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McLaughlin CS, Samant A, Saha AK, Lee LK, Gupta R, Templeton LB, Mathis MR, Vishneski S, Templeton TW. Bronchial Blocker Versus Endobronchial Intubation in Young Children Undergoing One-Lung Ventilation: A Multicenter Retrospective Cohort Study. Anesth Analg 2024:00000539-990000000-00939. [PMID: 39269648 DOI: 10.1213/ane.0000000000006973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
BACKGROUND Thoracic surgery and one-lung ventilation in young children carry significant risks. Approaches to one-lung ventilation in young children include endobronchial intubation (mainstem intubation) and use of a bronchial blocker. We hypothesized that endobronchial intubation is associated with a greater prevalence of airway complications compared to use of a bronchial blocker. METHODS The Multicenter Perioperative Outcomes Group database was queried from 2004 to 2022 for one-lung ventilation cases in children, 2 months to 3 years of age, inclusive. Airway notes and free-text comments were manually reviewed for airway complications. Documented airway complications were considered the primary outcome and were divided into "Moderate" and "Critical." Moderate airway complications were bronchial blocker or endotracheal tube movement leading to loss of isolation, hypoxemia requiring ventilatory intervention, bronchial blocker migration into the trachea, significant impairment of ventilation, and other. Critical complications included reintubation or airway replacement intraoperatively, complete endotracheal tube occlusion, cardiac arrest or airway-related bradycardia, and procedure aborted due to an airway issue. An adjusted propensity score-matched analysis was then used to assess the impact of a bronchial blocker on the outcomes of moderate and critical complications. RESULTS After exclusions, 704 patients were included in the primary analysis. In unadjusted analyses, no statistically significant difference was observed in moderate airway complications between endobronchial intubation and bronchial blocker cohorts: 37 of 444 (8.3%; 95% confidence interval [CI], 5.9%-11.3%) vs 28 of 260 (10.8%; 95% CI, 7.3%-15.2%) with P = .281. In the unadjusted analysis, the prevalence of critical airway complications was significantly higher in the endobronchial intubation cohort compared to the bronchial blocker cohort: 28 of 444 (6.3%; 95% CI, 4.2%-9.0%) vs 5 of 260 (1.9%; 95% CI, 0.6%-4.4%) with P = .008. In the propensity-matched cohort analysis, endobronchial intubation was associated with a slightly increased risk of critical complications compared to use of a bronchial blocker: 14 of 243 (5.8%; 95% CI, 2.8%-8.7%) vs 5 of 243 (2.1%; 95% CI, 0.3%-3.8%) with P = .035. CONCLUSIONS Endobronchial intubation might be associated with a slightly increased risk of critical airway complications compared to use of a bronchial blocker in young children undergoing thoracic surgery and one-lung ventilation. Further, prospective studies are needed before a definitive change in practice is recommended.
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Affiliation(s)
- Christopher S McLaughlin
- From the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Anusha Samant
- From the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Amit K Saha
- From the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lisa K Lee
- Department of Anesthesiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Ruchika Gupta
- Department of Anesthesiology, University of Michigan Anesthesiology, Ann Arbor, Michigan
| | - Leah B Templeton
- From the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Michael R Mathis
- Department of Anesthesiology, University of Michigan Anesthesiology, Ann Arbor, Michigan
| | - Susan Vishneski
- From the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - T Wesley Templeton
- From the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Kankoç A, Sayan M, Çelik A. Videothoracoscopic surgery in children. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S43-S54. [PMID: 38584793 PMCID: PMC10995678 DOI: 10.5606/tgkdc.dergisi.2024.25710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/22/2023] [Indexed: 04/09/2024]
Abstract
Video-assisted thoracic surgery (VATS) is now being used with increasing frequency for a wide variety of indications in pediatric patients. Although there is no high level of evidence for the advantages of VATS in the pediatric patient group, the proven benefits of this method in the adult patient group have encouraged thoracic surgeons to perform VATS in this patient population. In this study, the procedures performed in pediatric patients under 18 years of age and their results were reviewed with the help of articles obtained as a result of searches using relevant keywords in the English literature (PubMed, Web of Science, EMBASE, and Cochrane). The frequency, indications, and results of the procedures performed differed according to age groups.
