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Aparicio-López D, Asencio-Pascual JM, Blanco-Fernández G, Cugat-Andorrá E, Gómez-Bravo MÁ, López-Ben S, Martín-Pérez E, Sabater L, Ramia JM, Serradilla-Martín M. Evaluation of the validated intraoperative bleeding scale in liver surgery: study protocol for a multicenter prospective study. Front Surg 2023; 10:1223225. [PMID: 37850041 PMCID: PMC10577188 DOI: 10.3389/fsurg.2023.1223225] [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: 05/15/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
Background Surgical hemostasis has become one of the key principles in the advancement of surgery. Hemostatic agents are commonly administered in many surgical specialties, although the lack of consensus on the definition of intraoperative bleeding or of a standardized system for its classification means that often the most suitable agent is not selected. The recommendations of international organizations highlight the need for a bleeding severity scale, validated in clinical studies, that would allow the selection of the best hemostatic agent in each case. The primary objective of this study is to evaluate the VIBe scale (Validated Intraoperative Bleeding Scale) in humans. Secondary objectives are to evaluate the scale's usefulness in liver surgery; to determine the relationship between the extent of bleeding and the hemostatic agent used; and to assess the relationship between the grade of bleeding and postoperative complications. Methods Prospective multicenter observational study including 259 liver resections that meet the inclusion criteria: patients scheduled for liver surgery at one of 10 medium-high volume Spanish HPB centers using an open or minimally invasive approach (robotic/laparoscopic/hybrid), regardless of diagnosis, ASA score <4, age ≥18, and who provide signed informed consent during the study period (September 2023 until the required sample size has been recruited). The participating researchers will be responsible for collecting the data and for reporting them to the study coordinators. Discussion This study will allow us to evaluate the VIBe scale for intraoperative bleeding in humans, with a view to its subsequent incorporation in daily clinical practice. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT05369988?term = serradilla&draw = 2&rank = 3, [NCT0536998].
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Affiliation(s)
| | | | | | - Esteban Cugat-Andorrá
- Department of Surgery, Hospital Universitario Mutua de Terrassa, Terrassa, Spain
- Department of Surgery, Hospital Universitario German Trials I Pujol, Barcelona, Spain
| | | | - Santiago López-Ben
- Department of Surgery, Hospital Universitario Dr. Josep Trueta, Girona, Spain
| | - Elena Martín-Pérez
- Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain
| | - Luis Sabater
- Department of Surgery, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - José Manuel Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Mario Serradilla-Martín
- Department of Surgery, Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Lin YY, Hsieh MJ, Wu CY, Yang LY, Pan YB, Wu CF, Gonzalez-Rivas D, Chao YK. Comparison of active versus passive robotic-endoscope-holder-assisted unisurgeon uniportal thoracoscopic surgery in terms of surgical efficacy and patient safety. J Thorac Dis 2023; 15:3800-3810. [PMID: 37559654 PMCID: PMC10407473 DOI: 10.21037/jtd-23-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/09/2023] [Indexed: 08/11/2023]
Abstract
Background Few studies have compared robotic-arm-assisted unisurgeon uniportal surgeries with conventional human-assisted uniportal video-assisted thoracoscopic surgeries (VATSs) in terms of surgical efficacy and patient safety. In the present study, we compared the aforementioned surgeries. Methods We explored two robotic endoscope holders-a passive robotic platform (ENDOFIXexo, EA group) and a pedal-controlled active robotic platform (MTG-100, MA group)-for unisurgeon uniportal surgeries and compared the surgical outcomes with those of human-assisted uniportal surgeries (HA group) in 228 patients with a lung lesion (size, <5 cm). The primary parameters for this comparison were surgical efficacy, patient safety, and short-term patient outcomes. Results No significant differences were observed among the EA, MA, and HA groups. The success rate of robotic-arm-assisted unisurgeon uniportal wedge resection was 100%, regardless of the group. No major differences were noted in preparation time between the EA and MA groups. Segmentectomy was more favorable in the EA group than in the MA group. The rates of surgical conversion were 5% and 60% in the EA and MA groups, respectively. The EA and MA groups did not differ considerably from the HA group in terms of postoperative complications. Conclusions Unisurgeon uniportal wedge resection may be effectively performed using a robotic endoscope holder, without the need for any human assistants with an expert hand. However, the rate of surgical conversion increases with the complexity of uniportal anatomic resections. The passive platform appears to be more suitable for unisurgeon uniportal surgery than the active pedal-controlled platform given the equipment in contemporary operating rooms.
