of impaired pulmonary and cardiac function.
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Affiliation(s)
- Pei-Hsing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, Taiwan
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Jen-Hao Chuang
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei City, Taiwan
| | - Tzu-Pin Lu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Wan-Ting Hung
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsien-Chi Liao
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
- Department of Traumatology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Tung-Ming Tsai
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei City, Taiwan
| | - Mong-Wei Lin
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Ke-Cheng Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Jin-Shing Chen
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei City, Taiwan
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
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Ambrogi V, Patirelis A, Tajè R. Non-intubated Thoracic Surgery: Wedge Resections for Peripheral Pulmonary Nodules. Front Surg 2022; 9:853643. [PMID: 35465435 PMCID: PMC9021407 DOI: 10.3389/fsurg.2022.853643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
The feasibility of performing pulmonary resections of peripheral lung nodules has been one of the main objectives of non-intubated thoracic surgery. The aim was to obtain histological characterization and extend a radical intended treatment to oncological patients unfit for general anesthesia or anatomic pulmonary resections. There is mounting evidence for the role of wedge resection in early-stage lung cancer treatment, especially for frail patients unfit for general anesthesia and anatomic resections with nodules, demonstrating a non-aggressive biological behavior. General anesthesia with single lung ventilation has been associated with a higher risk of ventilator-induced barotrauma and volotrauma as well as atelectasis in both the dependent and non-dependent lungs. Nonetheless, general anesthesia has been shown to impair the host immune system, eventually favoring both tumoral relapses and post-operative complications. Thus, non-intubated wedge resection seems to definitely balance tolerability with oncological radicality in highly selected patients. Nonetheless, differently from other non-surgical techniques, non-intubated wedge resection allows for histological characterization and possible oncological targeted treatment. For these reasons, non-intubated wedge resection is a fundamental skill in the core training of a thoracic surgeon. Main indications, surgical tips, and post-operative management strategies are hereafter presented. Non-intubated wedge resection is one of the new frontiers in minimal invasive management of patients with lung cancer and may become a standard in the armamentarium of a thoracic surgeon. Appropriate patient selection and VATS expertise are crucial to obtaining good results.
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Rosboch GL, Lyberis P, Ceraolo E, Balzani E, Cedrone M, Piccioni F, Ruffini E, Brazzi L, Guerrera F. The Anesthesiologist's Perspective Regarding Non-intubated Thoracic Surgery: A Scoping Review. Front Surg 2022; 9:868287. [PMID: 35445075 PMCID: PMC9013756 DOI: 10.3389/fsurg.2022.868287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/24/2022] [Indexed: 12/24/2022] Open
Abstract
Non-intubated thoracic surgery (NITS) is a growing practice, alongside minimally invasive thoracic surgery. To date, only a consensus of experts provided opinions on NITS leaving a number of questions unresolved. We then conducted a scoping review to clarify the state of the art regarding NITS. The systematic review of all randomized and non-randomized clinical trials dealing with NITS, based on Pubmed, EMBASE, and Scopus, retrieved 665 articles. After the exclusion of ineligible studies, 53 were assessed examining: study type, Country of origin, surgical procedure, age, body mass index, American Society of Anesthesiologist's physical status, airway management device, conversion to orotracheal intubation and pulmonary complications rates and length of hospital stay. It emerged that NITS is a procedure performed predominantly in Asia, and certain European Countries. In China, NITS is more frequently performed for parenchymal resection surgery, whereas in Europe, it is mainly employed for pleural pathologies. The most commonly used device for airway management is the laryngeal mask. The conversion rate to orotracheal intubation is a~3%. The results of the scoping review seem to suggest that NITS procedures are becoming increasingly popular, but its role needs to be better defined. Further randomized clinical trials are needed to better define the role of the clinical variables possibly impacting on the technique effectiveness.Systematic Review Registrationhttps://osf.io/mfvp3/, identifier: 10.17605/OSF.IO/MFVP3.
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Affiliation(s)
- Giulio Luca Rosboch
- Department of Anesthesia, Intensive Care and Emergency, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
- *Correspondence: Giulio Luca Rosboch
| | - Paraskevas Lyberis
- Department of Cardiovascular and Thoracic Surgery, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
| | - Edoardo Ceraolo
- Department of Anesthesia, Intensive Care and Emergency, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
| | - Eleonora Balzani
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Martina Cedrone
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Federico Piccioni
- Anesthesia and Intensive Care Unit, General and Specialistic Surgical Department, Arcispedale Santa Maria Nuova, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Enrico Ruffini
- Department of Cardiovascular and Thoracic Surgery, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Luca Brazzi
- Department of Anesthesia, Intensive Care and Emergency, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Francesco Guerrera
- Department of Cardiovascular and Thoracic Surgery, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
- Department of Surgical Science, University of Turin, Torino, Italy
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11
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Wang ML, Hung MH, Hsu HH, Cheng YJ, Chen JS. Non-intubated Thoracoscopic Surgery to Minimize Contamination From Airway Secretions During the COVID-19 Pandemic. Front Surg 2022; 9:818824. [PMID: 35252335 PMCID: PMC8894440 DOI: 10.3389/fsurg.2022.818824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/27/2022] [Indexed: 01/08/2023] Open
Abstract
Background General anesthesia and tracheal intubation potentially pose a high risk to health care workers (HCWs) managing surgical patients during the coronavirus disease 2019 (COVID-19) pandemic. Non-intubated anesthesia is a rational way of managing patients undergoing thoracoscopic surgery that avoids tracheal intubation and minimizes the aerosols generated during airway instrumentation. The purpose of this study was to determine whether non-intubated anesthesia in combination with a face mask is safe and feasible in patients undergoing thoracoscopic surgery. Methods A total of 18 patients who underwent non-intubated thoracoscopic surgery with a face mask during the perioperative period between March 9, 2020 and April 6, 2020 were included. The main outcomes were anesthetic management and postoperative results. Results The 18 patients had a mean age of 64 years and a body mass index of 22.9 kg/m2. All patients wore a mask during induction of anesthesia and throughout surgery. Three patients underwent lobectomy, four segmentectomy, ten wedge resection, and one underwent anterior mediastinal tumor resection. No patient developed cough or vomiting during the perioperative period. All patients were transferred to the postoperative recovery unit within 15 min of the end of surgery (average 7.2 min). No patient required conversion to tracheal intubation or conversion to thoracotomy. Conclusion Non-intubated anesthesia with a mask was safe and feasible in patients undergoing thoracoscopic surgery. Avoidance of intubated general anesthesia and use of a lung separation device may reduce the risk to HCWs of contamination by airway secretions, thereby conserving personal protective equipment, especially during the COVID-19 pandemic.
