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Takamori S, Takenaka T, Shimokawa M, Hashinokuchi A, Matsudo K, Nagano T, Kohno M, Miura N, Yoshizumi T. Maximum resistance pressure at the time of lung tissue rupture after porcine lung transection using automatic linear staplers with different reinforcement methods. Surg Today 2024:10.1007/s00595-024-02858-2. [PMID: 38691222 DOI: 10.1007/s00595-024-02858-2] [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: 11/30/2023] [Accepted: 04/08/2024] [Indexed: 05/03/2024]
Abstract
PURPOSES Polyglycolic acid (PGA) sheets, fibrin glue, and staple line reinforcement are frequently used to prevent air leakage during lung resection. However, the optimal staple-line reinforcement method remains unclear. METHODS Cranial lung lobes of pigs were used to evaluate different staple line reinforcement methods (n = 6). Ventilator-assisted manometry was used to measure the maximum resistance pressure at the time of rupture of the lung tissue after stapling. RESULTS The mean maximum resistance pressures at the time of lung tissue rupture after using the stapler alone, stapler with PGA sheet and fibrin glue, and stapler with reinforcement were 38.0 cmH2O, 51.3 cmH2O, and 62.7 cmH2O, respectively. A significant increase in the maximum resistance pressure was observed with stapler reinforcement (P < 0.001), while the differences between the other groups were not statistically significant (P = 0.055, P = 0.111). A histological assessment revealed disruption of alveolar structures near the needle-stitching site in the stapler alone, and in the stapler with PGA sheet and fibrin glue groups. Pleural rupture near the staple line was observed in the stapler with reinforcement group. CONCLUSIONS The maximum resistance pressure before air leakage was significantly higher when using a stapler with reinforcement than when using a stapler alone.
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Affiliation(s)
- Shinkichi Takamori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Faculty of Medicine, Department of Thoracic and Breast Surgery, Oita University, Oita, Japan
| | - Tomoyoshi Takenaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Asato Hashinokuchi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kyoto Matsudo
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Taichi Nagano
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Mikihiro Kohno
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Naoko Miura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Initial Airtightness of the Lung Parenchyma After Transection of the Interlobar Fissure - Monopolar Cutter, Stapler Versus Nd: YAG Laser. J Surg Res 2022; 278:79-85. [PMID: 35594618 DOI: 10.1016/j.jss.2022.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Every lobectomy requires the transection of the interlobar fissure. Resection surfaces must be airtight in order to avoid leakage and infection. Using an ex vivo model based on porcine lung, we compared three techniques with respect to initial airtightness at different inspiratory pressures. MATERIALS AND METHODS In the first technique (group 1), we transected the interlobar fissure with a monopolar cutter and overstitched the edges of the resection area with a monofilament thread. In the second technique (group 2), the interlobar fissure was cut with a stapling device. In the third technique (group 3), the interlobar fissure was cut using a laser fibre connected to an Nd: YAG laser. The resection areas were not overstitched; 15 transections were performed in each group. RESULTS In group 1, three parenchymatous bridges leaked starting at a pressure of 25 mbar. In the other two groups, all preparations were airtight at this pressure. If the ventilation pressure was increased up to 40 mbar, all seams in group 1 were leaky at a pressure of 35 mbar. Four staple seams were airtight at a pressure of 40 mbar. In group 3, 11 preparations (73.3 %) were airtight up to a pressure of 40 mbar. CONCLUSIONS Based on our results, the use of an Nd: YAG laser is suitable for the transection of the interlobar fissure. In effect, this technique compares well with the other techniques examined.
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The Evolving Landscape of Lung Cancer Surgical Resection: An Update for Radiologists With Focus on Key Chest CT Findings. AJR Am J Roentgenol 2021; 218:52-65. [PMID: 34406062 DOI: 10.2214/ajr.21.26408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Evolution of the multimodality management of early lung cancer, including progress in surgical techniques, has introduced the possibility of resection for lung cancer cases that historically were considered unresectable (e.g., select cases of T4 disease and oligometastatic disease). However, the TNM classification does not uniformly correlate with lung cancer operability and resectability. Radiologic evaluation is therefore critical in identifying patients' suitability to undergo lung cancer resection and in guiding the selection of a surgical approach from among a range of such approaches, including wedge resection, segmentectomy, lobectomy, bilobectomy, and pneumonectomy. The radiologist must understand the available surgical options, along with their advantages and disadvantages, and provide a report that includes critical information on tumor size, location, and extension and anatomic relations that may influence the surgical technique. Preoperative CT findings may also help predict expected postoperative lung function and the associated impact on the postoperative course of the patient. This article reviews the role of chest CT in the preoperative evaluation of lung cancer, focusing on the key CT findings that help direct surgical decision making in the context of an expanding range of patients who may be considered candidates for resection.
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Ishigaki K, Höglund OV, Asano K. Resorbable self-locking device for canine lung lobectomy: A clinical and experimental study. Vet Surg 2021; 50 Suppl 1:O32-O39. [PMID: 33687090 DOI: 10.1111/vsu.13623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To test the feasibility of a resorbable self-locking device for sealing of lung tissue in lung lobectomy in experimental dogs and dogs with pulmonary mass, and to study its resorption with CT. STUDY DESIGN Experimental study and clinical case series. ANIMALS Five beagles in the experimental group; six canine patients with a pulmonary mass in the clinical group. METHODS In both groups, an intercostal incision into thorax was performed. A resorbable self-locking device, LigaTie, was applied at the hilum of left cranial lobe in the experimental group and the affected lobe in the clinical group. Each lobe was removed by cutting the tissue just distal to the device. Video-assisted thoracic surgery was used in the experimental group; postoperative diagnostic imaging was repeated monthly until the device was not apparent on CT. RESULTS Application of LigaTie was feasible for lung lobectomy in all dogs. The device enabled en bloc ligation of the hilum of the affected lobe including the pulmonary arteries and veins and lobular bronchus. No air leakage from the resection stump was observed in any dog. Trace of the device on CT images gradually decreased and was undetectable at 4 months postoperatively in experimental dogs. CONCLUSION This study suggested that the resorbable self-locking device may be used for sealing of airways in complete lung lobectomy. CLINICAL RELEVANCE The resorbable self-locking device is suggested to be useful for canine lung lobectomy and may facilitate thoracoscopic lung lobectomy. Further investigations on its clinical application in small animal surgery are warranted.
