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Cockrell HC, Kwon EG, Savochka L, Dellinger MB, Greenberg SLM, Waldhausen JHT. Long-term Outcomes Following Thoracoscopic Division of Vascular Rings. J Pediatr Surg 2024:S0022-3468(24)00240-9. [PMID: 38658219 DOI: 10.1016/j.jpedsurg.2024.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES We evaluate long-term symptomatic improvement in vascular ring patients who underwent thoracoscopic division at a single quaternary pediatric surgery center. METHODS All pediatric patients who underwent vascular ring division without Kommerell's diverticulum resection between 01/2007-12/2022 were included. Surgeries were performed by pediatric general and thoracic surgeons. Patient demographic and clinical characteristics were obtained from retrospective chart review. Data on long-term symptomatic improvement were collected with structured telephone interviews. RESULTS 60% of patients were male. Median age at operation was 24 months (IQR: 11, 60 months) with a median weight of 11.3 kg (IQR: 8.7, 19.8 kg). All patients were symptomatic preoperatively with dysphagia being the most frequent complaint (42%), followed by chronic cough (21%). Of 41 patients eligible for the long-term follow-up survey, 8 patients with a primary diagnosis of a double arch with an atretic segment in the non-dominant arch and 9 with a right dominant arch with left ligamentum arteriosum and aberrant left subclavian artery (LSCA) were contacted and consented for participation. Median interval from surgery to survey completion was 95 months (IQR 28, 135 months). Most patients had no, or only minor, symptoms related to breathing and swallowing at the time of long-term follow-up. 88% of patients experienced postoperative symptom improvement, and only one patient reported worsening of symptoms over time. CONCLUSION Division of an atretic arch and/or ligamentum for patients with an aberrant LSCA without Kommerell's resection may be adequate to ensure long-term improvement of breathing and swallowing problems attributable to vascular rings. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hannah C Cockrell
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Eustina G Kwon
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Liya Savochka
- University of Washington School of Medicine, 1959 NE Pacific Street, A-300 Health Sciences Center, Box 356340, Seattle, WA 98195, USA
| | - Matthew B Dellinger
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Sarah L M Greenberg
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - John H T Waldhausen
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
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Hawker W, Singh A. Advances in the Treatment of Chylothorax. Vet Clin North Am Small Anim Pract 2024:S0195-5616(24)00007-X. [PMID: 38503596 DOI: 10.1016/j.cvsm.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Idiopathic chylothorax is a challenging clinical condition historically associated with poor resolution rates following surgical intervention. Recent advances in imaging and surgical techniques have revolutionized the treatment of this disease process. Computed tomographic lymphangiography has facilitated improved surgical planning and postoperative assessment, while intraoperative use of near-infrared fluorescence imaging aids in highly accurate intraoperative thoracic duct identification. Utilizing these advancements, minimally invasive surgical techniques have been successfully developed and have been associated with considerable improvements in surgical outcomes.
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Affiliation(s)
- William Hawker
- Department of Clinical Studies, The Ontario Veterinary College, University of Guelph, 26 College Avenue West, Guelph, N1G 2W1, Ontario, Canada.
| | - Ameet Singh
- Department of Clinical Studies, The Ontario Veterinary College, University of Guelph, 26 College Avenue West, Guelph, N1G 2W1, Ontario, Canada
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Eichhorn M, Bernauer E, Rotärmel A, Heurich M, Winter H. Clinical effectiveness of robotic-assisted compared to open or video-assisted lobectomy in Germany: a real-world data analysis. Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae001. [PMID: 38175785 PMCID: PMC10805345 DOI: 10.1093/icvts/ivae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/03/2024] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Despite robotic-assisted thoracic surgery (RATS) lobectomy being on the rise in Europe, the majority of lobectomies in Germany are still performed with an open or thoracoscopic [video-assisted thoracic surgery (VATS)] approach. Empirical evidence in favour of RATS lobectomy is inconsistent. This retrospective cohort study investigates the impact of RATS lobectomy compared with open thoracic surgery (OPEN) and VATS lobectomy on short-term outcomes in Germany using multicentre real-world data. METHODS Anonymized routine data from Germany from 2018 to 2020 were retrospectively analysed. These data were provided by 61 German hospitals. Propensity score matching with subsequent generalized linear models was performed for statistical analysis. Additionally, in order to test the robustness of the results, multivariable regression analyses with cluster-robust standard errors were used. RESULTS A total of 2498 patients with lobectomy were identified: in 1345 patients OPEN, in 983 VATS and 170 a RATS lobectomy was performed. RATS-compared to OPEN and VATS-reduced length of stay (LOS) by 28% or 4.2 days [confidence interval: 2.9; 5.4] and by 13% or 1.6 days [confidence interval: 0.2; 3.0], respectively. The risk of pneumonia was reduced by 5.3 percentage points in the RATS group compared to both OPEN and VATS (P = 0.07/0.01). RATS-compared to an open approach-reduces the risk of blood transfusions by 8.8 percentage points (P < 0.001) and LOS on the intensive care unit (P < 0.001). CONCLUSIONS This study provides strong support that RATS lobectomy outperforms OPEN or VATS lobectomy in terms of hospital LOS, and short-term in-hospital postoperative complications in the real-world scenario in Germany.
