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Tanaka T, Murakami J, Yoshimine S, Yamamoto N, Ueda K, Suzuki R, Kurazumi H, Hamano K. Effectiveness of Stitch With Pledget to Prevent Prolonged Air Leak in Thoracoscopic Lung Resection. J Surg Res 2024; 296:589-596. [PMID: 38340493 DOI: 10.1016/j.jss.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 12/30/2023] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION We previously demonstrated the usefulness of combining stitching with covering to seal alveolar air leaks in an animal model. This study aimed to clarify the effectiveness and feasibility of this sealing method in the clinical setting. METHODS Data of 493 patients who underwent thoracoscopic anatomical resection between 2013 and 2020 for lung cancer were retrospectively reviewed. Prolonged air leak was defined as chest drain placement lasting 5 d or longer due to air leak. Until July 2017 (early study period), we covered air leaks using mesh. However, for sealing (late study period), we additionally stitched leaks with pledget in patients at high risk of prolonged air leak. The pneumostasis procedure, intraoperative confirmation test of pneumostasis, and chest tube management were uniform during both periods. RESULTS The incidence of prolonged air leak was significantly lower in the late than in the early period (3.6% versus 12.5%), whereas pulmonary emphysema was more severe in the late period compared to the early period. Intraoperative failure of sealing air leaks was significantly reduced in the late period than in the early period. In both univariate and propensity score matching analysis, the study period was a significant predictor of prolonged air leak. CONCLUSIONS The combination of stitching and covering with mesh may contribute to reducing prolonged air leak incidence in patients undergoing thoracoscopic anatomical lung resection for lung cancer.
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Affiliation(s)
- Toshiki Tanaka
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
| | - Junichi Murakami
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Sota Yoshimine
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Naohiro Yamamoto
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Kazuhiro Ueda
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Dental and Medical Sciences, Kagoshima, Japan
| | - Ryo Suzuki
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Hiroshi Kurazumi
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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Usefulness of free pericardial fat pads as pledgets for air leaks in pulmonary resection. Surg Today 2023; 53:31-41. [PMID: 36376403 DOI: 10.1007/s00595-022-02618-0] [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: 01/07/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Intraoperative control of air leaks is important for preventing prolonged air leaks after surgery. The usefulness of suturing free pericardial fat pads (FPFPs) as pledgets for repairing air leaks was investigated. METHODS A total of 111 patients who underwent anatomical lung resection and required suture repair for intraoperative air leaks were retrospectively reviewed. Mattress sutures were performed using polyglycolic acid (PGA) sheets (PGA group; n = 60) in the early period (April 2014 to March 2018) and FPFPs (FPFP group; n = 51) in the late period (April 2018 to March 2021) as pledgets. RESULTS More patients had a history of smoking in the FPFP group than in the PGA group. The duration of air leakage was significantly shorter (mean 1.2 vs. 3.5 days, p = 0.002) and prolonged air leakage (> 5 days) was less frequently observed (23.3% vs. 5.9%, p = 0.016) in the FPFP group than in the PGA group. The FPFP group had fewer cases requiring pleurodesis and with recurrent air leaks than in the PGA group. In one case in the FPFP group, fat necrosis with fibrosis and fibrous adhesion to the visceral pleura was found on a pathological examination. CONCLUSION Parenchymal repair using FPFPs as pledgets can reduce prolonged air leaks after surgery.
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Yanagihara T, Maki N, Wijesinghe AI, Sato S, Saeki Y, Kitazawa S, Yamaoka M, Kobayashi N, Kikuchi S, Goto Y, Ichimura H, Watnabe S, Taguchi T, Sato Y. Efficacy of Alaska pollock gelatin sealant for pulmonary air leakage in porcine models. Ann Thorac Surg 2021; 113:1641-1647. [PMID: 34102175 DOI: 10.1016/j.athoracsur.2021.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/22/2021] [Accepted: 05/06/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Postoperative prolonged air leakage is a frequent complication following lung resection. We have developed a new sealant based on a hydrophobically modified Alaska pollock-derived gelatin (ApGltn) sealant. The purpose of this study was to evaluate the adhesive strength of the ApGltn sealant in comparison with a fibrin sealant using a new spray system in ex vivo and in vivo models. METHODS Pleural defects in ex vivo and in vivo porcine models were created, to which the ApGltn sealant or the fibrin sealant was applied. The pressure resistance was assessed with a stepwise increase in airway pressure to confirm air leakage from the sealing site. Tissue samples covered with each sealant were obtained for histologic assessment. RESULTS In the ex vivo experiment, the leak pressures of the ApGltn sealant were significantly greater than those of the fibrin sealant (102.94 ± 15.6 cmH2O and 28.37 ± 5.1 cmH2O, respectively) (p < 0.01). In the in vivo experiment, the leak pressures of the ApGltn sealant were also significantly greater than those of the fibrin sealant (68.82 ± 18.04 cmH2O and 43.33 ± 7.13 cmH2O, respectively) (p = 0.043). The histologic examination confirmed that the ApGltn sealant adhered tightly to both the pleura and the surface of the pleural defect. CONCLUSIONS The ApGltn sealant has sufficiently high adhesive quality in ex vivo and in vivo porcine lungs, which could be considered suitable and effective for use in the prevention of air leakage from the lungs.