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Affiliation(s)
- Kumiko Ishigaki
- Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Fujisawa, Japan
| | - Odd Viking Höglund
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Kazushi Asano
- Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Fujisawa, Japan
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Deguchi H, Tomoyasu M, Shigeeda W, Kaneko Y, Kanno H, Saito H. Reduction of air leakage using linear staple device with bioabsorbable polyglycolic acid felt for pulmonary lobectomy. Gen Thorac Cardiovasc Surg 2019; 68:266-272. [DOI: 10.1007/s11748-019-01207-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022]
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Guedes RL, Höglund OV, Brum JS, Borg N, Dornbusch PT. Resorbable Self-Locking Implant for Lung Lobectomy Through Video-Assisted Thoracoscopic Surgery: First Live Animal Application. Surg Innov 2018; 25:158-164. [DOI: 10.1177/1553350617751293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rogério Luizari Guedes
- Federal University of Paraná, Curitiba, Paraná, Brazil
- Tuiuti University of Paraná, Curitiba, Paraná, Brazil
| | - Odd Viking Höglund
- Swedish University of Agricultural Sciences, Uppsala, Sweden
- Resorbable Devices AB, Uppsala, Sweden
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Medical and Economic Evaluation of FOREseal Bioabsorbable Reinforcement Sleeves Compared With Current Standard of Care for Reducing Air Leakage Duration After Lung Resection for Malignancy. Ann Surg 2017; 265:45-53. [DOI: 10.1097/sla.0000000000001687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Samejima J, Mun M, Matsuura Y, Nakao M, Uehara H, Nakagawa K, Masuda M, Okumura S. Thoracoscopic anterior 'fissure first' technique for left lung cancer with an incomplete fissure. J Thorac Dis 2016; 8:3105-3111. [PMID: 28066589 DOI: 10.21037/jtd.2016.11.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dealing with incomplete lung fissures during thoracoscopic surgery is difficult. Our objective was to evaluate the efficacy and safety of a thoracoscopic anterior 'fissure first' technique for dealing with incomplete left lung fissures. METHODS One hundred and seventy patients underwent left upper lobectomy or left lower lobectomy between April 2008 and July 2014. Of these, 34 patients underwent surgery using a thoracoscopic anterior 'fissure first' technique for incomplete fissures (group A) and 136 underwent surgery using a conventional thoracoscopic method for unfused fissures (group B). A four-port complete thoracoscopic approach was used in all patients. After completion of the fissure, hilar lymphadenectomy was performed in the conventional manner. RESULTS There were no significant differences between the two groups in operating time, blood loss, or duration of chest tube drainage. Patients in group A required more staple cartridges than those in group B (mean number of cartridges, 2.4 vs. 1.1; P<0.01). The two groups did not significantly differ with regard to the prevalence of air leaks (12% vs. 4%; P=0.11), either prolonged or delayed. CONCLUSIONS We found that a thoracoscopic anterior 'fissure first' technique for left lung cancer with an incomplete fissure enabled hilar lymphadenectomy to be performed in the conventional manner without any increase in the prevalence of air leaks, operating time, or duration of chest tube drainage. This technique should be considered for use in left upper lobectomy or left lower lobectomy in patients with an incomplete fissure.
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Affiliation(s)
- Joji Samejima
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan;; Department of Surgery, Yokohama City University School of Medicine, Kanagawa, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hirofumi Uehara
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ken Nakagawa
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University School of Medicine, Kanagawa, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Miller DL, Helms GA, Mayfield WR. Digital Drainage System Reduces Hospitalization After Video-Assisted Thoracoscopic Surgery Lung Resection. Ann Thorac Surg 2016; 102:955-961. [DOI: 10.1016/j.athoracsur.2016.03.089] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 03/23/2016] [Accepted: 03/28/2016] [Indexed: 12/20/2022]
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Efficacy and safety of Innoseal for air leak after pulmonary resection: a case-control study. J Surg Res 2016; 206:22-26. [PMID: 27916365 DOI: 10.1016/j.jss.2016.06.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Prolonged air leak is one of the most common complications after lung surgery and the cause of prolonged hospital stay frequently associated with major postoperative morbidity and thus responsible for even higher hospital costs. This case-control study was designed to test the sealing efficacy and safety of Enable-Innoseal TP4 in patients undergoing pulmonary resection for lung cancer. METHODS This was a case-control trial enrolling patients with primary or single site metastatic lung cancer scheduled for elective anatomic or nonanatomic pulmonary resection presenting intraoperative grade 1 or 2 air leak at water submersion test; the study group population was then matched 1:1 according to surgical procedure, male/female ratio, preoperative FEV1, and age. RESULTS In the study population, 21 patients (70.0%) presented intraoperative grade 1 air leak and 9 patients grade 2 (30.0%) air leak; after comparison with the control group, we observed a significant shorter time for chest drain removal in the study population (P = 0.0050), whereas no difference was registered in terms of number of days needing for discharge (P = 0.0762). CONCLUSIONS Enable-Innoseal TP4 was effective in treating limited intraoperative air leaks after pulmonary resection and preventing prolonged postoperative air leaks in patients receiving either anatomic or nonanatomic lung resections. Further randomized double-arm studies are required to confirm the efficacy of Enable-Innoseal TP4 demonstrated by this pilot study.
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Konstantinou F, Potaris K, Syrigos KN, Tsipas P, Karagkiouzis G, Konstantinou M. A Novel Technique to Treat Air Leak Following Lobectomy: Intrapleural Infusion of Plasma. Med Sci Monit 2016; 22:1258-64. [PMID: 27079644 PMCID: PMC4835152 DOI: 10.12659/msm.895134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Persistent air leak following pulmonary lobectomy can be very difficult to treat and results in prolonged hospitalization. We aimed to evaluate the efficacy of a new method of postoperative air leak management using intrapleurally infused fresh frozen plasma via the chest tube. Material/Methods Between June 2008 and June 2014, we retrospectively reviewed 98 consecutive patients who underwent lobectomy for lung cancer and postoperatively developed persistent air leak treated with intrapleural instillation of fresh frozen plasma. Results The study identified 89 men and 9 women, with a median age of 65.5 years (range 48–77 years), with persistent postoperative air leak. Intrapleural infusion of fresh frozen plasma was successful in stopping air leaks in 90 patients (92%) within 24 hours, and in 96 patients (98%) within 48 hours, following resumption of the procedure. In the remaining 2, air leak ceased at 14 and 19 days. Conclusions Intrapleural infusion of fresh frozen plasma is a safe, inexpensive, and remarkably effective method for treatment of persistent air leak following lobectomy for lung cancer.