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Affiliation(s)
- Man-Ling Wang
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Hui Hung
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- *Correspondence: Jin-Shing Chen
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12
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Rosboch GL, Giunta F, Ceraolo E, Piccioni F, Guerrera F, Balzani E, Pardolesi A, Ferrari PA, Tosi D, Rispoli M, Gregorio GD, Corso RM, Crisci R. Italian survey on non-intubated thoracic surgery: results from INFINITY group. BMC Anesthesiol 2022; 22:2. [PMID: 34979933 PMCID: PMC8722187 DOI: 10.1186/s12871-021-01514-3] [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: 04/30/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Non-Intubated Thoracic Surgery (NITS) is becoming increasingly adopted all over the world. Although it is mainly used for pleural operations,, non-intubated parenchymal lung surgery has been less frequently reported. Recently, NITS utilization seems to be increased also in Italy, albeit there are no multi-center studies confirming this finding. The objective of this survey is to assess quantitatively and qualitatively the performance of NITS in Italy. Methods In 2018 a web-based national survey on Non-Intubated management including both thoracic surgeons and anesthesiologists was carried out. Reference centers have been asked to answer 32 questions. Replies were collected from June 26 to November 31, 2019. Results We raised feedbacks from 95% (55/58) of Italian centers. Seventy-eight percent of the respondents perform NITS but only 38% of them used this strategy for parenchymal surgery. These procedures are more frequently carried out in patients with severe comorbidities and/or with poor lung function. Several issues as obesity, previous non-invasive ventilation and/or oxygen therapy are considered contraindications to NITS. The regional anesthesia technique most used to provide intra- and postoperative analgesia was the paravertebral block (37%). Conversion to general anesthesia is not anecdotal (31% of answerers). More than half of the centers believed that NITS may reduce postoperative intensive care unit admissions. Approximately a quarter of the centers are conducting trials on NITS and, three quarters of the respondent suppose that the number of these procedures will increase in the future. Conclusions There is a growing interest in Italy for NITS and this survey provides a clear view of the national management framework of these procedures. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01514-3.
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Affiliation(s)
- Giulio Luca Rosboch
- Department of Anesthesia and Intensive Care, AOU Città della Salute e della Scienza, Torino, Italy
| | - Federica Giunta
- Department of Surgical Science, Anesthesia and Intensive Care Unit, University of Turin, Via Verdi, 8 -, 10124, Torino, Italy
| | - Edoardo Ceraolo
- Department of Anesthesia and Intensive Care, AOU Città della Salute e della Scienza, Torino, Italy
| | - Federico Piccioni
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Guerrera
- Department of Surgical Sciences, Thoracic Surgery Unit, University of Turin, Torino, Italy
| | - Eleonora Balzani
- Department of Surgical Science, Anesthesia and Intensive Care Unit, University of Turin, Via Verdi, 8 -, 10124, Torino, Italy.
| | - Alessandro Pardolesi
- Division of Thoracic Surgery, Foundation IRCCS National Cancer Institute of Milan, Milan, Italy
| | - Paolo Albino Ferrari
- Division of Thoracic Surgery, A. Businco Cancer Center, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Davide Tosi
- Division of Thoracic Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Rispoli
- Unit of Anestesiology and Intensive Care, Vincenzo Monaldi Hospital, Naples, Italy
| | - Giudo Di Gregorio
- Unit of Anestesiology and Intensive Care, ULSS6 Euganea Ospedale di Cittadella (PD), Padova, Italy
| | - Ruggero Massimo Corso
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - Roberto Crisci
- Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
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13
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Hsu HH, Chen JS, Huang SC, Cheng C, Lin MW. Management of screen-detected lung nodule: A single-center experience. FORMOSAN JOURNAL OF SURGERY 2022. [DOI: 10.4103/fjs.fjs_113_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Qi L, Chen K, Luo B, Mao G, Pan L, Huang H, Li J, Chen S. Clinical application of preserving spontaneous breathing non-intubation anesthesia in thoracoscopic surgery for lung cancer under ERAS concept. Asia Pac J Clin Oncol 2021; 18:e329-e337. [PMID: 34818467 DOI: 10.1111/ajco.13726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore the safety and feasibility of thoracoscopic surgery in patients with lung cancer under non-intubation anesthesia, and to evaluate the advantages of the non-intubation anesthesia compared with intubation anesthesia on enhanced recovery after surgery (ERAS). METHODS A retrospective cohort study was conducted in which 100 patients who underwent thoracoscopic lung cancer surgery from January 2020 to February 2021 in the Department of Thoracic Surgery of the First Affiliated Hospital of Soochow University were included and divided into non-intubation group (n = 50) and intubation group (n = 50). The primary outcome was the comparison of intra- and postoperative parameters. Secondary outcomes included inflammatory response indicators and intra- and postoperative complications. RESULTS There was no significant difference between the two groups in anesthesia effect score, blood loss, lowest pulse oxygen saturation, operation time, postoperative chest tube indwelling time (P > 0.05). Non-intubation group had less intraoperative remifentanil dosage, less change of blood pressure and heart rate, lower postoperative pain numerical score(NRS), less medical costs, smaller incidence rate of throat discomfort (P < 0.05). The non-intubation group was also associated with less extubation time, postanesthesia care unit recovery time, ambulation time, food intake time, postoperative antibiotic use time, and hospital stay (P < 0.05). The increase of C-reactive protein in the non-intubation group was lower than that in the intubation group (P < 0.05). CONCLUSION Non-intubation anesthesia for thoracoscopic lung cancer surgery is safe and feasible. Compared with the intubation anesthesia, it has advantages in ERAS and reducing medical costs.