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Affiliation(s)
- Takahiro Yanagihara
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Naoki Maki
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - A I Wijesinghe
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Shoko Sato
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Yusuke Saeki
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Shinsuke Kitazawa
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Masatoshi Yamaoka
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Naohiro Kobayashi
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Shinji Kikuchi
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Yukinobu Goto
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Hideo Ichimura
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Shiharu Watnabe
- National Institute for Materials Science, Research Center for Functional Materials, Polymer-Bio Field, 1-1 Namiki, Tsukuba, Ibaraki, Japan
| | - Tetsushi Taguchi
- National Institute for Materials Science, Research Center for Functional Materials, Polymer-Bio Field, 1-1 Namiki, Tsukuba, Ibaraki, Japan
| | - Yukio Sato
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan.
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Ikeda K, Otsuki S, Okuno N, Sezaki S, Nakagawa K, Miyamoto Y, Okamoto Y, Wakama H, Okayoshi T, Neo M. Development of a novel meniscal sheet scaffold and its effectiveness for meniscal regeneration in a rabbit defect model. J Biomater Appl 2021; 36:517-527. [PMID: 33691527 DOI: 10.1177/08853282211000523] [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: 11/17/2022]
Abstract
This study evaluated the biomechanical strength of a novel two-layer meniscal sheet scaffold (MSS) consisting of polyglycolic acid and poly-Llactic acid/caprolactone and investigated meniscal healing using wrapping treatment for meniscal defect model in a rabbit. The ultimate failure load of the MSS was determined using a tensile testing machine, in vitro. A 2-mm cylindrical defects were created at the medial meniscus of rabbit knees (n = 40). Each knee was assigned to one of two groups. The defect group was not treated and the MSS group underwent wrapping treatment with MSS. Menisci were harvested at 2, 4, 8, and 12 weeks post-implantation. The regenerated meniscus and defect size were evaluated using macrophotographs. Ishida scores for regenerated tissue were determined using Safranin-O/Fast Green staining. Immunohistochemical analysis of Ki-67 for cell proliferation, anti-type I and II collagen antibodies for structure of the regenerated tissue was elucidated. Medial femoral cartilage was stained with Safranin-O/Fast Green and evaluated with Osteoarthritis Research Society International (OARSI) scores. The strength of MSS was maintained over 90% from initial time point to 4 weeks after hydrolysis and over 60% of the strength remained at 8 weeks. The surface area of the meniscus was larger and the defect size smaller in the MSS group than in the defect group at 8 and 12 weeks. Ishida scores revealed that the MSS group improved significantly compared to that of the defect group at all postsurgery time points evaluated. Ki-67 positive cell ratio was significantly higher in the MSS group. OARSI score of the defect group was significantly higher and the defect group showed progressive degeneration in the articular cartilage from 8 to 12 weeks. Overall, wrapping meniscus defects with MSS was useful for accelerating meniscal healing from an early stage and beneficial for tissue regeneration and promoting extracellular matrix maturation.
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Affiliation(s)
- Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | | | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Yuki Miyamoto
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
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Nakada T, Shirai S, Oya Y, Takahashi Y, Sakakura N, Ohtsuka T, Kuroda H. The impact of same-day chest drain removal on pulmonary function after thoracoscopic lobectomy. Gen Thorac Cardiovasc Surg 2020; 69:690-696. [PMID: 33123846 DOI: 10.1007/s11748-020-01516-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/10/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aims to assess the feasibility and impact on long-term pulmonary function of chest drain removal on the operation day following thoracoscopic right upper lobectomy for clinical stage I non-small cell lung cancer. METHODS We retrospectively evaluated the data of 116 patients between May 2013 and March 2019. We evaluated the correlations of clinical parameters of chest drain removal and medium- and long-term pulmonary function by comparing removal on operation day (R group) and retainment (D group). RESULTS The R group comprised 64 patients, and the D group had 52 patients. Fifty patients (96.2%) in the D group had chest drain removed within 3 postoperative days. Since February 2016, chest drain removal on operation day was performed in 64 of 74 patients (86.5%) according to our chest drain removal protocol. Removal of chest drains on operation day was associated with shorter postoperative hospitalization (p < 0.01) and lower postoperative complications ≧ grade II of the Clavien-Dindo classification (p = 0.026). Only one patient in the R group needed reinsertion. The R group had greater spirometry results at 3- and 12-postoperative months (POM). R group patients had statistically improved pulmonary functions from 3 to 12POM, while those in the D Group were stagnated at 6POM. CONCLUSIONS Removal of chest drains on operation day using our protocol is safe and feasible for thoracoscopic right upper lobectomy. This protocol was statistically associated with slightly better long-term pulmonary function, which could not bring clinically meaningful medium- and long-term benefit.
