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Furuta C, Yano M, Kitagawa Y, Katsuya R, Ozeki N, Fukui T. Prospective Observation Study for Primary Spontaneous Pneumothorax: Incidence of and Risk Factors for Postoperative Neogenesis of Bullae. Ann Thorac Cardiovasc Surg 2024; 30:23-00206. [PMID: 38599823 PMCID: PMC11082493 DOI: 10.5761/atcs.oa.23-00206] [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: 11/29/2023] [Accepted: 03/16/2024] [Indexed: 04/12/2024] Open
Abstract
PURPOSE Details of the neogenesis of bullae (NOB), which causes recurrent primary spontaneous pneumothorax (PSP) following bullectomy, have not been reported and risk factors for NOB remain unclear. We aimed to clarify the details of NOB. METHODS We conducted a prospective study using three computed tomography (CT) examinations performed 6, 12, and 24 months after bullectomy to identify the incidence of and risk factors for NOB. We enrolled 50 patients who underwent bullectomy for PSP. RESULTS After excluding 11 patients who canceled the postoperative CT examination at 6 months after bullectomy, only 39 patients were analyzed. The incidence of NOB at 6, 12, and 24 months after bullectomy was 38.5%, 55.2%, and 71.2%, respectively. The rate of NOB in the operated lung was almost 2 times higher than that in the contralateral nonoperative lung. Male sex, multiple bullae on preoperative CT, long stapling line (≥7 cm), deep stapling depth (≥1.5 cm), and heavier resected sample (≥5 g) were suggested to be risk factors for NOB. CONCLUSIONS We recognized a high incidence of postoperative NOB in PSP patients. Bullectomy itself seems to promote NOB. Postoperative NOB occurs frequently, especially in patients who require a large-volume lung resection with a long staple line.
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Affiliation(s)
- Chihiro Furuta
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Motoki Yano
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yuka Kitagawa
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Ryotaro Katsuya
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Naoki Ozeki
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Takayuki Fukui
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
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Saini N, Nar A, Jabbal HS, Mishra A, Bains MS. Video-Assisted Thoracoscopic Surgery (VATS) for Spontaneous Pneumothorax and Emphysematous Bullous Lung Disease: A Study From Northern India. Cureus 2022; 14:e25769. [PMID: 35702639 PMCID: PMC9177938 DOI: 10.7759/cureus.25769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Bullous lung disease is the most common cause of spontaneous pneumothorax. The management of the same is primarily surgical, aiming at the bullectomy, which was earlier performed by standard postero-lateral thoracotomy. The last two decades have seen more frequent use of video-assisted thoracoscopic surgery (VATS) for the same and has been shown to be a low morbidity, efficacious, and cost-effective method. In this study we assess the role of VATS in the spectrum of bullous lung disease. Method: The study was conducted in the Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, for a period of three years from January 1, 2016 to December 31, 2019 in which patients with bullous lung diseases were enrolled and the role of video-assisted thoracoscopic surgery was assessed in them. Results: The study included a total of 75 patients who were managed operatively either by VATS or open thoracotomy. In the study group, the average age of patients was 35.6 years (range 16-68 years). The most common presentation was only bullous lung disease (BLD) in 40% of patients followed by 32% of patients having both BLD and broncho-pleural fistula (BPF). Apical segmentectomy/non-anatomical wedge resection was done in 36% of patients whereas VATS bullectomy was done in 36% of patients. Elective conversion to thoracotomy was planned in six patients because of dense adhesions and thick pleural peel. We performed pleurodesis in almost all cases (96%). Mean blood loss in the VATS procedure was 48.7 ml and mean operative time was 67.2 minutes. Mean duration of hospital stay was 4.8 days. Forced expiratory volume (FEV1) increased significantly from a mean of 65.80% to 77.60%. There was significant increase in forced vital capacity (FVC) mean from 70.30% to 79.50%. Conclusion: VATS can be used as a safe, feasible and effective procedure in patients presenting with spontaneous pneumothorax and bullous lung disease with or without a broncho-pleural fistula or parenchymal leak. It should be preferred over the traditional open thoracotomy procedure, whenever feasible to do so, in view of decreased perioperative morbidity and better functional outcome.
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Zengin M, Sazak H, Baldemir R, Ulger G, Aydemir S, Acar LN, Alagoz A. Parameters Affecting Nausea and Vomiting After Thoracoscopic Wedge Resection in Patients With Pneumothorax. Cureus 2021; 13:e19926. [PMID: 34966615 PMCID: PMC8710436 DOI: 10.7759/cureus.19926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is one of the complications that can occur frequently in the first 24 hours postoperatively. We aimed to investigate the parameters that could predict PONV in patients who underwent thoracoscopic wedge resection for pneumothorax. MATERIALS AND METHODS After obtaining the approval of the ethics committee (ID: 2012-KEAK-15/2358, Date: 14.09.2021), the records of patients who underwent elective video-assisted thoracic surgery (VATS) between January 2018 and June 2021 were analyzed retrospectively. The patients who underwent elective thoracoscopic wedge resection for pneumothorax, who were between the ages of 18-65, American Society of Anesthesiologists (ASA) I-III, and whose body mass index (BMI) was between 18-30 kg/m2 were included in the study. However, patients who received a blood transfusion or used antiemetics, anticholinergic drugs, and analgesics continuously were not included. In addition, patients with a history of chronic pain were not included in the study. The patients were divided into two groups, the PONV group (Group 1) and the control group (Group 2). The PONV incidence, visual analog scale (VAS) scores, 24-hour morphine consumption, additional analgesic requirement, neutrophil/lymphocyte ratios (NLR), and platelet/lymphocyte ratios (PLR) were evaluated. RESULTS The groups were similar in terms of demographic data (p > 0.05). Additional analgesic requirement and 24-hour morphine consumption were significantly higher in the PONV group (p: 0.005, p < 0.001, respectively). Preoperative NLR (p < 0.001), postoperative NLR (p < 0.001), preoperative PLR (p < 0.022), the VAS scores of the first hour (p: 0.004), and 24th hour (p < 0.001) were statistically significantly higher in the PONV group compared to the control group. CONCLUSIONS NLR parameters can be effective with high sensitivity and specificity in predicting PONV during the preoperative and postoperative period. Besides, preoperative PLR may also be effective in predicting PONV. A treatment that can be planned according to these parameters may play a key role in preventing PONV. In addition, efficient perioperative analgesia management may be effective in reducing PONV by limiting the emetogenic analgesics.
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Affiliation(s)
- Musa Zengin
- Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
| | - Hilal Sazak
- Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
| | - Ramazan Baldemir
- Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
| | - Gulay Ulger
- Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
| | - Semih Aydemir
- Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
| | - Leyla N Acar
- Thoracic Surgery, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
| | - Ali Alagoz
- Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
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Puri HV, Asaf BB, Pulle MV, Bishnoi S, Kumar A. Video-assisted thoracoscopic surgery management of primary spontaneous pneumothorax: Results in 110 consecutive cases. Lung India 2021; 38:36-40. [PMID: 33402636 PMCID: PMC8066916 DOI: 10.4103/lungindia.lungindia_453_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Primary spontaneous pneumothorax (PSP) results from the rupture of small blebs or bullae in a patient without any pre-existing lung disease. Last decade witnessed a paradigm shift in the surgical management of pneumothorax from open to video-assisted thoracoscopic surgery (VATS) method. In this study, we aim to report our single center experience of surgical management of PSP along with surgical outcomes in 110 consecutive cases of PSP. Materials and Methods: This is a retrospective study of 110 operated cases of PSP over 5 years. Demography, computed tomography findings, operative technique, endoscopic classification (Vanderschueren), surgical duration, intraoperative and postoperative complications, duration of Intercostal Drain (ICD), hospital stay, and recurrence in follow-up were recorded. Results: The average age of patients was 27.59 years (range 9–68 years). The average number of episodes before the presentation was 2 (range 1–5). The average number of loss of working days because of symptoms, conservative management, or long-term intercostal drainage was 13.33 days (range 5–60 days). As per intra-operative findings, patients were categorized as per Vanderschueren's classification and managed accordingly. Conversion rate was in 1.8% (n = 2). Mean time to removal of chest tubes was 4 days (2–12 days). Mean hospital stay was 3.83 days (2–9 days). There were no postoperative deaths. The mean follow-up was 25.05 months (6–60 months). Overall complication rate was 3.6% (n = 4) and recurrence happened in 2.7% (n = 3) cases. Conclusions: VATS is an efficient and safe treatment modality for PSP with low recurrence rates and high level of patient satisfaction.