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Affiliation(s)
- Yi-Yu Lin
- College of Medicine, Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan
| | - Ming-Ju Hsieh
- College of Medicine, Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan
| | - Ching-Yang Wu
- College of Medicine, Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan
| | - Lan-Yan Yang
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan
| | - Yu-Bin Pan
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan
| | - Ching-Feng Wu
- College of Medicine, Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan
- Department of Thoracic Surgery, Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospita, Coruña, Spain
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospita, Coruña, Spain
| | - Yin-Kai Chao
- College of Medicine, Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan
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Cao Y, Xiong F, Xia X, Gu P, Wang Q, Wu A, Zhan H, Chen W, Qian Z. Economic impact of powered stapler in video-assisted thoracic surgery lobectomy for lung Cancer in a Chinese tertiary hospital: a cost-minimization analysis. HEALTH ECONOMICS REVIEW 2022; 12:12. [PMID: 35141818 PMCID: PMC8830080 DOI: 10.1186/s13561-022-00359-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 02/03/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND To assess the economic impact of powered stapler use in video-assisted thoracic surgery (VATS) lobectomy for lung cancer in a Chinese tertiary care hospital. METHODS This study identified 388 patients who received VATS lobectomy using the ECHELON powered stapler (n = 296) or the ECHELON manual stapler (n = 92) for lung cancer in a Chinese tertiary hospital. Multiple generalized linear regression analyses were conducted using data on hospital costs and patient characteristics to develop predictive equations for hospital costs in a cost-minimization analysis (CMA) model comparing hospital costs associated with the ECHELON powered stapler and the ECHELON manual stapler. CMA model was used to conduct scenario analysis to compare the ECHELON powered stapler with another manual stapler (Victor Medical). RESULTS The multiple generalized linear regression analyses identified that using the ECHELON powered stapler in VATS lobectomy for lung cancer was associated with significantly lower drug costs than using the ECHELON manual stapler (coefficient - 0.256, 95% confidence interval: - 0.375 to - 0.139). The CMA model estimated that the ECHELON powered stapler could save hospital costs by ¥1653 when compared with the ECHELON manual stapler (¥65,531 vs. ¥67,184). The use of the ECHELON powered stapler also saved hospital costs by ¥4411 when compared with the Victor Medical manual stapler (¥65,531 vs. ¥69,942) in the scenario analysis. CONCLUSIONS Compared to the two manual staplers used for VATS lobectomy for lung cancer in a Chinese tertiary hospital, the ECHELON powered stapler had 100% probability to save total hospital costs under present prices of the three staplers according to the CMA.
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Affiliation(s)
- Yang Cao
- Xiangya Hospital, Central South University, Changsha, China
| | - Fang Xiong
- Xiangya Hospital, Central South University, Changsha, China
| | - Xiaozhe Xia
- Xiangya Hospital, Central South University, Changsha, China
| | - Pengjuan Gu
- Xiangya Hospital, Central South University, Changsha, China
| | - Qinghong Wang
- Xiangya Hospital, Central South University, Changsha, China
| | - Aiping Wu
- Xiangya Hospital, Central South University, Changsha, China
| | - Huan Zhan
- Changsha Normin Health Technology Ltd, Changsha, China
| | | | - Zhaoxin Qian
- Xiangya Hospital, Central South University, Changsha, China.
