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Gu Y, Li X, Zhou Q, Deng H, Zhang F, Wei J, Lv X. Enhanced pain management improves CPTS outcomes. J Anesth 2024:10.1007/s00540-024-03390-w. [PMID: 39138699 DOI: 10.1007/s00540-024-03390-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024]
Affiliation(s)
- Yang Gu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 507 Zhengmin Rd, Yangpu, Shanghai, China
| | - Xiang Li
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 507 Zhengmin Rd, Yangpu, Shanghai, China
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Qing Zhou
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 507 Zhengmin Rd, Yangpu, Shanghai, China
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huimin Deng
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 507 Zhengmin Rd, Yangpu, Shanghai, China
| | - Faqiang Zhang
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 507 Zhengmin Rd, Yangpu, Shanghai, China
| | - Juan Wei
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 507 Zhengmin Rd, Yangpu, Shanghai, China
| | - Xin Lv
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 507 Zhengmin Rd, Yangpu, Shanghai, China.
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Nachira D, Napolitano AG, Nocera A, Congedo MT, Senatore A, Meacci E, Vita ML, Margaritora S. Letter to editor: to cover or not to cover, to promote adhesions or not? Comment on: "comparison of early recurrence in young-onset primary spontaneous pneumothorax following surgery using different covering methods". Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02070-6. [PMID: 39133456 DOI: 10.1007/s11748-024-02070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 08/03/2024] [Indexed: 08/13/2024]
Affiliation(s)
- Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Antonio Giulio Napolitano
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | - Adriana Nocera
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Alessia Senatore
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
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Giovanni P, Dania N. May fascial blocks reduce chronic pain in Uniportal-VATS? Comment on "Uniportal video-assisted thoracic surgery versus open thoracotomy for chronic pain after surgery: a prospective cohort study". J Anesth 2024:10.1007/s00540-024-03382-w. [PMID: 39098987 DOI: 10.1007/s00540-024-03382-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Punzo Giovanni
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nachira Dania
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
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Janssen N, Franssen AJPM, Ramos González AA, Laven IEWG, Jansen YJL, Daemen JHT, Lozekoot PWJ, Hulsewé KWE, Vissers YLJ, de Loos ER. Uniportal versus multiportal video-assisted thoracoscopic surgery for spontaneous pneumothorax. J Cardiothorac Surg 2024; 19:387. [PMID: 38926766 PMCID: PMC11201089 DOI: 10.1186/s13019-024-02931-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Multiportal video-assisted thoracic surgery (mVATS) is the standard approach for the surgical treatment of spontaneous pneumothorax. However, uniportal VATS (uVATS) has emerged as an alternative aiming to minimize surgical morbidity. This study aims to strengthen the evidence on the safety and efficiency of uVATS compared to mVATS. METHODS From January 2004 to December 2020, records of patients who had undergone surgical treatment for primary or secondary spontaneous pneumothorax were evaluated for eligibility. Patients who had undergone pleurectomy combined with bullectomy or apical wedge resection via uVATS or mVATS were included. Surgical characteristics and postoperative data were compared between patients who had undergone surgery via uVATS or mVATS. Univariable and multivariable analyses were performed to determine whether the surgical approach was associated with any complication (primary outcome), major complications (i.e., Clavien-Dindo ≥ 3), recurrence, prolonged hospitalization or prolonged chest drainage duration (secondary outcomes). RESULTS A total of 212 patients were enrolled. Patients treated via uVATS (n = 71) and mVATS (n = 141) were significantly different in pneumothorax type (secondary spontaneous; uVATS: 54 [76%], mVATS: 79 [56%]; p = 0.004). No significant differences were observed in (major) complications and recurrence rates between both groups. Multivariable analyses revealed that the surgical approach was no significant predictor for the primary or secondary outcomes. CONCLUSIONS This study indicates that uVATS is non-inferior to mVATS in the surgical treatment of spontaneous pneumothorax regarding safety and efficiency, and thus the uVATS approach has the potential for further improvements in the perioperative surgical care for spontaneous pneumothorax.