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Affiliation(s)
- Harsh Vardhan Puri
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Belal Bin Asaf
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Sukhram Bishnoi
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Kumar
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Sim SKR, Nah SA, Loh AHP, Ong LY, Chen Y. Mechanical versus Chemical Pleurodesis after Bullectomy for Primary Spontaneous Pneumothorax: A Systemic Review and Meta-Analysis. Eur J Pediatr Surg 2020; 30:490-496. [PMID: 31600803 DOI: 10.1055/s-0039-1697959] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Primary spontaneous pneumothorax (PSP) and its high recurrence rate pose a therapeutic challenge to both patients and their managing surgeons. Mechanical or chemical pleurodesis can be used to prevent recurrence, but the optimal treatment often remains a matter of debate. This meta-analysis aims to compare the outcomes between mechanical and chemical pleurodesis following bullectomy for PSP. MATERIALS AND METHODS Studies published up to 2019 were searched from Medline, Embase, Google Scholar, and Cochrane databases. A meta-analysis of randomized controlled trials (RCTs) and observational cohort studies (OCSs) comparing outcomes between mechanical and chemical pleurodesis for PSP was performed. RESULTS Seven studies (one RCT and six OCSs) were included, comprising 1,032 cases of mechanical (799 abrasions, 202 pleurectomies, and 31 unspecified abrasions/pleurectomies/both), and 901 cases of chemical (643 talc, 69 minocycline, and 189 unspecified talc/kaolin) pleurodesis. The recurrence rate of pneumothorax after chemical pleurodesis (1.2%) was significantly lower than mechanical pleurodesis (4.0%) (pooled odds ratio [OR] = 3.00; 95% confidence interval [CI] = 1.59-5.67; p = 0.0007; I 2 = 19%). Hospital stay was also slightly shorter in the chemical pleurodesis group (pooled mean difference [MD] = 0.42 days; 95% CI = 0.12-0.72; p = 0.005; I 2 = 0%). There was no statistically significant difference in postoperative complications (pooled OR = 1.18; 95%CI = 0.40-3.48; p = 0.76; I 2 = 71%) and operative time (pooled MD = 3.50; 95%CI = -7.28 to 14.28; p = 0.52; I 2 = 99%) between these two groups. CONCLUSION Chemical pleurodesis is superior to mechanical pleurodesis following bullectomy for PSP in reducing hospital stay and recurrence rate. However, more RCTs with longer follow-up are necessary to demonstrate the benefit of chemical pleurodesis for PSP.
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Affiliation(s)
- Sarah Kher Ru Sim
- Department of General Surgery, Singapore General Hospital, Singapore
| | - Shireen Anne Nah
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Amos Hong Pheng Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Lin Yin Ong
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Yong Chen
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
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Bertoglio P, Viti A, Lomangino I, Terzi CA, Minervini F. Surgical management of pneumothorax: still sailing with no compass. J Thorac Dis 2020; 12:3007-3009. [PMID: 32642220 PMCID: PMC7330780 DOI: 10.21037/jtd.2020.03.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Andrea Viti
- Division of Thoracic Surgery, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Ivan Lomangino
- Division of Thoracic Surgery, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.,Division of Thoracic Surgery, University Hospital of Padua, Padua, Italy
| | - Claudio Alberto Terzi
- Division of Thoracic Surgery, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Fabrizio Minervini
- Department of Thoracic Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
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Pleural Coating by 50% Glucose Solution Reduces Postoperative Recurrence of Spontaneous Pneumothorax. Ann Thorac Surg 2018; 106:184-191. [PMID: 29577928 DOI: 10.1016/j.athoracsur.2018.02.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/13/2018] [Accepted: 02/12/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery is the standard procedure for treatment of spontaneous pneumothorax. However, postoperative recurrence is relatively common even if an absorbable covering sheet is used for reinforcement of the visceral pleura. Injection of a high concentration glucose solution to the thoracic cavity was recently reported to be effective in stopping postoperative air leakage or as a prophylactic procedure to prevent postoperative recurrence of spontaneous pneumothorax. Therefore, we used 50 mL of a 50% glucose solution for pleural coating (GPC) on an absorbable sheet intraoperatively to prevent postoperative recurrence of spontaneous pneumothorax. This is a retrospective study, and patient backgrounds are heterogeneous. We evaluated the feasibility of GPC using propensity scores to adjust for heterogeneity in their backgrounds. METHODS Between January 2010 and December 2017, 376 patients who underwent video-assisted thoracoscopic surgery, with or without GPC, were evaluated. The GPC group consisted of 106 patients, and the non-GPC group consisted of 270. We analyzed the factors preventing postoperative recurrence of spontaneous pneumothorax by univariate analysis and Cox regression analysis with or without propensity score matching. RESULTS Univariate analysis revealed age of 25 or older, smoking habit, no history of an ipsilateral operation, and GPC were significant factors preventing postoperative recurrence. GPC significantly prevented postoperative recurrence as shown by Cox regression analysis with propensity score matching (hazard ratio, 0.15; p = 0.014) and the inverse-probability of treatment weighted method (hazard ratio, 0.23; p = 0.0038). CONCLUSIONS Intraoperative GPC significantly reduced the postoperative recurrence rate of spontaneous pneumothorax.
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Olesen WH, Katballe N, Sindby JE, Titlestad IL, Andersen PE, Lindahl-Jacobsen R, Licht PB. Surgical treatment versus conventional chest tube drainage in primary spontaneous pneumothorax: a randomized controlled trial†. Eur J Cardiothorac Surg 2018; 54:113-121. [DOI: 10.1093/ejcts/ezy003] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/28/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Niels Katballe
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Eske Sindby
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Rune Lindahl-Jacobsen
- Danish Aging Research Center, Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
- Max-Planck Center on Biodemography of Aging, Odense, Denmark
| | - Peter Bjørn Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
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Steger V, Sostheim U, Leistner M, Walles T. Recurrence of Spontaneous Pneumothorax Is Not Associated with Allegedly Risk-Prone Lifestyle Conduct. Ann Thorac Cardiovasc Surg 2018; 24:25-31. [PMID: 29279462 DOI: 10.5761/atcs.oa.17-00130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Spontaneous pneumothorax (PNTX) is a common disease frequently operated at specialized thoracic surgery units. Videothoracoscopic surgery (VATS) has become the standard for treatment and recurrence prevention. While there is broad consensus regarding indications and techniques of PNTX surgery, postoperative risks and consecutive patient behavioral advice have not been sufficiently elucidated. METHODS Single-center cohort analysis of 641 patients operated for primary PNTX by VATS over 10 years. Putatively recurrence-prone lifestyle activities (smoking status, flying habits, and scuba diving) and actual occurrence of recurrences were correlated. RESULTS Follow-up rate was 46% (279/607 patients). Mean time interval between primary operation and follow-up was 61 (range: 5-177) months. In 10 patients (3.6%), a PNTX recurrence was observed. Regarding postoperative risk behavior reported at follow-up, 28% of patients were active smokers (15 ± 7 cigarettes/day), 59% traveled by plane repeatedly, and only two patients did scuba diving (0.7%). Low body-mass-index was associated with an increase in PNTX recurrence, whereas smoking, flying, and scuba diving could not be identified as risk factors. CONCLUSION In our study, none of the supposed "classic" lifestyle-associated risk factors for PNTX recurrence after VATS proved to be a significant threat. Postoperative patient behavior might not be constrained by overcautious medical advice.
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Affiliation(s)
- Volker Steger
- Department of Thoracic, Cardiac and Vascular Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Ulrike Sostheim
- Department of Thoracic Surgery, Schillerhoehe Hospital, Schillerhoehe, Germany
| | - Marcus Leistner
- Department of Thoracic, Cardiac and Vascular Surgery, Goettingen University Hospital, Goettingen, Germany
| | - Thorsten Walles
- Department of Thoracic Surgery, Schillerhoehe Hospital, Schillerhoehe, Germany.,Department of Cardiothoracic Surgery, Magdeburg University Hospital, Magdeburg, Germany
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10
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If Background Lung Abnormalities Do Not Affect the Presentation of Spontaneous Pneumothorax, Is Lung Resection Always Justified? J Bronchology Interv Pulmonol 2017; 24:225-231. [DOI: 10.1097/lbr.0000000000000386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim KS. Barbed suture material technique for wound closure and concomitant tube placement in uniportal VATS for pneumothorax. J Thorac Dis 2017; 9:1265-1272. [PMID: 28616277 DOI: 10.21037/jtd.2017.03.163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Uniportal video-assisted thoracoscopic surgery (VATS) is an alternative modality for treatment of primary spontaneous pneumothorax (PSP) with its less invasiveness and acceptable surgical outcomes. However, a few reports have been introduced for wound management to achieve better cosmetic wound healing and for placement of the chest tube in uniportal VATS. Thus, we aimed to evaluate the feasibility of our novel method for wound closure and concomitant tube placement using continuous barbed suture material in uniportal VATS for PSP. METHODS Between July 2012 and December 2015, consecutive 31 patients (22 males) underwent uniportal VATS to treat PSP. Bilateral approaches were performed in four patients, thus total 35 cases were enrolled. We divided them into two groups with one group of 17 (48.5%) cases (group A), using barbed absorbable wound closure device for knotless continuous wound closure and subsequent chest tube anchoring, and the other group of 18 (51.4%) cases (group B), using conventional suture anchoring after skin closure using absorbable suture device. Postoperative surgical outcomes were compared to assess the feasibility of this technique. RESULTS Demographic data demonstrate no significant difference in both groups. There was no significant difference in length of hospital stay (3.7±1.2 vs. 4.1±1.2 days, P=0.267) and in median chest tube indwelling time (2.4±0.9 vs. 3.1±1.2 days, P=0.066), respectively. Operation time in group A was shorter than in group B but there was no significant difference (41.7±11.8 vs. 45.6±16.0 minutes, P=0.415). There was neither conversion to two or three port VATS in all cases. In group A, all chest tubes were removed with concomitant sealing the tube removal site by pulling the thread. Residual knots do not exist that stitch out procedure is not required. There was no wound complication in both groups during the median follow-up period of 18 months. CONCLUSIONS Knotless, barbed suture material technique for continuous wound closure with concomitant chest tube placement achieved equivocal outcomes in comparison to the conventional suture anchoring method. We suggest this simple technique for wound closure and easy tube removal with cosmetic wound healing in uniportal VATS for PSP.
