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Kumar A, Asaf BB, Puri HV, Sharma MK, Lingaraju VC, Rajput VS. Video-assisted thoracoscopic surgery lobectomy: The first Indian report. J Minim Access Surg 2018; 14:291-297. [PMID: 29319014 PMCID: PMC6130190 DOI: 10.4103/jmas.jmas_148_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/11/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The fear of pleural adhesions and densely stuck lymph nodes in India, a country where tuberculosis is endemic, is one major factor keeping our surgeons away from video-assisted thoracoscopic surgery (VATS) lobectomy. In this paper, we aim to report our experience with performing VATS lobectomy in 102 cases using a standardised three-port anterior approach. MATERIALS AND METHODS Between March 2012 and September 2016, we performed 102 VATS lobectomies. Sixty patients (58.8%) were males and 42 females (41.2%), with a mean age of 42.02 years. Diagnoses were as follows: benign disease (72), lung cancer (27) and pulmonary metastases (3). Among the cases with primary lung cancer, twenty out of 27 (74%) were adenocarcinoma and 7 cases of squamous carcinoma (25.92%). All patients underwent lobectomy by a standardised three-port anterior approach. RESULTS The overall conversion rate was 8.82% (n = 9). We observed no postoperative complications in 82 (80.4%) patients. The average blood loss was 211.37 ml. Mean operative time was 173 min. Median length of hospital stay was 5 with median chest tube duration of 4.9 days. There was no in hospital or 30-day mortality. The most common complication was prolonged air leak. CONCLUSION From this first Indian series, it is clear that VATS lobectomy is feasible in both benign and malignant cases. It also shows that the fear of adhesions is unwarranted and properly selected benign cases can also undergo VATS lobectomy safely.
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Affiliation(s)
- Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | | | - Vimesh S. Rajput
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Reichert M, Kerber S, Pösentrup B, Bender J, Schneck E, Augustin F, Öfner D, Padberg W, Bodner J. Anatomic lung resections for benign pulmonary diseases by video-assisted thoracoscopic surgery (VATS). Langenbecks Arch Surg 2016; 401:867-75. [PMID: 27456676 DOI: 10.1007/s00423-016-1478-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Based on increasing evidence of its benefits regarding perioperative and oncologic outcome, video-assisted thoracoscopic surgery (VATS) has gained increasing acceptance in the surgical treatment of early stage non-small cell lung cancer (NSCLC). However, the evidence for a VATS approach in anatomic lung resection for benign pulmonary diseases is still limited. METHODS Between March 2011 and May 2014, data from 33 and 63 patients who received VATS anatomic lung resection for benign diseases (VATS-B) and early stage NSCLC (VATS-N), respectively, were analyzed retrospectively. For subgroup analyses, VATS-B was subdivided by operation time and underlying diseases. Subgroups were compared to VATS-N. RESULTS Three patients from VATS-B and four from VATS-N experienced conversion to open surgery. Causes of conversion in VATS-B were intraoperative complications, whereas conversions in VATS-N were elective for oncological concerns (p < 0.05). Operation time and duration of postoperative mechanical ventilation were longer by tendency; postoperative stay on intensive care unit and chest tube duration were significantly longer in VATS-B. Subgroup analyses showed a longer operation time as a predictor for worse perioperative outcome regarding postoperative mechanical ventilation, postoperative stay on intensive care unit, chest tube duration, and length of hospital stay. Patients with longer operation time suffered from more postoperative complications. Differences in perioperative outcome data were not significantly dependent on the underlying benign diseases compared to VATS-N. CONCLUSIONS VATS is feasible and safe in anatomic lung resection for benign pulmonary diseases. Not the underlying disease, but a longer operation time is a factor for worse postoperative outcome.
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Affiliation(s)
- Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany.
| | - Stefanie Kerber
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Bernd Pösentrup
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Julia Bender
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Emmanuel Schneck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Winfried Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Johannes Bodner
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany.,Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.,Department of Thoracic Surgery, Klinikum Bogenhausen, Englschalkinger Strasse 77, 81925, Munich, Germany
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Mazzella A, Olland A, Garelli E, Renaud S, Reeb J, Santelmo N, Falcoz PE, Massard G. Video-assisted thoracoscopic surgery is a safe option for benign lung diseases requiring lobectomy. Surg Endosc 2016; 31:1250-1256. [PMID: 27405483 DOI: 10.1007/s00464-016-5099-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lobectomy for benign lung disease is renowned to be technically complex and to be subjected to an increased complication rate. The objective of this study was to evaluate whether the results obtained with video-assisted surgery (VATS) in benign disease are comparable to those obtained in oncologic surgery, where VATS has been validated. METHODS We have reviewed the files of 246 consecutive patients who underwent VATS lobectomy from January 2012 to August 2015. The cohort was divided into two groups according to pathology (benign or malignant). Outcome parameters on scrutiny were demographics, pathology, duration of air leak, drainage and hospital stay, conversion, and perioperative complication rate. Comparisons were made with the χ 2 test and Student's t test; any p value ≤0.05 was considered as significant. RESULTS Group 1 (36 patients) included patients who underwent lobectomy for benign disease and group 2 (210 patients) patients affected by lung cancer or pulmonary metastases. The two groups differed with reference to age (p < 0.001), history of cancer (p < 0.001), history of stroke (p = 0.05), and the presence of pleural adhesions (p = 0.03). There was no difference for duration of air leaks, chest tube drainage and hospital stay, conversion rate, and perioperative complication rate. CONCLUSIONS We conclude that pathology did not impact on outcomes after VATS lobectomy. This study suggests that VATS is as a safe option in selected patients with benign disease requiring lobectomy, despite a more complex technical context.
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Affiliation(s)
- Antonio Mazzella
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Anne Olland
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
- E.A. 7213 stress vasculaire et tissulaire en transplantation, Strasbourg, France
| | - Elena Garelli
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Stephane Renaud
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
- EA 3430: Progression tumorale et micro-environnement. Approches translationnelles et épidémiologie, Strasbourg, France
| | - Jeremie Reeb
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Nicola Santelmo
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Pierre Emmanuel Falcoz
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Gilbert Massard
- Department of thoracic surgery, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France.
- E.A. 7213 stress vasculaire et tissulaire en transplantation, Strasbourg, France.
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