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Affiliation(s)
- Aykut Kankoç
- Department of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Muhammet Sayan
- Department of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Ali Çelik
- Department of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
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Chang SL, Lai CH, Chen GY, Chou CM, Huang SY, Chen YM, Liu TJ, Lai HC. Case reports of one-lung ventilation using Fuji Uniblocker bronchial blockers for infants under one-year-old in uniportal video-assisted thoracoscopic surgery. Medicine (Baltimore) 2021; 100:e26325. [PMID: 34232168 PMCID: PMC8270611 DOI: 10.1097/md.0000000000026325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Uniportal video-assisted thoracoscopic surgery (VATS) for various pulmonary diseases provides advantages of less postoperative pain and earlier post-operative recovery over traditional open surgery. The inherent limitation of this surgical modality in manipulation of surgical instruments renders intra-operative one-lung ventilation a requisite to increase the substantially restricted working space and thus visibility of the surgical filed. PATIENT CONCERNS Patient 1, an 8-month-old, 9-kg, and 70 cm-in-height male infant was diagnosed as congenital pulmonary airway malformation (CPAM) over left lower lobe.Patient 2, a 9-month-old, 8-kg and 72 cm-in-height male infant was diagnosed as CPAM over right lower lobe.Patient 3, an 8-month-old, 8-kg and 67 cm-in-height female infant was diagnosed as CPAM over left lower lobe.This facilitating one-lung ventilation yet was rarely conducted in infants under one year of age for the extremely small body size, the unavailability of dedicated tools, and therein the very tough techniques demanded. DIAGNOSIS Infants with congenital cystic adenomatoid malformation. INTERVENTIONS Here we report three infants of less than one year of age in whom one-lung ventilation was successfully achieved by intraluminal use of 5-Fr Fuji Uniblocker Bronchial Blocker devices and in turn assisted the completion of uniportal VATS for congenital cystic adenomatoid malformation in unilateral lungs. OUTCOMES Three infants received VATS under uniblocker smoothly. Patient 1 had two episode of balloon dislodgement and desaturation and solved by re-insertion. And he had subglottic tracheal stenosis which treatment with laser coagulation. Patient 2 had overall blood loss 80 ml. Patient 3 had one episode of desaturation after stapling the bronchus and fiberoptic bronchoscope revealed obstruction by blood and secretion which solved by suction. CONCLUSION In conclusion, OLV in infants undergoing uniportal VATs could be successfully achieved by Fuji 5 Fr Uniblocker bronchial blockers for as long as 4 hours, as exemplified by our three cases, and balloon poor sealing and dislodgment can be immediately solved by bronchoscope-guided re-positioning without compromising surgical proceeding or outcome.