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Affiliation(s)
- Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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12
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Masmoudi H, Etienne H, Sylvestre R, Evrard D, Ouede R, Le Roux M, Giol M, Assouad J. Three Hundred Fifty-One Patients With Pneumothorax Undergoing Uniportal (Single Port) Video-Assisted Thoracic Surgery. Ann Thorac Surg 2017; 104:254-260. [PMID: 28410634 DOI: 10.1016/j.athoracsur.2017.01.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 01/01/2017] [Accepted: 01/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) is usually performed using three ports. Uniportal VATS has not yet been widely developed. We report our single institution experience in uniportal VATS for the surgical management of 351 patients with pneumothorax. METHODS Between November 2009 and February 2016, we conducted a study in 351 patients treated for pneumothorax using uniportal VATS. Resection of apical bullae associated with partial pleurectomy, pleural abrasion, or talc effusion was performed. RESULTS The mean age was 29.6 ± 10.1 years. Surgical indications were mainly persistence or recurrence of pneumothorax. Sixty-seven patients (19%) presented with complications. At the 30-day control, 60.1% of patients were asymptomatic; 85% of patients were satisfied with the single small scar. The recurrence rate was 3.6% at 24 ± 13 months. CONCLUSIONS Uniportal VATS is feasible, safe, and reproducible in the treatment of pneumothorax. Morbidity is similar to multiport VATS. The recurrence rate is comparable with best results after multiport VATS or thoracotomy. Patients were satisfied with the single small scar.
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Affiliation(s)
- Hicham Masmoudi
- Department of Thoracic Surgery, Tenon Hospital, Paris, France.
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | | | - Diane Evrard
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | - Raphaël Ouede
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | | | - Mihaela Giol
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
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13
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Zhang D, Miao J, Hu X, Hu B, Li H. A clinical study of efficacy of polyglycolic acid sleeve after video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax. J Thorac Dis 2017; 9:1093-1099. [PMID: 28523164 DOI: 10.21037/jtd.2017.03.109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) is a common disease in thoracic surgery, and a prolonged postoperative air leakage is the most frequent and troublesome early complication after video-assisted thoracoscopic (VATS) bullectomy. This study aimed to explore the efficacy of polyglycolic acid (PGA) sleeve in preventing postoperative air leakage after a VATS bullectomy for PSP. METHODS This study was a prospectively randomised clinical study. The patients who underwent a VATS bullectomy were continuously enrolled from January 2015 to June 2016 in the Beijing Chaoyang Hospital and were randomly assigned to the experimental and control groups. The experimental group applied a PGA sleeve combined with an automatic stapler in the bullectomy, while in the control group, the bullae were resected using an automatic stapler alone during the operation. In addition, the staple lines in both groups were covered with an absorbable polyglycolic acid sheet and both groups performed pleural abrasion after the resection. Useful clinical data were recorded, including the number of cases there was no air leakage immediately after the operation and air leakage lasted more than 3 days, the average postoperative air leakage, the drainage tube removal time, the postoperative hospital stay, the postoperative complications, and the postoperative recurrence. RESULTS A total of 134 patients were enrolled in this study. The experimental group consisted of 60 subjects, and there were 74 in the control group. No operative related mortality was observed in either group. In the experimental group, 44 of the 60 patients did not have an air leakage immediately after the operation, which was significantly higher than the control group (73.33% vs. 54.05%, P=0.031). Compared with the control group, the average postoperative air leakage (0.57±1.11 days), the chest tube removal time (3.03±0.92 days), and the postoperative hospital stay (3.98±0.92 days) were all significantly shorter in the experimental group (P=0.048, P=0.012, and P=0.010, respectively). Moreover, the rate of postoperative complications in the experimental group was lower than the control group (3.33% vs. 16.22%, P=0.021). No postoperative recurrence was observed in either group during the follow-up period that ranged from 8 to 25 months. CONCLUSIONS The use of PGA sleeve during surgery for PSP might effectively prevent early postoperative air leakage, as well as reduce the postoperative drainage tube removal time and the postoperative hospital stay.
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Affiliation(s)
- Duo Zhang
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Jinbai Miao
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Xiaoxing Hu
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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Dżeljilji A, Rokicki W, Rokicki M, Karuś K. New aspects in the diagnosis and treatment of primary spontaneous pneumothorax. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2017; 14:27-31. [PMID: 28515745 PMCID: PMC5404124 DOI: 10.5114/kitp.2017.66926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 10/14/2016] [Indexed: 11/26/2022]
Abstract
This paper provides a recapitulation of the position of the British Thoracic Society and the American College of Chest Physicians based on a review of the literature concerning the current methods of diagnosing and treating primary spontaneous pneumothorax (PSP). The previously developed guidelines were re-evaluated in 2015 by a task force of the European Respiratory Society (ERS). They are intended to be used by surgeons as well as emergency and pulmonary ward physicians, and they apply largely to emergency procedures. In recent years, the effectiveness of minimally invasive methods (punctures, drainage) in combination with talc pleurodesis for the initial therapy of PSP has been recognized. The efficacy of thoracoscopy (VATS) for the treatment of this disease has been proven by the development of minimally invasive surgical techniques in thoracic surgery. This paper also discusses the efficacy of the surgical methods available.
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Affiliation(s)
- Agata Dżeljilji
- Department of Surgery, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Wojciech Rokicki
- Department of Thoracic Surgery in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Marek Rokicki
- Department of Thoracic Surgery in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Krzysztof Karuś
- Center of Pulmonology and Thoracic Surgery, Bystra Śląska, Poland
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15
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Optimal surgical technique in spontaneous pneumothorax: a systematic review and meta-analysis. J Surg Res 2016; 210:32-46. [PMID: 28457339 DOI: 10.1016/j.jss.2016.10.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/16/2016] [Accepted: 10/26/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Numerous thoracoscopic techniques have been used in the management of primary spontaneous pneumothorax (PSP), including wedge resection, pleurectomy, pleural abrasion, chemical pleurodesis, and staple line covering. The purpose of this systematic review was to compare outcomes for the most commonly reported techniques. MATERIALS AND METHODS A systematic literature search looking at pneumothorax recurrence rate, length of stay, and chest tube duration after surgery was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed database. RESULTS Fifty-one unique studies comprised of 6907 patients published between January 1988 and June 2015 were identified. Heterogeneity among effect sizes was significant for all outcomes. The lowest recurrence rates were observed in the wedge resection + chemical pleurodesis (1.7%; 95% confidence interval [CI], 1.0%-2.7%) and the wedge resection + pleural abrasion + chemical pleurodesis (2.8%; 95% CI, 1.7%-4.7%) groups. The shortest chest tube duration and length of stay were observed in the wedge resection + staple line covering ± other group (2.1 d; 95% CI, 1.4-2.9 and 3.3 d; 95% CI, 2.6-4.0, respectively). CONCLUSIONS The variability in reported outcomes and the lack of published multicenter randomized controlled trials highlights a need for more robust investigations into the optimal surgical technique in the management of PSP. Based on the limited quality studies available, this systematic review favors wedge resection + chemical pleurodesis and wedge resection + pleural abrasion + chemical pleurodesis in terms of recurrence rate after surgery for PSP.
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Matsumoto Y, Hata Y, Makino T, Koezuka S, Otsuka H, Sugino K, Isobe K, Homma S, Iyoda A. The best time for surgery on a patient with recurrent pneumothorax and undetectable culprit lesions is at the exact time air leakage is discovered: a case report. J Cardiothorac Surg 2016; 11:114. [PMID: 27484083 PMCID: PMC4970293 DOI: 10.1186/s13019-016-0514-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 07/27/2016] [Indexed: 12/05/2022] Open
Abstract
Background One cause of recurrent spontaneous pneumothorax includes overlooking bullae during a previous surgery for pneumothorax; and the identification of the culprit lesions is necessary for prevention of recurrence. Case presentation A 28-year-old man was referred to our hospital because of spontaneous right-sided pneumothorax. He underwent video-assisted thoracoscopic surgery, which did not reveal air leakage. The patient was subsequently seen at our hospital for 2 additional episodes of recurrent right-sided pneumothorax. At the third admission we observed intermittent air leakage while the patient was in the sitting position after chest drainage, and we performed surgery. An intraoperative submersion test showed air leakage dorsally from the pleural surface of S6 and a minute culprit lesion, which were not seen at the first operation and confirmed the leakage site. The area was ligated and coated with regenerated oxidized cellulose mesh and autologous blood. Conclusion In cases of pneumothorax with repeated recurrence, the best time to perform surgery on the patient with undetectable culprit lesion is the exact time that air leakage is observed.
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Affiliation(s)
- Yousuke Matsumoto
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Yoshinobu Hata
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Takashi Makino
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Satoshi Koezuka
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Hajime Otsuka
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Keishi Sugino
- Division of Respiratory Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Kazutoshi Isobe
- Division of Respiratory Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Sakae Homma
- Division of Respiratory Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Akira Iyoda
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan.