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Chan JWY, Yu PSY, Lau RWH, Ng CSH. Hybrid operating room-one stop for diagnosis, staging and treatment of early stage NSCLC. J Thorac Dis 2020; 12:123-131. [PMID: 32190362 DOI: 10.21037/jtd.2019.08.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Joyce W Y Chan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Peter S Y Yu
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Rainbow W H Lau
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
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Ji Y, Qiu B, Gao S. The powered vascular staple (PVS) versus conventional powered linier cutter (PLC) for the application of bronchial transection in thoracoscopic anatomic segmentectomy. J Thorac Dis 2020; 11:4647-4653. [PMID: 31903253 DOI: 10.21037/jtd.2019.10.68] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Recent studies indicated that thoracoscopic anatomical segmentectomy (TAS) is widely adopted in early non-small cell lung cancer. Considering the slender segmental bronchi and the narrow space around segmental bronchi, it is easier to treat segmental bronchi with powered vascular stapler (PVS), which was designed to have a narrower anvil and a beak like tip. However, the safety and feasibility of PVS in stapling segmental bronchi are not yet clear. Methods We retrospectively compared the perioperative features of segmental bronchial closure treated with PVS and powered linier cutter (PLC) in thoracoscopic anatomic segmentectomy performed by a single surgeon and evaluated the safety and feasibility of PVS for the segmental or subsegmental bronchus. Results Between April 2018 and April 2019, a total of 162 patients who underwent anatomic segmentectomy were analyzed (PVS n=75 and PLC n=87). No bronchopleural fistula (BPF) occurred in 162 patients. Intraoperative blood loss in PVS group (15.2±8.91 mL) was significantly lower than that in PLC group (25.29±24.06 mL) (P<0.05). The operative time of PVS group was similar to the PLC group (P>0.05). There was no significant difference between the two groups in postoperative drainage and chest tube duration (all P>0.05). In terms of postoperative complications, the incidence of hemoptysis in PVS group was similar to PLC group (P>0.05). Two cases of subcutaneous emphysema occurred in PVS group, one case of pulmonary air leakage (>3 days) and one case of subcutaneous emphysema occurred in PLC group. Besides, all the surgeons (100%) slight agree or strongly agree that PVS is easier to pass through the segmental bronchus. Conclusions PVS is a smoother and easier instrument and has the same effectiveness and security as PLC. It leads to reduced operation difficulty and potential intraoperative complications.
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Affiliation(s)
- Ying Ji
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Bin Qiu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Qiu B, Kang X, Chen KN, Hu J, Li J, Zeng L, Fegelman EJ, Schwiers ML, Creedon EE, Waggoner JR, Ding D, Yang T, Gao S. Clinical outcomes following an initial experience with a novel powered vascular stapler in video-assisted thoracoscopic lobectomies: results of a Chinese multi-center study. J Thorac Dis 2019; 11:1973-1979. [PMID: 31285890 DOI: 10.21037/jtd.2019.04.89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background The development of minimally invasive surgical approaches has revolutionized surgical care and greatly improved surgical outcomes. This study aimed to evaluate the clinical effectiveness of a powered vascular stapler (PVS) during video-assisted thoracoscopic surgery (VATS) lobectomy. Methods This prospective, multi-center, post-market clinical study in China enrolled 50 patients with either a suspected or formal diagnosis of clinical stage IA to IIB non-small cell lung cancer (NSCLC) scheduled for VATS lobectomy. The clinical effectiveness of the PVS for successful pulmonary artery (PA)/pulmonary vein (PV) transection was evaluated. In addition, the surgeon's stress, device usability, and surgeon satisfaction were measured using multiple questionnaires. Results A total of 167 PAs/PVs were transected with 3 (1.8%) requiring intra-operative intervention. Fourteen of the 50 patients (28.0%) experienced at least one adverse event (AE), among whom 5 (10.0%) suffered from serious AEs. There were no postoperative hemorrhagic complications related to transection of the PA/PV with PVS. Surgeon satisfaction was surveyed by questionnaire after each of the 50 procedures resulting in a 96% reported satisfaction with device usability, specifically related to a low stress load and an increase in work efficiency. Conclusions For VATS lobectomy, the PVS demonstrated a positive surgical effectiveness and value in cognitive and physical distress reduction. Complications following VATS lobectomy to treat NSCLC were generally low and as expected. Intraoperative complications were few and there were no postoperative complications related to the transection of the PA and PV during VATS lobectomy. Favorable results were reported on the surgeon satisfaction questionnaire regarding usability and surgeon stress.