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Affiliation(s)
- Martin Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | | | - Andre Rotärmel
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Hauke Winter
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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Bethell GS, Eastwood MP, Neville JJ, Harwood R, Ali S, Ooi SZY, Brown J, Tullie L, Hotonu S, Bradnock TJ, Hall NJ, Chacon S, Osgouei RH, Neville JJ. Development of a 3D-printed neonatal congenital diaphragmatic hernia model and standardisation of intra-operative measurement. Pediatr Surg Int 2023; 40:28. [PMID: 38147130 PMCID: PMC10751268 DOI: 10.1007/s00383-023-05600-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Three-dimensional (3D) printing is frequently used for surgical simulation and training, however, no widely available model exists for neonatal congenital diaphragmatic hernia (CDH). The aim of this study was to develop a 3D-printed model of CDH and test interobserver variability in the simulated model for obtaining measurements of the diaphragmatic defect and ipsilateral diaphragm. METHODS A term fetal MRI (3.5 kg) of thorax, diaphragm and defect (15 mm × 5 mm) were delineated and segmented after parental consent to produce 3D-printed models. Consultant and trainee paediatric surgeons were invited to measure the posterior-lateral diaphragmatic defect and ipsilateral diaphragm. Mean measurement error was calculated (millimetres). Data are presented as median (range) and number/total (%). RESULTS An abdominal and thoracoscopic model were produced and tested by 52 participants (20 consultants and 32 trainees). Diaphragmatic defect via laparotomy measured 15 (10-20) mm (AP) × 16 (10-25) mm (ML) and thoracoscopically 14 (11-19) mm (AP) × 15 (11-22) mm (ML). Mean error per measurement was 4 (1-17) mm via laparotomy vs. 3 (0.5-9.5) mm thoracoscopically. Mean error was similar between consultants and trainees via laparotomy (4.3 vs. 3.9 mm, p = 0.70) and thoracoscopically (3 vs. 3 mm, p = 0.79). Error did not correlate with experience as operating surgeon via laparotomy (β = 13.0 [95% CI - 55.9 to 82.0], p = 0.71) or thoracoscopically (β = 1.4[95% CI - 6.4 to 9.2], p = 0.73. CONCLUSIONS We have designed and built simulation models for CDH repair via laparotomy and thoracoscopically. Operators can reliably measure the diaphragmatic defect and ipsilateral diaphragm, regardless of surgical experience and operative approach.
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Ortiz RJ, Reusmann A, Boglione MM, Giuseppucci C, Ruiz J, Pérez CM, Redondo EJ, Giubergia V, Barrenechea ME. Bronchogenic Cyst: Lessons Learned in 20 Years of Experience at a Tertiary Pediatric Center. J Pediatr Surg 2023; 58:2156-2159. [PMID: 37433699 DOI: 10.1016/j.jpedsurg.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Bronchogenic cysts are benign congenital malformations of the primitive ventral foregut. The aim of this study is to analyze and report 20 years of experience in the diagnosis and treatment of bronchogenic cysts at a tertiary pediatric center. METHODS A retrospective review was conducted of all patients diagnosed with a bronchogenic cyst between 2000-2020. Presence of symptoms, cyst location, surgical technique, postoperative complications, need for pleural drainage, and recurrence were reviewed. RESULTS Forty-five children were included in the study. In 37 patients a partial resection of the cyst was done, followed by cauterization or chemical obliterateration with iodopovidone of the mucosa of the remaining cyst wall that was adherent to the airway. A lobectomy was done in patients who had intrapulmonary cysts (n = 8). Cyst location was subcarinal in 23 (51.1%), paratracheal in 14 (31.1%), and intrapulmonary in eight patients (17.8%). The majority of subcarinal and paratracheal cysts (90%) were approached by thoracoscopy. Complications occurred in seven patients (15%): subcutaneous emphysema after pleural drain removal in one, extubation failure in two, reoperation due to bleeding in one, surgical site infection in one, bronchopleural fistula in one, and pneumothorax in one. Reoperation due to cyst recurrence was necessary in two patients (4.4%). Mean follow-up was 56 months (range, 0-115). CONCLUSION A minimally invasive approach is a safe option for the management of paratracheal and subcarinal bronchogenic cysts with no history of infection in specialized pediatric surgery center. Thoracoscopic partial resection is a feasible option in most patients with subcarinal and paratracheal bronchogenic cysts with a low complication and reoperation rate. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ramiro Jorge Ortiz
- Pediatric Hospital Dr. Juan Garrahan, Pichincha 1890, C1245 CABA, Buenos Aires, Argentina.