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Kim JT, Kim KH, Yoon YH, Baek WK, Lim HK. A 2-mm Videothoracoscopic Incision for Primary Spontaneous Pneumothorax. Asian Cardiovasc Thorac Ann 2016. [DOI: 10.1177/021849230100900108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was designed to evaluate a recently developed 2-mm video-thoracoscope and instruments for primary spontaneous pneumothorax. Between January 1998 and June 1999, 62 consecutive patients were studied. The 2-mm video-thoracoscope was used in 30 patients (group 1), and a conventional video-thoracoscope was used in 32 (group 2). There was no significant difference in operation time, number of staples, or duration of chest tube drainage between the 2 groups. The need for parenteral analgesic (ketoprofen) postoperatively was less in group 1 (56%) than group 2 (72%), but this was not statistically significant. During a mean follow-up of 15 months, there was 1 readmission for recurrent pneumothorax in each group. It was concluded that the 2-mm video-thoracoscope and instruments can be used successfully to manage primary spontaneous pneumothorax with cosmetically excellent results.
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Affiliation(s)
| | | | | | | | - Hyun Kyoung Lim
- Department of Anesthesiology Inha University Hospital Inchon, Korea
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18
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Evaluation of Spontaneous Pneumothorax Surgeries: A 16-Year Experience in Japan. Surg Res Pract 2016; 2016:7025793. [PMID: 27191013 PMCID: PMC4846764 DOI: 10.1155/2016/7025793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/12/2016] [Accepted: 03/24/2016] [Indexed: 11/18/2022] Open
Abstract
Background. Video-assisted thoracoscopic surgery is the surgical procedure of choice for spontaneous pneumothorax due to its noninvasiveness and convenience. A higher recurrence rate with thoracoscopic bullectomy (TB) than that after traditional thoracotomy (TT) led us to adopt thoracoscopic double-loop ligation (TLL) as our standard procedure in 1998. This study compares the effectiveness and safety of these 3 operative procedures. Methods. Patients who underwent their first surgery for spontaneous pneumothorax at our hospital between January 1994 and December 2010 were included. Patients with a history of surgery for spontaneous pneumothorax, those with special clinical conditions such as lymphangioleiomyomatosis, or those with catamenial, traumatic, or iatrogenic pneumothorax were excluded. Results. A total of 777 males (14-91 years old; 814 pneumothorax sides), and 96 females (16-78 years old; 99 pneumothorax sides) were included in the study. TT was performed in 137 patients (143 sides), TB in 106 patients (112 sides), and TLL in 630 patients (658 sides). The postoperative recurrence rates were 3.5%, 16.1%, and 5.3% in the TT, TB, and TLL groups, respectively (p < 0.0001). Mean blood loss and operating time were lowest for TLL. Conclusions. The results suggest that TLL should be the surgical procedure of choice for spontaneous pneumothorax.
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19
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Xu W, Wang Y, Song J, Mo L, Jiang T. One-port video-assisted thoracic surgery versus three-port video-assisted thoracic surgery for primary spontaneous pneumothorax: a meta-analysis. Surg Endosc 2016; 31:17-24. [DOI: 10.1007/s00464-016-4940-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/09/2016] [Indexed: 11/28/2022]
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20
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Qin SL, Huang JB, Yang YL, Xian L. Uniportal versus three-port video-assisted thoracoscopic surgery for spontaneous pneumothorax: a meta-analysis. J Thorac Dis 2016; 7:2274-87. [PMID: 26793349 DOI: 10.3978/j.issn.2072-1439.2015.12.56] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Whether or not uniportal video-assisted thoracoscopic surgery (VATS) is beneficial for spontaneous pneumothorax remains inconclusive. This meta-analysis aimed to summarize the available evidence to assess the feasibility and advantages of uniportal VATS for the treatment of spontaneous pneumothorax compared with three-port VATS. METHODS Eligible publications were identified by searching the Cochrane Library, PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data databases and CQVIP. Odds ratios (OR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated to compare dichotomous and continuous variables, respectively. RESULTS This meta-analysis was based on 17 studies and included a total of 988 patients with spontaneous pneumothorax. No death was reported during the perioperative period. Compared with three-port VATS groups, there was a statistically significant difference in uniportal VATS groups regarding postoperative hospital stay (SMD= -0.58; 95% CI: -1.04 to -0.12; P=0.01), paresthesia (OR=0.13; 95% CI: 0.07 to 0.24; P<0.00001), visual analogue pain score (VAS) at 24 hours (h) (SMD= -0.87; 95% CI: -1.07 to -0.68; P<0.00001), VAS at 72 h (SMD= -0.49; 95% CI: -0.68 to -0.30; P<0.00001), and patients satisfaction scale (PSS) at 24 h (SMD= -0.81; 95% CI: -1.21 to -0.41; P<0.0001), PSS at 48 h (SMD= -0.69; 95% CI: -1.08 to -0.29; P=0.0007). However there was no statistically significant difference on the recurrence (OR=0.79; 95% CI: 0.42 to 1.46; P=0.45), operative time (SMD= -0.23; 95% CI: -0.21 to 0.67; P=0.31), length of postoperative drainage (SMD= -0.17; 95% CI: -0.40 to -0.07; P=0.16), VAS at 48 h (SMD= -0.40; 95% CI: -1.47 to 0.67; P=0.46), and PSS at 72 h (SMD= -0.13; 95% CI: -0.52 to -0.25; P=0.50). CONCLUSIONS The results for mortality, recurrence, operative time, and length of postoperative drainage were similar between uniportal and three-port VATS. Uniportal VATS resulted in reduction in postoperative pain and paresthesia as well as an improvement in patients' satisfaction. This meta-analysis indicated that using uniportal VATS to treat spontaneous pneumothorax was safe and feasible, and it may be a better alternative procedure because of its advantage in reducing postoperative pain and paresthesia.
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Affiliation(s)
- Shi-Lei Qin
- 1 Department of Cardiothoracic Surgery, the First Affiliated Hospital of GuangXi Medical University, Nanning 530021, China ; 2 Class 3 in Grade 2009 of GuangXi Medical University, Nanning 530021, China
| | - Jin-Bo Huang
- 1 Department of Cardiothoracic Surgery, the First Affiliated Hospital of GuangXi Medical University, Nanning 530021, China ; 2 Class 3 in Grade 2009 of GuangXi Medical University, Nanning 530021, China
| | - Yan-Long Yang
- 1 Department of Cardiothoracic Surgery, the First Affiliated Hospital of GuangXi Medical University, Nanning 530021, China ; 2 Class 3 in Grade 2009 of GuangXi Medical University, Nanning 530021, China
| | - Lei Xian
- 1 Department of Cardiothoracic Surgery, the First Affiliated Hospital of GuangXi Medical University, Nanning 530021, China ; 2 Class 3 in Grade 2009 of GuangXi Medical University, Nanning 530021, China
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Hirai K, Kawashima T, Takeuchi S, Usuda J. Covering the staple line with a polyglycolic acid sheet after bullectomy for primary spontaneous pneumothorax prevents postoperative recurrent pneumothorax. J Thorac Dis 2015; 7:1978-85. [PMID: 26716036 DOI: 10.3978/j.issn.2072-1439.2015.11.23] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Postoperative recurrent pneumothorax (PORP) can arise after surgery for primary spontaneous pneumothorax (PSP) that is recurrent or involves prolonged air leakage. In this study, which included 265 patients (279 cases) with PSP who underwent surgery at our department, the percentage of patients that did not experience PORP was compared between a group that underwent bullectomy alone (group A) and a group in which the staple line and the surrounding visceral pleura were covered with a PGA sheet after bullectomy (group B) in order to study the utility of PGA sheets for preventing PORP. METHODS Among the patients with PSP who underwent surgery, the cases of 92 patients (98 cases) from Group A and 173 patients (181 cases) from Group B were reviewed retrospectively. The incidence rates of PORP in these two groups were statistically analyzed in addition to the associations between PORP and age, gender, the affected side, height, body weight, height/weight ratio, smoking habits, or the surgical procedure. RESULTS In total, 96.7% of the patients in group B did not suffer PORP, which was significantly higher than the equivalent figure for group A (83.7%, log-rank test: P=0.0003). Moreover, among the examined parameters, only covering the staple line with a PGA sheet was found to be an independent prognostic factor (Cox regression: P=0.0003; HR =0.212; 95% CI, 0.082-0.547). CONCLUSIONS It was revealed that when bullectomy is performed in patients with PSP, wide coverage of the staple line and the surrounding visceral pleura with a PGA sheet significantly reduces the risk of PORP.
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Affiliation(s)
- Kyoji Hirai
- 1 Department of Thoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba 270-1674, Japan ; 2 Meikai Clinic, Chiba, Japan ; 3 Division of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
| | - Tetsuo Kawashima
- 1 Department of Thoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba 270-1674, Japan ; 2 Meikai Clinic, Chiba, Japan ; 3 Division of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
| | - Shingo Takeuchi
- 1 Department of Thoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba 270-1674, Japan ; 2 Meikai Clinic, Chiba, Japan ; 3 Division of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
| | - Jitsuo Usuda
- 1 Department of Thoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba 270-1674, Japan ; 2 Meikai Clinic, Chiba, Japan ; 3 Division of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
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22
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Pompili C, Xiumè F, Hristova R, Salati M, Refai M, Milton R, Brunelli A. Regulated drainage reduces the incidence of recurrence after uniportal video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax: a propensity case-matched comparison of regulated and unregulated drainage. Eur J Cardiothorac Surg 2015; 49:1127-31; discussion 1131. [DOI: 10.1093/ejcts/ezv300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 07/27/2015] [Indexed: 11/13/2022] Open
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23
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Affiliation(s)
- Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
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24
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Tschopp JM, Bintcliffe O, Astoul P, Canalis E, Driesen P, Janssen J, Krasnik M, Maskell N, Van Schil P, Tonia T, Waller DA, Marquette CH, Cardillo G. ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax. Eur Respir J 2015; 46:321-35. [PMID: 26113675 DOI: 10.1183/09031936.00219214] [Citation(s) in RCA: 205] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/17/2015] [Indexed: 12/15/2022]
Abstract
Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons to produce a comprehensive review of available scientific evidence.Smoking remains the main risk factor of PSP. Routine smoking cessation is advised. More prospective data are required to better define the PSP population and incidence of recurrence. In first episodes of PSP, treatment approach is driven by symptoms rather than PSP size. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of PSP recurrence includes pleurodesis. Talc poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc is available. Video-assisted thoracic surgery is preferred to thoracotomy as a surgical approach.In first episodes of PSP, aspiration is required only in symptomatic patients. After a persistent or recurrent PSP, definitive treatment including pleurodesis is undertaken. Future randomised controlled trials comparing different strategies are required.