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Affiliation(s)
- Bin Qiu
- Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Xiaozheng Kang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the First Department of Thoracic Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ke-Neng Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the First Department of Thoracic Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China
| | - Jian Li
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Liping Zeng
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China
| | | | | | | | | | - Ding Ding
- Johnson & Johnson Medical (Shanghai) LTD, Shanghai 200233, China
| | - Tengfei Yang
- Johnson & Johnson Medical (Shanghai) LTD, Shanghai 200233, China
| | - Shugeng Gao
- Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China
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Shimizu N, Tanaka Y, Okamoto T, Doi T, Hokka D, Maniwa Y. How to prevent adverse events of vascular stapling in thoracic surgery: recommendations based on a clinical and experimental study. J Thorac Dis 2019; 10:6466-6471. [PMID: 30746189 DOI: 10.21037/jtd.2018.11.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Advances in the development of staplers for pulmonary vessels have contributed to safe and convenient procedures in thoracic surgery. However, adverse events (AEs) can occur during vascular stapling and cause fatal hemorrhage. We aimed to assess the risk level of using the vessel stapling procedure to reduce such AEs. Methods First, an animal experiment using pig cardiopulmonary blocks was conducted. Pulmonary arteries were closed with staplers under stressful conditions such as lifting or twisting; vessel stump endurance was analyzed through different methods. Second, AEs associated with clinical stapler use for pulmonary vessels were retrospectively reviewed by studying clinical videos of 263 patients. Results In the animal experiment, the pressure resistance was significantly lower in the twisted group than in the no strain group (no strain vs. lifting: P=0.2008, no strain vs. twisting: P=0.002, no strain vs. twisting and lifting: P<0.0001). Regarding clinical stapler use, 754 staplers were used against the vessels. AEs occurred in 9 cases, and 7 cases were suspected to be caused by vessel tension. Conclusions The pulmonary vessel stapling causes stress due to twisting and lifting that decreased stump durability. Avoiding such stress when using stapler for vessels leads to a safer thoracic surgery.
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Affiliation(s)
- Nahoko Shimizu
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yugo Tanaka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Okamoto
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takefumi Doi
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Hokka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Impact of Powered and Tissue-Specific Endoscopic Stapling Technology on Clinical and Economic Outcomes of Video-Assisted Thoracic Surgery Lobectomy Procedures: A Retrospective, Observational Study. Adv Ther 2018; 35:707-723. [PMID: 29663180 PMCID: PMC5960486 DOI: 10.1007/s12325-018-0679-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Indexed: 12/22/2022]
Abstract
Introduction Video-assisted thoracic surgery (VATS) lung resections are complex procedures with a critical role played by endoscopic staplers in the transection of vessels, bronchi, and lung tissue. This retrospective, observational study compared hospital resource use, costs, and complications of VATS lobectomy procedures for whom powered versus manual endoscopic surgical staplers were used. Methods Patients ≥ 18 years of age undergoing elective VATS lobectomy during an inpatient admission from January 1, 2012 to September 30, 2016 were identified from the Premier Healthcare Database (first admission = index admission). Use of either powered or manual endoscopic staplers during the index admission was identified from hospital administrative records. Multivariable regression analyses adjusting for patient, hospital, and provider characteristics and hospital-level clustering were carried out to compare the following outcomes between the powered and manual stapler groups: hospital length of stay (LOS), operating room time (ORT), hospital costs, complications (bleeding and/or transfusions, air leak complications, pneumonia, and infection), discharge status, and 30-, 60-, and 90-day all-cause readmissions. Results The powered and manual stapler groups comprised 659 patients (mean age 66.1 years; 53.6% female) and 3100 patients (mean age 66.7 years; 54.8% female), respectively. In the multivariable analyses, the powered stapler group had shorter LOS (4.9 vs. 5.9 days, P < 0.001), lower total hospital costs ($23,841 vs. $26,052, P = 0.009), and lower rates of combined hemostasis complications (bleeding and/or transfusions; 8.5% vs. 16.0%, P < 0.001) and transfusions (5.4% vs. 10.9%, P = 0.002), compared with the manual stapler group. Other outcomes did not differ significantly between the study groups. Similar trends were observed in subanalyses comparing devices across predominant manufacturers in each group, and in subanalyses of patients with comorbid chronic obstructive pulmonary disease. Conclusion In this analysis of VATS lobectomy procedures, powered staplers were associated with significant benefits with respect to selected types of hospital resource use, costs, and clinical outcomes when compared with manual staplers. Funding Johnson & Johnson. Electronic supplementary material The online version of this article (10.1007/s12325-018-0679-z) contains supplementary material, which is available to authorized users.
