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Kösek V, Al Masri E, Nikolova K, Ellger B, Wais S, Redwan B. Comparative clinical experience of subcostal VATS versus conventional uniportal lateral VATS approach. J Minim Access Surg 2024; 20:326-333. [PMID: 39047681 PMCID: PMC11354960 DOI: 10.4103/jmas.jmas_26_24] [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: 02/11/2024] [Revised: 05/07/2024] [Accepted: 05/28/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION The present study reports the first clinical experience with subcostal uniportal VATS (suVATS) compared with the conventional lateral uniportal VATS (luVATS) approach. PATIENTS AND METHODS All patients who underwent suVATS between January 2019 and April 2020 were included. Patients who had undergone luVATS for similar indications were included as the control group. The data were prospectively and retrospectively analysed. RESULTS The suVATS group included 38 patients with a mean age of 61 (30-83) years. The luVATS group included 33 patients (mean age, 69 years; range: 46-89 years). An intercostal block was performed intraoperatively in the luVATS group. Local infiltration under anaesthesia was performed around the incision in the suVATS group. The duration of the surgery was significantly longer in the suVATS group. However, the chest tube treatment and hospital stay duration were significantly shorter in the suVATS group. The routinely recorded Visual Analogue Scale scores on the first post-operative day and the day of discharge were significantly lower in the suVATS group. CONCLUSION Subcostal uniportal VATS enables a shorter drainage treatment duration and hospital stay and significantly reduces post-operative pain. Thus, a faster patient recovery can be achieved.
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Affiliation(s)
- Volkan Kösek
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen, Lünen, Germany
- Faculty of Medicine, University of Witten/Herdecke, Witten, Germany
| | - Eyad Al Masri
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen, Lünen, Germany
| | - Katina Nikolova
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen, Lünen, Germany
| | - Björn Ellger
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Knappschaftskrankenhaus Dortmund, Klinikum Westfalen, Dortmund, Germany
| | - Shadi Wais
- Department of General Visceral, Thoracic and Endocrine Surgery, Augusta Hospital, Düsseldorf, Germany
| | - Bassam Redwan
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen, Lünen, Germany
- Faculty of Medicine, University of Witten/Herdecke, Witten, Germany
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Mei LY, Feng YG, Tao SL, Jiang B, Dai FQ, Zhou JH, Shen C, Guo W, Tan QY, Deng B. Analysis of the unplanned reoperation following surgical treatment of pulmonary tumor. J Cardiothorac Surg 2022; 17:306. [PMID: 36510224 PMCID: PMC9746151 DOI: 10.1186/s13019-022-02064-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In this study, we aimed to summarize the extremely important lesson and experience in the whole process of surgical treatments of lung tumors for the benefit of steps taken to prevent against unplanned reoperation. METHODS Demographical and clinical information of 7732 patients were retrospectively retrieved and reviewed, who were diagnosed with pulmonary tumor and underwent surgical treatments from January 2016 to March 2021. Those patients who underwent unplanned reoperation for the treatment of severe complications were focused carefully and analyzed meticulously. RESULTS A total of forty-one patients (41/7732) received 44 unplanned reoperations. Among them, eight and thirty-three patients were diagnosed with benign and malignant tumor, respectively. The incidence of unplanned reoperations seemed to be similar on both sides (Left vs. Right: 12/3231 vs. 29/4501, p = 0.103). Lobectomy plus segmentectomy is prone to reoperation (2/16, 12.5%) as compared to the other types of surgery. The complications leading to reoperation was hemothorax, including active hemorrhage (23/44, 52.3%) and clotted hemothorax (6/44, 13.6%), chylothorax (8/44, 18.2%), and the others (7/44, 15.9%) including bronchopleural fistula, torsion, or injury of right middle bronchus and pulmonary bulla rupture. The morbidity and mortality after unplanned reoperation were 17.1% (7/41) and 12.2% (5/41), respectively. CONCLUSIONS Bronchi or vessel stumps, the surgical edges of the lung parenchyma, and pleural adhesions should be checked to avoid postoperative bleeding. Prophylactic ligation of the thoracic duct should be recommended in case of the suspected oily-like exudation in the lymph node bed. Smooth expansion of the middle lobe is important to avoid narrowing and torsion before transection of the bronchus.
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Affiliation(s)
- Long-Yong Mei
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Yong-Geng Feng
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Shao-Lin Tao
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Bin Jiang
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Fu-Qiang Dai
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Jing-Hai Zhou
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Cheng Shen
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Wei Guo
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Qun-You Tan
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Bo Deng
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
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Wang L, Dong Y, Ji Y, Song W, Cheng C, Yang M, Che G. Clinical outcome and risk factors for subcutaneous emphysema in patients with lung cancer after video-assisted thorascopic surgery. Front Surg 2022; 9:956431. [PMID: 36117818 PMCID: PMC9478373 DOI: 10.3389/fsurg.2022.956431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background and purpose With the clinical application of minimally invasive surgery and concept of enhanced recovery after surgery, the incidence of postoperative complications in lung cancer patients has been significantly reduced. However, postoperative subcutaneous emphysema (SE) becomes the main factor affecting the early discharge of patients. The aim of this study was to analyze the clinical outcome and risk factors for postoperative SE in lung cancer patients. Methods The clinical data of 414 lung cancer patients who were admitted to the Department of Thoracic Surgery, West China Hospital, Sichuan University from September 2021 to December 2021 were prospectively collected. The incidence, severity and treatment of patients who had SE, surgery approach, application of drainage tube and clinical information were analyzed. Results The incidence rate of postoperative SE in patients with lung cancer was 33.09% (137/414) and mild cases accounted for the vast majority (30.19%, 125/414). Multivariate analysis indicated that male [odds ratio (OR) = 2.247, P = .014] and advanced age (OR = 1.021, P = .043) were main risk factors for postoperative SE in patients with lung cancer. Conservative treatment was the main treatment option for SE (98.5%, 135/137). The average hospital stay in the subcutaneous emphysema group (5.49 ± 4.41 days) was significantly longer than that in the non-subcutaneous emphysema group (4.44 ± 3.32 days) (P = .014) and no significant statistical difference in the average total hospital cost between the two groups (7,798.31 ± 1,414.85$ vs. 7,501.14 ± 1,605.18$, P = .072). Conclusion Postoperative SE in patients with minimally invasive lung cancer is mainly mild, and conservative treatment is appropriate for most cases.
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Affiliation(s)
- Lei Wang
- Department of Thoracic Surgery, West China School of Nursing, Sichuan University, Chengdu, China
| | - Yingxian Dong
- Lung Cancer Center, West-China Hospital, Sichuan University, Chengdu, China
| | - Yanli Ji
- Department of Thoracic Surgery, West China School of Nursing, Sichuan University, Chengdu, China
| | - Wenpeng Song
- Lung Cancer Center, West-China Hospital, Sichuan University, Chengdu, China
| | - Chao Cheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mei Yang
- Department of Thoracic Surgery, West China School of Nursing, Sichuan University, Chengdu, China
| | - Guowei Che
- Lung Cancer Center, West-China Hospital, Sichuan University, Chengdu, China
- Correspondence: Guowei Che
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