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Affiliation(s)
- Jean-Marie Tschopp
- Centre Valaisan de Pneumologie, Dept of Internal Medicine RSV, Montana, Switzerland Task Force Chairs
| | - Oliver Bintcliffe
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Philippe Astoul
- Dept of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hospital North Aix-Marseille University, Marseille, France
| | - Emilio Canalis
- Dept of Surgery, University of Rovira I Virgili, Tarragona, Spain
| | | | - Julius Janssen
- Dept of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marc Krasnik
- Dept of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Nicholas Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul Van Schil
- Dept of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Thomy Tonia
- Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | - David A Waller
- Dept of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Charles-Hugo Marquette
- Hospital Pasteur CHU Nice and Institute for Research on Cancer and Ageing, University of Nice Sophia Antipolis, Nice, France
| | - Giuseppe Cardillo
- Dept of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy Task Force Chairs
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25
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Rogers T, Ratnayaka K, Schenke WH, Sonmez M, Kocaturk O, Mazal JR, Chen MY, Flugelman MY, Troendle JF, Faranesh AZ, Lederman RJ. Fully percutaneous transthoracic left atrial entry and closure as a potential access route for transcatheter mitral valve interventions. Circ Cardiovasc Interv 2015; 8:e002538. [PMID: 26022536 DOI: 10.1161/circinterventions.114.002538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous access for mitral interventions is currently limited to transapical and transseptal routes, both of which have shortcomings. We hypothesized that the left atrium could be accessed directly through the posterior chest wall under imaging guidance. METHODS AND RESULTS We tested percutaneous transthoracic left atrial access in 12 animals (10 pigs and 2 sheep) under real-time magnetic resonance imaging or x-ray fluoroscopy plus C-arm computed tomographic guidance. The pleural space was insufflated with CO2 to displace the lung, an 18F sheath was delivered to the left atrium, and the left atrial port was closed using an off-the-shelf nitinol cardiac occluder. Animals were survived for a minimum of 7 days. The left atrial was accessed, and the port was closed successfully in 12/12 animals. There was no procedural mortality and only 1 hemodynamically insignificant pericardial effusion was observed at follow-up. We also successfully performed the procedure on 3 human cadavers. A simulated trajectory to the left atrium was present in all of 10 human cardiac computed tomographic angiograms analyzed. CONCLUSIONS Percutaneous transthoracic left atrial access is feasible without instrumenting the left ventricular myocardium. In our experience, magnetic resonance imaging offers superb visualization of anatomic structures with the ability to monitor and address complications in real-time, although x-ray guidance seems feasible. Clinical translation seems realistic based on human cardiac computed tomographic analysis and cadaver testing. This technique could provide a direct nonsurgical access route for future transcatheter mitral implantation.
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Affiliation(s)
- Toby Rogers
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Kanishka Ratnayaka
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - William H Schenke
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Merdim Sonmez
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Ozgur Kocaturk
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Jonathan R Mazal
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Marcus Y Chen
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Moshe Y Flugelman
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - James F Troendle
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Anthony Z Faranesh
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.)
| | - Robert J Lederman
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research (T.R., K.R., W.H.S., M.S., O.K., J.R.M., M.Y.C., A.Z.F., R.J.L.) and Office of Biostatistics Research, Division of Cardiovascular Sciences (J.F.T.), National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Department of Cardiology, Children's National Medical Center, Washington DC (K.R.); Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey (O.K.); and Department of Cardiology, Carmel Medical Center, Haifa, Israel (M.Y.F.).
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Scanagatta P, Sestini S, Duranti L, Piccioni F. eComment. A bicycle inner tube in a glass of water! Video-assisted thoracoscopic surgery for spontaneous pneumothorax and the submersion test. Interact Cardiovasc Thorac Surg 2015; 20:652-3. [PMID: 25911370 DOI: 10.1093/icvts/ivv052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paolo Scanagatta
- Division of Thorac Surg and Department of Anesthesia, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Sestini
- Division of Thorac Surg and Department of Anesthesia, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Leonardo Duranti
- Division of Thorac Surg and Department of Anesthesia, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federico Piccioni
- Division of Thorac Surg and Department of Anesthesia, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Paliouras D, Barbetakis N, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Kioumis I, Pitsiou G, Papaiwannou A, Karavergou A, Lampaki S, Katsikogiannis N, Mpakas A, Tsakiridis K, Korantzis I, Fassiadis N, Zarogoulidis K, Zarogoulidis P. Video-assisted thoracic surgery and pneumothorax. J Thorac Dis 2015; 7:S56-61. [PMID: 25774310 DOI: 10.3978/j.issn.2072-1439.2015.01.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/09/2015] [Indexed: 12/12/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) is a type of thoracic surgery performed using a small video camera that is introduced into the patient's chest via a scope. It is considered a minimally invasive technique where the surgeon is able to view the instruments that are being used along with the anatomy on which the surgeon is operating. The camera and instruments are inserted through separate holes in the chest wall also known as "ports", depending on the patient and problem there are surgeries with one port "uniport", two or three ports. These small ports have the advantage that fewer infections are observed. This allows for a faster recovery. Traditionally, thoracic surgery performed for diagnosis or treatment of chest conditions has required access to the chest through thoracotomy or sternotomy incisions. Vats minimally invasive technique has replaced in many cases thoracotomy or sternotomy. In our current review we will present this technique in detail.
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Affiliation(s)
- Dimitrios Paliouras
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Nikolaos Barbetakis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - George Lazaridis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Sofia Baka
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Ioannis Mpoukovinas
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Vasilis Karavasilis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Ioannis Kioumis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Georgia Pitsiou
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Antonis Papaiwannou
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Anastasia Karavergou
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Sofia Lampaki
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Nikolaos Katsikogiannis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Andreas Mpakas
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Kosmas Tsakiridis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Ipokratis Korantzis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Nikolaos Fassiadis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Konstantinos Zarogoulidis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Paul Zarogoulidis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
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How CH, Chen JS. Chemical pleurodesis for first presentation of primary spontaneous pneumothorax. CURRENT PULMONOLOGY REPORTS 2015. [DOI: 10.1007/s13665-015-0103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Madani A, Ferri L, Seely A. Pleural Disorders. POCKET MANUAL OF GENERAL THORACIC SURGERY 2015. [PMCID: PMC7123486 DOI: 10.1007/978-3-319-17497-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
This chapter provides an overview of both benign and malignant pleural disorders, starting with the relevant anatomy and physiology. The focus is on the management of pneumothoraces and pleural effusions—conditions that are commonly encountered on a general thoracic surgery service. The pleural cavity is lined by parietal and visceral pleura, which are smooth membranes that are continuous with one another at the hilum and pulmonary ligaments.
Parietal Pleura: innermost chest wall layer, divided into cervical, costal, mediastinal and diaphragmatic pleura.
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Affiliation(s)
| | | | - Andrew Seely
- The Ottawa Hospital – General Campus, University of Ottawa, Ottawa, Ontario Canada
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Dadaş E, Özkan B, Sabuncu T, Tanju S, Toker A, Dilege Ş. Video-Assisted Thoracoscopic Pleurectomy in Spontaneous Pneumothorax Surgery. Turk Thorac J 2015; 16:22-27. [PMID: 29404073 DOI: 10.5152/ttd.2014.4475] [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: 09/22/2014] [Accepted: 11/04/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Published experiences with thoracoscopic apical or total pleurectomy for patients with a pneumothorax are limited. We aimed to evaluate the long-term results and effectiveness of pleurectomy in our patients, that vast majority of whom underwent thoracoscopic apical or total pleurectomy. MATERIAL AND METHODS Between January 2001 and December 2010, in the Istanbul University Medical School Department of Thoracic Surgery, 67 patients, consisting of 52 patients with a primary spontaneous pneumothorax and 15 with a secondary spontaneous pneumothorax who underwent 72 processes of thoracoscopic resection of blebs or bullae and pleural symphysis, consisting of 43% total pleurectomy, 42% apical pleurectomy plus pleural abrasion, and 15% non-pleurectomy pleurodesis procedures due to prolonged air leak or recurrent spontaneous pneumothorax, were analyzed retrospectively. The applied pleural procedures were: 1. total pleurectomy 2. apical pleurectomy and pleural abrasion for the remaining parts and 3. non-pleurectomy pleurodesis procedures. The long-term outcomes of patients undergoing the three different pleural procedures were compared. RESULTS Total pleurectomy process, apical pleurectomy and abrasion process for remaining parietal pleura, and non-pleurectomy pleurodesis procedures were performed 31, 30, and 11 times, respectively. No recurrence was observed in the total pleurectomy group, 1 recurrence was observed for the apical pleurectomy plus pleural abrasion group, and 2 recurrences were observed for the non-pleurectomy group. CONCLUSION Video-assisted thoracoscopic pleurectomy is a safe and effective method in spontaneous pneumothorax surgery. Especially, total pleurectomy has efficient results in the prevention of recurrences.