| | - Aixa Reusmann
- Pediatric Hospital Dr. Juan Garrahan, Pichincha 1890, C1245 CABA, Buenos Aires, Argentina
| | | | - Carlos Giuseppucci
- Pediatric Hospital Dr. Juan Garrahan, Pichincha 1890, C1245 CABA, Buenos Aires, Argentina
| | - Javier Ruiz
- Pediatric Hospital Dr. Juan Garrahan, Pichincha 1890, C1245 CABA, Buenos Aires, Argentina
| | - Carolina María Pérez
- Pediatric Hospital Dr. Juan Garrahan, Pichincha 1890, C1245 CABA, Buenos Aires, Argentina
| | - Emiro José Redondo
- Pediatric Hospital Dr. Juan Garrahan, Pichincha 1890, C1245 CABA, Buenos Aires, Argentina
| | - Verónica Giubergia
- Pediatric Hospital Dr. Juan Garrahan, Pichincha 1890, C1245 CABA, Buenos Aires, Argentina
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Zhang M, Liu X, Ge M. Prevalence and anatomical characteristics of medial-basal segment in right lung. Eur J Cardiothorac Surg 2023; 64:ezad342. [PMID: 37831894 DOI: 10.1093/ejcts/ezad342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/10/2023] [Accepted: 10/13/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVES The anatomic features and surgical techniques focusing on the right medial-basal segment (RS7) are few reported. This study aimed to accurately define the new nomenclature and classifications of B7 anatomy, elucidate its prevalence and anatomical characteristics and summarize the surgical outcomes. METHODS Between August 2019 and February 2022, 5023 patients were admitted for pulmonary nodules. Their chest computed tomography images were obtained. All of the images were reconstructed in 3 dimensions. The RS7 were screened according to their new definition and statistically analysed for their anatomical characteristics. RESULTS The bronchovascular anatomy of S7 can be newly classified into 6 types: B7a type, B7p type, B7o type, B7t type, BX7a type and BX7t type. The B7 anterior to the inferior pulmonary vein (IPV) was B7a (a, anterior) (3617/5023, 72%). The B7 posterior to IPV was B7p (p, posterior) (306/5023, 6.1%). The B7 over IPV was B7o (o, over) (904/5023, 18%). The B7 through IPV was B7t (t, through) (7/5023, 0.14%). An abnormal origin of B7 was named the BX7 type. The BX7 anterior to IPV sharing a common trunk with B8 was named BX7a (a, anterior) (176/5023, 3.5%). The BX7 through IPV originated from B10 and was named BX7t (t, through) (13/5023, 0.26%). 0.2% (12/5023) of patients had the nodules in RS7 and underwent RS7 surgery. CONCLUSIONS The variation pattern of B7 is far more complex than expected. The results of this study can help surgeons better understand S7 and perform segmentectomies more accurately.
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Affiliation(s)
- Min Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xudong Liu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingjian Ge
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Agarwal L, Varshney VK, Jabbar S, Selvakumar B, Yadav T, Khera S. Thoracoscopy-Assisted Esophagectomy for Esophageal Leiomyomatosis. J Gastrointest Cancer 2023:10.1007/s12029-023-00974-9. [PMID: 37803192 DOI: 10.1007/s12029-023-00974-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Diffuse esophageal leiomyomatosis is a rare esophageal tumor characterized by circumferential thickening of smooth muscle layers of the entire esophagus. CLINICAL CASE: Herein, we describe the case of a 19-year-old girl, who presented with a history of long-standing dysphagia. On evaluation she was found to have diffuse esophageal leiomyomatosis and was managed successfully by thoracoscopy-assisted esophagectomy with intra-nodal indocyanine green injection. DISCUSSION In this report, we discuss the pre-operative workup and our surgical approach to managing this rare entity. We also discuss the available literature on the subject and the lessons learnt in managing this complex condition.