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Affiliation(s)
- Nicky Janssen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Aimée J P M Franssen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Arlette A Ramos González
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Iris E W G Laven
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Yanina J L Jansen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Jean H T Daemen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Pieter W J Lozekoot
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Karel W E Hulsewé
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Erik R de Loos
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands.
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How CH, Chen PH, Chen YC, Lin YC, Chen KC, Young TH. Mechanical and biological properties of poly-ε-caprolactone membrane for pleurodesis: A preclinical study in pigs. J Formos Med Assoc 2024; 123:594-599. [PMID: 38383169 DOI: 10.1016/j.jfma.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/03/2023] [Accepted: 01/11/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND/PURPOSE Biomaterial implants are emerging as a treatment choice for pleurodesis; however, the optimal biomaterial and form for managing spontaneous pneumothorax, particularly post-video-assisted thoracic surgery, remain under investigation. This study evaluated the mechanical and biological properties of the poly-ε-caprolactone (PCL) membrane as a sclerosing agent for pleurodesis in Landrace pigs. METHODS Twenty-four Landrace pigs were split into two groups for mechanical abrasion and PCL membrane pleurodesis, with the latter group's PCL meshes inserted using video-assisted thoracic surgery. The mechanical and biological properties of the PCL membrane were assessed in pigs at three, six, and 12 months after the procedure. This assessment involved a range of techniques, such as the T-Peel test, macroscopic evaluation with a scoring scale, microscopic examination, and biomechanical and molecular weight analysis. RESULTS The PCL membrane group outperformed the traditional abrasion group, with stronger adhesions seen over longer implantation durations. This group also showed superior and more consistent results in both macroscopic and microscopic evaluations compared to the control group. The membrane-based method was easier and faster to perform than the control group's method, and importantly, no mortality occurred following membrane implantation. CONCLUSION This study is the pioneering effort to present long-term findings regarding the mechanical and biological properties of the PCL membrane in an in vivo animal model. The membrane demonstrated better adhesion ability than that of traditional abrasion and showed reassuring biocompatibility in both the pig model, suggesting its potential as treatment for patients with primary spontaneous pneumothorax. Further clinical studies are needed to support these observations.
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Affiliation(s)
- Cheng-Hung How
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan; Department of Surgery, Division of Thoracic Surgery, Far Eastern Memorial Hospital, Taipei City, Taiwan
| | - Pei-Hsing Chen
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan; Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Yu-Ching Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yong-Chong Lin
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Ke-Cheng Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
| | - Tai-Horng Young
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
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Feasibility of tubeless thoracoscopic bullectomy in primary spontaneous pneumothorax patients. Gen Thorac Cardiovasc Surg 2023; 71:138-144. [PMID: 36036321 DOI: 10.1007/s11748-022-01869-5] [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: 07/22/2022] [Accepted: 08/19/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Although early removal of postoperative chest drains can facilitate postoperative recovery, there are risks of undetected bleeding and a need for re-drainage to treat delayed pulmonary air leaks. In this study, we aimed to prospectively examine the feasibility of tubeless thoracoscopic bullectomy in primary spontaneous pneumothorax (PSP) patients. METHODS Between January 2021 and November 2021, 30 PSP patients were enrolled in this prospective study. The absence of air leakage was confirmed and radiographic evidence of lung expansion was acquired; the tube was then removed in the operating room. The primary endpoint was postoperative air leakage requiring re-drainage among patients who underwent tube removal in the operating room. The secondary endpoints were postoperative pain (numerical rating scale) on postoperative days (PODs) 1, 7, and 28, morbidity, and postoperative hospitalization time. RESULTS Four (13.3%) patients were excluded because of underlying pulmonary disease (n = 2) and air leaks (n = 2) detected in the operating room. Chest drainage tubes were removed in the operating room for the remaining 26 patients; none of them required re-drainage. The mean postoperative hospitalization time was 1.2 ± 0.4 days. The mean numerical rating scale scores were 4.2 ± 2 (median: 4.5), 1.6 ± 1.6 (median: 1), and 0.4 ± 0.8 (median: 0) on PODs 1, 7, and 28, respectively. Only one case of hemoptysis occurred as a postoperative complication. CONCLUSIONS Tubeless thoracoscopic bullectomy for PSP is feasible and may reduce the postoperative hospitalization time; however, it does not significantly reduce pain on POD1.