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Affiliation(s)
- Erdoğan Dadaş
- Department of Chest Surgery, Adıyaman University Faculty of Medicine, Adıyaman, Turkey
| | - Berker Özkan
- Department of Chest Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Timuçin Sabuncu
- Clinic of Cardiovascular Surgery Adıyaman Training and Research Hospital, Adıyaman, Turkey
| | - Serhan Tanju
- Clinic of Chest Surgery, Vehbi Koç Vakfı American Hospital, İstanbul, Turkey
| | - Alper Toker
- Department of Chest Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Şükrü Dilege
- Department of Chest Surgery, Koç University Faculty of Medicine, İstanbul, Turkey
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Staple Line Coverage After Bullectomy for Primary Spontaneous Pneumothorax: A Randomized Trial. Ann Thorac Surg 2014; 98:2005-11. [DOI: 10.1016/j.athoracsur.2014.06.047] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 06/03/2014] [Accepted: 06/11/2014] [Indexed: 11/24/2022]
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Goto T, Kadota Y, Mori T, Yamashita SI, Horio H, Nagayasu T, Iwasaki A. Video-assisted thoracic surgery for pneumothorax: republication of a systematic review and a proposal by the guideline committee of the Japanese association for chest surgery 2014. Gen Thorac Cardiovasc Surg 2014; 63:8-13. [PMID: 25182971 DOI: 10.1007/s11748-014-0468-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this consensus conference was to determine whether video-assisted thoracic surgery (VATS) improves clinical outcomes compared with conventional thoracotomy in patients undergoing surgery for pneumothorax, and to outline evidence-based recommendations for the use of VATS. METHODS Before the consensus conference, the best available evidence was reviewed, with systematic reviews, randomized trials, and nonrandomized trials all taken into consideration in descending order of validity and importance. At the consensus conference, evidence-based interpretative statements were created, and consensus processes were used to determine the ensuing recommendations. The Medical Information Network Distribution Service in Japan (Minds) system was used to label the levels of evidence for the references and the classes of recommendations. RESULTS AND RECOMMENDATIONS The consensus panel agreed upon the following statements and recommendations for patients with pneumothorax undergoing surgery: 1. VATS is broadly indicated as surgery for pneumothorax. 2. VATS is judged to be less invasive, as it results in minimal postoperative pain, the periods of chest tube placement and hospitalization are short, and it shows a trend toward early realization of social integration. 3. There is no difference in terms of safety and complications between VATS and open thoracotomy. 4. As it is anticipated that VATS will result in a higher recurrence rate than open thoracotomy, it may be desirable to add a supplemental procedure during surgery. In summary, VATS can be recommended as pneumothorax surgery (Recommendation grade: Level B).
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Affiliation(s)
- Taichiro Goto
- Guidelines Committees of Japanese Association for Chest Surgery, Kyoto, Japan,
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How CH, Tsai TM, Kuo SW, Huang PM, Hsu HH, Lee JM, Chen JS, Lai HS. Chemical pleurodesis for prolonged postoperative air leak in primary spontaneous pneumothorax. J Formos Med Assoc 2014; 113:284-90. [DOI: 10.1016/j.jfma.2012.12.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 12/24/2012] [Accepted: 12/27/2012] [Indexed: 10/27/2022] Open
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Tsou KC, Huang PM, Hsu HH, Chen KC, Kuo SW, Lee JM, Chang YC, Chen JS, Lai HS. Role of computed tomographic scanning prior to thoracoscopic surgery for primary spontaneous pneumothorax. J Formos Med Assoc 2014; 113:606-11. [PMID: 24709294 DOI: 10.1016/j.jfma.2014.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/03/2014] [Accepted: 02/27/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/PURPOSE The role computed tomography (CT) performed prior to thoracoscopic surgery for primary spontaneous pneumothorax (PSP) remains unclear. METHODS We retrospectively reviewed medical records of all patients who underwent thoracoscopic surgery for PSP during 2008-2012. Patients were stratified into two groups: CT group (patients who received preoperative CT scanning) and control group (patients who did not receive preoperative scanning). Short-term postoperative results and long-term pneumothorax recurrence rates were compared. RESULTS A total of 298 patients were studied. Preoperative CT scanning was performed in 140 of them. The duration of operation, incidence of bullae formation, number of excised specimens, rate of complications, and postoperative hospital stay were similar between the two groups. After a mean follow-up of 20 months, the recurrence rates were 8.6% (12/140) in the CT group and 5.7% (9/158) in the control group (p = 0.371). In the CT group, five patients had unexpected pulmonary findings and three of them (60%) developed pneumothorax recurrence, the rate of which was significantly higher than that in patients without unexpected pulmonary findings (9/135, 6.7%, p = 0.004). Unexpected pulmonary lesions were more commonly noted in females (4/19, 21.1%) than in males (1/121, 0.8%; p < 0.001). CONCLUSION Preoperative CT scanning was not associated with better results after thoracoscopic surgery for PSP and is, therefore, not justified as a routine examination prior to the operation. In female patients, however, preoperative CT scanning might be needed because these patients tended to have a higher incidence of unexpected pulmonary lesions, which were associated with a higher rate of recurrence.
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Affiliation(s)
- Kuan-Chuan Tsou
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Ming Huang
- 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
| | - Ke-Cheng Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shuenn-Wen Kuo
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jang-Ming Lee
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, 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.
| | - Hong-Shiee Lai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Igai H, Kamiyoshihara M, Ibe T, Kawatani N, Shimizu K. Single-incision thoracoscopic surgery for spontaneous pneumothorax using multi-degrees of freedom forceps. Ann Thorac Cardiovasc Surg 2014; 20:974-9. [PMID: 24492179 DOI: 10.5761/atcs.oa.13-00278] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The objective of this study was to assess the perioperative results of a single-incision approach using multi-DOF forceps for spontaneous pneumothorax, in comparison with the traditional 3-port approach. METHODS Between May 2012 and June 2013, 44 patients with spontaneous pneumothorax underwent SITS, and their clinical characteristics and perioperative results were evaluated. We then compared those who had undergone SITS (SITS group) with those who had undergone traditional 3-port surgery before the study period (3-port group). RESULTS The two groups were similar in terms of mean patient age and pneumothorax laterality (p = 0.81, 0.38), but the proportion of male patients was higher in the 3-port group than in the SITS group (p = 0.0026). Operation time in the SITS group (52.4 min) was longer than in the 3-port group (35.9 min, p <0.0001). The duration of postoperative drainage and hospital stay did not differ significantly between the groups (p = 0.19, 0.075). Although 14 of the 56 SITS patients (25%) showed mild adhesion in the pleural cavity, none required conversion to a 3-port approach. The bullous region in two or three lobes was resected in 23 patients (41%). CONCLUSIONS SITS using multi-DOF forceps is a useful approach for treatment of spontaneous pneumothorax in selected patients.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan
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Kawaguchi T, Kushibe K, Yasukawa M, Kawai N. Can preoperative imaging studies accurately predict the occurrence of bullae or blebs? Correlation between preoperative radiological and intraoperative findings. Respir Investig 2013; 51:224-228. [PMID: 24238230 DOI: 10.1016/j.resinv.2013.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 03/27/2013] [Accepted: 04/19/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Radiological findings of patients with primary spontaneous pneumothorax (PSP) undergoing surgery have not been well analyzed. The aim of this study was to evaluate the accuracy of imaging studies for predicting the presence of emphysema-like changes (ELCs) detectable during surgery. METHODS Ninety-three PSP patients who underwent surgery from September 2005 to October 2009 were included in the study. We analyzed preoperative chest radiographic and computed tomographic (CT) findings, and compared the findings with intraoperative detection of ELCs. Chest radiographic findings were analyzed by classifying the PSP size into three categories: small, moderate, and complete. RESULTS Seventy-six of the 93 patients (82%) had ELCs detected during surgery. The size of the PSP on a radiograph was significantly correlated with the presence of ELCs (p=0.0121). Preoperative CT revealed 64 of the 76 ELCs (sensitivity, 84%; specificity, 100%; accuracy, 87%). Twenty-nine patients without ELCs detected by preoperative CT were analyzed separately. In this group, a larger PSP size also increased the likelihood of ELCs being present (p=0.0049). Seven patients (8%) experienced a recurrence after surgery. No factor could significantly predict recurrence. CONCLUSIONS Chest CT analysis alone was associated with a false-negative rate of about 15% for ELCs. Combining the analysis of chest radiographic and CT findings could improve sensitivity.
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Affiliation(s)
- Takeshi Kawaguchi
- Department of Thoracic Surgery, Nara Prefectural Nara Hospital, Japan; Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Japan.