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Affiliation(s)
- Takeo Nakada
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan.
| | - Suguru Shirai
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Yuko Oya
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Yusuke Takahashi
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Takashi Ohtsuka
- Department of Surgery, Division of Thoracic Surgery, The Jikei University School of Medicine, Nishishinbashi 3-19-18, Minatoku, Tokyo, 105-8471, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
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Sridhar P, Litle VR, Okada M, Suzuki K. Prevention of Postoperative Prolonged Air Leak After Pulmonary Resection. Thorac Surg Clin 2020; 30:305-314. [PMID: 32593363 DOI: 10.1016/j.thorsurg.2020.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Postoperative prolonged air leaks (PALs) occur after thoracic surgery in which lung parenchyma is resected, divided, or manipulated. These air leaks can place patients at risk for intensive care unit readmissions, longer hospital length of stay, and infectious complications. Studies have been conducted to identify patients who are at risk for air leak and several methods have been examined for the prevention and treatment of PALs. A standard method of air leak prevention or treatment has not been established. This article discusses the prophylactic measures that have been studied for the prevention of PALs following lung surgery.
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Affiliation(s)
- Praveen Sridhar
- Division of Thoracic Surgery, Department of Surgery, Boston Medical Center, Boston University School of Medicine, Surgical Education Office, 88 East Newton Street, Collamore Building, Suite C-515, Boston, MA 02118, USA. https://twitter.com/Psridhar127
| | - Virginia R Litle
- Division of Thoracic Surgery, Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston University, 88 East Newton Street, Collamore Building, Suite 7380, Boston, MA 02118, USA. https://twitter.com/vlitlemd
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8551, Japan
| | - Kei Suzuki
- Division of Thoracic Surgery, Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston University, 88 East Newton Street, Collamore Building, Suite 7380, Boston, MA 02118, USA.
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Li P, Li S, Che G. Role of chest tube drainage in physical function after thoracoscopic lung resection. J Thorac Dis 2019; 11:S1947-S1950. [PMID: 31632794 DOI: 10.21037/jtd.2019.08.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Pengfei Li
- Department of Thoracic Surgery, West China Hospital, West China Medical Center, Sichuan University, Chengdu 610041, China
| | - Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, West China Medical Center, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, West China Medical Center, Sichuan University, Chengdu 610041, China
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Intercostal block vs. epidural analgesia in thoracoscopic lung cancer surgery: a randomized trial. Gen Thorac Cardiovasc Surg 2019; 68:254-260. [DOI: 10.1007/s11748-019-01197-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
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Gondé H, Le Gac C, Gillibert A, Bottet B, Laurent M, Sarsam M, Hervouët C, Varin R, Baste JM. Feedback on the use of three surgical sealants for preventing prolonged air leak after robot-assisted anatomical lung resection. J Thorac Dis 2019; 11:2705-2714. [PMID: 31463097 DOI: 10.21037/jtd.2019.06.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Prolonged air leak (PAL) is the most common complication after lung resection. Several surgical sealants have been developed to reduce PAL, including fibrin-based (FS), polyethylene glycol-based (PEGS) and polyglycolic acid-based (PGAS) sealants. In this work we report our experience of surgical sealant use after robot-assisted lung resection. Methods A 7-year retrospective study was conducted, including patients who had robot-assisted lobectomy or segmentectomy. Data were collected using a prospective national database. The use of surgical sealants was recorded in traceability sheets. Results PAL occurred in 60 of the 299 patients included. American Society of Anesthesiologists score (ASA) and index of prolonged air leak (IPAL) were higher for patients with sealants. In this group, operative time, chest drain duration and length of stay were significantly longer. PAL occurrence was significantly associated to sealant in univariate analysis (odds ratio =1.88, 95% CI: 1.07 to 3.36, P=0.03) but the association was slightly decreased when adjusting on IPAL and ASA score (Odds ratio =1.70, 95% CI: 0.94 to 3.10, P=0.08). Comparing sealants, more segmentectomies were performed in patients with PGAS (P=0.0013) and their operative time was shorter (P=0.0002). PAL occurrences were not different. Length of stay (P=0.0045) and operative time (P=0.0002) were longer in patients with PEGS who had more postoperative complications (P=0.024). Conclusions This study did not identify a positive effect of surgical sealants for preventing PAL. However it highlighted the need to rationalize their use.