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Saiki A, Mizobuchi T, Nagato K, Ishibashi F, Tsuyusaki J, Sugano I. Uniportal video-assisted thoracic surgery and perioperative pirfenidone for lung cancer and idiopathic pulmonary fibrosis: a case report. J Int Med Res 2021; 49:3000605211016998. [PMID: 34521243 PMCID: PMC8447107 DOI: 10.1177/03000605211016998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/21/2021] [Indexed: 11/15/2022] Open
Abstract
Patients with idiopathic pulmonary fibrosis (IPF) occasionally experience acute exacerbations after surgery for lung cancer. Several recent studies have revealed a prophylactic effect of perioperative pirfenidone treatment on postoperative acute exacerbations of IPF in patients with lung cancer. A 75-year-old woman consulted with her pulmonologist because of an IPF shadow detected by follow-up chest computed tomography 2 months after surgical treatment of biliary cancer. Another 7 months later, chest computed tomography showed a 23- × 14-mm nodule located in the right lower lobe with high accumulation of fluorodeoxyglucose detected by positron emission tomography, resulting in a radiological diagnosis of primary lung cancer with IPF. We administered perioperative pirfenidone treatment followed by right lower lobectomy using uniportal video-assisted thoracoscopic surgery after attaining a pathological diagnosis of adenocarcinoma. The patient developed no acute exacerbations of IPF during the postoperative period, and she had no recurrence of lung cancer for 15 months after surgery. We successfully used a combination of perioperative antifibrotic medication and minimally invasive surgery after lung cancer surgery in a patient with IPF.
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Affiliation(s)
- Ayae Saiki
- Department of General Thoracic Surgery, Social Welfare
Organization Saiseikai Imperial Gift Foundation, Chibaken Saiseikai Narashino
Hospital, Chiba, Japan
- Department of Respiratory Medicine, Social Welfare Organization
Saiseikai Imperial Gift Foundation, Chibaken Saiseikai Narashino Hospital,
Chiba, Japan
| | - Teruaki Mizobuchi
- Department of General Thoracic Surgery, Social Welfare
Organization Saiseikai Imperial Gift Foundation, Chibaken Saiseikai Narashino
Hospital, Chiba, Japan
| | - Kaoru Nagato
- Department of General Thoracic Surgery, Social Welfare
Organization Saiseikai Imperial Gift Foundation, Chibaken Saiseikai Narashino
Hospital, Chiba, Japan
| | - Fumihiro Ishibashi
- Department of General Thoracic Surgery, Social Welfare
Organization Saiseikai Imperial Gift Foundation, Chibaken Saiseikai Narashino
Hospital, Chiba, Japan
| | - Junichi Tsuyusaki
- Department of Respiratory Medicine, Social Welfare Organization
Saiseikai Imperial Gift Foundation, Chibaken Saiseikai Narashino Hospital,
Chiba, Japan
| | - Isamu Sugano
- Department of Pathology, Social Welfare Organization Saiseikai
Imperial Gift Foundation, Chibaken Saiseikai Narashino Hospital, Chiba,
Japan
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Igai H, Kamiyoshihara M, Furusawa S, Ohsawa F, Yazawa T, Matsuura N. A prospective comparative study of thoracoscopic transareolar and uniportal approaches for young male patients with primary spontaneous pneumothorax. Gen Thorac Cardiovasc Surg 2021; 69:1414-1420. [PMID: 34145507 DOI: 10.1007/s11748-021-01647-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/03/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In this study, we introduce a novel approach, thoracoscopic transareolar bullectomy, for treating young male patients with primary spontaneous pneumothorax (PSP). This approach might be less invasive and cosmetically superior to existing methods. We also prospectively compared transareolar and uniportal approaches. METHODS Between April 2018 and July 2019, 40 patients were prospectively assigned to transareolar (n = 21) and uniportal (n = 19) groups. We compared patient characteristics and perioperative results. Approximately 1 week or 1 year after the operation, postoperative pain was evaluated using a numerical rating scale (NRS), and cosmetic satisfaction was graded on a four-point scale. RESULTS We found no significant between-group differences in patient characteristics or perioperative results. NRS scores did not differ on postoperative day (POD) 7 (transareolar, 1.8 ± 0.9 vs. uniportal, 1.6 ± 0.9; p = 0.62) or in postoperative month (POM) 12 (transareolar, 1.3 ± 0.5 vs. uniportal, 1.1 ± 0.5; p = 0.18). In terms of cosmetic satisfaction, the transareolar group was more satisfied on POD 7 (transareolar, 3.5 ± 0.6 vs. uniportal, 2.9 ± 0.9; p = 0.02) and in POM 12 (transareolar, 3.8 ± 0.5 vs. uniportal, 3.3 ± 0.9; p = 0.0065). CONCLUSION Although the perioperative results of the transareolar and uniportal approaches were similar, the former approach afforded a little better cosmetic satisfaction and might be useful option for young males with PSP.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-cho, Maebashi, Gunma, 371-0811, Japan.