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How CH, Hsu HH, Chen JS. Chemical pleurodesis for spontaneous pneumothorax. J Formos Med Assoc 2013; 112:749-55. [PMID: 24268613 DOI: 10.1016/j.jfma.2013.10.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/16/2013] [Accepted: 10/17/2013] [Indexed: 11/29/2022] Open
Abstract
Pneumothorax is defined as the presence of air in the pleural cavity. Spontaneous pneumothorax, occurring without antecedent traumatic or iatrogenic cause, is sub-divided into primary and secondary. The severity of pneumothorax could be varied from asymptomatic to hemodynamically compromised. Optimal management of this benign disease has been a matter of debate. In addition to evacuating air from the pleural space by simple aspiration or chest tube drainage, the management of spontaneous pneumothorax also focused on ceasing air leakage and preventing recurrences by surgical intervention or chemical pleurodesis. Chemical pleurodesis is a procedure to achieve symphysis between the two layers of pleura by sclerosing agents. In the current practice guidelines, chemical pleurodesis is reserved for patients unable or unwilling to receive surgery. Recent researches have found that chemical pleurodesis is also safe and effective in preventing pneumothorax recurrence in patients with the first episode of spontaneous pneumothorax or after thoracoscopic surgery and treating persistent air leakage after thoracoscopic surgery. In this article we aimed at exploring the role of chemical pleurodesis for spontaneous pneumothorax, including ceasing air leakage and preventing recurrence. The indications, choice of sclerosants, safety, effects, and possible side effects or complications of chemical pleurodesis are also reviewed here.
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Affiliation(s)
- Cheng-Hung How
- 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 Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Li KK, Chan S, Chum HL, Thung KH, Ko KM. Single-port video-assisted thoracic surgical pleurodesis for primary spontaneous pneumothorax. SURGICAL PRACTICE 2013. [DOI: 10.1111/1744-1633.12031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ki-Kwong Li
- Department of Surgery; Tuen Mun Hospital; Hong Kong
| | - Shun Chan
- Department of Surgery; Tuen Mun Hospital; Hong Kong
| | | | | | - Kai-Ming Ko
- Department of Surgery; Tuen Mun Hospital; Hong Kong
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Yoon JS, Choi SY, Suh JH, Jeong JY, Lee BY, Park YG, Kim CK, Park CB. Tension pneumothorax, is it a really life-threatening condition? J Cardiothorac Surg 2013; 8:197. [PMID: 24128176 PMCID: PMC4016536 DOI: 10.1186/1749-8090-8-197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 10/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tension pneumothorax is a life-threatening occurrence that is infrequently the consequence of spontaneous pneumothorax. The aim of this study was to identify the risk factors for the development of tension pneumothorax and its effect on clinical outcomes. METHODS We reviewed patients who were admitted with spontaneous pneumothorax between August 1, 2003 and December 31, 2011. Electronic medical records and the radiological findings were reviewed with chest x-ray and high-resolution computed tomography scans that were retrieved from the Picture Archiving Communication System. RESULTS Out of the 370 patients included in this study, tension pneumothorax developed in 60 (16.2%). The bullae were larger in patients with tension pneumothorax than in those without (23.8 ± 16.2 mm vs 16.1 ± 19.1 mm; P = 0.007). In addition, the incidence of tension pneumothorax increased with the lung bulla size. Fibrotic adhesion was more prevalent in the tension pneumothorax group than in that without (P = 0.000). The bullae were large in patients with fibrotic adhesion than in those without adhesion (35.0 ± 22.3 mm vs 10.4 ± 11.5 mm; P = 0.000). On multivariate analysis, the size of bullae (odds ratio (OR) = 1.03, P = 0.001) and fibrotic adhesion (OR = 10.76, P = 0.000) were risk factors of tension pneumothorax. Hospital mortality was 3.3% in the tension pneumothorax group and it was not significantly different from those patients without tension pneunothorax (P = 0.252). CONCLUSIONS Tension pneumothorax is not uncommon, but clinically fatal tension pneumothorax is extremely rare. The size of the lung bullae and fibrotic adhesion contributes to the development of tension pneumothorax.
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Affiliation(s)
| | | | | | | | | | | | | | - Chan Beom Park
- Department of Thoracic and Cardiovascular Surgery, Incheon St, Mary's Hospital, The Catholic University of Korea, 665-8, Bupyeong-dong, Bupyeong-gu, Incheon 403-720, Republic of Korea.
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Matsumoto K, Sano I, Taniguchi H, Yamasaki N, Tsuchiya T, Miyazaki T, Tomoshige K, Nagayasu T. Thoracoscopic surgery for lung emphysema using an infrared camera. J Cardiothorac Surg 2013; 8:134. [PMID: 23705766 PMCID: PMC3679844 DOI: 10.1186/1749-8090-8-134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 02/19/2013] [Indexed: 11/25/2022] Open
Abstract
Localized emphysema is difficult to detect on normal thoracoscopy. Indocyanine green (ICG) was used to precisely delineate an emphysematous lesion using an infrared camera system in a 75-year-old woman with a large emphysematous lesion in the right lower lobe. Due to repeated infections of the emphysematous lesion, right basal segmentectomy for localized lung emphysema was performed. During surgery, ICG (0.5 mg/kg) was injected intravenously, and the emphysematous lesion was detected as a fluorescence defect. This method could be used for precise resection of large emphysematous lesions because it permits clear detection with a small amount of ICG.
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Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in children. Pediatr Surg Int 2013; 29:505-9. [PMID: 23400267 DOI: 10.1007/s00383-013-3273-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE There is controversy regarding the best way to prevent recurrences of primary spontaneous pneumothorax (PSP) in children. The purpose of this study was to evaluate the efficacy of video-assisted thoracoscopic surgery (VATS) for pediatric PSP. METHODS We retrospectively reviewed patients under 29 years of age who underwent VATS for PSP between March 2005 and February 2011. Patients were divided into 2 groups: children (under the age of 17 years) and young adults (over the age of 18 years). RESULTS Two hundred eighty-one VATS procedures in 257 patients were included in this study. The mean follow-up was 47.1 ± 20.5 months. No mortality was observed. The mean duration of pleural drainage was 3.4 ± 2.2 days. The overall recurrence rate was 6.8 %. The operative outcomes did not differ significantly. However, the recurrence rate was significantly higher in the children's group than the young adult group (10.6 vs. 3.9 %, P = 0.032). Younger age and postoperative prolonged air leak had a significantly higher risk of postoperative recurrence. CONCLUSIONS VATS is a safe and effective procedure for PSP in children. However, the risk of recurrence is increased in children and it is related to the formation of new bullae.
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Efficacy of polyglycolic acid sheet after thoracoscopic bullectomy for spontaneous pneumothorax. Ann Thorac Surg 2013; 95:1919-23. [PMID: 23623546 DOI: 10.1016/j.athoracsur.2013.03.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/02/2013] [Accepted: 03/07/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Various procedures have been performed to decrease the incidence of recurrent postoperative pneumothorax after thoracoscopic bullectomy. The purpose of this study was to determine the efficacy of a polyglycolic acid (PGA) sheet and pleural abrasion for prevention of recurrent postoperative pneumothorax. METHODS From January 2009 to August 2011, 257 patients underwent thoracoscopic bullectomy for primary spontaneous pneumothorax. In group A, 128 patients underwent pleural abrasion. These patients were compared with 129 patients (group B) who underwent a procedure to cover stable lines with an absorbable PGA sheet in addition to pleural abrasion. RESULTS There was no difference in preoperative demographics, although the age of patients in group A was statistically higher than that of patients in group B (23.67 ± 6.54 versus 21.69 ± 5.65; p = 0.010). In group A, prolonged postoperative air leaks (≥ 3 days) occurred more frequently (7.8% versus 2.3%; p = 0.045). A Kaplan-Meier curve showed that recurrence-free rates were higher in group B (p = 0.047). CONCLUSIONS Coverage with PGA sheet and pleural abrasion after thoracoscopic bullectomy is effective for preventing prolonged postoperative air leaks and reducing postoperative recurrence rates.
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Clinico-pathological findings in stage-I primary spontaneous pneumothorax: analysis of 19 cases and literature review. Eur Surg 2013. [DOI: 10.1007/s10353-012-0169-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Haraguchi S, Koizumi K, Mikami I, Okamoto J, Iijima Y, Ibi T, Shimizu K. Staple line coverage with a polyglycolic acid sheet plus pleural abrasion by thoracoscopic surgery for primary spontaneous pneumothorax in young patients. J NIPPON MED SCH 2012; 79:139-42. [PMID: 22687357 DOI: 10.1272/jnms.79.139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE We investigated surgical results of staple line coverage with a polyglycolic acid sheet plus pleural abrasion by thoracoscopic surgery for treating primary spontaneous pneumothorax in young patients. METHODS Forty-seven patients younger than 40 years underwent 48 thoracoscopic surgical procedures for spontaneous pneumothorax at the Division of Thoracic Surgery, Department of Surgery, Nippon Medical School, from May 2007 through August 2010. All patients underwent thoracoscopic bullectomy with stapling devices and pleural abrasion performed with a gauze sponge held by forceps until the pleura became petechial. Finally, the staple line was covered with a polyglycolic acid sheet (10 × 10 cm). No fibrin glue was used. We investigated both short-time results after surgery and the postoperative recurrence of pneumothorax. RESULTS There was no operative mortality or morbidity, such as air leakage from staple lines or hemorrhage due to pleural abrasion. Pneumothorax recurred after surgery in 3 cases. In 2 cases, neither re-operation nor tube thoracostomy was necessary because intrapleural adhesions allowed only partial collapse of the lung. One patient underwent re-operation for an overlooked bulla facing the diaphragm in left lower lobe of the lung 2 days after the first operation. The rate of freedom from pneumothorax 4 years after surgery was 94%. CONCLUSIONS Staple line coverage with a polyglycolic acid sheet plus pleural abrasion by thoracoscopic surgery is a useful method for preventing morbidity and the postoperative recurrence of pneumothorax.