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Affiliation(s)
- Henri Gondé
- Department of Pharmacy, Rouen University Hospital, Normandie Univ, UNIROUEN, U1234, F 76000 Rouen, France
| | - Constance Le Gac
- Department of Pharmacy, Rouen University Hospital, F 76000 Rouen, France
| | - André Gillibert
- Department of Biostatistics, Rouen University Hospital, Normandie Univ, UNIROUEN, F 76000 Rouen, France
| | - Benjamin Bottet
- Department of General and Thoracic Surgery, Rouen University Hospital, F 76000 Rouen, France
| | - Marc Laurent
- Department of Pharmacy, Rouen University Hospital, F 76000 Rouen, France
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, Rouen University Hospital, F 76000 Rouen, France
| | - Charles Hervouët
- Department of Pharmacy, Rouen University Hospital, F 76000 Rouen, France
| | - Rémi Varin
- Department of Pharmacy, Rouen University Hospital, Normandie Univ, UNIROUEN, U1234, F 76000 Rouen, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, Normandie Univ, UNIROUEN, U1096, F 76000 Rouen, France
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Tanaka T, Ueda K, Murakami J, Hamano K. Use of Stitching and Bioabsorbable Mesh and Glue to Combat Prolonged Air Leaks. Ann Thorac Surg 2019; 106:e215-e218. [PMID: 29775604 DOI: 10.1016/j.athoracsur.2018.04.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/10/2018] [Accepted: 04/15/2018] [Indexed: 10/28/2022]
Abstract
Prolonged postoperative air leaks are associated with extended periods of postoperative hospitalization, increased hospital costs, and increased incidence of major cardiopulmonary complications. To prevent prolonged air leaks, we used small pieces of polyglycolic acid mesh as a pledget during the stitching of air leak sites. The stitched sites were then covered with mesh and fibrin glue. This novel technique showed the highest airway pressure tolerance in an ex vivo experimental study. There were no incidents of prolonged air leak among the five clinical cases in which this technique was initially applied. A large-scale study of patients with a high risk of prolonged air leak is warranted.
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Affiliation(s)
- Toshiki Tanaka
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kazuhiro Ueda
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
| | - Junichi Murakami
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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Ueda K, Haruki T, Murakami J, Tanaka T, Hayashi M, Hamano K. No Drain After Thoracoscopic Major Lung Resection for Cancer Helps Preserve the Physical Function. Ann Thorac Surg 2019; 108:399-404. [DOI: 10.1016/j.athoracsur.2019.03.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 02/23/2019] [Accepted: 03/04/2019] [Indexed: 11/26/2022]
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Otsuki S, Nakagawa K, Murakami T, Sezaki S, Sato H, Suzuki M, Okuno N, Wakama H, Kaihatsu K, Neo M. Evaluation of Meniscal Regeneration in a Mini Pig Model Treated With a Novel Polyglycolic Acid Meniscal Scaffold. Am J Sports Med 2019; 47:1804-1815. [PMID: 31172797 DOI: 10.1177/0363546519850578] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal injury is a severe impediment to movement and results in accelerated deterioration of the knee joint. PURPOSE To evaluate the effect of a novel meniscal scaffold prepared from polyglycolic acid coated with polylactic acid/caprolactone on the treatment of meniscal injury in a mini pig model. STUDY DESIGN Controlled laboratory study. METHODS The model was established with a 10-mm resection at the anterior medial meniscus on both knee joints. A scaffold was implanted in the right knee joint. The meniscal scaffold was inserted and sutured next to the native meniscus. The histological analysis was performed to determine meniscal regeneration with safranin O staining, cell proliferation with PCNA, inflammation with TNF, and collagen structure and production with picrosirius red and immunofluorescence. Cartilage degeneration was evaluated with Safranin O. Meniscal regeneration and joint fluid were evaluated with magnetic resonance imaging. RESULTS Although compressive stress and elastic modulus were significantly lower in the scaffold than in the native porcine menisci, ultimate tensile stress was similar. Implanted scaffolds were covered with tissue beginning at 4 weeks, with increased migration of proliferating cells to the implant area at 4 and 8 weeks. Scaffolds were absorbed with freshly produced collagen at 24 weeks. Cartilage degeneration was significantly lower in the meniscus-implanted group than in the meniscectomy group. Magnetic resonance imaging results did not show severe accumulation of joint fluids, suggesting negligible inflammation. Density of the implanted menisci was comparable with that of the native menisci. CONCLUSION Meniscal scaffold prepared from polyglycolic acid has therapeutic potential for meniscal regeneration. CLINICAL RELEVANCE This meniscal scaffold can improve biological knee reconstruction and prevent the increase of total knee arthroplasty.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | | | - Hideki Sato
- Gunze Limited, QOL Research Laboratory, Kyoto, Japan
| | | | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | | | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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Sakaguchi Y, Sato T, Yutaka Y, Muranishi Y, Komatsu T, Yoshizawa A, Nakajima N, Nakamura T, Date H. Development of novel force-limiting grasping forceps with a simple mechanism. Eur J Cardiothorac Surg 2018; 54:1004-1012. [PMID: 29878096 DOI: 10.1093/ejcts/ezy216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 05/01/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES In endoscopic surgery, fragile tissues may be damaged by the application of excessive force. Thus, we developed novel endoscopic forceps with a simple force-limiting mechanism. METHODS The novel forceps were constructed with a leaf spring, and the spring thickness determines grasping pressure. We established an evaluation system (maximum score is 11 points) for lung tissue damage leading to complications. We tested the conventional forceps (186.8 kPa) and 3 novel spring forceps with the following thicknesses: 1.3 mm (53.0 kPa), 2.2 mm (187.7 kPa) and 2.8 mm (369.2 kPa). After grasping, peripheral canine lung tissues were microscopically examined for acute- and late-phase damages. RESULTS In the acute phase (20 sites), the novel forceps caused capillary congestion and haemorrhage in the subpleural tissue, whereas the conventional forceps caused deep tissue and pleural damages. In the late phase (30 sites), both forceps caused fibroblast formation and interstitial thickening, which progressed to the deeper tissues as grasping pressure increased. In the acute phase, the median scores were 2.0 and 6.0 for the novel and conventional forceps, respectively (P = 0.003). In the late phase, the median scores were 2.0, 2.5 and 5.0 for 1.3-, 2.2- and 2.8-mm thick forceps, respectively, and 5.0 for the conventional forceps (P < 0.001). In both phases, the novel forceps with grasping pressure set below 187.7 kPa (2.2 mm) caused significantly less lung tissue damage than the conventional forceps. CONCLUSIONS The novel endoscopic forceps are able to regulate the tissue-grasping pressure and induce less damage in lung tissues than conventional forceps.