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Affiliation(s)
- Longzhou Qi
- Department of Thoracic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ke Chen
- Department of Thoracic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bin Luo
- Department of Thoracic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Guocai Mao
- Department of Thoracic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Liangbin Pan
- Department of Thoracic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haitao Huang
- Department of Thoracic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian Li
- Department of Anesthesiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China.,Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shaomu Chen
- Department of Thoracic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, China
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15
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Chiang XH, Lin MW. Converting to Intubation During Non-intubated Thoracic Surgery: Incidence, Indication, Technique, and Prevention. Front Surg 2021; 8:769850. [PMID: 34765639 PMCID: PMC8576186 DOI: 10.3389/fsurg.2021.769850] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/30/2021] [Indexed: 12/19/2022] Open
Abstract
Traditionally, intubated general anesthesia with one-lung ventilation is standard in thoracoscopic surgery. However, in recent decades, non-intubated thoracoscopic surgery (NITS) has become an alternative method to minimize the adverse effects of intubated general anesthesia. Non-intubated procedures result in fewer adverse events than tracheal intubation and general anesthesia, such as intubation-related airway injury, ventilation-induced lung injury, prolonged hospital stay, and postoperative nausea and vomiting. Despite these benefits, surgeons must consider the possibility of converting to intubation during NITS as the conversion rate is between 2 and 11%, varying between regions and learning time. The conversion rate is also affected by race, body size, the learning curve, and the surgical team's preferred methods. There are surgical (e.g., significant respiratory movements, uncontrolled bleeding, hindered surgical fields, large tumor sizes, adhesions) and anesthetic (e.g., hypoxemia, hypercapnia, airway spasms) reasons for converting to intubation. When a conversion is deemed necessary by the surgical team, the members should be well-prepared and act rapidly. Anesthesiologists should also feel comfortable intubating patients in the lateral decubitus position with or without bronchoscopic guidance. Patient selection is the key factor for avoiding conversion into an intubated surgery. Patients with an American Society of Anesthesiologists grade 2 or less, a body mass index <25, and less surgical complexity may be good candidates for NITS. Careful monitoring, adequate anesthesia depth, an experienced surgical team, and sufficient preparation can also prevent conversion. Conversion from a non-intubated into intubated thoracic surgery is unwanted but not inevitable. Therefore, NITS can be successful when performed on select patients by a well-prepared and experienced surgical team and is worthy of recommendation owing to its non-invasiveness.
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Affiliation(s)
- Xu-Heng Chiang
- Department of Medical Education, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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16
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Research on the application of uniportal video-assisted thoracoscopic segmental resection of the lung in elderly patients with non-small cell lung cancer aged over 65 years. Wideochir Inne Tech Maloinwazyjne 2021; 16:571-579. [PMID: 34691308 PMCID: PMC8512503 DOI: 10.5114/wiitm.2021.106829] [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: 05/02/2021] [Accepted: 05/14/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction The literature regarding the application of uniportal video-assisted thoracoscopic segmental resection of the lung in patients aged over 65 years with non-small cell lung cancer (NSCLC) is sparse. This paper reports 175 cases of uniportal video-assisted thoracoscopic segmental resection of the lung performed at one center, of which 63 patients were over 65 years old. Aim To investigate the safety and feasibility of uniportal video-assisted thoracoscopic segmental resection of the lung in elderly patients aged over 65 years with NSCLC. Material and methods A retrospective analysis of 175 NSCLC patients who underwent uniport video-assisted thoracoscopic segmental resection of the lung in the center from August 2018 to August 2020 was conducted, and based on the age of 65 years, patients were divided into elderly and non-elderly groups. The general data and perioperative indicators of the two groups were compared. Results The procedures were completed in all patients without death or conversion to open surgery. In the general data of the two groups of patients, the prevalence of emphysema in the elderly group was significantly higher than that in the non-elderly group (p = 0.001). However, there was no statistically significant difference between the two groups in surgery time, intraoperative blood loss, thoracic drainage tube retention time, postoperative hospital stay, incision satisfaction, or postoperative complications (p > 0.05). Conclusions Uniportal video-assisted thoracoscopic segmental resection of the lung is feasible and safe in elderly patients with NSCLC aged over 65 years.
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17
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He J, Liang H, Wang W, Akopov A, Aiolfi A, Ang KL, Bertolaccini L, Cai K, Cao Q, Chen B, Chen C, Chen C, Chen D, Chen F, Chen J, Chen L, Chen M, Chen Y, Chen Z, Cheng C, Cui D, Cui F, Dai T, Dong Q, Ferrari PA, Flores RM, Fu J, Funaki S, Froudarakis ME, Gan X, Geng M, Guo J, Guo Q, Han Y, He J, He K, Hirai K, Hu J, Hu S, Huang J, Huang J, Jiang W, Kim KS, Kiss G, Kong F, Lan L, Leng X, Li B, Li G, Li H, Li H, Li H, Li J, Li X, Li S, Li Y, Li Z, Liang Y, Liang L, Liang W, Liao Y, Lin W, Lin X, Liu H, Liu H, Liu J, Liu J, Liu X, Liu Z, Lu X, Luo Q, Mao N, Pan Q, Pang D, Peng J, Peng J, Pompeo E, Qian R, Qiao K, Redwan B, Sang Z, Shao W, Shen J, Shen W, Sung SW, Tang W, Wang T, Wang G, Wang H, Wang H, Wang J, Wang W, Wang Y, Wang Z, Wei L, Wei W, Wu H, Wu J, Xia Z, Xu C, Xu E, Xu H, Xu N, Xu Q, Xu R, Xu S, Yang C, Yang H, Yang S, Yi J, Zhang G, Zhang H, Zhang J, Zhang M, Zhang X, Zhang Y, Zhang Z, Zhang Z, Zhao H, Zhao J, Zhao X, Zhou J, Zhou Y, Zhu C, Zhu S, Zhu X, Cui J, Yan Y, Chen KN. Tubeless video-assisted thoracic surgery for pulmonary ground-glass nodules: expert consensus and protocol (Guangzhou). Transl Lung Cancer Res 2021; 10:3503-3519. [PMID: 34584853 PMCID: PMC8435391 DOI: 10.21037/tlcr-21-663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wei Wang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Andrey Akopov
- Department of Thoracic Surgery, First Pavlov State Medical University, Saint-Petersburg, Russia
| | - Alberto Aiolfi
- Division of Minimally Invasive Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Keng-Leong Ang
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Qingdong Cao
- Department of Thoracic Surgery, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Baojun Chen
- Department of Thoracic Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fengxia Chen
- Department of Thoracic Surgery, Hainan General Hospital, Hainan, China
| | - Jun Chen
- Lung Cancer Department, Tianjin General Hospital, Tianjin Medical University, Tianjin, China
| | - Lei Chen
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mingwu Chen
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yongbing Chen
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Soochow, China
| | - Zhuxing Chen
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Chao Cheng
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dong Cui
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Fei Cui
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Tianyang Dai
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou, China
| | - Qinglong Dong
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Paolo A Ferrari
- Division of Thoracic Surgery, Oncology Hospital "A. Businco", A.R.N.A.S. "G. Brotzu", Cagliari, Italy
| | - Raja M Flores
- Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Junke Fu
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Marios E Froudarakis
- Department of Pneumonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, St-Etienne, France
| | - Xiangfeng Gan
- Department of Thoracic Surgery, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Mingfei Geng
- Department of Thoracic Surgery, Anyang Tumour Hospital, Anyang, China
| | - Jialong Guo
- Department of Cardiothoracic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Qiang Guo
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Yongtao Han
- Division of Thoracic Surgery, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Jintao He
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Kaiming He
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou, China
| | - Kyoji Hirai
- Division of Thoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuqiao Hu