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Affiliation(s)
- Lokesh Agarwal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area, Phase-II, 342005, Jodhpur, Rajasthan, India
| | - Vaibhav Kumar Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area, Phase-II, 342005, Jodhpur, Rajasthan, India.
| | - Shabana Jabbar
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area, Phase-II, 342005, Jodhpur, Rajasthan, India
| | - B Selvakumar
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area, Phase-II, 342005, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sudeep Khera
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Moore HG, McClung A, Thornberg DC, Santillan BC, Sucato DJ. A thoracoscopic anterior approach to the spine for adolescent idiopathic scoliosis does not have a detrimental effect on pulmonary function at 2 years compared to posterior-only surgery. Spine Deform 2023; 11:943-950. [PMID: 37046101 DOI: 10.1007/s43390-023-00681-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/18/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE This study aims to examine pulmonary function outcomes in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) with an anterior thoracoscopic release compared to those undergoing PSF alone. METHODS A retrospective review of patients with AIS over a 9-year period at a single institution compared 2 groups: PSF with video-assisted thoracoscopic surgery (PSF/VATS) and patients undergoing a posterior spinal fusion (PSF) alone. Standard radiographs and Forced Expiratory Volume (FEV1) and Forced Vital Capacity (FVC) were obtained preoperatively and at regular follow up periods up to 2-year post-operatively. Within group and between-group comparisons were performed. RESULTS There were 110 patients in the study: 12 in the PSF/VATS cohort and 98 in the PSF only cohort. The PSF/VATS group were younger (12.6 vs. 14.6, p = 0.003) and had larger coronal curves (80.8° vs. 60.7°, p = 0.001), and worse preoperative FVC (64.7% vs. 79.6%, p = 0.018) and FEV1 (62.3% vs. 77.6%, p = 0.003). At 2 years, the percent coronal Cobb correction was greater in the PSF/VATS group (67.9% vs. 48.4%, p < 0.001) with greater improvement in thoracic height (32.8 mm vs. 20.7 mm, p = 0.028). While the 2-year PFTs were the same for FEV1% (75.8% vs. 81.8%, p = 0.368) and FVC% (77.3% vs. 83.7%, p = 0.562), there was greater percent improvement over the 2 years in the PSF/VATS cohort: FEV1% (13.5% vs. 4.2%, p = 0.082) and FVC% (12.7% vs. 4.1%, p = 0.112). CONCLUSION AIS patients who have a VATS approach in addition to PSF have greater coronal plane correction and improved pulmonary function compared to PSF alone despite more severe spinal deformity and worse baseline pulmonary function.
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Affiliation(s)
- Harold G Moore
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Anna McClung
- Scottish Rite for Children, 2222 Welborn St., Dallas, TX, 75219, USA
| | - David C Thornberg
- Scottish Rite for Children, 2222 Welborn St., Dallas, TX, 75219, USA
| | | | - Daniel J Sucato
- Scottish Rite for Children, 2222 Welborn St., Dallas, TX, 75219, USA.
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Wang XF, Li ZY, Chen L, Chen LX, Xie F, Luo HQ. Anesthesia for extracorporeal membrane oxygenation-assisted thoracoscopic lower lobe subsegmental resection in a patient with a single left lung: A case report. World J Clin Cases 2023; 11:4368-4376. [PMID: 37449220 PMCID: PMC10336995 DOI: 10.12998/wjcc.v11.i18.4368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/03/2023] [Accepted: 05/23/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND It is difficult and risky for patients with a single lung to undergo thoracoscopic segmental pneumonectomy, and previous reports of related cases are rare. We introduce anesthesia for Extracorporeal membrane oxygenation (ECMO)-assisted thoracoscopic lower lobe subsegmental resection in a patient with a single left lung.