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Affiliation(s)
- Yasuto Sakaguchi
- Department of Bioartificial Organs, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan.,Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Toshihiko Sato
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.,Institute for Advancement of Clinical and Translational Sciences, Kyoto University Hospital, Kyoto, Japan
| | - Yojiro Yutaka
- Department of Bioartificial Organs, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan.,Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Yusuke Muranishi
- Department of Bioartificial Organs, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan.,Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Teruya Komatsu
- Department of Bioartificial Organs, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan.,Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Akihiko Yoshizawa
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Naoki Nakajima
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Tatsuo Nakamura
- Department of Bioartificial Organs, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
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14
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Liu CY, Hsu PK, Chien HC, Hsieh CC, Ting CK, Tsou MY. Tubeless single-port thoracoscopic sublobar resection: indication and safety. J Thorac Dis 2018; 10:3729-3737. [PMID: 30069371 DOI: 10.21037/jtd.2018.05.119] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The tubeless technique, defined as non-intubated general anesthesia with omission of chest drainage after video-assisted thoracoscopic surgery (VATS), is a new concept to further minimize surgical trauma. However, there has been little investigation into the associated feasibility and safety. Minimization of postoperative pneumothorax is challenging. We set up a "tubeless protocol" to select patients for tubeless single-port VATS with monitoring of a digital drainage system (DDS). Methods From November 2016 to September 2017, 50 consecutive non-intubated single-port VATS for pulmonary resection were performed. In our study, patients with small and peripheral pulmonary lesions indicated for sublobar resections, as diagnostic or curative intent, were included. After excluding patients having tumors >2 cm, or intrapleural adhesions noted during operation, or forced expiratory volume in the 1 second <1.5 L, 36 patients were selected for tubeless protocol. The clinical characteristics and perioperative outcomes of these patients are presented. Results Among 36 cases, 5 patients had minor air leaks detected using the DDS and required intercostal drainage after wound closure. Among the remaining 31 patients in whom the DDS showed no air leak, the chest drainage was removed immediately after wound closure. A postoperative chest roentgenogram on the surgery day showed full expansion in all patients without pneumothorax. Only 7 (19.4%) patients developed minor subclinical pneumothorax on the first postoperative day without the need for chest drainage. All patients were discharged uneventfully without the need for intervention. Conclusions Our tubeless protocol utilizes DDS to select patients who can have intercostal drainage omitted after non-intubated single-port VATS for pulmonary resection. Using objective DDS parameters, we believe that this is an effective way to reduce the rate of pneumothorax after tubeless single-port VATS in selected patients.