- Department of Thoracic Surgery, Longyan City First Hospital, Longyan, China
| | - Jian Huang
- Department of Thoracic Surgery, Maoming People's Hospital, Maoming, China
| | - Jun Huang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wenfa Jiang
- Department of Thoracic Surgery, Ganzhou People's Hospital, Ganzhou, China
| | - Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gabor Kiss
- Department of Cardiovascular and Thoracic Surgery, Anaesthesia and Surgical Intensive Care, University Hospital Felix Guyon, Saint Denis, Reunion Island, France
| | - Fanyi Kong
- Department of Thoracic Surgery, Cangzhou Central Hospital, Cangzhou, China
| | - Lan Lan
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuefeng Leng
- Division of Thoracic Surgery, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Bin Li
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Gaofeng Li
- 2nd Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hefei Li
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Heng Li
- 2nd Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiwei Li
- Department of Thoracic Surgery, Zhengzhou Key Laboratory for Surgical Treatment for End-stage Lung Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Xiaoqiang Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Shuben Li
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yinfen Li
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhuoyi Li
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yi Liang
- Department of Cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Lixia Liang
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yongde Liao
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wanli Lin
- Department of Thoracic Surgery, Gaozhou People's Hospital, Gaozhou, China
| | - Xu Lin
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Hui Liu
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jixian Liu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xiang Liu
- Department of Thoracic Surgery, Second Affiliated Hospital of the University of South China, Hengyang, China
| | - Zihao Liu
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xingzhao Lu
- Department of Cardiothoracic Surgery, Dongguan People's Hospital, Dongguan, China
| | - Qingquan Luo
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Naiquan Mao
- Department of Thoracic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Qi Pan
- Department of Thoracic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Dazhi Pang
- Department of Thoracic Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jun Peng
- Department of Thoracic Surgery, the First People's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jun Peng
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University of Rome, Rome, Italy
| | - Rulin Qian
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Kun Qiao
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen, China
| | - Bassam Redwan
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen, Lünen, Germany
| | - Zi Sang
- Department of Thoracic Surgery, Anyang Tumour Hospital, Anyang, China
| | - Wenlong Shao
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianfei Shen
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou, China
| | - Weiyu Shen
- Department of Thoracic Surgery, Ningbo medical center LIHUILI Hospital, Ningbo, China
| | - Sook-Whan Sung
- Thoracic and Cardiovascular Surgery, Ewha Womens University Seoul Hospital, Seoul, Korea
| | - Wenfang Tang
- Department of Cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Tianhu Wang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guangsuo Wang
- Department of Thoracic Surgery, People's Hospital of Shenzhen, Shenzhen, China
| | - Haitao Wang
- Department of Thoracic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Huien Wang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, China
| | - Jiyong Wang
- Department of Cardiothoracic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen Wang
- Department of Cardio-Thoracic Surgery, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yongyong Wang
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Soochow, China
| | - Zhenyuan Wang
- Department of Thoracic Surgery, The People's Hospital of Liaoning Province, Shenyang, China
| | - Li Wei
- Department of Thoracic Surgery, Zhengzhou Key Laboratory for Surgical Treatment for End-stage Lung Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Wei Wei
- Department of Thoracic Surgery, Huizhou Municipal Central Hospital, Huizhou, China
| | - Hao Wu
- Department of Thoracic Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Jie Wu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhaohua Xia
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen, China
| | - Chenyang Xu
- Department of Thoracic Surgery, Ganzhou People's Hospital, Ganzhou, China
| | - Enwu Xu
- General Hospital of Southern Theater Command, PLA, Guangzhou, China
| | - Hai Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Ning Xu
- Department of Thoracic Surgery, Anhui Chest Hospital, Hefei, China
| | - Quan Xu
- Department of Thoracic Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Rongyu Xu
- Department of Thoracic Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Shun Xu
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Chaokun Yang
- Department of Thoracic Surgery, The Second Peoples' Hospital of Yibin, Yibin, China
| | - Hanyu Yang
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shengli Yang
- Department of Thoracic Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Jun Yi
- Department of Thoracic and Cardiovascular Surgery, The First People's Hospital of Jingmen, Jingmen, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hao Zhang
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jia Zhang
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Man Zhang
- Department of Thoracic Surgery, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xiao Zhang
- Department of Thoracic Surgery, The Affiliated Luoyang Central Hospital of Zhengzhou University, Luoyang, China
| | - Yajie Zhang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhe Zhang
- Department of Thoracic Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Zhifeng Zhang
- Department of Thoracic Surgery, Jieyang People's Hospital, Jieyang, China
| | - Honglin Zhao
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jian Zhao
- Department of Chest Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Xiaodong Zhao
- Department of Thoracic Surgery, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Jianping Zhou
- Department of Cardiothoracic Surgery, Dongguan People's Hospital, Dongguan, China
| | - Yanran Zhou
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chengchu Zhu
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou, China
| | - Shaojin Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Xinhai Zhu
- Department of Thoracic Surgery, Zhejiang Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Cui
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of Harbin Medical University L, Harbin, China
| | - Yubo Yan
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Ke-Neng Chen
- Department of Thoracic Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
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Chiang XH, Lu TP, Hsieh MS, Tsai TM, Liao HC, Kao TN, Chang CH, Lin MW, Hsu HH, Chen JS. Thoracoscopic Wedge Resection Versus Segmentectomy for cT1N0 Lung Adenocarcinoma. Ann Surg Oncol 2021; 28:8398-8411. [PMID: 34145505 DOI: 10.1245/s10434-021-10213-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/05/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The choice between wedge resection and segmentectomy as a sublobar resection method for patients with cT1N0 lung cancer remains debatable. This study aimed to evaluate the clinical outcomes after wedge resection and segmentectomy for patients with cT1N0 lung adenocarcinoma. METHODS The study enrolled 1002 consecutive patients with cT1N0 lung adenocarcinoma who underwent sublobar resection at the authors' institution between 2011 and 2017. A propensity score-matching analysis was used to compared the clinical outcomes between the wedge resection and segmentectomy groups. RESULTS Wedge resection was performed for 810 patients (80.8%), and segmentectomy was performed for 192 patients (19.2%). Wedge resection resulted in better perioperative outcomes than segmentectomy. The multivariate analysis showed that the significant risk factors for poor disease-free survival (DFS) were elevated preoperative serum carcinoembryonic antigen levels, total tumor diameter greater than 2 cm, and a consolidation-to-tumor (C/T) ratio higher than 50%. After propensity-matching, no differences in overall survival or DFS were noted between the two matched groups. However, subgroup analysis showed that segmentectomy was associated with better DFS than wedge resection (p = 0.039) for the patients with a tumor diameter greater than 2 cm and a C/T ratio higher than 50%. CONCLUSION Segmentectomy is the appropriate surgical method for sublobar resection in cT1N0 lung adenocarcinoma patients with a tumor diameter greater than 2 cm and a C/T ratio higher than 50%. Wedge resection may be a safe and feasible sublobar resection method for patients with a tumor diameter of 2 cm or smaller or a C/T ratio of 50% or lower.