CASE SUMMARY The patient underwent comprehensive treatment for synovial sarcoma of the right lung and nodules in the lower lobe of the left lung. Examination showed pulmonary function that had severe restrictive ventilation disorder, forced expiratory volume in 1 second of 0.72 L (27.8%), forced vital capacity of 1.0 L (33%), and maximal voluntary ventilation of 33.9 L (35.5%). Lung computed tomography showed a nodular shadow in the lower lobe of the left lung, and lung metastasis was considered. After multidisciplinary consultation and adequate preoperative preparation, thoracoscopic left lower lung lobe S9bii+S10bii combined subsegmental resection was performed with the assistance of total intravenous anesthesia and ECMO intraoperative pulmonary protective ventilation. The patient received postoperative ICU supportive care. After surgical treatment, the patient was successfully withdrawn from ECMO on postoperative Day 1. The tracheal tube was removed on postoperative Day 4, and she was discharged from the hospital on postoperative Day 15.
CONCLUSION The multi-disciplinary treatment provided maximum medical optimization for surgical anesthesia and veno-venous ECMO which provided adequate protection for the patient's perioperative treatment.
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Affiliation(s)
- Xiang-Feng Wang
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province, China
| | - Zi-Yan Li
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province, China
| | - Lei Chen
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province, China
| | - Long-Xiang Chen
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province, China
| | - Fang Xie
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province, China
| | - Hui-Qin Luo
- Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province, China
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Chen C, Ding C, He Y, Guo X. Prone position thoracoscopic-assisted total mesoesophageal excision: initial experiences and benefits of lymph node dissection. Surg Endosc 2023; 37:2379-2387. [PMID: 36289085 DOI: 10.1007/s00464-022-09704-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/02/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Total mesoesophageal excision (TME) is a promising procedure. Prone position thoracoscopic-assisted TME might be a good choice, even without robust evidence yet. Therefore, it is necessary to explore the safety and efficacy of this procedure. METHODS We retrospectively analyzed the short-term outcomes regarding intraoperative unplanned events, postoperative complications, and lymphadenectomy in 61 patients who underwent prone position thoracoscopic-assisted TME from June, 2020 to August, 2021. The learning curve was also defined. RESULTS Of these sixty-one patients, there were 10, 24 and 27 cases of tumor in the upper, middle, and lower thoracic, respectively. Although there were five cases of unplanned events during surgery, no conversion to thoracotomy occurred. The median thoracic operation time was 113(43-161) minutes, R0 resection rate was 93.4% (57/61), and negative circumferential resection margin rate was 96.7% (59/61). Median overall lymph node dissection was 21(9-47), with 13(5-41) thoracic lymph node dissection. Incidence of postoperative pulmonary complications, cardiovascular complications, and leakage were 9.8%, 3.3%, and 9.8%, respectively, with no death within 30 days after operation. The positive rate of middle and lower mediastinal lymph nodes was 1.1%, 3.5%, and 2.4% for upper, middle, and lower tumors, and 5.5%, 1.8%, and 1.3% for pT3-4, pT2, and pT1 patients. Learning curve showed that 36 cases are the best cut-off value for proficiency of prone position thoracoscopic-assisted TME. CONCLUSIONS The prone position thoracoscopic-assisted TME is a safe procedure that is more conducive to thoracic lymph node dissection, especially for middle and lower mediastinum.
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Affiliation(s)
- Chunji Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai, 200030, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Chengzhi Ding
- Department of Thoracic Surgery, Henan Chest Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Yi He
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai, 200030, China
| | - Xufeng Guo
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai, 200030, China.
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Mansour S, Curry J, Blackburn S, Mullassery D, Thakkar H, Ballington J, Leukogeorgakis S, Cross K, Giuliani S, De Coppi P. Minimal access surgery for congenital diaphragmatic hernia: surgical tricks to facilitate anchoring the patches to the ribs. Pediatr Surg Int 2023; 39:135. [PMID: 36805329 PMCID: PMC9941218 DOI: 10.1007/s00383-022-05303-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Minimal Access Surgery (MAS) for Congenital Diaphragmatic Hernia (CDH) repair is well described, yet only a minority of surgeons report this as their preferred operative approach. Some surgeons find it particularly difficult to repair the defect using MAS and convert to laparotomy when a patch is required. We present in this study our institutional experience in using an easy and relatively cheap methodology to anchor the patch around the ribs using Endo Close™. This device has an application in MAS for tissue approximation using percutaneous suturing. METHODS AND TECHNIQUE We retrospectively reviewed our database for patients undergoing MAS repair of CDH between 2009 and 2021. Outcome measures included length of surgery and recurrence rates after patch repair. Endo Close™ was used in all patients who required patch repair. We declare no conflict of interest and to not having received any funding from Medtronic (UK). The technique is as follows: (1) The edges of the diaphragm are delineated by dissection. When primary suture repair of the diaphragmatic hernia was unfeasible without tension, a patch was used. (2) The patch is anchored in place by two corner stitches at the medial and lateral borders. (3) The posterior border of the patch is fixed to the diaphragmatic edge by running or interrupted stitches. (4) For securing the anterior border, a non-absorbable suture is passed through the anterior chest wall and the patch border is taken with intracorporeal instruments. (5) Without making another stab incision, the Endo Close™ is tunnelled subcutaneously through the anterior chest wall. (6) The suture end is pulled through the Endo Close™ and the knot is tied around the rib. This procedure can be performed as many times as required to secure the patch. RESULTS 58 patients underwent MAS surgery for repair of CDH between 2009 and 2021. 48 (82%) presented with a left defect. 34 (58%) had a patch repair. The length of patch repair surgery for CDH ranged from 100-343 min (median 197). There was only one patient (3%) in the patch repair cohort that had a recurrent hernia, diagnosed 12 months after the initial surgery. CONCLUSIONS In our experience, MAS repair of CDH is feasible. We adopted a low threshold in using a patch to achieve a tension-free repair. We believe that the Endo Close™ is a cheap and safe method to help securing the patch around the ribs.