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Affiliation(s)
- Froso Konstantinou
- Oncology Unit, 3rd Internal Medicine Clinic of Athens University, Sotiria General Hospital, Athens, Greece
| | - Konstantinos Potaris
- Department of Thoracic Surgery, 3rd Internal Medicine Clinic of Athens University, Sotiria General Hospital, Athens, Greece
| | - Konstantinos N Syrigos
- Oncology Unit, 3rd Internal Medicine Clinic of Athens University, Sotiria General Hospital, Athens, Greece
| | - Panteleimon Tsipas
- Department of Thoracic Surgery, 3rd Internal Medicine Clinic of Athens University, General Hospital Sotiria, Athens, Greece
| | - Grigorios Karagkiouzis
- Department of Thoracic Surgery, 3rd Internal Medicine Clinic of Athens University, General Hospital Sotiria, Athens, Greece
| | - Marios Konstantinou
- Department of Thoracic Surgery, 3rd Internal Medicine Clinic of Athens University, General Hospital Sotiria, Athens, Greece
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Rotman JA, Plodkowski AJ, Hayes SA, de Groot PM, Shepard JAO, Munden RF, Ginsberg MS. Postoperative complications after thoracic surgery for lung cancer. Clin Imaging 2015; 39:735-49. [PMID: 26117564 DOI: 10.1016/j.clinimag.2015.05.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/18/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022]
Abstract
UNLABELLED Lung cancer is the leading cause of cancer-related deaths in the United States. Several surgical techniques are currently used as part of the standard of care for early-stage lung cancer. Differentiating normal postoperative changes from complications is essential in the management of these patients. This article will review the various surgical approaches used, ranging from wedge resection to pneumonectomy, and will outline their expected postsurgical changes. Early and late postsurgical complications will be described, some of which are unique to the type of surgery performed. In addition, local tumor recurrence is a form of postoperative complication and must be distinguished from typical postoperative or postradiation change. Knowledge of both common and uncommon postoperative complications is crucial in the follow-up of lung cancer patients. SUMMARY STATEMENT Familiarity with the appearance of postoperative complications in lung cancer patients is vital to distinguish it from the normal postoperative or postradiation appearance in follow-up imaging.
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Affiliation(s)
- Jessica A Rotman
- Department of Radiology, NY Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065.
| | - Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
| | - Sara A Hayes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
| | - Patricia M de Groot
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030.
| | - Jo-Anne O Shepard
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114.
| | - Reginald F Munden
- Department of Radiology, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030.
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
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Tsubokawa N, Miyata Y, Mimae T, Sasada S, Yoshiya T, Mimura T, Arihiro K, Okada M. Histologic changes associated with the use of fibrinogen- and thrombin-impregnated collagen in the prevention of pulmonary air leakage. J Thorac Cardiovasc Surg 2015; 149:982-8. [DOI: 10.1016/j.jtcvs.2014.12.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/21/2014] [Accepted: 12/25/2014] [Indexed: 10/24/2022]
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Decaluwe H, Sokolow Y, Deryck F, Stanzi A, Depypere L, Moons J, Van Raemdonck D, De Leyn P. Thoracoscopic tunnel technique for anatomical lung resections: a ‘fissure first, hilum last’ approach with staplers in the fissureless patient. Interact Cardiovasc Thorac Surg 2015; 21:2-7. [DOI: 10.1093/icvts/ivv048] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 02/17/2015] [Indexed: 11/14/2022] Open
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Li Z, Chen L, Wang J, Qin J, Zhu Q, Zhang B, Chen Y. A single institution experience using the LigaSure vessel sealing system in video-assisted thoracoscopic surgery for primary spontaneous pneumothorax. J Biomed Res 2014; 28:494-7. [PMID: 25469119 PMCID: PMC4250528 DOI: 10.7555/jbr.28.20130098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/21/2013] [Accepted: 04/04/2014] [Indexed: 11/03/2022] Open
Abstract
This study sought to report our 6-year experience with the LigaSure vessel sealing system (LVSS) in video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax. A series of 180 consecutive patients with primary spontaneous pneumothorax were operated on in our institution from May 2005 to December 2010. Intraoperatively, large lesions (bullae or blebs) with a diameter more than 2 cm were resected by staplers, and the residual lesions were treated by LVSS. LVSS was also used to ablate the apical area when no lesions were found. Conventional apical pleural abrasion was done in all cases. All patients were successfully treated using VATS with minimal perioperative bleeding. The mean operating time was 76 minutes (range, 43-160 minutes) for single-side procedures and 169 minutes (range, 135-195 minutes) for bilateral procedures, the mean number of applied staples was 1.93 per patient (range, 0-8 days), the duration of drainage was 3.8 days (range, 2-15 days), and the duration of hospital stay was 5.8 days (range, 3-16 days). Postoperative complications included persistent air leak (> 5 days) in 11 cases (6.1%) and residual pneumothorax in 6 (3.3%). None required reoperation. The mean duration of follow-up was 57 months (range, 24-105 months). Recurrence was seen in three cases (1.7%), and all underwent another operation thereafter. None of the lesions in the relapse cases received ablation with LVSS in the first operation. LVSS can optimize VATS for primary spontaneous pneumothorax and reduces the use of single-use staples. The method is safe, easy to use, and cost-effective and produces satisfactory results.
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Affiliation(s)
- Zhi Li
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Liang Chen
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jun Wang
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jianwei Qin
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Quan Zhu
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Bin Zhang
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yijiang Chen
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
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Preventing Staple-Line Leak in Sleeve Gastrectomy: Reinforcement with Bovine Pericardium vs Oversewing. Obes Surg 2013; 23:1915-21. [DOI: 10.1007/s11695-013-1062-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Tantraworasin A, Seateang S, Bunchungmongkol N. Staplers versus hand-sewing for pulmonary lobectomy: randomized controlled trial. Asian Cardiovasc Thorac Ann 2013; 22:309-14. [DOI: 10.1177/0218492313491754] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background division of the parenchymal lung for lobectomy is performed in patients who have an incomplete fissure. A stapler device can reduce postoperative air leak, but it is expensive. Objective to investigate the advantage of using a stapler, in terms of postoperative air leak and cost, compared to hand-sewn techniques. Method a non-blinded randomized controlled trial was conducted in Chiang Mai University Hospital, Thailand, from November 15, 2011 to September 30, 2012. Fifty-three adult patients were randomized to undergo a hand-sewn technique (27 patients) or stapler closure (26 patients). Results postoperative air leak in the stapler group was less than that in the hand-sewn group (7.7% vs. 29.6%, p = 0.044), and the duration of air leak in the stapler group was significantly shorter than that in the hand-sewn group (1.0 vs. 13.4 days, p = 0.032). The cost of treatment was not significantly different between groups; however, the total cost in the stapler group was less than that in the hand-sewn group (mean difference 4454 Thai baht (US$144.75). Conclusion a stapler reduces postoperative air leaks and the duration of air leaks. Furthermore, the total cost of treatment was comparable. Therefore, using staples may provide substantial financial benefits.
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Affiliation(s)
- Apichat Tantraworasin
- Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital, Chaing Mai, Thailand
| | - Somcharean Seateang
- Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital, Chaing Mai, Thailand
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Gompelmann D, Eberhardt R, Herth FJF. Collateral ventilation. Respiration 2013; 85:515-20. [PMID: 23485627 DOI: 10.1159/000348269] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 01/17/2013] [Indexed: 11/19/2022] Open
Abstract
Although known for more than 80 years, 'collateral ventilation' (CV) became a focus of endoscopic research in the recent decade. Implantation of one-way valves presents an effective treatment option for patients with advanced heterogeneous emphysema optimizing symptoms and quality of life. However, this treatment modality is only successful in case of low interlobar CV. Based on this evidence, attempts to develop different approaches for the quantification of CV have been initiated. In this regard, it is crucial to illuminate the meaning and different aspects of CV.