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-cho, Maebashi, Gunma, 371-0811, Japan
| | - Shinya Furusawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-cho, Maebashi, Gunma, 371-0811, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-cho, Maebashi, Gunma, 371-0811, Japan
| | - Tomohiro Yazawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-cho, Maebashi, Gunma, 371-0811, Japan
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-cho, Maebashi, Gunma, 371-0811, Japan
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Yoshikawa R, Matsuura N, Igai H, Yazawa T, Ohsawa F, Kamiyoshihara M. Uniportal approach as an alternative to the three-portal approach to video-assisted thoracic surgery for primary spontaneous pneumothorax. J Thorac Dis 2021; 13:927-934. [PMID: 33717565 PMCID: PMC7947474 DOI: 10.21037/jtd-20-2928] [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] [Indexed: 11/28/2022]
Abstract
Background In recent years, uniportal video-assisted thoracic surgery (U-VATS) has been used for primary spontaneous pneumothorax (PSP). This study compared the perioperative outcomes of U-VATS and three-port VATS (3P-VATS) and sought to determine the risk factors for postoperative recurrence. Methods From October 2010 to February 2017, 232 patients with PSP undergoing surgical treatment were enrolled in this study. The patients were divided into two groups: U-VATS (n=161) and 3P-VATS (n=71) depending on the period of surgery. Retrospective analysis of the perioperative results and the risk factors for recurrence was performed. Results Both the operation time and duration of postoperative drainage were initially longer in the U-VATS group, but the difference gradually decreased such that ultimately there was no significant difference compared to the 3P-VATS group (P=0.10 and P=0.12, respectively). The duration of postoperative hospital stay and postoperative recurrence rate were not different between the two groups (P=0.084 and P=0.44, respectively). By multivariate analysis, the age (HR, 0.42, 95% CI: 0.24−0.72, P<0.01) and number of bullae (single vs. multiple: HR, 0.03, 95% CI: 0.002−0.54, P=0.02) were risk factors for recurrence. Conclusions The perioperative results and recurrence rate did not differ between the U-VATS and 3P-VATS groups, thereby demonstrating the non-inferiority of U-VATS. Postoperative risk factors for PSP recurrence were patient age and the number of bullae. Additional treatment may be needed to reduce recurrence in young patients with multiple bullae. Clinical registration number: The Institutional Review Board of Maebashi Red Cross Hospital (no. 2019-21).