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Özyurtkan MO, Kaba E, Toker A. Technological innovation in video-assisted thoracic surgery. J Vis Surg 2017; 3:20. [PMID: 29078583 DOI: 10.21037/jovs.2017.01.03] [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] [Received: 12/07/2016] [Accepted: 12/09/2016] [Indexed: 11/06/2022]
Abstract
The popularity of video-assisted thoracic surgery (VATS) which increased worldwide due to the recent innovations in thoracic surgical technics, equipment, electronic devices that carry light and vision and high definition monitors. Uniportal VATS (UVATS) is disseminated widely, creating a drive to develop new techniques and instruments, including new graspers and special staplers with more angulation capacities. During the history of VATS, the classical 10 mm 0° or 30° rigid rod lens system, has been replaced by new thoracoscopes providing a variable angle technology and allowing 0° and 120° range of vision. Besides, the tip of these novel thoracoscopes can be positioned away from the operating side minimize fencing with other thoracoscopic instruments. The curved-tip stapler technology, and better designed endostaplers helped better dissection, precision of control, more secure staple lines. UVATS also contributed to the development of embryonic natural orifice transluminal endoscopic surgery. Three-dimensional VATS systems facilitated faster and more accurate grasping, suturing, and dissection of the tissues by restoring natural 3D vision and the perception of depth. Another innovation in VATS is the energy-based coagulative and tissue fusion technology which may be an alternative to endostaplers.
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Affiliation(s)
- Mehmet Oğuzhan Özyurtkan
- Department of Thoracic Surgery, Istanbul Bilim University Medical Faculty and Group Florence Nightingale Hospitals, Istanbul, Turkey
| | - Erkan Kaba
- Department of Thoracic Surgery, Istanbul Bilim University Medical Faculty and Group Florence Nightingale Hospitals, Istanbul, Turkey
| | - Alper Toker
- Department of Thoracic Surgery, Istanbul Bilim University Medical Faculty and Group Florence Nightingale Hospitals, Istanbul, Turkey
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Zhao ZR, Li Z, Situ DR, Ng CSH. Recent clinical innovations in thoracic surgery in Hong Kong. J Thorac Dis 2016; 8:S618-26. [PMID: 27651937 DOI: 10.21037/jtd.2016.03.93] [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: 01/30/2023]
Abstract
The concept of personalized medicine, which aims to provide patients with targeted therapies while greatly reducing surgical trauma, is gaining popularity among Asian clinicians. Single port video-assisted thoracic surgery (VATS) has rapidly gained popularity in Hong Kong for major lung resections, despite bringing new challenges such as interference between surgical instruments and insertion of the optical source through a single incision. Novel types of endocutters and thoracoscopes can help reduce the difficulties commonly encountered during single-port VATS. Our region has been the testing ground and has led the development of many of these innovations. Performing VATS, in particular single-port VATS in hybrid operating theatre helps to localise small pulmonary lesions with real-time images, thus increasing surgical accuracy and pushes the boundaries in treating subcentimeter diseases. Such approach may be assisted by use of electromagnetic navigational bronchoscopy in the same setting. In addition, sublobar resection can also be more individualised according to pathologic tumour subtype that require rapid intraoperative diagnostic test to guide appropriate surgical therapy. A focus on technology and innovation for large tumours that require chest wall resection and reconstructions have also been on going, with new materials and prostheses that may be tailored to each individual needs. The current paper reviews the literature pertaining to the above topics and discusses recent related innovations in Hong Kong, highlighting the study results and future perspectives.