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Affiliation(s)
- Xu-Heng Chiang
- Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
| | - Tzu-Pin Lu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tung-Ming Tsai
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsien-Chi Liao
- Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzu-Ning Kao
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Hong Chang
- Statistics Education Center, National Taiwan University, Taipei, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Wang ML, How CH, Hung MH, Huang HH, Hsu HH, Cheng YJ, Chen JS. Long-term outcomes after nonintubated versus intubated thoracoscopic lobectomy for clinical stage I non-small cell lung cancer: A propensity-matched analysis. J Formos Med Assoc 2021; 120:1949-1956. [PMID: 33994233 DOI: 10.1016/j.jfma.2021.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/08/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Nonintubated thoracoscopic lobectomy has been described as a feasible surgical treatment for early-stage lung cancer since 2011. Despite promising perioperative results, studies on tumor recurrence and long-term survival are very limited. This study was aimed to compare outcomes after thoracoscopic lobectomy with versus without intubation for stage I non-small cell lung cancer. METHODS A retrospective data set including 115 and 155 patients who underwent nonintubated and intubated thoracoscopic lobectomy, respectively, between January 2011 and December 2013 was used to identify matched nonintubated and intubated cohorts (n = 97 per group) using a propensity score matching algorithm that accounted for confounding effects of preoperative patient variables. Primary outcome variables included freedom from recurrence and overall survival. Factors affecting survival were assessed using Cox regression analysis and Kaplan-Meier survival estimates. RESULTS No perioperative mortality occurred in both groups. At an average follow-up of 74 months, comparing nonintubated thoracoscopic lobectomy with intubated procedure, no differences were observed in recurrence rates (14.4% vs. 25.8%, respectively; p = .057). Furthermore, no significant differences were noted in overall survival (97.9% vs. 93.8%, respectively; p = .144). Nonintubated thoracoscopic lobectomy was not found to be an independent predictor of recurrence (hazard ratio, .53; 95% confidence interval [CI], .28-1.02) or overall survival (hazard ratio, .33; 95% CI, .07-1.61). CONCLUSIONS In this propensity-matched comparison, nonintubated thoracoscopic lobectomy was not associated with an increased risk for recurrence and overall survival during the 5-year follow-up. However, more randomized trials should be conducted for further validation of these results.
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Affiliation(s)
- Man-Ling Wang
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Hung How
- Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ming-Hui Hung
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hui-Hsun Huang
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgical Oncology, National Taiwan University Cancer Center, Taiwan.
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20
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Comparison of perioperative outcomes between intubated and nonintubated thoracoscopic surgery in children. J Formos Med Assoc 2021; 121:278-284. [PMID: 33888360 DOI: 10.1016/j.jfma.2021.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 01/16/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/PURPOSE This study aimed to compare our experiences of nonintubated video-assisted thoracoscopic surgery (VATS) for pneumothorax and lung tumor resections with that of intubated VATS in pediatric patients. METHODS In total, 17 nonintubated and 64 intubated pediatric VATS were performed between January 2012 and December 2018. Patient characteristics, operation period, comorbidities, precedent lung surgery, diagnosis, type of anesthesia, side and type of procedure, and perioperative outcomes were collected from medical records. Perioperative outcome data included induction time, operation time, postoperative chest tube drainage duration, and length of stay. Simple linear regression and multiple linear regression analyses were used to determine the influence of selected variables on perioperative outcomes. RESULTS The mean age was 16.2 years in the intubated group and 15.2 years in the nonintubated group. Comorbidities including malignancy and asthma were noted in 9 intubated patients and 6 nonintubated patients. Nonintubated VATS was performed in 9 pneumothorax surgeries and 8 lung tumor resections. Five patients breathed oxygen through a face mask, 3 patients through a high-flow nasal cannula, and 9 patients through a laryngeal mask airway. No patient required tracheal intubation or thoracotomy. No major operative complications were noted in either group. After adjustments for statistically relevant confounders, the multiple regression analysis showed that the nonintubated technique influenced the length of stay, leading to a reduction of 0.75 days. CONCLUSION Nonintubated VATS is feasible and safe in selected children undergoing bullectomy or wedge resections for lung tumors. The nonintubated approach might enhance postoperative recovery.
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21
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Zhang XX, Song CT, Gao Z, Zhou B, Wang HB, Gong Q, Li B, Guo Q, Li HF. A comparison of non-intubated video-assisted thoracic surgery with spontaneous ventilation and intubated video-assisted thoracic surgery: a meta-analysis based on 14 randomized controlled trials. J Thorac Dis 2021; 13:1624-1640. [PMID: 33841954 PMCID: PMC8024812 DOI: 10.21037/jtd-20-3039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Video-assisted thoracic surgery (VATS) generally involves endotracheal intubation under general anesthesia. However, inevitably, this may cause intubation-related complications and prolong the postoperative recovery process. Gradually, non-intubated video-assisted thoracic surgery (NIVATS) is increasingly being utilized. However, its safety and efficacy remain controversial. Methods Randomized controlled trials (RCTs) published up to August 2020 were selected from the Cochrane Library, Web of Science, PubMed, Embase, and ClinicalTrials.gov databases and included in this study according to the inclusion criteria. Two reviewers screened these RCTs and independently extracted the relevant data. After assessing the risk of bias in these RCTs, a meta-analysis was performed using Review Manager 5.3. Pooled data were meta-analyzed using a random-effects model. Results Meta-analysis data demonstrated that the mean difference (MD) in the length of hospital stay between non-intubated patients and intubated patients was −1.41 days, with a 95% confidence interval (CI) of −2.47 to −0.34 (P=0.01). The visual analogue scale (VAS) score between the two groups showed a MD of −0.34 (95% CI: −0.58 to −0.10; P=0.006). Patients who underwent NIVATS presented with lower rates of overall complications [odds ratio (OR) 0.41; 95% CI: 0.25 to 0.67; P=0.0004], air leak (OR 0.45; 95% CI: 0.24 to 0.87; P=0.02), pharyngeal discomfort (OR 0.08; 95% CI: 0.04 to 0.17; P<0.00001), hoarseness (OR 0.06; 95% CI: 0.02 to 0.21; P<0.00001), and gastrointestinal reactions (OR 0.23; 95% CI: 0.10 to 0.53; P=0.0005) compared to intubated patients. The anesthesia satisfaction scores in the NIVATS group were significantly higher than those of the VATS group (MD 0.50; 95% CI: 0.12 to 0.88; P=0.009). However, there were no statistically significant differences in the length of operation time (MD 0.90 hours; 95% CI: −0.23 to 2.03; P=0.12) and surgical field satisfaction (1 point) (OR 0.73; 95% CI: 0.34 to 1.59; P=0.43) between the two groups. Conclusions NIVATS is a safe and feasible form of intervention that can reduce the postoperative pain and complications of various systems and shorten hospital stay duration without prolonging the operation time.