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Affiliation(s)
- Ryohei Yoshikawa
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 389-1 Asakura-cho, Maebashi, Gunma 371-0811, Japan
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 389-1 Asakura-cho, Maebashi, Gunma 371-0811, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 389-1 Asakura-cho, Maebashi, Gunma 371-0811, Japan
| | - Tomohiro Yazawa
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 389-1 Asakura-cho, Maebashi, Gunma 371-0811, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 389-1 Asakura-cho, Maebashi, Gunma 371-0811, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 389-1 Asakura-cho, Maebashi, Gunma 371-0811, Japan
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Cattoni M, Rotolo N, Mastromarino MG, Cardillo G, Nosotti M, Mendogni P, Rizzi A, Raveglia F, Siciliani A, Rendina EA, Cagini L, Matricardi A, Filosso PL, Passone E, Margaritora S, Vita ML, Bertoglio P, Viti A, Dominioni L, Imperatori A. Chronic chest pain and paresthesia after video-assisted thoracoscopy for primary pneumothorax. J Thorac Dis 2021; 13:613-620. [PMID: 33717534 PMCID: PMC7947510 DOI: 10.21037/jtd-20-2860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background This study aims to identify clinical and surgical risk factors for chronic chest pain and paresthesia after video thoracoscopic surgery for primary spontaneous pneumothorax. Methods We retrospectively collected the data of 1,178 consecutive patients <40-years-old undergoing video thoracoscopic surgery for primary spontaneous pneumothorax in 9 Italian centers in 2007–2017. Cases with <2-month follow-up were excluded, leaving 920 patients [80% male; median age: 21 (IQR, 18–27) years] for statistical analysis. The following risk factors for chronic chest pain and chronic paresthesia were assessed by univariable and multivariable Cox regression model: age, gender, cannabis smoking, video thoracoscopy ports number, pleurodesis technique (partial pleurectomy/pleural electrocauterization/pleural abrasion/talc poudrage), chest tube size (24/28 F), postoperative chest tube stay. Results Blebs/bullae resection with pleurodesis was performed in 732 (80%) cases; pleurodesis alone in 188 (20%). During a median follow-up of 68 (IQR: 42–95) months, chronic chest pain developed in 8% of patients, chronic chest paresthesia in 22%; 0.5% of patients regularly assumed painkillers. Chronic chest pain was independently associated with partial pleurectomy/pleura abrasion (P<0.001) and postoperative chest tube stay (P=0.019). Chronic chest paresthesia was independently associated with pleurodesis by partial pleurectomy (P<0.001), chest tube stay (P=0.035) and 28 F chest tube (P<0.001). Conclusions After video thoracoscopic surgery for primary spontaneous pneumothorax, the incidence of chronic chest pain and paresthesia was significantly lower when pleurodesis was performed by pleural electrocauterization or talc poudrage, and chest tube was removed early. A 24 F chest tube was associated with lower risk of chronic chest paresthesia.
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Affiliation(s)
- Maria Cattoni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Regional Hospital San Camillo-Forlanini, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Rizzi
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milan, Italy
| | - Federico Raveglia
- Thoracic Surgery, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milan, Italy
| | | | | | - Lucio Cagini
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Alberto Matricardi
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Pier Luigi Filosso
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Erika Passone
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS, Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella,Verona, Italy
| | - Andrea Viti
- Division of Thoracic Surgery, IRCCS, Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella,Verona, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Bio-artificial pleura using autologous dermal fibroblast sheets to mitigate air leaks during thoracoscopic lung resection. NPJ Regen Med 2021; 6:2. [PMID: 33398054 PMCID: PMC7782673 DOI: 10.1038/s41536-020-00113-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 11/20/2020] [Indexed: 11/09/2022] Open
Abstract
Lung air leaks (LALs) due to visceral pleura injury during surgery are a difficult-to-avoid complication in thoracic surgery (TS). Reliable LAL closure is an important patient management issue after TS. We demonstrated both safeties of transplantation of a cultured human autologous dermal fibroblast sheet (DFS) to LALs. From May 2016 to March 2018, five patients who underwent thoracoscopic lung resection met all the inclusion criteria. Skin biopsies were acquired from each patient to source autologous dermal cells for DFS fabrication. During the primary culture, fibroblasts migrated from the dermal tissue pieces and proliferated to form cell monolayers. These fibroblasts were subcultured to confluence. Transplantable DFSs were fabricated from these subcultured fibroblasts that were trypsinized and seeded onto temperature-responsive culture dishes. After 10 days of fabrication culture, intact patient-specific DFS were harvested. DFSs were analyzed for fibroblast cell content and tissue contaminants prior to application. For closing intraoperative LAL, mean number of transplanted autologous DFS per patient was 6 ± 2 sheets. Mean chest drainage duration was 5.0 ± 4.8 days. The two patients with major LAL had a drainage duration of more than 7 days. All patients currently have no LAL recurrence after discharge. DFSs effectively maintain LAL closure via remodeling of the deposited extracellular matrix. The use of autologous DFSs to permanently close air leaks using a patient-derived source is expected to reduce surgical complications during high-risk lung resections.