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Affiliation(s)
- Shuji Haraguchi
- Department of Biological Regulation and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
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Nonsteroidal antiinflammatory medications: efficient and safe treatment following video-assisted pleurodesis for spontaneous pneumothorax. World J Surg 2012; 35:2563-7. [PMID: 21882030 DOI: 10.1007/s00268-011-1207-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Recurrent spontaneous pneumothorax is widely treated by video-assisted thoracoscopic (VATS) bullectomy and pleurodesis. Treatment of postoperative pain with nonsteroidal antiinflammatory drugs (NSAIDs) is controversial as many surgeons believe that it reduces the efficacy of pleurodesis and increases the pneumothorax recurrence rate. METHODS In this retrospective study, we reviewed the hospital records for patients following VATS pleurodesis for recurrent spontaneous pneumothorax. The patients were divided into two groups: (1) NSAID group: patients were treated with NSAIDs for more than a week following surgery and (2) control group: patients did not receive NSAIDs. Data regarding short- and long-term outcomes were compared. RESULTS The study cohort included 105 patients: 48 in the NSAID group and 57 in the control group. During the early postoperative period the average daily requirement of narcotic analgesia and the incidence of narcotic-related side effects were lower in the NSAIDs group. No difference was found in the long-term recurrence rate: two of 48 (4%) in the NSAID group and three of 57 (5%) in the control group. There was one case of early recurrence in the NSAID group. Both groups had similar length of stay with no cases of mortality or major morbidity. CONCLUSIONS NSAIDs for postsurgical pleurodesis pain obviates the need for narcotics without increasing the pneumothorax recurrence rate. Prospective randomized controlled studies are needed to further investigate this issue.
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Thoracoscopic pleurodesis for primary spontaneous pneumothorax with high recurrence risk: a prospective randomized trial. Ann Surg 2012; 255:440-5. [PMID: 22323011 DOI: 10.1097/sla.0b013e31824723f4] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the efficacy and safety between apical pleurectomy and pleural abrasion with minocycline in primary spontaneous pneumothorax (PSP) with high recurrence risk. BACKGROUND The optimal thoracoscopic pleurodesis procedure for PSP with high recurrence risk remains controversial. METHODS Between January 2006 and May 2009, a total of 369 patients with spontaneous pneumothorax were treated by video-assisted thoracoscopic surgery. After stapled bullectomy, 160 patients with no identifiable bleb or multiple blebs (≥3) were randomly chosen to undergo apical pleurectomy (pleurectomy group, 80 patients) or pleural abrasion with minocycline (abrasion/minocycline group, 80 patients). RESULTS Patients in the pleurectomy group had a longer operation duration (mean, 81.4 minutes vs 55.8 minutes, P < 0.001), a greater amount of operation bleeding (mean, 29.4 mL vs 13.2 mL, P = 0.025), and a greater amount of postoperative chest drainage (mean, 287.4 mL vs 195.8 mL, P = 0.040). Patients in the abrasion/minocycline group had a higher intensity of chest pain and required more frequent meperidine injections. Hemothorax occurred in 3 pleurectomy patients (3.8%). The short-term results showed that the 2 groups had comparable durations of postoperative chest drainage, durations of postoperative hospital stay, and complication rates. After a mean follow-up of 26.1 months, recurrent ipsilateral pneumothorax occurred in 3 patients (3.8%) in the pleurectomy group and 3 patients (3.8%) in the abrasion/minocycline group. Postoperative long-term residual chest pain and pulmonary function were comparable in both groups. CONCLUSIONS : Pleural abrasion with minocycline pleurodesis is as effective as apical pleurectomy and either technique is appropriate for treating PSP patients with high recurrence risk. This trial was registered at http://www.clinicaltrials.gov (ID: NCT00270751).
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Uramoto H, Tanaka F. Natural air leak test without submergence for spontaneous pneumothorax. J Cardiothorac Surg 2011; 6:165. [PMID: 22196849 PMCID: PMC3259056 DOI: 10.1186/1749-8090-6-165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 12/24/2011] [Indexed: 11/30/2022] Open
Abstract
Background Postoperative air leaks are frequent complications after surgery for a spontaneous pneumothorax (SP). We herein describe a new method to test for air leaks by using a transparent film and thoracic tube in a closed system. Method Between 2005 and 2010, 35 patients underwent a novel method for evaluating air leaks without submergence, and their clinical records were retrospectively reviewed. The data on patient characteristics, surgical details, and perioperative outcomes were analyzed. Results The differences in the clinical background and intraoperative factors did not reach a statistically significant level between the new and classical methods. The incidence of recurrence was also equivalent to the standard method. However, the length of the operation and drainage periods were significantly shorter in patients evaluated using the new method than the conventional method. Further, no postoperative complications were observed in patients evaluated using the new method. Conclusions This simple technique is satisfactorily effective and does not result in any complications.
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Affiliation(s)
- Hidetaka Uramoto
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807, Japan.
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Chou SH, Chuang IC, Huang MF, Chang SJ, Li HP, Lee JY, Lee YL, Chiang HH. Comparison of needlescopic and conventional video-assisted thoracic surgery for primary spontaneous pneumothorax. MINIM INVASIV THER 2011; 21:168-72. [PMID: 21574829 DOI: 10.3109/13645706.2011.580763] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Whether the outcome of primary spontaneous pneumothorax (PSP) when treated with needlescopic video-assisted thoracic surgery is positive is still under scrutiny. The present study was conducted to compare the needlescopic approach with the conventional approach. One-hundred and six patients with primary spontaneous pneumothorax who had undergone needlescopic video-assisted thoracic surgery (NVATS) between May 2006 and August 2008 were reviewed. Their age, gender, smoking status, BMI, side of attack, operative indications, operative time, intraoperative blood loss, postoperative length of stay, postoperative pain in visual analog scale (VAS), postoperative recurrence and follow-up period were recorded. These data were compared with those of 89 patients with PSP who had undergone conventional video-assisted thoracic surgery (CVATS) between June 2002 and April 2006. The operative time was shorter (NVATS: 82.36 ± 35.58 min, CVATS: 99.78 ± 35.74 min; p = 0.008) and intraoperative blood loss was less (NVATS: 16.67 ± 25.90 ml, CVATS: 24.36 ± 26.86 ml; p = 0.04) for the NVATS group. The postoperative pain in VAS was significantly less in NVATS. No major complication or mortality was found in either group. For treatment of primary spontaneous pneumothorax, NVATS is a safe and effective option. Further, it has the added benefit of less pain and improved cosmetics.
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Affiliation(s)
- Shah-Hwa Chou
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Funai K, Suzuki K, Shimizu K, Shiiya N. Ablation of weak emphysematous visceral pleura by an ultrasonically activated device for spontaneous pneumothorax. Interact Cardiovasc Thorac Surg 2011; 12:908-11. [PMID: 21388985 DOI: 10.1510/icvts.2010.264044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Staple bullectomy is widely performed for the thoracoscopic treatment of spontaneous pneumothorax. When weak emphysematous change was observed to extend to the whole pleura around the localized bulla, weak emphysematous pleura always remain around the stapler after bullectomy. Such cases along with weak pleural surfaces around staplers belong to the groups at high risk of postoperative recurrence. We performed thoracoscopic ablation using an ultrasonically activated device (USAD) for such lesions and studied the efficacy. From April 2002 to December 2006, a total of 85 surgeries for spontaneous pneumothorax were performed in this hospital, of which 34 cases underwent ablation with a USAD for a weak pleural surface. No complications due to ablation were observed. Recurrence was observed in four subjects, but the cause of recurrence was the regeneration of a bulla outside the range of the ablation and was unrelated to the ablation itself. Moreover, significant white pleural thickening was observed at the ablation sites, demonstrating a stiffening effect of the weak visceral pleura. Ablation using a USAD is a safe and easy operative method, and it is an appropriate operative system as a stiffening procedure for a visceral pleura.
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Affiliation(s)
- Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan.
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Gygax-Genero M, Manen O, Chemsi M, Bisconte S, Dubourdieu D, Vacher A, Brocq FX, Leduc PA, Deroche J, Boussif M, Perrier E, Gourbat JP. [Treatment specifics for spontaneous pneumothorax in flight personnel]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:302-307. [PMID: 21087725 DOI: 10.1016/j.pneumo.2010.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 06/24/2010] [Indexed: 05/30/2023]
Abstract
Spontaneous pneumothorax is one cause of aeronautical unfitness in flight personnel, because of the risk of recurrence in flight, making it an issue of flight safety. Specific treatment is required for fighter pilots, pilots flying single-pilot and pilots in professional training: surgical synthesis via video-thoracoscopy is obligatory from the first episode. Considering the exposure to an accumulation of aeronautical factors that are likely to encourage pneumothorax recurrence in flight, it is apical pleurectomy together with abrasion of the remaining pleura and resection of bullae/blebs that is required for fighter pilots to allow them to recover aeronautical fitness unrestrictedly. For all other categories of flight personnel, treatment is no different from that of the common patient. Knowledge of these treatment specifics is essential, to avoid unnecessary systematic surgical indication for all flight personnel, or jeopardise professional fitness in some of them due to inappropriate treatment.
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Affiliation(s)
- M Gygax-Genero
- Centre principal d'expertise médicale du personnel navigant, hôpital d'instruction des armées Percy, Ilôt Percy, Clamart, France.
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