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Affiliation(s)
- Xi-Xuan Zhang
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Chun-Tao Song
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Zhen Gao
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Bin Zhou
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Hai-Bo Wang
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Qiang Gong
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Ben Li
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Qiang Guo
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - He-Fei Li
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
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Lai CJ, Chen JS, Ho SI, Lu ZY, Huang YJ, Cheng YJ. Detecting Oropharyngeal and Esophageal Emptying by Submental Ultrasonography and High-Resolution Impedance Manometry: Intubated vs. Non-Intubated Video-Assisted Thoracoscopic Surgery. Diagnostics (Basel) 2020; 10:diagnostics10121079. [PMID: 33322685 PMCID: PMC7763338 DOI: 10.3390/diagnostics10121079] [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: 10/23/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/04/2022] Open
Abstract
Postoperative swallowing, affected by general anesthesia and intubation, plays an important part in airway and oral intake safety regarding effective oropharyngeal and esophageal emptying. However, objective evidence is limited. This study aimed to determine the time required from emergence to effective oropharyngeal and esophageal emptying in patients undergoing non-intubated (N) or tracheal-intubated (I) video-assisted thoracoscopic surgery (VATS). Hyoid bone displacement (HBD) by submental ultrasonography and high-resolution impedance manometry (HRIM) measurements were used to assess oropharyngeal and esophageal emptying. HRIM was performed every 10 min after emergence, up to 10 times. The primary outcome was to determine whether intubation affects the time required from effective oropharyngeal to esophageal emptying. The secondary outcome was to verify if HBD is comparable to preoperative data indicating effective oropharyngeal emptying. Thirty-two patients suitable for non-intubated VATS were recruited. Our results showed that comparable HBDs were achieved in all patients after emergence. Effective esophageal emptying was achieved at the first HRIM measurement in 11 N group patients and 2 I group patients (p = 0.002) and was achieved in all N (100%) and 13 I group patients (81%) within 100 min (p = 0.23). HBD and HRIM are warranted for detecting postoperative oropharyngeal and esophageal emptying.
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Affiliation(s)
- Chih-Jun Lai
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei 100025, Taiwan;
- Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (S.-IH.); (Z.-Y.L.); (Y.-J.H.)
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei 106037, Taiwan;
| | - Shih-I Ho
- Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (S.-IH.); (Z.-Y.L.); (Y.-J.H.)
| | - Zhi-Yin Lu
- Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (S.-IH.); (Z.-Y.L.); (Y.-J.H.)
| | - Yi-Ju Huang
- Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (S.-IH.); (Z.-Y.L.); (Y.-J.H.)
| | - Ya-Jung Cheng
- Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei 100233, Taiwan
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei 106037, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456 (ext. 65517)
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Pham LH, Trinh DK, Doan HTN, Nguyen UH, Do QD. Nonintubated Uniportal Video-Assisted Thoracoscopic Surgery for Intrathoracic Diseases: Initial Results in Vietnam. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 16:63-67. [PMID: 33179550 DOI: 10.1177/1556984520969746] [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: 11/16/2022]
Abstract
OBJECTIVE Nonintubated uniportal video-assisted thoracoscopic surgery (VATS) is a recent controversial procedure in many countries. Hence, the authors would like to present the experience in performing this approach and evaluate its initial results in the treatment, particularly, of intrathoracic diseases in Vietnam. METHODS A prospective, descriptive study was conducted on 17 patients with intrathoracic diseases treated with nonintubated uniportal VATS from February to July 2019. Preoperative, intraoperative, and postoperative parameters were gathered and analyzed by SPSS Statistics, Version 18.0. RESULTS Patients had an average age of 49.2 ± 20.5 (range 6 to 71) years. Regarding operative indications and methods, there were 3 ground glass opacity (17.6%) and 1 bullous lung disease receiving wedge resection (5.9%); 8 mediastinal tumors (47.1%) having resection, and 5 non-small-cell lung cancers receiving lobectomy combined with node dissection (29.4%). The average operative time and pleural drainage time were 108.6 ± 28.17 min (range 60 to 160) and 3.7 ± 1.18 days (range 2 to 8), respectively. The average hospitalization time was 4.9 ± 1.76 (range 3 to 12) days. No mortalities or major complications were recorded postoperatively. CONCLUSIONS Nonintubated uniportal VATS is a safe and considerable surgical choice for appropriate intrathoracic conditions.