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Affiliation(s)
- Szu-Ling Chang
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung
- Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei
| | - Chih-Hung Lai
- Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei
- Department of Medicine and Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Guan-Yu Chen
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taichung
| | - Chia-Man Chou
- Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital
| | - Sheng-Yang Huang
- Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital
| | - Yung-Ming Chen
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung
| | - Tsun-Jui Liu
- Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei
- Department of Medicine and Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- National Chung-Hsing University, Taichung, Taiwan
| | - Hui-Chin Lai
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung
- Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei
- National Chung-Hsing University, Taichung, Taiwan
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Serial improvement of quality metrics in pediatric thoracoscopic lobectomy for congenital lung malformation: an analysis of learning curve. Surg Endosc 2017; 31:3932-3938. [PMID: 28205035 DOI: 10.1007/s00464-017-5425-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) pulmonary resection in children is a technically demanding procedure that requires a relatively long learning period. This study aimed to evaluate the serial improvement of quality metrics according to case volume experience in pediatric VATS pulmonary resection of congenital lung malformation (CLM). Methods VATS anatomical resection in CLM was attempted in 200 consecutive patients. The learning curve for the operative time was modeled by cumulative sum analysis. Quality metrics were used to measure technical achievement and efficiency outcomes. Results The median operative time was 95 min. The median length of hospital stay and chest tube indwelling time was 4 and 2 days, respectively. The improvement of operation time was observed persistently until 200 cases. However, two cut-off points, the 50th case and 110th case, were identified in the learning curve for operative time, and the 110th case was the turning point for stable outcomes with short operation time. Significant reduction of length of hospital stay and chest tube indwelling time was observed after 50 cases (p = .002 and p = .021, respectively). The complication rate decreased but continued at a low rate for entire study period and the interval decrease was not statistically significant. Conversion rate decreased significantly (p = .001), and technically challenging procedures were performed more frequently in later cases. Conclusions Improvements of quality metrics in operation time, conversion rate, length of hospital stay, and chest tube indwelling time were observed in proportion to case volume. Minimum experience of 50 is necessary for stable outcomes of pediatric VATS pulmonary resection.
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Na KJ, Jung JC, Hwang Y, Lee HJ, Park IK, Kang CH, Jang JY, Kim YT. Minimally Invasive Surgical Repair for Congenital Bronchobiliary Fistula in an Adult. Ann Thorac Surg 2016; 101:1584-7. [PMID: 27000583 DOI: 10.1016/j.athoracsur.2015.05.126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 04/19/2015] [Accepted: 05/15/2015] [Indexed: 12/30/2022]
Abstract
Congenital bronchobiliary fistula (CBBF) is a very rare disease and usually requires surgical intervention at a young age. We report a case of CBBF in an adult who was treated successfully with a minimally invasive endoscopic operation.
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Affiliation(s)
- Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Joon Chul Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Yoohwa Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Hyun Joo Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Jin-Young Jang
- Department of General Surgery, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University, Seoul, South Korea; Cancer Research Institute, Seoul National University, College of Medicine, Seoul, South Korea.
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Laje P, Pearson EG, Simpao AF, Rehman MA, Sinclair T, Hedrick HL, Adzick NS, Flake AW. The first 100 infant thoracoscopic lobectomies: Observations through the learning curve and comparison to open lobectomy. J Pediatr Surg 2015; 50:1811-6. [PMID: 26100691 DOI: 10.1016/j.jpedsurg.2015.05.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/22/2015] [Accepted: 05/26/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the study is to describe our initial 100 attempted infant thoracoscopic lobectomies for asymptomatic, prenatally diagnosed lung lesions, and compare the results to contemporaneous age-matched patients undergoing open lobectomy. BACKGROUND Infant thoracoscopic lobectomy is a technically challenging procedure, which has only gained acceptance worldwide in recent years. METHODS This is a retrospective review of all patients undergoing thoracoscopic or open lung lobectomy between March 2005 and January 2014. Included were all asymptomatic infants younger than 4months. Excluded were patients undergoing emergent lobectomy and patients with isolated extralobar bronchopulmonary sequestrations. RESULTS A total of 100 attempted thoracoscopic lobectomies were compared with 188 open lobectomies. In the thoracoscopic group, mean age and weight at surgery were 7.3weeks and 4.8kg, mean operative time was 185minutes, and mean hospital stay was 3days. Twelve cases were converted to open (12%). Ten conversions occurred within the first third of the series and none in the last third. There were no mortalities. There were no differences between the thoracoscopic and open groups in perioperative complications or hospital stay. There was a significant difference in the operative time: 111minutes vs. 185minutes (open vs. thoracoscopic; p<0.001). There was a higher mean end-tidal carbon dioxide (ETCO2) and lower mean peripheral capillary oxygen saturation (SpO2) in the thoracoscopic group versus the open group (51.7 versus 38.6mmHg and 97.5 versus 99.1%, respectively). CONCLUSION In high volume centers, the learning curve of thoracoscopic lobectomy can be overcome and the procedure can be performed with equivalent outcomes and, in our opinion, superior cosmetic results to open lobectomy.