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Affiliation(s)
- Chao-Yu Liu
- Faculty of Medicine, National Yang-Ming University, Taipei.,Division of Thoracic Surgery, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City
| | - Po-Kuei Hsu
- Faculty of Medicine, National Yang-Ming University, Taipei.,Division of Chest Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei
| | - Hung-Che Chien
- Faculty of Medicine, National Yang-Ming University, Taipei.,Department of Surgery, National Yang-Ming University Hospital, Yilan
| | - Chih-Cheng Hsieh
- Faculty of Medicine, National Yang-Ming University, Taipei.,Division of Chest Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei
| | - Chien-Kun Ting
- Faculty of Medicine, National Yang-Ming University, Taipei.,Department of Anesthesiology, Taipei Veteran General Hospital, and National Yang-Ming University, Taipei
| | - Mei-Yung Tsou
- Faculty of Medicine, National Yang-Ming University, Taipei.,Department of Anesthesiology, Taipei Veteran General Hospital, and National Yang-Ming University, Taipei
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15
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Murakami J, Ueda K, Tanaka T, Kobayashi T, Hamano K. Grading of Emphysema Is Indispensable for Predicting Prolonged Air Leak After Lung Lobectomy. Ann Thorac Surg 2018; 105:1031-1037. [DOI: 10.1016/j.athoracsur.2017.11.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/22/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
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16
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Reduction of Pulmonary Air Leaks with a Combination of Polyglycolic Acid Sheet and Alginate Gel in Rats. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3808675. [PMID: 29487867 PMCID: PMC5816875 DOI: 10.1155/2018/3808675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/11/2017] [Indexed: 11/18/2022]
Abstract
Postoperative air leaks remain a major cause of morbidity after lung resection. This study evaluated the effect of a combination of polyglycolic acid (PGA) sheet and alginate gel on pulmonary air leaks in rats. Four pulmonary sealing materials were evaluated in lung injury: fibrin glue, combination of PGA sheet and fibrin glue, alginate gel, and combination of PGA sheet and alginate gel. With the airway pressure maintained at 20 cmH2O, a 2 mm deep puncture wound was created on the lung surface using a needle. Lowering the airway pressure to 5 cmH2O, each sealing material was applied. The lowest airway pressure that broke the seal was measured. The seal-breaking pressure in each experimental group was fibrin, 10.4 ± 6.8 cmH2O; PGA + fibrin, 13.5 ± 6.5 cmH2O; alginate gel, 10.3 ± 4.9 cmH2O; and PGA + alginate, 35.8 ± 11.9 cmH2O, respectively. The seal-breaking pressure was significantly greater in the PGA + alginate gel group than in the other groups (p < 0.01). There were no significant differences among the other three groups. Alginate gel combined with a PGA sheet is a promising alternative to fibrin glue as a safe and low-cost material for air leak prevention in pulmonary surgery.
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17
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Yamamoto S, Endo S, Minegishi K, Shibano T, Nakano T, Tetsuka K. Polyglycolic acid mesh occlusion for postoperative bronchopleural fistula. Asian Cardiovasc Thorac Ann 2015; 23:931-6. [PMID: 26187458 DOI: 10.1177/0218492315594071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative bronchopleural fistula is one of the most life-threatening complications after anatomical pulmonary resection. Bronchopleural fistula may cause empyema and aspiration pneumonia with subsequent acute respiratory distress syndrome. Surgical interventions for bronchopleural fistula can prolong hospitalization and impair postoperative quality of life. Postoperative care requires minimally invasive endoscopic occlusion. METHODS We retrospectively reviewed the records of 7 patients who developed bronchopleural fistula among 689 patients who underwent segmentectomy or lobectomy without sleeve resection for lung cancer in Jichi Medical University from 2009 to 2013. Bronchopleural fistula occurred in the right lower bronchial stump in 3 patients, in the superior segmental bronchus of the right lower lobe in 2, in the superior segmental bronchus of the left lower lobe in one, and in the right intermediate bronchus in one. Flexible bronchoscopy was used to occlude 3-mm fistulas with polyglycolic acid mesh in 2 patients. Larger fistulas in 5 patients were occluded with polyglycolic acid mesh plus fibrin glue to secure the mesh. The median procedure was 37 min. Procedures were considered complete upon resolution of air leakage from the chest drainage system. RESULTS Bronchoscopic interventions for bronchopleural fistula were repeated an average of 2 times. No procedure-related complications or death occurred. Bronchoscopic interventions were successful in all patients. CONCLUSIONS Bronchoscopic occlusion with polyglycolic acid mesh with or without fibrin glue is easy and feasible as the first step in postoperative management of bronchopleural fistula.
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Affiliation(s)
- Shinichi Yamamoto
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shunsuke Endo
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kentaro Minegishi
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tomoki Shibano
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tomoyuki Nakano
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kenji Tetsuka
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
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18
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Shintani Y, Inoue M, Funaki S, Kawamura T, Minami M, Okumura M. Clinical usefulness of free subcutaneous fat pad for reduction of intraoperative air leakage during thoracoscopic pulmonary resection in lung cancer cases. Surg Endosc 2014; 29:2910-3. [PMID: 25537378 DOI: 10.1007/s00464-014-4019-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Intraoperative alveolar air leaks remain a significant problem in thoracoscopic surgery (TS) cases. We examined the usefulness of covering damaged lung tissue with a subcutaneous fat pad for preventing postoperative air leakage in patients with non-small cell lung cancer (NSCLC). METHODS Patients with NSCLC underwent a thoracoscopic lobectomy or segmentectomy. When alveolar air leakage from the superficial pulmonary parenchyma was found, fibrin glue in combination with an absorbable mesh sheet was applied (S group; n = 100). When leakage originated from deep within the pulmonary parenchyma, a subcutaneous fat pad about 2 × 2 cm in size was harvested from the utility incision and placed on the damaged lung tissue with fibrin glue and sutures (F group; n = 66). Patient characteristics, air leak duration, and chest-tube removal time were analyzed. RESULTS The homogeneity of each group was consistent, with no statistical differences for age, respiratory function, surgical procedures, pathologic stage, and histological type. The air leak duration was significantly shorter (p = 0.015), and the chest tube was removed significantly earlier (p = 0.002) in patients in the F group. CONCLUSION Use of a free subcutaneous fat pad during pulmonary resection for TS patients with NSCLC reduced the duration of air leakage and chest tube drainage. The present method is easy, safe, and effective for repairing an air leak from remaining lung tissues in such cases.
