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Hui S, Zhang Q, Lang J, Yi J. Temperature effect on coagulation function in mild hypothermic patients undergoing thoracic surgeries: thromboelastography (TEG) versus standard tests. Perioper Med (Lond) 2024; 13:55. [PMID: 38867331 PMCID: PMC11167826 DOI: 10.1186/s13741-024-00405-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/22/2024] [Indexed: 06/14/2024] Open
Abstract
PURPOSE Our previous research has revealed that mild hypothermia leads to excessive bleeding in thoracic surgeries, while the underlying mechanism stayed unrevealed by the standard coagulation tests. The research question in this study was as follows: "How does mild hypothermia impair the hemostatic function in patients receiving thoracic surgeries?". The purpose was to detect the disturbed coagulation processes by comparing the TEG parameters in patients receiving active vs. passive warming during thoracic surgeries. METHODS Standard coagulation tests and thromboelastography (TEG) were adopted to compare the hemostatic functions in patients receiving active vs. passive warming during thoracic surgeries. Furthermore, blood samples from passive warming group were retested for TEG at actual core body temperatures. RESULTS Sixty-four eligible patients were included in this study. TEG revealed that mild hypothermia significantly disturbed coagulation by decreasing MA (59.4 ± 4.5 mm vs. 64.2 ± 5.7 mm, p = 0.04) and α angle (70.4 ± 5.2° vs. 74.9 ± 4.4°, p = 0.05) and prolonging ACT (122.2 ± 19.3 s vs. 117.3 ± 15.2 s, p = 0.01) and K time (1.9 ± 1.0 s vs. 1.3 ± 0.4 min, p = 0.02). TEGs conducted under core body temperatures revealed more impaired coagulation than those incubated at 37 °C. Furthermore, postoperative shivering and waking time were significantly increased in mild hypothermic patients. CONCLUSION Mild hypothermia significantly impaired coagulation function in patients receiving thoracic surgeries, which could be detected by TEGs other than the standard coagulation tests. Temperature-adjusted TEGs may provide a preferable method of hemostatic monitoring and transfusion guidance in thoracic surgeries, which warrants further clinical investigations.
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Affiliation(s)
- Shangyi Hui
- Department of Anesthesiology, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China
| | - Qian Zhang
- Department of Anesthesiology, Hebei Petrochina Central Hospital, No. 51 Xin Kai Road, Langfang, 065000, China
| | - Jiaxin Lang
- Department of Anesthesiology, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China
| | - Jie Yi
- Department of Anesthesiology, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China.
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Bulgarelli Maqueda L, Têtu M, Guimarães Rocha Lima P, Abu-Reida F, Alashgar O, Dayan G, Nasir B, Ferraro P, Liberman M. Outside the Cage Subcostal RATS Lobectomy: Technical Aspects and Results of the First Series of a Novel Approach to Pulmonary Lobectomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:519-524. [PMID: 38073258 PMCID: PMC10757067 DOI: 10.1177/15569845231217257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE The goal of minimally invasive surgery is to reduce trauma to patients and improve their postoperative outcomes. In this context, the utilization of robot-assisted thoracic surgery (RATS) in the treatment of lung cancer has increased worldwide. The feasibility of single-incision major pulmonary resections by RATS was recently reported, with the objective of minimizing the surgical trauma of the traditional multiportal RATS approach. However, both techniques require intercostal incisions, potentially causing immediate and chronic pain resulting from intercostal nerve injury. To reduce postoperative pain resulting from intercostal approaches, we developed a nonintercostal, outside the thoracic cage (OTC) approach for RATS lobectomy, avoiding intercostal instrumentation. This report aims to describe the results of the first reported series of OTC subcostal RATS lobectomies. METHODS Retrospective analysis of a series of the first consecutive patients operated on using the novel OTC subcostal RATS lobectomy technique. RESULTS Between August and December 2022, a total of 10 consecutive cases were analyzed. The median age was 63 (55 to 84) years, the mean body mass index was 29 (24 to 45) kg/m2, and the median American Society of Anesthesiologists score was III (II to IV). No serious adverse events were observed, and there was no conversion of the surgical technique. The mean operative time was 132.6 (98 to 223) min. The median length of stay was 2 days. No pain-related complications, readmissions, or 30-day mortality were observed. CONCLUSIONS This series demonstrates that OTC RATS lobectomy is feasible and safe. A phase I clinical trial is currently underway to prospectively assess the safety of the technique as well as its clinical relevance.