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Affiliation(s)
- Sherif Mansour
- Great Ormond Street Hospital for Children, Surgery Offices, Zayed Centre for Research, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Joe Curry
- Great Ormond Street Hospital for Children, Surgery Offices, Zayed Centre for Research, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Simon Blackburn
- Great Ormond Street Hospital for Children, Surgery Offices, Zayed Centre for Research, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Dhanya Mullassery
- Great Ormond Street Hospital for Children, Surgery Offices, Zayed Centre for Research, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Hemanshoo Thakkar
- Great Ormond Street Hospital for Children, Surgery Offices, Zayed Centre for Research, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- , Present address: Evelina Children's Hospital, London, UK
| | - Jennifer Ballington
- Great Ormond Street Hospital for Children, Surgery Offices, Zayed Centre for Research, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Stavros Leukogeorgakis
- Great Ormond Street Hospital for Children, Surgery Offices, Zayed Centre for Research, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Kate Cross
- Great Ormond Street Hospital for Children, Surgery Offices, Zayed Centre for Research, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Stefano Giuliani
- Great Ormond Street Hospital for Children, Surgery Offices, Zayed Centre for Research, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Paolo De Coppi
- Great Ormond Street Hospital for Children, Surgery Offices, Zayed Centre for Research, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
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Visocchi M, Ducoli G, Signorelli F. The Thoracoscopic Approach in Spinal Cord Disease. Acta Neurochir Suppl 2023; 135:385-388. [PMID: 38153497 DOI: 10.1007/978-3-031-36084-8_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Video-assisted thoracic surgery (VATS) has been growing in popularity over the past 2 decades as an alternative to open thoracotomy for the treatment of several spinal conditions, and in the field of minimally invasive surgery, it now acts as a keyhole to the thoracic spine. MATERIALS AND METHODS Most VATS approaches are from the right side for pathologies involving the middle and upper thoracic spine because there is a greater working spinal surface area lateral to the azygos vein than that lateral to the aorta. Below T-9, a left-sided approach is made possible because the aorta moves away from the left posterolateral aspect of the spine to an anterior position as it passes through the diaphragm. RESULTS VATS has been used extensively in spinal deformities such as scoliosis. The use of VATS in spine surgery includes the treatment of thoracic prolapsed disk diseases, vertebral osteomyelitis, fracture management, vertebral interbody fusion, tissue biopsy, anterior spinal release, and fusion without or with instrumentation (VAT-I) for spinal deformity correction. As the knowledge and the comfort of using such techniques have expanded, the indications have extended to corpectomy for tumor resections. DISCUSSION AND CONCLUSIONS In the field of minimally invasive surgery, VATS now acts as a keyhole to the thoracic spine and an alternative to open thoracotomy for the treatment of several spinal conditions.Although VATS can be performed in such spine conditions, it is most beneficial in the treatment of scoliotic deformity, which requires taking a multilevel approach, from the upper to the lower thoracic spine.