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Affiliation(s)
- Lu Huu Pham
- Center of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam
| | - Diep Ke Trinh
- 435680 Center of Anesthesia and Surgical Intensive Care, Viet Duc University Hospital, Hanoi, Vietnam
| | - Ha Thi-Ngoc Doan
- 106156 Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Uoc Huu Nguyen
- Center of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam
| | - Quynh Danh Do
- 435680 Center of Anesthesia and Surgical Intensive Care, Viet Duc University Hospital, Hanoi, Vietnam
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24
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Liu HY, Chiang XH, Hung MH, Wang ML, Lin MW, Cheng YJ, Hsu HH, Chen JS. Nonintubated uniportal thoracoscopic segmentectomy for lung cancer. J Formos Med Assoc 2020; 119:1396-1404. [DOI: 10.1016/j.jfma.2020.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/25/2020] [Accepted: 03/23/2020] [Indexed: 11/16/2022] Open
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Nonintubated Versus Intubated Uniportal Thoracoscopic Segmentectomy for Lung Tumors. Ann Thorac Surg 2020; 111:1182-1189. [PMID: 32857994 DOI: 10.1016/j.athoracsur.2020.06.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/20/2020] [Accepted: 06/15/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although the use of the uniportal thoracoscopic technique has spread exponentially recently, a comparison of nonintubated and intubated uniportal thoracoscopic segmentectomies for lung tumors has not been reported. We aimed to compare the feasibility, safety, and short-term postoperative outcomes between the 2 methods. METHODS From January 2014 to June 2019 we retrospectively reviewed 185 consecutive patients with lung tumors who underwent uniportal thoracoscopic segmentectomy at our institute. A body mass index of ≥25 kg/m2 was considered a contraindication for the nonintubated anesthetic approach. For the remaining cases the anesthetic approach was made at the discretion of each individual anesthesiologist. A propensity-matched analysis incorporating sex and body mass index was used to compare the clinical outcomes of the nonintubated and intubated groups. RESULTS Fifty patients (27.0%) underwent the procedure with the nonintubated anesthetic approach. The nonintubated group was more likely to be female (P < .001) and with a lower body mass index (P < .001). Other clinical features showed no significant difference. There was no significant difference between the 2 groups in the type of segmentectomy according to the difficulty classification system. After propensity matching 43 matched patients in each group were included. Anesthetic induction duration (12.0 vs 15.3 minutes, P = .014) was shorter in the nonintubated group. No other significant differences in perioperative, postoperative, and anesthetic results were noted between the 2 matched groups. CONCLUSIONS The nonintubated anesthetic approach can be a safe and feasible alternative to intubated uniportal thoracoscopic segmentectomy.
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Gilyard SN, Khaja MS, Goswami AK, Kokabi N, Saad WE, Majdalany BS. Traumatic Chylothorax: Approach and Outcomes. Semin Intervent Radiol 2020; 37:263-268. [PMID: 32773951 DOI: 10.1055/s-0040-1713443] [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: 10/23/2022]
Abstract
Traumatic chylothorax occurs more often now than in historic reports. In part, this is due to the increased ability to perform more advanced and aggressive thoracic resections and cardiovascular surgeries as well as the improved mortality of cancer patients. If untreated, chylothorax can result in significant morbidity and mortality, particularly in patients with underlying malignancy. Thoracic duct embolization for chylothorax was the first successful lymphatic intervention and has been performed for over 20 years. An overview of the clinical and technical approach to thoracic duct embolization for traumatic chylothorax is presented in addition to a review of outcomes.
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Affiliation(s)
- Shenise N Gilyard
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Minhaj S Khaja
- Division of Vascular and Interventional Radiology, Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia
| | - Abhishek K Goswami
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Nima Kokabi
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Wael E Saad
- Division of Vascular and Interventional Radiology, Department of Radiology, National Institutes of Health, Bethesda, Maryland
| | - Bill S Majdalany
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
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Chen PH, Hung WT, Chen JS. Nonintubated Video-Assisted Thoracic Surgery for the Management of Primary and Secondary Spontaneous Pneumothorax. Thorac Surg Clin 2020; 30:15-24. [PMID: 31761280 DOI: 10.1016/j.thorsurg.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Nonintubated video-assisted thoracoscopic surgery for the treatment of primary and secondary pneumothorax was first reported in 1997 by Nezu. However, studies on this technique are few. Research in the past 20 years has focused on the perioperative outcomes, including the surgical duration, length of hospital stay, and postoperative morbidity and respiratory complication rates, which appear to be better than those of surgery under intubated general anesthesia. This study provides information pertaining to the physiologic, surgical, and anesthetic aspects and describes the potential benefits of nonintubated thoracoscopic surgery for the management of primary and secondary spontaneous pneumothorax.
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Affiliation(s)
- Pei-Hsing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, No. 579, Sec. 2, Yun-Lin Road, Douliu City, Yun-Lin County 64041, Taiwan
| | - Wan-Ting Hung
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 10002, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei 10002, Taiwan.
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Hung MH, Wang YP. Preventing Hypoxemia During Nonintubated Thoracoscopic Surgery. Ann Thorac Surg 2020; 110:747-748. [PMID: 32074504 DOI: 10.1016/j.athoracsur.2019.12.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/27/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Ming-Hui Hung
- Department of Anesthesiology, National Taiwan University Hospital Hsinchu Branch, 25, Lane 442, Section 1, Jingguo Rd, Hsinchu, 300195, Taiwan.
| | - Yi-Ping Wang
- Department of Anesthesiology, National Taiwan University Hospital Hsinchu Branch, 25, Lane 442, Section 1, Jingguo Rd, Hsinchu, 300195, Taiwan
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29
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Hung WT, Cheng YJ, Chen JS. Video-Assisted Thoracoscopic Surgery Lobectomy for Lung Cancer in Nonintubated Anesthesia. Thorac Surg Clin 2020; 30:73-82. [DOI: 10.1016/j.thorsurg.2019.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Huang PM, Lin WY. Suction Ventilation for Uniportal Video-Assisted Thoracic Surgery Without Endotracheal Intubation. Ann Thorac Surg 2019; 109:e301-e303. [PMID: 31821809 DOI: 10.1016/j.athoracsur.2019.10.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/22/2019] [Accepted: 10/05/2019] [Indexed: 11/15/2022]
Abstract
The aim of this study is to describe the technique of pulmonary expansion by suction control from a surgical wound during nonintubated uniportal video-assisted thoracic surgery. Five patients developed oxygen desaturation intraoperatively even with facial mask ventilation. Oxygenation was completed after 3 minutes with the suction technique through the uniportal wound. All the patients underwent the operation under spontaneous ventilation, without conversion to endotracheal intubation. The suction ventilation technique can provide an alternative solution during deoxygenation conditions of nonintubated video-assisted thoracic surgery.