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Affiliation(s)
- Luciano Bulgarelli Maqueda
- Department of Thoracic Surgery, CHUM
Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de
l’Université de Montréal (CHUM), University of Montréal, QC, Canada
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
| | - Maxime Têtu
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
| | - Pedro Guimarães Rocha Lima
- Department of Thoracic Surgery, CHUM
Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de
l’Université de Montréal (CHUM), University of Montréal, QC, Canada
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
| | - Feras Abu-Reida
- Department of Thoracic Surgery, CHUM
Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de
l’Université de Montréal (CHUM), University of Montréal, QC, Canada
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
| | - Omniyah Alashgar
- Department of Thoracic Surgery, CHUM
Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de
l’Université de Montréal (CHUM), University of Montréal, QC, Canada
| | - Gabriel Dayan
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
| | - Basil Nasir
- Department of Thoracic Surgery, CHUM
Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de
l’Université de Montréal (CHUM), University of Montréal, QC, Canada
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
| | - Pasquale Ferraro
- Department of Thoracic Surgery, CHUM
Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de
l’Université de Montréal (CHUM), University of Montréal, QC, Canada
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
| | - Moishe Liberman
- Department of Thoracic Surgery, CHUM
Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de
l’Université de Montréal (CHUM), University of Montréal, QC, Canada
- Centre de Recherche de Centre
Hospitalier de l’Université de Montréal (CR-CHUM), QC, Canada
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Forster C, Hasenauer A, Perentes JY, Abdelnour-Berchtold E, Zellweger M, Krueger T, Gonzalez M. Is faster better? Impact of operative time on postoperative outcomes after VATS anatomical pulmonary resection. J Thorac Dis 2022; 14:1980-1989. [PMID: 35813729 PMCID: PMC9264101 DOI: 10.21037/jtd-21-1774] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/21/2022] [Indexed: 12/03/2022]
Abstract
Background Video-assisted thoracic surgery (VATS) is now the preferred approach for standard anatomical pulmonary resections. This study evaluates the impact of operative time (OT) on post-operative outcomes after VATS anatomical pulmonary resection for non-small cell lung cancer (NSCLC). Methods We retrospectively reviewed all consecutive patients undergoing VATS lobectomy or segmentectomy for NSCLC between November 2010 and December 2019. Postoperative outcomes were compared between short (<150 minutes) and long (≥150 minutes) OT groups. A multivariable analysis was performed to identify predictors of long OT and overall post-operative complications. Results A total of 670 patients underwent lobectomy (n=496, 74%) or segmentectomy (n=174, 26%) for NSCLC. Mediastinal lymph node dissection was performed in 621 patients (92.7%). The median OT was 141 minutes (SD: 47 minutes) and 387 patients (57.8%) were operated within 150 minutes. Neoadjuvant chemotherapy was given in 25 patients (3.7%). Conversion thoracotomy was realized in 40 patients (6%). Shorter OT was significantly associated with decreased post-operative overall complication rate (30% vs. 41%; P=0.003), shorter median length of drainage (3 vs. 4 days; P<0.001) and shorter median length of hospital stay (6 vs. 7 days; P<0.001). On multivariable analysis, long OT (≥150 minutes) (OR 1.64, P=0.006), ASA score >2 (OR 1.87, P=0.001), FEV1 <80% (OR 1.47, P=0.046) and DLCO <80% (OR 1.5, P=0.045) were significantly associated with postoperative complications. Two predictors of long OT were identified: neoadjuvant chemotherapy (OR 3.11, P=0.01) and lobectomy (OR 1.5, P=0.032). Conclusions A prolonged OT is significantly associated with postoperative complications in our collective of patients undergoing VATS anatomical pulmonary resection.
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Affiliation(s)
- Céline Forster
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Arpad Hasenauer
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | | | - Matthieu Zellweger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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Mangiameli G, Bottoni E, Voulaz E, Cariboni U, Testori A, Crepaldi A, Giudici VM, Morenghi E, Alloisio M. Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas's Experience. J Clin Med 2021; 10:jcm10214968. [PMID: 34768488 PMCID: PMC8584559 DOI: 10.3390/jcm10214968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We analysed a series of malignant pleural mesothelioma (MPM) patients who consecutively underwent extended Pleurectomy/Decortication (eP/D) in a centre with a high level of thoracic surgery experience (IRCCS Humanitas Research Hospital) to explore postoperative morbidity and mortality, pattern of recurrence and survival. METHODS A retrospective analysis was performed on MPM patients underwent eP/D in our centre from 2010 to 2021. All patients were identified from our departmental database. Postoperative complications were scored according to Clavien-Dindo criteria. Survival analysis was performed by the Kaplan-Meier methods and Cox multivariable analysis. RESULTS Eighty-five patients underwent extended pleurectomy decortication (eP/D) during study period. Macroscopical residual disease (R2) was reported in one case. A neoadjuvant chemotherapy regiment was administrated in 88% of the surgical cohort. A complete trimodality treatment including induction with platinum agents and pemetrexed, radical cytoreductive surgery and volumetric modulated arc therapy technology (VMAT) could be administered in 63 patients (74%). Postoperative morbidity rate was 54.11%, major complications (defined as Clavien-Dindo ≥ 3) were reported in 11 patients (12.9%). Thirty-day mortality and 90-day mortality were, respectively, 2.35% and 3.53%. Median disease-free and overall survival were, respectively, 13.7 and 25.5 months. The occurrence of major complications (Clavien-Dindo ≥ 3), operative time, pT3-T4, pathological node involvement (pN+) were prognostic factors associated with worse survival. CONCLUSIONS In our experience, eP/D is a well-tolerated procedure with acceptable mortality and morbidity, allowing for the administration of trimodality regimens in most patients. eP/D offered in a multimodality treatment setting have satisfactory long term oncological results. To obtain best oncological results the goal of surgery should be macroscopic complete resection in carefully selected patients (clinical N0).
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Affiliation(s)
- Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, MI, Italy
- Correspondence: ; Tel.: +39-02-82247585
| | - Edoardo Bottoni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
| | - Emanuele Voulaz
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, MI, Italy
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
| | - Alessandro Crepaldi
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
| | - Veronica Maria Giudici
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
| | - Emanuela Morenghi
- Biostatistic Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy;
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (E.B.); (E.V.); (U.C.); (A.T.); (A.C.); (V.M.G.); (M.A.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, MI, Italy
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Bertolaccini L, Calabrese F, Kawamukai K, Brandolini J, Solli P. The relativity of operative time on the outcomes of the video-assisted thoracoscopic lobectomies. J Thorac Dis 2019; 11:S354-S355. [PMID: 30997219 DOI: 10.21037/jtd.2018.12.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | | | - Kenji Kawamukai
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | - Jury Brandolini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | - Piergiorgio Solli
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
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Petrella F. Indications and timing of conversion to thoracotomy during video-assisted lung resection. J Thorac Dis 2019; 10:S4159-S4161. [PMID: 30631581 DOI: 10.21037/jtd.2018.10.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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