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Affiliation(s)
| | - Giorgio Ducoli
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Francesco Signorelli
- Department of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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13
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Li H, Zhao S, Wu C, Pan Z, Wang G, Dai J. Surgical treatment of congenital diaphragmatic hernia in a single institution. J Cardiothorac Surg 2022; 17:344. [PMID: 36585728 DOI: 10.1186/s13019-022-02098-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/11/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the effectiveness of video-assisted thoracic surgery for the treatment of congenital diaphragmatic hernia (CDH) in a larger series compared with conventional open surgery. Additionally, we summarized the experience of thoracoscopic surgery in the treatment of CDH in infants. METHODS We retrospectively analysed the clinical data of 109 children with CDH who underwent surgical treatment at the Department of Cardiothoracic Surgery of Children's Hospital of Chongqing Medical University from January 2011 to January 2021. According to the surgical method, the children were divided into an open group (62 cases) and a thoracoscopy group (47 cases).Patients who underwent surgical correction had the diaphragmatic defect size graded (A-D) using a standardized system. We compared the operation time, intraoperative blood loss, postoperative mechanical ventilation time, postoperative hospital stay, postoperative CCU admission time and other surgical indicators as well as the recurrence rate, mortality rate and complication rate of the two groups of children. RESULTS The index data on the operation time, intraoperative blood loss, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P < 0.05). We compared the number of incision infections, lung infections, atelectasis, pleural effusion, and chylothorax between the two groups. There were more children in the open group than in the thoracoscopy group. The overall incidence of postoperative complications in the open group (51.61%) was higher than that in the thoracoscopy group (44.68%).The recurrence rate of the thoracoscopy group (8.51%) was higher than that of the open group (3.23%). In the open group, 7 patients died of respiratory distress after surgery, and no patients died in the thoracoscopy group. CONCLUSIONS Thoracoscopic surgery and open surgery can effectively treat CDH. Compared with conventional open surgery, thoracoscopy has the advantages of shorter operation time, less trauma, faster recovery and fewer complications. We believe that thoracoscopic surgery for type A/B diaphragmatic defect has certain advantages, but there is a risk of recurrence.
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Young S, Rettig RL, Hutchinson IV, Sutcliffe MG, Sydorak RM. Surgical approach to pediatric mediastinal masses based on imaging characteristics. Pediatr Surg Int 2022; 38:1297-1302. [PMID: 35794495 DOI: 10.1007/s00383-022-05166-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric mediastinal masses may be resected using an open or video-assisted thoracoscopic surgery (VATS) approach. We sought to define the preoperative imaging findings predicting amenability to VATS. METHODS This multicenter retrospective study of pediatric patients undergoing either VATS or open surgical mediastinal mass resection between 2008 and 2018 evaluated the preoperative imaging descriptors associated with VATS. Postoperative endpoints included length of stay (LOS), 30-day readmission, 90-day mortality and complication rates. RESULTS Mediastinal mass resection was performed in 33 patients. Median tumor size was 6 cm, and 51.5% had anterior mediastinal tumors. The 23 (69.7%) patients who underwent VATS were significantly older (144 months vs 32, P = 0.01) and larger (33.6 kg vs 13.8 P = 0.03). Preoperative imaging characteristics in VATS included "well circumscribed", "smooth margins" and "cystic", while the open surgery group were "heterogeneous" and "coarse calcification". The open group had more germ cell tumors (60.0% vs 13.0%, P = 0.16) but no difference in malignancy. VATS patients had shorter LOS (2 days vs 6.5, P = 0.24). Readmission, complication and mortality rates were similar. CONCLUSIONS Pediatric patients with apparent malignancy frequently underwent open resection compared with the thoracoscopic group, although final malignant pathology was similar. Equivalent outcomes and shorter LOS should favor a minimally invasive approach. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Stephanie Young
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, 4760 Sunset Blvd, 3rdFloor, Los Angeles, CA, 90027, USA
- Department of Surgical Oncology, Providence Saint John's Cancer Institute, Santa Monica, CA, USA
| | - R Luke Rettig
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, 4760 Sunset Blvd, 3rdFloor, Los Angeles, CA, 90027, USA
| | - Ian V Hutchinson
- Clinical Research Services, Providence Health & Services, Santa Monica, CA, USA
| | - Michael G Sutcliffe
- Clinical Research Services, Providence Health & Services, Santa Monica, CA, USA
| | - Roman M Sydorak
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, 4760 Sunset Blvd, 3rdFloor, Los Angeles, CA, 90027, USA.