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Affiliation(s)
- Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2-L5 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Masayoshi Inoue
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2-L5 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2-L5 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tomohiro Kawamura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2-L5 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2-L5 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2-L5 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Shintani Y, Inoue M, Nakagiri T, Okumura M. Use of free subcutaneous fat pad for reduction of intraoperative air leak in thoracoscopic pulmonary resection cases with lung cancer. Eur J Cardiothorac Surg 2014; 46:324-6. [PMID: 24459217 DOI: 10.1093/ejcts/ezt608] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Intraoperative alveolar air leaks occur in patients with non-small-cell lung cancer (NSCLC) following a pulmonary resection using thoracoscopic surgery. We showed the efficacy of covering damaged lung tissue with a subcutaneous fat pad for preventing postoperative air leak. Thoracoscopic surgery was performed for NSCLC patients with three incisions along with a 3-4 cm anterior utility incision. When an air leak originated from deep within the pulmonary parenchyma or was large, a subcutaneous fat pad ∼2 × 2 cm in size was harvested from the utility incision and placed on the damaged lung tissue with fibrin glue and 2-3 mattress sutures. Subcutaneous fat pads were used for 50 patients with NSCLC during thoracoscopic surgery procedures. There were no intraoperative complications in any of the patients. A prolonged air leak (>7 days) was noted in 3 (6%) of the 50 patients. Air leak was diminished at 1.5 ± 2.6 postoperative days and the chest tubes removed at 3.2 ± 2.8 postoperative days. Reinforcement of damaged lung tissues by use of subcutaneous free fat pads is a safe and intriguing procedure in NSCLC patients who underwent a pulmonary resection in thoracoscopic surgery.
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Affiliation(s)
- Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayoshi Inoue
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoyuki Nakagiri
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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20
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Nakada A, Shigeno K, Sato T, Kobayashi T, Wakatsuki M, Uji M, Nakamura T. Manufacture of a weakly denatured collagen fiber scaffold with excellent biocompatibility and space maintenance ability. Biomed Mater 2013; 8:045010. [DOI: 10.1088/1748-6041/8/4/045010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Ueda K, Hayashi M, Tanaka T, Hamano K. Omitting chest tube drainage after thoracoscopic major lung resection. Eur J Cardiothorac Surg 2013; 44:225-9; discussion 229. [DOI: 10.1093/ejcts/ezs679] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Ueda K, Tanaka T, Hayashi M, Li TS, Hamano K. Verification of early removal of the chest tube after absorbable mesh-based pneumostasis subsequent to video-assisted major lung resection for cancer. World J Surg 2012; 36:1603-7. [PMID: 22422172 DOI: 10.1007/s00268-012-1557-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We previously reported that the combined use of absorbable mesh and fibrin glue is superior to the use of fibrin glue alone to stop intraoperative air leaks. However, concern remains about whether mesh-based pneumostasis can induce the recurrence of air leaks after chest tube removal. METHODS We reviewed our prospective database of selected patients (n = 206) who underwent video-assisted major lung resection for cancer. Exclusion criteria included simultaneous combined resection, induction radiotherapy, entire intrathoracic adhesion, or a history of prior ipsilateral thoracotomy. We sealed any intraoperative air leaks with absorbable mesh and fibrin glue and then carried out prophylactic chest-tube drainage for 1 day. RESULTS Intraoperative air leaks were detected in 133 (65%) patients. Overall, air leaks were not detected postoperatively in 186 (91%) patients, allowing chest tube removal on the day after the operation. The mean length of time for chest tube drainage was 1.2 days. A prolonged air leak (>7 days) was observed in one (0.5%) patient, and this leak resolved by itself. After chest tube removal, an air leak recurred in six (2.9%) patients during the 30 day follow-up period, necessitating chest tube reinsertion. Although the recurrence was observed more frequently after segmentectomy than after lobectomy (p = 0.04), the recurrence was not observed more frequently in patients who had an intraoperative air leak than in patients who did not (p = 0.3). CONCLUSION Early removal of the chest tube after pneumostasis with absorbable mesh is verified in selected patients who underwent video-assisted major lung resection for cancer. However, further attempts should be made to prevent air leaks after anatomical segmentectomy.
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Affiliation(s)
- Kazuhiro Ueda
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
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Takahashi M, Matsukura T, Hirai T, Mino N. Recurrent catamenial hemopneumothorax treated by coverage with polyglycolic acid sheets. J Thorac Cardiovasc Surg 2012; 145:300-2. [PMID: 22982032 DOI: 10.1016/j.jtcvs.2012.08.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/14/2012] [Accepted: 08/23/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Mamoru Takahashi
- Department of Chest Surgery, Fukui Red Cross Hospital, Fukui, Japan.