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Affiliation(s)
- D Gompelmann
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.
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Anile M, Diso D, Rendina EA, Venuta F. A simple technique to avoid postoperative air leakages after right upper lobectomy. Eur J Cardiothorac Surg 2012; 43:e99-e100. [PMID: 23258088 DOI: 10.1093/ejcts/ezs651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A simple technique to complete interlobar fissures during right upper lobectomy is described. After closing and sectioning the vein, the arteries and the bronchus, the residual lung is gently inflated to visualize the border with the upper lobe. The parenchyma is stapled (GIA 75) at the level of the first non-ventilated part of the upper lobe. This method allows placing the parenchymal stapler line in a fully non-ventilated zone. Since at this level there should be no air, no air leakages are expected during the postoperative course. This technique was performed in 15 patients undergoing right upper lobectomy and no postoperative air leakage was observed.
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Affiliation(s)
- Marco Anile
- Department of Thoracic Surgery, Fondazione Eleonora Lorillard Spencer Cenci, University of Rome Sapienza, Rome, Italy
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Pool K, Munden R, Vaporciyan A, O'Sullivan P. Radiographic imaging features of thoracic complications after pneumonectomy in oncologic patients. Eur J Radiol 2012; 81:165-72. [DOI: 10.1016/j.ejrad.2010.08.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 08/26/2010] [Accepted: 08/27/2010] [Indexed: 10/19/2022]
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Salgado W, Rosa GV, Nonino-Borges CB, Ceneviva R. Prospective and Randomized Comparison of Two Techniques of Staple Line Reinforcement During Open Roux-en-Y Gastric Bypass: Oversewing and Bioabsorbable Seamguard®. J Laparoendosc Adv Surg Tech A 2011; 21:579-82. [DOI: 10.1089/lap.2010.0469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Wilson Salgado
- Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Guilherme Vianna Rosa
- Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Carla Barbosa Nonino-Borges
- Nutritional Division of the Department of Medical Clinic, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Reginaldo Ceneviva
- Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil
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22
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Rivera C, Bernard A, Falcoz PE, Thomas P, Schmidt A, Bénard S, Vicaut E, Dahan M. Characterization and Prediction of Prolonged Air Leak After Pulmonary Resection: A Nationwide Study Setting Up the Index of Prolonged Air Leak. Ann Thorac Surg 2011; 92:1062-8; discussion 1068. [DOI: 10.1016/j.athoracsur.2011.04.033] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 04/02/2011] [Accepted: 04/06/2011] [Indexed: 11/30/2022]
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Hashimoto A, Kuwabara M, Hirasaki Y, Tsujimoto H, Torii T, Nakamura T, Hagiwara A. Reduction of air leaks in a canine model of pulmonary resection with a new staple-line buttress. J Thorac Cardiovasc Surg 2011; 142:366-71. [PMID: 21664626 DOI: 10.1016/j.jtcvs.2011.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 04/13/2011] [Accepted: 05/05/2011] [Indexed: 10/18/2022]
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Petrella F, Rizzo S, Radice D, Borri A, Galetta D, Gasparri R, Solli P, Veronesi G, Bellomi M, Spaggiari L. Predicting prolonged air leak after standard pulmonary lobectomy: Computed tomography assessment and risk factors stratification. Surgeon 2011; 9:72-7. [DOI: 10.1016/j.surge.2010.07.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 07/18/2010] [Accepted: 07/19/2010] [Indexed: 11/16/2022]
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Malapert G, Hanna HA, Pages PB, Bernard A. Surgical Sealant for the Prevention of Prolonged Air Leak After Lung Resection: Meta-Analysis. Ann Thorac Surg 2010; 90:1779-85. [DOI: 10.1016/j.athoracsur.2010.07.033] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 07/08/2010] [Accepted: 07/09/2010] [Indexed: 10/18/2022]
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Merritt RE, Singhal S, Shrager JB. Evidence-based suggestions for management of air leaks. Thorac Surg Clin 2010; 20:435-48. [PMID: 20619236 DOI: 10.1016/j.thorsurg.2010.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The management of postoperative alveolar air leaks (AALs) continues to challenge thoracic surgeons. AALs increase length of stay and health care costs, and likely lead to other postoperative complications. Staple line buttresses, topical sealants, pleural tents, pneumoperitoneum, and modifications of traditional chest tube management (ie, reduced suction) have all been proposed to help reduce AAL. However, the cost of some of the commercial products being marketed may outweigh their relative effectiveness, and some of these techniques and products have not been adequately studied to date. This article provides a review of the available evidence-based literature that addresses the efficacy of the options currently available to prevent and manage AALs. Management suggestions based on this literature are presented.
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Affiliation(s)
- Robert E Merritt
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford Medical Center, 2nd floor Falk Building, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Singhal S, Shrager JB. Should buttresses and sealants be used to manage pulmonary parenchymal air leaks? J Thorac Cardiovasc Surg 2010; 140:1220-5. [PMID: 20951389 DOI: 10.1016/j.jtcvs.2010.06.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 06/02/2010] [Accepted: 06/28/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Sunil Singhal
- Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa 19104, USA.
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Use of Sealants and Buttressing Material in Pulmonary Surgery: An Evidence-Based Approach. Thorac Surg Clin 2010; 20:377-89. [DOI: 10.1016/j.thorsurg.2010.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Incidence and Risk Factors of Persistent Air Leak After Major Pulmonary Resection and Use of Chemical Pleurodesis. Ann Thorac Surg 2010; 89:891-7; discussion 897-8. [DOI: 10.1016/j.athoracsur.2009.12.012] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 12/06/2009] [Accepted: 12/09/2009] [Indexed: 11/30/2022]
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Pu J, Zheng B, Leader JK, Fuhrman C, Knollmann F, Klym A, Gur D. Pulmonary lobe segmentation in CT examinations using implicit surface fitting. IEEE TRANSACTIONS ON MEDICAL IMAGING 2009; 28:1986-96. [PMID: 19628453 PMCID: PMC2839920 DOI: 10.1109/tmi.2009.2027117] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Lobe identification in computed tomography (CT) examinations is often an important consideration during the diagnostic process as well as during treatment planning because of their relative independence of each other in terms of anatomy and function. In this paper, we present a new automated scheme for segmenting lung lobes depicted on 3-D CT examinations. The unique characteristic of this scheme is the representation of fissures in the form of implicit functions using Radial Basis Functions (RBFs), capable of seamlessly interpolating "holes" in the detected fissures and smoothly extrapolating the fissure surfaces to the lung boundaries resulting in a "natural" segmentation of lung lobes. A previously developed statistically based approach is used to detect pulmonary fissures and the constraint points for implicit surface fitting are selected from detected fissure surfaces in a greedy manner to improve fitting efficiency. In a preliminary assessment study, lobe segmentation results of 65 chest CT examinations, five of which were reconstructed with three section thicknesses of 0.625 mm, 1.25 mm, and 2.5 mm, were subjectively and independently evaluated by two experienced chest radiologists using a five category rating scale (i.e., excellent, good, fair, poor, and unacceptable). Thirty-three of 65 examinations (50.8%) with a section thickness of 0.625 mm were rated as either "excellent" or "good" by both radiologists and only one case (1.5%) was rated by both radiologists as "poor" or "unacceptable." Comparable performance was obtained with a slice thickness of 1.25 mm, but substantial performance deterioration occurred in examinations with a section thickness of 2.5 mm. The advantages of this scheme are its full automation, relative insensitivity to fissure completeness, and ease of implementation.