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Matsuura N, Igai H, Ohsawa F, Yazawa T, Kamiyoshihara M. Uniport vs. multiport video-assisted thoracoscopic surgery for anatomical lung resection-which is less invasive? J Thorac Dis 2021; 13:244-251. [PMID: 33569204 PMCID: PMC7867835 DOI: 10.21037/jtd-20-2759] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Video-assisted thoracoscopic surgery (VATS) has been recognized as a standard procedure, but whether uniport VATS (U-VATS) is a more effective and minimally invasive approach compared with multiport VATS (M-VATS) is controversial. Methods The medical records of 184 patients in the M-VATS group and 69 patients in the U-VATS group who underwent anatomical lung resection from April 2017 to July 2020 at our institution were retrospectively reviewed. Postoperative outcomes were compared among U-VATS and M-VATS. Multivariate analysis was performed to identify factors that reduce postoperative pain. Results The mean operation time was significantly shorter in U-VATS than in M-VATS (172±43 min in M-VATS vs. 143±43 min in U-VATS, P<0.0001). Duration of postoperative drainage (2.2±1.2 days in M-VATS vs. 1.6±1.0 days in U-VATS, P=0.0002) and hospitalization (4.0±1.6 days in M-VATS vs. 3.1±1.6 days in U-VATS, P=0.0003) were significantly shorter in U-VATS than in M-VATS. The rate of postoperative complications was not significantly different between the groups (P=0.732). The number of analgesic prescriptions over 10 days postoperatively was significantly less in U-VATS than in M-VATS [68 (37.0%) in M-VATS vs. 8 (11.6%) in U-VATS, P<0.0001]. A multivariate logistic regression model showed that U-VATS was the only significant predictor for reduction of postoperative pain (odds ratio =0.204, P=0.0001). Conclusions U-VATS shortened the operation time, postoperative drainage duration, and hospitalization compared with conventional M-VATS, and it significantly reduced the use of analgesics. There were no differences in perioperative results such as blood loss and the postoperative complication rate. U-VATS can be said to be a safe and minimally invasive surgical procedure.
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Affiliation(s)
- Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
| | - Tomohiro Yazawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
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Yazawa T, Igai H, Ohsawa F, Yoshikawa R, Matsuura N, Kamiyoshihara M. Feasibility of thoracoscopic pulmonary bullectomy using a transareolar approach for treatment of primary spontaneous pneumothorax. J Thorac Dis 2020; 12:5794-5801. [PMID: 33209411 PMCID: PMC7656421 DOI: 10.21037/jtd-20-1548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Primary spontaneous pneumothorax (PSP) is a common disease among young patients, particularly men. While the most common thoracoscopic approach is triportal, the transareolar approach is rare. In this study, we prospectively investigated the feasibility of thoracoscopic pulmonary bullectomy using a transareolar approach for treatment of PSP. Methods Ten patients with PSP who underwent thoracoscopic transareolar pulmonary bullectomy were prospectively enrolled in this study between September 2017 and March 2018. For all 10 patients, we evaluated the perioperative outcomes, postoperative complications, recurrence, wound-related pain, and cosmetic satisfaction regarding the surgical wound. Results The mean patient age was 18.9±4.2 years; three patients were affected on the right side and seven patients were affected on the left side. Bullae and blebs were localized at the apex of the affected lung in all patients. All procedures were completed using a transareolar approach without additional ports or conversion to thoracotomy in any patient. The mean operative time was 39.8±8.6 min. The mean volume of blood lost during surgery was extremely small in all patients. The duration of postoperative drainage was 1 day, while the length of postoperative hospital stay was 2 days in all patients. No morbidities or recurrence of PSP occurred during the study period. The mean cosmetic satisfaction scores of the surgical wound were 3.3 and 3.2 on postoperative day (POD) 7 and at postoperative month (POM) 12. The mean NRS score was 1.5 on POD 7. All patients were pain-free at POM 12. Conclusions Transareolar thoracoscopic pulmonary bullectomy for treatment of PSP is feasible and safe, with a high degree of satisfaction for postoperative pain and cosmetics. This new approach could be a novel option for surgical treatment of PSP.