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Yano T, Haro A, Shikada Y, Okamoto T, Maruyama R, Maehara Y. A unique method for repairing intraoperative pulmonary air leakage with both polyglycolic acid sheets and fibrin glue. World J Surg 2012; 36:463-7. [PMID: 22089922 DOI: 10.1007/s00268-011-1355-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND In the present study we present a unique maneuver, using both fibrin glue and polyglycolic acid (PGA) sheets, for repairing intraoperative pulmonary air leakage, and report our clinical results. METHODS Based on the results from in vitro experiments, we retrospectively investigated the clinical effects of our method for repairing intraoperative pulmonary air leakage in 377 consecutive patients, who underwent a pulmonary resection for primary lung cancer or metastatic lung tumors from 2004 to 2009. From April 2004 through September 2007, repair of intraoperative pulmonary air leakage was performed in 204 patients using only fibrin glue. From October 2007 through December 2009, the repair was performed in 173 patients with a unique application of both fibrin glue and PGA sheets, i.e., (1) rubbing fibrin glue A solution, (2) applying a PGA sheet cut to an appropriate size, (3) rubbing fibrin glue B solution on the PGA sheet, and (4) reapplying fibrin glue A solution and rubbing. RESULTS The mean duration of postoperative pleural drainage was significantly shorter in the latter time period when both fibrin glue and PGA sheets were used than in the former period when fibrin glue was used alone. The incidence of prolonged air leakage longer than 1 week was also significantly lower in the latter era than in the former era. CONCLUSION Our unique application of both fibrin glue and PGA sheets for the intraoperative repair of pulmonary air leakage effectively resulted in a shortening of the duration of postoperative pleural drainage.
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Affiliation(s)
- Tokujiro Yano
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.
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Postoperative bronchial stump fistula after lobectomy: response to occlusion with polyglycolic acid mesh and fibrin glue via bronchoscopy. Gen Thorac Cardiovasc Surg 2011; 59:771-4. [PMID: 22083699 DOI: 10.1007/s11748-010-0767-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 12/16/2011] [Indexed: 10/15/2022]
Abstract
Bronchial stump fistula after resection of lung cancer is an extremely difficult to treat postoperative complication. Endoscopic fistula closure is a favorable alternative, potentially avoiding major surgical intervention. an 80-year-old man underwent curative resection of squamous cell carcinoma by left upper lobectomy of the lung. The patient suddenly developed massive subcutaneous emphysema on postoperative day 10. Bronchoscopy revealed a fistula about 3 mm in diameter at the lateral edge of the bronchial stump. Concentrated fibrinogen 0.5 ml (fluid A) was sprinkled on the bronchial fistula initially, and then pieces of polyglycolic acid mesh presoaked in fluid A or fluid B (thrombin) of the fibrin glue were pushed with biopsy forceps into the fistula in an alternating fashion (A→B→A→B) under endotracheal local anesthesia. Air leakage was stopped, and the patient did not develop empyema. Particularly for patients in poor general condition, our noninvasive technique seems to serve as a therapy of first choice.
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Ueda K, Tanaka T, Hayashi M, Li TS, Tanaka N, Hamano K. Mesh-based pneumostasis contributes to preserving gas exchange capacity and promoting rehabilitation after lung resection. J Surg Res 2009; 167:e71-5. [PMID: 20097374 DOI: 10.1016/j.jss.2009.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 10/21/2009] [Accepted: 11/04/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND We recently introduced a technique of sutureless, mesh-based pneumostasis for preventing alveolar air leaks after lung resection. To verify the clinical usefulness of this technique, we examined if it can contribute to preserving gas exchange capacity and promoting postoperative rehabilitation. METHODS We prospectively collected perioperative data, including arterial oxygen saturation on postoperative day (POD) 1 and the length of postoperative rehabilitation in 100 patients undergoing elective, video-assisted major lung resection for cancer. Before April, 2006, intraoperative air leaks were sealed with the conventional method (control group), and thereafter, with bioabsorbable mesh and glue, without suturing, (treated group). To reduce the bias in comparison of the nonrandomized control group, we paired the treated group with the control group using the nearest available matching method on the estimated propensity score. RESULTS Thirty-five patients in the control group were matched to 35 patients in the treated group based on the estimated propensity score. The length of both chest tube drainage and postoperative rehabilitation were significantly shorter in the treated group than in the control group (median, 1 versus 1 d, P = 0.03; 2 versus 3 d, P = 0.01, respectively). The arterial oxygen saturation on POD 1 was significantly higher in the treated group than in the control group (median, 94.0 versus 92.5 %, P = 0.03). CONCLUSION Mesh-based pneumostasis during video-assisted major lung resection enabled early chest tube removal, preserved postoperative oxygenation capacity, and promoted postoperative rehabilitation, which may facilitate fast-track surgery for patients undergoing video-assisted major lung resection for cancer.
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Affiliation(s)
- Kazuhiro Ueda
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
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