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Affiliation(s)
- Jiantao Pu
- Imaging Research Division, Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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31
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Satoh Y, Matsui Y, Ogawa F, Amano H, Hara H, Nezu K, Iyoda A. Clinical report on a computer-controlled hand-actuated stapling system for general lung surgery: the first application in Japan. Gen Thorac Cardiovasc Surg 2009; 57:402-5. [PMID: 19779787 DOI: 10.1007/s11748-009-0407-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 01/19/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Computer-controlled stapling systems can improve lung tissue approximation during thoracic surgery. We report our experience with a handy system with computer-controlled placement of staples for lung resection in Japan. METHODS The iDrive system is the improved second version of the SurgAssist stapling system. It comprises a self-contained computer microprocessor and hand-held control unit combined with a digital loading unit (a power linear cutter with a blue or green cartridge) for use in open and minimally invasive thoracic surgery. The mounted control unit has two uses: (1) controlling accurate placement of the cartridge by orientating the tip of the rigid and curved shaft and (2) controlling the closure of the stapler and the firing. Each cartridge contains a programmed electronic device that triggers activation of the appropriate program in the self-contained microprocessor. The compression level on lung tissue is determined by the computer. RESULTS From March to October 2008, the iDrive system was used 53 times in a consecutive series of 39 patients during open thoracic lung surgery. There were 12 women and 27 men. The following procedures were performed: lobectomy, segmentectomy, and wedge resection. The power linear cutters were used for stapling lung parenchyma for wedge resection in 6 patients, bullectomy in 1, segmentectomy in 2, and fissure division in 33. There were no stapling failures and no complications related to the staplers. CONCLUSION The new computer-controlled stapling system may be safe and efficient for lung parenchymal tissue resection during open thoracic surgery.
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Affiliation(s)
- Yukitoshi Satoh
- Department of Thoracic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara-shi, Kanagawa, 228-8555, Japan.
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Pu J, Leader JK, Zheng B, Knollmann F, Fuhrman C, Sciurba FC, Gur D. A Computational geometry approach to automated pulmonary fissure segmentation in CT examinations. IEEE TRANSACTIONS ON MEDICAL IMAGING 2009; 28:710-9. [PMID: 19272987 PMCID: PMC2839918 DOI: 10.1109/tmi.2008.2010441] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Identification of pulmonary fissures, which form the boundaries between the lobes in the lungs, may be useful during clinical interpretation of computed tomography (CT) examinations to assess the early presence and characterization of manifestation of several lung diseases. Motivated by the unique nature of the surface shape of pulmonary fissures in 3-D space, we developed a new automated scheme using computational geometry methods to detect and segment fissures depicted on CT images. After a geometric modeling of the lung volume using the marching cubes algorithm, Laplacian smoothing is applied iteratively to enhance pulmonary fissures by depressing nonfissure structures while smoothing the surfaces of lung fissures. Next, an extended Gaussian image based procedure is used to locate the fissures in a statistical manner that approximates the fissures using a set of plane "patches." This approach has several advantages such as independence of anatomic knowledge of the lung structure except the surface shape of fissures, limited sensitivity to other lung structures, and ease of implementation. The scheme performance was evaluated by two experienced thoracic radiologists using a set of 100 images (slices) randomly selected from 10 screening CT examinations. In this preliminary evaluation 98.7% and 94.9% of scheme segmented fissure voxels are within 2 mm of the fissures marked independently by two radiologists in the testing image dataset. Using the scheme detected fissures as reference, 89.4% and 90.1% of manually marked fissure points have distance </= 2 mm to the reference suggesting a possible under-segmentation of the scheme. The case-based root mean square (rms) distances ("errors") between our scheme and the radiologist ranged from 1.48 +/-0.92 to 2.04 +/-3.88 mm. The discrepancy of fissure detection results between the automated scheme and either radiologist is smaller in this dataset than the interreader variability.
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Affiliation(s)
- Jiantao Pu
- Imaging Research Division, Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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33
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Prokakis C, Koletsis EN, Apostolakis E, Panagopoulos N, Kouki HS, Sakellaropoulos GC, Filos K, Dougenis DV. Routine suction of intercostal drains is not necessary after lobectomy: a prospective randomized trial. World J Surg 2009; 32:2336-42. [PMID: 18787890 DOI: 10.1007/s00268-008-9741-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The decision to proceed to simple underwater seal drainage or apply active suction to the underwater seal after lung resection is mostly based on surgeon preference. The purpose of this study was to test whether routine application of active suction is necessary after lobectomy. PATIENTS AND METHODS This was a prospective randomized controlled trial conducted in the Patras University Hospital. Ninety-one patients who underwent lobectomy or bilobectomy for lung cancer and met the eligibility criteria were enrolled. Group I included 47 patients and group II had 44 patients. The two groups were comparable. At the end of surgical procedure patients were randomly assigned to receive -15 to -20 cm H2O active suction applied to the underwater seal drainage (group I) or simple underwater seal drainage (group II). The primary end point was the time elapsed between placement and removal of drains. RESULTS No statistically significant differences were observed between the two groups in terms of time elapsed between the removal of chest drains, mortality, morbidity, adequacy of drainage system, and postoperative hospital stay. Suction applied to the underwater seal to re-expand the lung succeeded in 3 of 10 cases of persistent pneumothorax in group II. Discontinuing suction in 7 patients with persistent air leak in group I resulted in leak resolution in 4 patients. CONCLUSIONS Routine application of active drain suction to the underwater seal is not necessary after lobectomy. However, it could be useful in persistent pneumothorax with sufficient air entry in the lung and clear airways. It is of no help in persistent air leaks when the lung is expanded.