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Affiliation(s)
- Tomohiro Yazawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Ryohei Yoshikawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
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Zhang C, Zhang M, Wang H, Ma Z, Wu Y, Fu L, Zhu T, Yu G. Next-day discharge following small uniportal thoracoscopic bullectomy assisted with an anchoring suture. J Int Med Res 2020; 48:300060519896926. [PMID: 31937154 PMCID: PMC7113697 DOI: 10.1177/0300060519896926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Manipulating the instruments during uniportal video-assisted thoracoscopic surgery (U-VATS) bullectomy requires a relatively large incision. This study aimed to investigate the feasibility of next-day discharge following U-VATS bullectomy using an anchoring suture. Methods A stapler and a scope were inserted through a single incision in the anchoring group. The bullae were retracted by the suture, which was inserted from outside of the chest wall into the thorax, and then bullectomy was performed. For those in the control group, resection of the bullae was performed with the assistance of a grasping forceps. Results The length of the incision of the patients in the anchoring group ([13.2 ± 2.2] mm) was significantly smaller than in the control group ([26.2 ± 3.9] mm). In addition, the number of staplers used in the anchoring group was significantly less than in the control group ([1.2 ± 0.4] vs. [1.4 ± 0.5]). Furthermore, 36 (92.3%) cases in the anchoring group were uneventfully discharged within 24 hours after bullectomy. Conclusion Next-day discharge after U-VATS bullectomy through a small incision assisted with an anchoring suture is safe and feasible.
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Affiliation(s)
- Chu Zhang
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Miao Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou, Jiangsu, P.R. China
| | - Haiyong Wang
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Zhifeng Ma
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Yuanlin Wu
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Linhai Fu
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Ting Zhu
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Guangmao Yu
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
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Minimally invasive approach to pneumothorax: Single port or two ports? TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:347-351. [PMID: 32551166 DOI: 10.5606/tgkdc.dergisi.2020.18778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/16/2019] [Indexed: 11/21/2022]
Abstract
Background This study aims to compare the effectiveness of single-port and two-port video-assisted thoracoscopic surgery in patients with pneumothorax. Methods Between June 2016 and December 2018, a total of 44 patients (39 males, 5 females; mean age 27.0±9.5 years; range, 15 to 60 years) who underwent video-assisted thoracoscopic surgery due to the spontaneous pneumothorax in our center were retrospectively evaluated. The study population was divided into two groups as the single-port (n=29) and two-port (n=15) procedure according to the number of port entries applied during the operation. Age, gender, number of days of drainage, length of hospitalization, number of days of air leak, the indication of operation, pneumothorax side, type of pneumothorax, duration of operation, and complications were compared between the groups. Results Twenty-two patients (50%) were operated on the right side and 22 patients (50%) on the left side. The mean operation time was 81.1±19.2 min, indicating no significant difference between the groups (p=0.053). No significant difference was observed in the number of days of drainage, the length of hospitalization, and number of days of air leak between the two groups. Complications developed in eight patients (27.6%) in the single-port group and five patients (33.3%) in the two-port group, indicating no significant difference between the groups (p=0.475). Conclusion Our study results show that video-assisted thoracoscopic surgery for the treatment of pneumothorax can be successfully performed via a single-port approach.
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Nachira D, Meacci E, Congedo MT, Pogliani L, Chiappetta M, Vita ML, Margaritora S. Surgical treatment of primary spontaneous pneumothorax: what is better to do? J Thorac Dis 2020; 12:1274-1276. [PMID: 32395261 PMCID: PMC7212159 DOI: 10.21037/jtd.2020.03.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Pogliani
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Chiappetta
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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