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Affiliation(s)
- Pablo Laje
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erik G Pearson
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allan F Simpao
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mohammed A Rehman
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tiffany Sinclair
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Holly L Hedrick
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N Scott Adzick
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alan W Flake
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Yu D, Han Y, Zhou S, Song X, Li Y, Xiao N, Liu Z. Video-assisted thoracic bronchial sleeve lobectomy with bronchoplasty for treatment of lung cancer confined to a single lung lobe: a case series of Chinese patients. J Cardiothorac Surg 2014; 9:67. [PMID: 24708731 PMCID: PMC3999504 DOI: 10.1186/1749-8090-9-67] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 03/17/2014] [Indexed: 11/25/2022] Open
Abstract
Background The outcomes of video-assisted thoracic bronchial sleeve lobectomy (VABSL), a minimally invasive video-assisted thoracoscopic (VATS) lobectomy, are mostly unknown in Chinese patients. Objectives To investigate operative and postoperative outcomes of VABSL in a cases series of Chinese patients with lung cancer. Methods Retrospective study of 9 patients (male:female 8:1; mean age 59.4 ± 17.6 years, ranging 21–79 years) diagnosed with lung cancer of a single lobe, treated with VABSL between March 2009 and November 2011, and followed up for at least 2 months (mean follow-up: 14.17 ± 12.91 months). Operative outcomes (tumor size, operation time, estimated blood loss and blood transfusion), postoperative outcomes (intensive care unit [ICU] stay, hospitalization length and pathological tumor stage), death, tumor recurrence and safety were assessed. Results Patients were diagnosed with carcinoid cancer (11.1%), squamous carcinoma (66.7%) or small cell carcinoma (22.2%), affecting the right (77.8%) or left (22.2%) lung lobes in the upper (55.6%), middle (11.1%) or lower (33.3%) regions. TNM stages were T2 (88.9%) or T3 (11.1%); N0 (66.7%), N1 (11.1%) or N2 (22.2%); and M0 (100%). No patient required conversion to thoracotomy. Mean tumor size, operation time and blood loss were 2.50 ± 0.75 cm, 203 ± 20 min and 390 ± 206 ml, respectively. Patients were treated in the ICU for 18.7 ± 0.7 hours, and overall hospitalization duration was 20.8 ± 2.0 days. No deaths, recurrences or severe complications were reported. Conclusions VABSL surgery is safe and effective for treatment of lung cancer by experienced physicians, warranting wider implementation of VABSL and VATS training in China.
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Affiliation(s)
| | | | | | | | | | | | - Zhidong Liu
- Department of thoracic surgery, Beijing Chest Hospital, Beijing 101149, China.
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Minimally invasive thoracic surgery in pediatric patients: the Taiwan experience. BIOMED RESEARCH INTERNATIONAL 2013; 2013:850840. [PMID: 23819123 PMCID: PMC3683426 DOI: 10.1155/2013/850840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 05/06/2013] [Accepted: 05/07/2013] [Indexed: 11/17/2022]
Abstract
Minimally invasive technology or laparoscopic surgery underwent a major breakthrough over the past two decades. The first experience of thoracoscopy in children was reported around 1980 for diagnosis of intrathoracic pathology and neoplasia. Up until the middle of the 1990s, the surgical community in Taiwan was still not well prepared to accept the coming era of minimally invasive surgery. In the beginning, laparoscopy was performed in only a few specialties and only relatively short or simple surgeries were considered. But now, the Taiwan's experiences over the several different clinical scenarios were dramatically increased. Therefore, we elaborated on the experience about pectus excavatum: Nuss procedure, primary spontaneous hemopneumothorax, thoracoscopic thymectomy, and empyema in Taiwan.
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