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Affiliation(s)
- Christos Prokakis
- Department of Cardiothoracic Surgery, Patras University, School of Medicine, Patras, Greece
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Droghetti A, Schiavini A, Muriana P, Folloni A, Picarone M, Bonadiman C, Sturani C, Paladini R, Muriana G. A prospective randomized trial comparing completion technique of fissures for lobectomy: Stapler versus precision dissection and sealant. J Thorac Cardiovasc Surg 2008; 136:383-91. [DOI: 10.1016/j.jtcvs.2008.04.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 04/22/2008] [Accepted: 04/25/2008] [Indexed: 11/28/2022]
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The utility of intrapleural instillation of autologous blood for prolonged air leak after lobectomy. Curr Opin Pulm Med 2008; 14:343-7. [DOI: 10.1097/mcp.0b013e3282fcea76] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Meghan G Lubner
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Box 8131, St. Louis, MO 63110, USA.
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Assalia A, Ueda K, Matteotti R, Cuenca-Abente F, Rogula T, Gagner M. Staple-line reinforcement with bovine pericardium in laparoscopic sleeve gastrectomy: experimental comparative study in pigs. Obes Surg 2007; 17:222-8. [PMID: 17476876 DOI: 10.1007/s11695-007-9033-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND We studied the usefulness of Bovine Pericardial strips (BPS) as a buttress in the prevention of complications from the gastric staple-line in laparoscopic sleeve gastrectomy (LSG). METHODS LSG was carried out in 18 pigs. Resection of the stomach was performed with 4.8-mm/30-mm linear stapler either without (Control Group--n = 9) or with BPS (Buttress Group--n = 9). Intra- and postoperative blood losses were assessed. Leaks were evaluated with methylene blue test intra-operatively and then clinically. The animals were sacrificed 2 weeks after surgery and the abdominal cavity was evaluated for fluid collections and adhesions, and the burst pressure of the stomach was measured and histopathological study of the staple-line was performed. Student t-test was used for statistical analysis. RESULTS No leaks were detected except for one small subclinical leak in the buttress group. Internal ulcers at the staple-line were seen more frequently in the Buttress group (6 vs 3, not significant). There was no significant difference between the two groups with regards to operative time (65.3 +/- 14.2 min, 69.7 +/- 12.8 min), intra-operative bleeding (9.6 +/- 2.2 ml, 8.2 +/- 1.5 ml), postoperative hemoglobin levels (11.3 +/- 1.9 g%, 11.8 +/- 2.2 g%), and burst pressure (152.6 +/- 23.5 mmHg, 161.2 +/- 15.8 mmHg) for the Control and Buttress groups respectively. More intense adhesions and inflammatory response were observed in the Buttress Group. CONCLUSIONS In this experimental model, the use of bovine pericardium as a staple-line buttress in LSG was easy and safe; however, it did not decrease the occurrence of complications.
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Affiliation(s)
- Ahmad Assalia
- Department of Surgery B, Rambam Health Care Campus, Haifa, Israel
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Andreetti C, Venuta F, Anile M, De Giacomo T, Diso D, Di Stasio M, Rendina EA, Coloni GF. Pleurodesis with an autologous blood patch to prevent persistent air leaks after lobectomy. J Thorac Cardiovasc Surg 2007; 133:759-62. [PMID: 17320580 DOI: 10.1016/j.jtcvs.2006.10.042] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 09/29/2006] [Accepted: 10/09/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Air leakage after pulmonary lobectomy is a well-known problem often contributing to extended hospitalization. Many techniques have been proposed to prevent and treat air leakage, but none have been proved incontrovertibly effective. We evaluated the role of an autologous blood patch after pulmonary lobectomy. METHODS Twenty-five patients with air leaks on the sixth postoperative day after lobectomy were enrolled in this study. They were randomly assigned to 2 groups: group A (12 patients), with 50 mL of autologous blood infused in the pleural cavity; and group B (13 patients), with 100 mL of blood infused. These 2 groups were retrospectively compared with the last 15 patients showing the presence of air leaks for at least 6 days (group C) (in this group the duration of leakage after the sixth postoperative day was compared). We recorded the duration of posttreatment air leaks and hospitalization. RESULTS Air leaks stopped 2.3 +/- 0.6 days after the procedure in group A, 1.5 +/- 0.6 days after the procedure in group B, and after 6.3 +/- 3.7 days in group C. The air leakage disappeared within 72 hours in all patients in groups A and B. There was a statistically significant difference in the duration of drainage between groups A and B (P = .005), groups A and C (P = .0009), and groups B and C (P = .0001), showing the effectiveness of an autologous blood patch, particularly with 100 mL of blood. CONCLUSIONS Management of air leaks after lobectomy with an autologous blood patch is easy, safe, and effective, and does not add costs. It may become the gold standard treatment early in the postoperative course.
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Affiliation(s)
- Claudio Andreetti
- University of Rome La Sapienza, Department of Thoracic Surgery, Rome, Italy
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Droghetti A, Schiavini A, Muriana P, Comel A, De Donno G, Beccaria M, Canneto B, Sturani C, Muriana G. Autologous blood patch in persistent air leaks after pulmonary resection. J Thorac Cardiovasc Surg 2006; 132:556-9. [PMID: 16935110 DOI: 10.1016/j.jtcvs.2006.05.033] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 05/22/2006] [Accepted: 05/23/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Persistent air leak is among the most common complications after pulmonary resection, leading to prolonged hospitalization and increased costs. At present there is not yet a consensus on their treatment. METHODS During a 7-year experience, 21 patients submitted to pulmonary resection were postoperatively treated with an autologous blood patch for persistent air leaks. Persistent air leaks were catalogued twice daily according to the classification previously reported by Cerfolio and associates. Chest radiographs showed a fixed pleural space deficit in 18 (86%) patients. A total of 50 to 150 mL of autologous blood was drawn from the patient and injected into the chest tube, which was removed 48 hours after cessation of the air leak. RESULTS We observed a 4% incidence of persistent air leaks after pulmonary resection in our series. Persistent air leaks were categorized as follows: 14% forced expiratory, 57% expiratory, 29% continuous, and 0% inspiratory. The mean duration of prolonged air leaks was 11 days after surgery. In 81% of the cases examined, a blood patch was only carried out once and gave successful results within 24 hours. In the remaining 19% of cases, the air leak ceased within 12 hours after the second procedure. Mean hospital stay was 15 days. In our experience this procedure had a 100% success rate. CONCLUSIONS Pleurodesis with an autologous blood patch is well tolerated, safe, and inexpensive. This procedure is an effective technique for treatment of postoperative persistent air leaks, even in the presence of an associated fixed pleural space deficit.