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Affiliation(s)
- Ze-Rui Zhao
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zheng Li
- Institute of Digestive Disease, Chow Yuk Ho Technology Centre for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dong-Rong Situ
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Centre for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-sen University Cancer Centre, Guangzhou 510060, China
| | - Calvin S H Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Zhao ZR, Lau RWH, Ng CSH. Hybrid theatre and alternative localization techniques in conventional and single-port video-assisted thoracoscopic surgery. J Thorac Dis 2016; 8:S319-27. [PMID: 27014480 DOI: 10.3978/j.issn.2072-1439.2016.02.27] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Management of pulmonary nodules in terms of diagnosis and intraoperative localization can be challenging, especially in the minimal invasive video-assisted thoracoscopic surgery (VATS) approach, and may be even more difficult with single port VATS with limited access. The ability to localize small lesions intraoperatively is particularly important for excisional biopsy for diagnostic frozen section, as well as to guide sublobar resection. Some of the common techniques to aid localization include preoperative percutaneous hookwire localization, colour dye or radio-dye labelling injection of the nodule or adjacent site to allowing visualization or detection by radioactive counter intraoperatively. The use of hybrid operating room (OR) for intraoperative localization of lung nodules was first reported in 2013, and was called image guided VATS (iVATS). Subsequently, we have expanded the iVATS application for single port VATS major lung resection of small or ground-glass opacity lesions. By performing an on-table cone-beam CT scan, real-time and accurate assessment of the pulmonary lesion can be made, which can aid the localization process. Other types of physical or colour marker that can be deployed percutaneously in the hybrid OR immediate before surgery can enhance haptic feedback and sensitivity of digital palpation, as well as provide a radiopaque nidus for radiological confirmation. In the past decade, the electromagnetic navigation bronchoscopy (ENB) technology had developed into a useful adjunct technology for the localization of peripheral lung nodules by injection of marking agent or deployment of fiducial to the lesion through the endobronchial route causing much lower marking agent diffusion and artefacts. Recently, the combination of hybrid OR and ENB for lung nodule localization and marking has further increased the accuracy and applicability of the technology. The article will be exploring the latest development of the above approaches to lung nodule localization, and discuss some of the techniques' advantages and flaws.
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Affiliation(s)
- Ze-Rui Zhao
- 1 Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China ; 2 State Key Laboratory of Oncology in Southern China, Collaborative Innovation Centre for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-Sen University Cancer Centre, Guangzhou 510060, China
| | - Rainbow W H Lau
- 1 Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China ; 2 State Key Laboratory of Oncology in Southern China, Collaborative Innovation Centre for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-Sen University Cancer Centre, Guangzhou 510060, China
| | - Calvin S H Ng
- 1 Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China ; 2 State Key Laboratory of Oncology in Southern China, Collaborative Innovation Centre for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-Sen University Cancer Centre, Guangzhou 510060, China
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Abstract
Single port video-assisted thoracic surgery (VATS) is the most recent evolution in minimally invasive thoracic surgery. With increasing global popularity, the single port VATS approach has been adopted by experienced thoracic surgeons in many Asian countries. From initial experience of single port VATS lobectomy to the more complex sleeve resection procedures now forming part of daily practice in some Asia institutes, the region has been the proving ground for single port VATS approaches' feasibility and safety. In addition, certain technical refinements in single port VATS lung resection and lymph node dissection have also sprung from Asia. Novel equipment designed to facilitate single port VATS allowing further reduce access trauma are being realized by the partnership between surgeons and the industries. Advanced thoracoscopes and staplers that are narrower and more maneuverable are particularly important in the smaller habitus of patients from Asia. These and similar new generation equipment are being applied to single port VATS in novel ways. As dedicated thoracic surgeons in the region continue to striving for excellence, innovative ideas in single incision access including subxiphoid and embryonic natural-orifice transluminal endoscopic surgery (e-NOTES) have been explored. Adjunct techniques and technology used in association with single port VATS such as non-intubated surgery, hybrid operating room image guidance and electromagnetic navigational bronchoscopy are all in rapid development in Asia.
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Affiliation(s)
- Peter S Y Yu
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Freddie Capili
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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