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Affiliation(s)
- Pei-Ming Huang
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan.
| | - Wen-Ying Lin
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Anesthesiology, Cancer Center, National Taiwan University, Taipei, Taiwan
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31
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Chiang XH, Hsu HH, Hsieh MS, Chang CH, Tsai TM, Liao HC, Tsou KC, Lin MW, Chen JS. Propensity-Matched Analysis Comparing Survival After Sublobar Resection and Lobectomy for cT1N0 Lung Adenocarcinoma. Ann Surg Oncol 2019; 27:703-715. [PMID: 31646453 DOI: 10.1245/s10434-019-07974-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal surgical method for cT1N0 lung adenocarcinoma remains controversial. OBJECTIVE The aim of this study was to evaluate the differences in clinical outcomes of sublobar resection and lobectomy for cT1N0 lung adenocarcinoma patients. METHODS We included 1035 consecutive patients with cT1N0 lung adenocarcinoma who underwent surgery at our institute from January 2011 to December 2016. The surgical approach, either sublobar resection or lobectomy, was determined at the discretion of each surgeon. A propensity-matched analysis incorporating total tumor diameter, solid component diameter, consolidation-to-tumor (C/T) ratio, and performance status was used to compare the clinical outcomes of the sublobar resection and lobectomy groups. RESULTS Sublobar resection and lobectomy were performed for 604 (58.4%; wedge resection/segmentectomy: 470/134) and 431 (41.6%) patients, respectively. Patients in the sublobar resection group had smaller total tumor diameters, smaller solid component diameters, lower C/T ratios, and better performance status. More lymph nodes were dissected in the lobectomy group. Patients in the sublobar resection group had better perioperative outcomes. A multivariable analysis revealed that the solid component diameter and serum carcinoembryonic antigen level are independent risk factors for tumor recurrence. After propensity matching, 284 paired patients in each group were included. No differences in overall survival (OS; p = 0.424) or disease-free survival (DFS; p = 0.296) were noted between the two matched groups. CONCLUSIONS Sublobar resection is not inferior to lobectomy regarding both DFS and OS for cT1N0 lung adenocarcinoma patients. Sublobar resection may be a feasible surgical method for cT1N0 lung adenocarcinoma.
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Affiliation(s)
- Xu-Heng Chiang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Hong Chang
- Statistics Education Center, National Taiwan University, Taipei, Taiwan
| | - Tung-Ming Tsai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsien-Chi Liao
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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32
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Hung WT, Cheng YJ, Chen JS. Nonintubated thoracoscopic surgery for early-stage non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2019; 68:733-739. [PMID: 31605286 DOI: 10.1007/s11748-019-01220-5] [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] [Received: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Recent advances in the management of early-stage non-small cell lung cancer have focused on less invasive anesthetic and surgical techniques. Video-assisted thoracoscopic surgery without tracheal intubation is an evolving technique to provide a safe alternative with less short-term complication and faster postoperative recovery. The purpose of this review was to explore the latest developments and future prospects of nonintubated thoracoscopic surgery for early lung cancer. METHODS We examined various techniques and surgical procedures as well as the outcomes and benefits. RESULTS The results indicated a new era of video-assisted thoracoscopic surgery in which there is reduced procedure-related injury and enhanced postoperative recovery for lung cancer. CONCLUSIONS Nonintubated thoracoscopic surgery is a safe and feasible minimally invasive alternative surgery for early non-small cell lung cancer. Faster recovery and less short-term complication are potential benefits of this approach.
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Affiliation(s)
- Wan-Ting Hung
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 10002, Taiwan. .,National Taiwan University College of Medicine, Taipei, Taiwan.
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He J, Liu J, Zhu C, Dai T, Cai K, Zhang Z, Cheng C, Qiao K, Liu X, Wang G, Xu S, Yang R, Fan J, Li H, Jin J, Dong Q, Liang L, Ding J, He K, Liu Y, Ye J, Feng S, Jiang Y, Huang H, Zhang H, Liu Z, Feng X, Xia Z, Ma M, Duan Z, Huang T, Li Y, Shen Q, Tan W, Ma H, Sun Y, Chen C, Cui F, Wang W, Li J, Hao Z, Liu H, Liang W, Zou X, Liang H, Yang H, Li Y, Jiang S, Ng CSH, González-Rivas D, Pompeo E, Flores RM, Shargall Y, Ismail M, Ambrogi V, Elkhouly AG, Sung SW, Ang K. Expert consensus on tubeless video-assisted thoracoscopic surgery (Guangzhou). J Thorac Dis 2019; 11:4101-4108. [PMID: 31737292 DOI: 10.21037/jtd.2019.10.04] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jianxing He
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jun Liu
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Chengchu Zhu
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou 318000, China
| | - Tianyang Dai
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou 646000, China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Zhifeng Zhang
- Department of Thoracic Surgery, Jieyang People's Hospital, Jieyang 522000, China
| | - Chao Cheng
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Kun Qiao
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Xiang Liu
- Department of Thoracic Surgery, Second Affiliated Hospital of the University of South China, Hengyang 420100, China
| | - Guangsuo Wang
- Department of Thoracic Surgery, People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Shun Xu
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Rusong Yang
- Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing 210000, China
| | - Junqiang Fan
- Department of Thoracic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
| | - Jiang Jin
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou 318000, China
| | - Qinglong Dong
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Lixia Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jinfeng Ding
- Department of Anesthesia, Taizhou Hospital, Taizhou 318000, China
| | - Kaiming He
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou 646000, China
| | - Yulin Liu
- Department of Anesthesia, Southwest Medical University Affiliated Hospital, Luzhou 646000, China
| | - Jing Ye
- Department of Anesthesia, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Siyang Feng
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Yu Jiang
- Department of Anesthesia, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Haoda Huang
- Department of Thoracic Surgery, Jieyang People's Hospital, Jieyang 522000, China
| | - Huankai Zhang
- Department of Anesthesia, Jieyang People's Hospital, Jieyang 522000, China
| | - Zhenguo Liu
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Xia Feng
- Department of Anesthesia, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Zhaohua Xia
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Mingfei Ma
- Department of Anesthesia, Third People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Zhongxin Duan
- Department of Anesthesia, Second Affiliated Hospital of the University of South China, Guangzhou 510120, China
| | - Tonghai Huang
- Department of Thoracic Surgery, People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Yali Li
- Department of Anesthesia, People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Qiming Shen
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Wenfei Tan
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Hong Ma
- Department of Anesthesia, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Yang Sun
- Department of Anesthesia, Nanjing Chest Hospital, Nanjing 210000, China
| | - Congcong Chen
- Department of Anesthesia, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Fei Cui
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wei Wang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jingpei Li
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Zhexue Hao
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hui Liu
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wenhua Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Xusen Zou
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hengrui Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hanyu Yang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yingfen Li
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Shunjun Jiang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | | | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Raja M Flores
- Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University, St. Joseph's Healthcare, Hamilton, Canada
| | - Mahmoud Ismail
- Department of Thoracic Surgery, Klinikum Ernst von Bergmann, Academic Hospital of the Charité - Universitätsmedizin Humboldt University Berlin, Potsdam Germany
| | - Vincenzo Ambrogi
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Ahmed G Elkhouly
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sook Whan Sung
- Department of Thoracic & Cardiovascular Surgery, Ewha Womens University Seoul Hospital, Gangseo, Seoul, Republic of Korea
| | - Keng Ang
- Department of Thoracic Surgery, Nottingham City Hospital and Glenfield Hospital, Leicester, UK
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