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Venuta F, Diso D, De Giacomo T, Anile M, Rendina EA, Coloni GF. Use of a polymeric sealant to reduce air leaks after lobectomy. J Thorac Cardiovasc Surg 2006; 132:422-3. [PMID: 16872973 DOI: 10.1016/j.jtcvs.2006.03.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Accepted: 03/23/2006] [Indexed: 11/15/2022]
Affiliation(s)
- Federico Venuta
- University of Rome La Sapienza, Department of Thoracic Surgery, Rome, Italy.
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Tansley P, Al-Mulhim F, Lim E, Ladas G, Goldstraw P. A prospective, randomized, controlled trial of the effectiveness of BioGlue in treating alveolar air leaks. J Thorac Cardiovasc Surg 2006; 132:105-12. [PMID: 16798309 DOI: 10.1016/j.jtcvs.2006.02.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Revised: 02/18/2006] [Accepted: 02/24/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The use of tissue glues has been advocated to reduce post-thoracotomy alveolar air leaks, but outcomes have been inconclusive. The aim of this study was to determine the effectiveness of BioGlue (CryoLife Europa Ltd, Hampshire, United Kingdom) in eliminating post-thoracotomy alveolar air leaks. METHODS A prospective, randomized, single-blind, controlled trial was conducted in which patients were stratified according to the severity of post-thoracotomy air leak that could not be controlled by conventional surgical techniques. They were allocated to a control arm (surgical treatment only) or an interventional arm (surgical treatment and BioGlue). Duration of air leak, intercostal drainage, and hospital stay comprised primary study end points. RESULTS From December 2002 to January 2005, 52 patients were randomized, 29 (56%) of whom were men. The mean age was 59 +/- 15 years, and other characteristics were comparable in both groups. Indications for surgery were malignancy in 46 patients (88%), carcinoid tumor in 2 patients (4%), and infective disease in 4 patients (8%). Patients in the BioGlue arm had shorter median duration of air leaks, 1 (0-2) versus 4 (2-6) days (P < .001); intercostal chest drainage, 4 (3-4) versus 5 (4-6) days (P = .012); and hospital stay, 6 (5-7) versus 7 (7-10) days (P = .004), compared with controls. No major complications were encountered using BioGlue. CONCLUSIONS This study demonstrates clear benefit from BioGlue in the treatment of alveolar air leaks through reduction of air leak duration, chest drainage time, and hospital stay. Systematic use of BioGlue may be warranted in adult thoracic surgical procedures (except pneumonectomy and decortication) when an air leak remains after all other steps to control it have failed.
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Affiliation(s)
- Patrick Tansley
- Department of Thoracic Surgery, Royal Brompton Hospital, Sydney Street, London, United Kingdom.
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Sakamaki Y, Kido T, Fujiwara T, Kuwae K, Maeda M. A Novel Procedure Using a Tissue Expander for Management of Persistent Alveolar Fistula After Lobectomy. Ann Thorac Surg 2005; 79:2130-2. [PMID: 15919325 DOI: 10.1016/j.athoracsur.2003.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2003] [Indexed: 11/29/2022]
Abstract
We treated a patient with postlobectomy persistent alveolar fistula using a tissue expander, which is a prosthesis widely used in plastic surgery. The patient had thoracic empyema develop after right bilobectomy for lung cancer, and consequently underwent drainage of empyema followed by muscle flap closure for alveolar fistula. A residual space remained, and air leak persisted. However, implanting and expanding a tissue expander enabled us to tightly fix the flap on the raw pulmonary surface, which eventually solved the air leak. The tissue expander greatly contributed to muscle flap closure for a persistent alveolar-pleural fistula with a large remaining thoracic space.
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Affiliation(s)
- Yasushi Sakamaki
- Department of Chest Surgery, Osaka Police Hospital, Osaka, Japan.
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Abstract
BACKGROUND In contrast to the rare large-airway bronchopleural fistulas after lung resection, peripheral or alveolar air leaks (AAL) are very common, often prolong hospital stay, increase utilization of resources, and on occasion result in significant morbidity. Various adjuncts have been used in attempts to reduce AAL. One of these, the topical application of fibrin glue, has to date failed to demonstrate efficacy in small clinical trials. This study reexamines the role of fibrin glue in routine lobar and wedge pulmonary resections. METHODS Of 113 patients enrolled, 13 became ineligible because of intraoperative findings. The remaining 100 patients were randomly assigned to one of two groups at the conclusion of lung resection, regardless of the presence or absence of identifiable air leak. The control group received no additional intervention. The experimental group underwent application of 5 mL of fibrin glue delivered by a pressurized, aerosolized spraying mechanism. Postoperatively a blinded clinical observer recorded outcomes including the incidence and duration of AAL, prolonged AAL (PAAL), the volume of pleural drainage, the time to tube removal, and the postoperative length of stay (LOS), as well as any complications related to treatment. RESULTS Both groups were comparable with regard to demographics, diagnoses, and procedures. Statistically significant reductions were found in the experimental group in the overall incidence of AAL (34% versus 68%, p = 0.001), mean duration of AAL (1.1 versus 3.1 days, p = 0.005), mean time to chest tube removal (3.5 versus 5.0 days, p = 0.02), and the incidence of PAAL (2% versus 16%, p = 0.015). There was no significant difference in the volume of chest tube drainage or LOS (4.6 days glue and 4.9 days control, p = 0.318). There were no complications related to the use of fibrin glue. CONCLUSIONS Aerosolized fibrin glue appears to be safe and effective in reducing AAL. The overall incidence of AAL was reduced by 50% and PAAL occurred in only 1 treated patient (2% versus the usually reported 15%). Further studies with this and other methods are required to delineate routine versus selective use, to compare methods, and clarify cost benefit.
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Affiliation(s)
- Thomas Fabian
- Department of Surgery, The Hospital of St. Raphael, New Haven, Connecticut, USA
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Abstract
Lung volume reduction surgery (LVRS) continues to stimulate controversy and spirited discussion. The purpose of the operation is to palliate dyspnea and improve functional status and quality of life for highly selected patients with emphysema. The value of LVRS as a palliative procedure is clearly dependent on the surgeon's ability to minimize the frequency and severity of postoperative complications. This article investigates the sources of morbidity and mortality after LVRS and reports techniques to avoid and manage such complications.
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Affiliation(s)
- Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO 63110, USA
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Toloza EM, Harpole DH. Intraoperative techniques to prevent air leaks. CHEST SURGERY CLINICS OF NORTH AMERICA 2002; 12:489-505. [PMID: 12469483 DOI: 10.1016/s1052-3359(02)00020-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Persistent air leaks prolong chest tube duration and hospital stay after lung surgery. Air leaks also may lead to life-threatening empyemas. Preventing postoperative air leaks and BPFs is the best treatment for air-leak complications. Meticulous closure of parenchymal, pleural, and bronchial defects is the mainstay of air-leak control. The reinforcement of parenchymal suture and staple lines, pleural apposition, and well-vascularized tissue-flap coverage of bronchial suture and staple lines further reduce the incidence of prolonged air leaks and BPFs.
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Affiliation(s)
- Eric M Toloza
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Box 3048, Durham, NC 27710, USA.
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Kim EA, Lee KS, Shim YM, Kim J, Kim K, Kim TS, Yang PS. Radiographic and CT findings in complications following pulmonary resection. Radiographics 2002; 22:67-86. [PMID: 11796900 DOI: 10.1148/radiographics.22.1.g02ja0367] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A variety of pulmonary resection techniques are currently available, including pneumonectomy (intrapleural, extrapleural, intrapericardial, and sleeve pneumonectomy), lobectomy, and limited resection (sleeve lobectomy, segmentectomy, nonanatomic parenchyma-sparing resection). However, pulmonary resection is often followed by postoperative complications that differ according to the type of surgery and the time elapsed since surgery was performed. The most common complications are bleeding, pulmonary edema, atelectasis, pneumonia, persistent air leak, bronchopleural fistula, and empyema. Other, less frequent complications include cardiac herniation, lung torsion, chylothorax, anastomotic dehiscence, wound infection, esophagopleural fistula, and recurrent tumor. The radiologist plays a major role in the diagnosis of various complications following pulmonary resection. Unfortunately, chest radiography has a relatively low diagnostic accuracy in the detection of these complications. When radiographic findings are subtle or equivocal, computed tomography frequently allows more accurate identification of the disease process. Several complications that follow pulmonary resection are life-threatening and require prompt management. Therefore, knowledge of the diverse radiologic appearances of these complications as well as familiarity with the clinical settings in which specific complications are likely to occur are vital for prompt, effective treatment.
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Affiliation(s)
- Eun A Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
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Hayashi K, Aziz A, Ashizawa K, Hayashi H, Nagaoki K, Otsuji H. Radiographic and CT appearances of the major fissures. Radiographics 2001; 21:861-74. [PMID: 11452059 DOI: 10.1148/radiographics.21.4.g01jl24861] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The major fissure is an important anatomic landmark in the interpretation of chest radiographs and computed tomographic (CT) scans. At radiography, the major fissures normally appear as hairlines of soft-tissue density; at conventional CT, they typically appear as lucent, hypovascular bands; and at high-resolution CT, they most often appear as sharp lines. The superolateral major fissure usually manifests as a curving edge at the upper lateral lung field with lateral opacity and medial lucency. The vertical fissure line appears as a fine, linear shadow, commencing in or near the costophrenic angle and coursing upward. The superomedial major fissure manifests as a short, obliquely oriented straight line. Progressive widening of the major fissure inferiorly manifests as a triangular area of increased opacity and represents intrafissural fat. Various inflammatory, granulomatous, neoplastic, and abnormal hemodynamic conditions involving the major fissure can affect its imaging appearance. Oblique orientation of the major fissure may complicate radiographic interpretation. The fissure may be incomplete or absent, complicating identification of various diseases. An incomplete major fissure may lead to disease spread, collateral air drift, or the "incomplete fissure sign," a sign that may, however, also be present in cases of complete fissure. Knowledge of the anatomy and normal variants of the major fissures is essential for recognizing their variable imaging appearances as well as related abnormalities.
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Affiliation(s)
- K Hayashi
- Department of Radiology, Nagasaki University School of Medicine, Sakamoto 1-7-1, Nagasaki 852-8501, Japan.
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Miller JI, Landreneau RJ, Wright CE, Santucci TS, Sammons BH. A comparative study of buttressed versus nonbuttressed staple line in pulmonary resections. Ann Thorac Surg 2001; 71:319-22; discussion 323. [PMID: 11216769 DOI: 10.1016/s0003-4975(00)02203-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Prolonged air leak is the major limiting factor in early hospital discharge following pulmonary resection. The purpose of this study was to determine whether the use of bovine pericardial strips as a buttress along the lung staple line would decrease air leaks and hospital stay after lobectomy and segmentectomy. METHODS This was a multicenter trial consisting of 80 patients undergoing pulmonary resection, randomly assigned to the control group (40 patients) or treatment group (40 patients). The treatment group had reinforcement with bovine pericardium. RESULTS No statistical differences were noted in the mean intensive care unit length of stay (p = 0.9), number of days with a chest tube (p = 0.6), or total length of stay (p = 0.24). Increased air leak duration was associated with assignment to the control group (r = 0.27, p = 0.02). The mean duration of air leak was 2 days and the mean time to chest tube removal was 5.9 days in patients with a buttressed staple line compared to 3 days and 6.3 days, respectively, for patients with nonbuttressed staple lines. CONCLUSIONS Within the data of this study, no statistical differences were noted between buttressed and nonbuttressed patients. However, the trend toward shortened air leak time and tube removal time was apparent in the buttressed group. With greater number of patients studied, it is likely that the cost of bovine pericardium would be justified by shorter air leak duration and hospitalization.
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Affiliation(s)
- J I Miller
- Section of General Thoracic Surgery, Emory University, Atlanta, Georgia 30322, USA
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Stammberger U, Klepetko W, Stamatis G, Hamacher J, Schmid RA, Wisser W, Hillerjan L, Weder W. Buttressing the staple line in lung volume reduction surgery: a randomized three-center study. Ann Thorac Surg 2000; 70:1820-5. [PMID: 11156078 DOI: 10.1016/s0003-4975(00)01903-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The intention of buttressing the staple line in lung volume reduction surgery is to reduce air leaks and to shorten the hospital stay. A randomized three-center study was carried out to test this hypothesis. METHODS Sixty-five patients with a mean age of 59.2 +/- 1.2 years underwent bilateral lung volume reduction surgery by video-assisted thoracoscopy using endoscopic staplers (ET 45B; Ethicon Endo-Surgery, Cincinnati, OH) either without or with bovine pericardium for buttressing (Peri-Strips Dry; Bio-Vascular, Inc, Saint Paul, MN). There were no differences between the control and treatment groups in lung function, degree of dyspnea, and arterial blood gases before and 3 months after LVRS. RESULTS Seven patients (3 in the treatment group) needed a reoperation because of persistent air leak. The median duration of air leaks was shorter in the treatment group (0.0 day [range, 0 to 28 days versus 4 days [range, 0 to 27 days); p < 0.001), confirmed by a shorter median drainage time in this group (5 days [range, 1 to 35 days] versus 7.5 days [range, 2 to 29 days); p = 0.045). Hospital stay was comparable between the two groups (9.5 days [range, 6 to 44 days] versus 12.0 days [range, 5 to 46 days]; p = 0.14). CONCLUSIONS Buttressing the staple line significantly shortens the duration of air leaks and the drainage time. As hospital stay did not differ significantly between the two groups, cost-effectiveness may depend on the local situation.
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Affiliation(s)
- U Stammberger
- Division of Thoracic Surgery, University Hospital, Zürich, Switzerland
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