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15
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Varshney VK, Nayar R, Soni SC, Selvakumar B, Garg PK, Varshney P, Khera PS. Intra-Nodal Indocyanine Green Injection to Delineate Thoracic Duct During Minimally Invasive Esophagectomy. J Gastrointest Surg 2022; 26:1559-65. [PMID: 35501550 DOI: 10.1007/s11605-022-05341-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/16/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Post-operative chylothorax is a dreaded complication after esophagectomy; hence real-time identification of the thoracic duct (TD) may aid in avoiding its injury or promptly tackling injury when it occurs. We utilized intra-nodal injection of Indocyanine green (ICG) dye to delineate TD anatomy while performing esophagectomy for esophageal carcinoma. METHOD Two ml of 1 mg/ml solution of ICG was injected into the inguinal lymph nodes under ultrasound guidance. TD was checked with the laparoscopic Karl Storz IMAGE1 STM or Robotic da Vinci Xi system. The thoracic esophagus, periesophageal tissue, and lymph nodes were dissected. The TD was visualized throughout the dissection using OverlayTM technology & Firefly mode™ and checked at the end to rule out any dye leak. TD was clipped if any dye leakage or TD injury (TDI) was noted using Near Infra-Red Spectroscopy. RESULTS Twenty one patients with M:F 13:8 underwent minimally invasive esophagectomy (MIE) [thoracoscopic assisted (n = 15) and robotic-assisted (n = 6)]. TD was visualized in all the cases after a median (IQR) time of 35 (30, 35) min. The median (IQR) duration of the thoracic phase was 150 (120,165) min. TDI occurred in 1 case, identified intra-operatively, and TD was successfully clipped. There were no post-operative chylothorax or adverse reactions from the ICG injection. CONCLUSION Intra-nodal ICG injection before MIE helps to identify the TD in real-time and is a valuable intra-operative aid to prevent or successfully manage a TD injury. It may help to prevent the dreaded complication of post-operative chylothorax after esophagectomy.
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16
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Choi C, Wells J, Luenenschloss N, Yi M, Morison C, Cook N, Beasley S, Jones R. The role of motion tracking in assessing technical skill acquisition using a neonatal 3D-printed thoracoscopic esophageal atresia/tracheo-esophageal fistula simulator. J Pediatr Surg 2022; 57:1087-1091. [PMID: 35216795 DOI: 10.1016/j.jpedsurg.2022.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 01/22/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Acquiring the technical skills required for thoracoscopic repair of esophageal atresia with tracheo-esophageal fistula (EA/TEF) is challenging. A high-fidelity 3D-printed pediatric thoracoscopic EA/TEF simulator has been developed to address this issue. This study explored motion-tracking as an assessment tool to distinguish between surgeons of different expertise using the simulator. METHODS Participants performed a single intracorporeal suture between the esophageal ends in EA with TEF. Total relative path lengths of the right and left surgical instruments were recorded during the task. Each video-recorded attempt was assessed by a blinded pediatric surgeon using a modified Objective Structured Assessment of Technical Skills (OSATS) score. Data recorded as median (range) and statistical significance as p<0.05. RESULTS The task was performed by 17 participants. The median OSATS scores identified a significant difference between experts and novices. A difference between left- and right-hands was only found in the mid-skill level group. Right-hand path length was greatest in novices and lowest in experts. Left-hand path length was greatest in novices and the mid-skill level group compared to experts. CONCLUSION Experts had the lowest total path length for either hand, suggesting they had the greatest efficiency of movement. The similar high path lengths in both hands for novices indicate their relatively low level of skill with either hand. The difference between right- and left-hand path lengths in the mid-skill level group likely reflects the improved right-handed technical skills in contrast to the still developing left hand. Further focus on the left hand during simulation training may improve left-handed economy of movement.
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Affiliation(s)
- Clara Choi
- School of Medicine, University of Otago Christchurch, Christchurch, New Zealand.
| | - Jonathan Wells
- Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand; School of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Symulus Limited, Christchurch, New Zealand
| | - Nicola Luenenschloss
- Department of Medical Physics and Bioengineering, Christchurch Hospital, Christchurch, New Zealand
| | - Ma Yi
- Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Chris Morison
- Department of Medical Physics and Bioengineering, Christchurch Hospital, Christchurch, New Zealand
| | - Nick Cook
- Department of Medical Physics and Bioengineering, Christchurch Hospital, Christchurch, New Zealand
| | - Spencer Beasley
- Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand; School of Medicine, University of Otago Christchurch, Christchurch, New Zealand; Symulus Limited, Christchurch, New Zealand
| | - Rory Jones
- Symulus Limited, Christchurch, New Zealand
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17
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Deie K, Nakagawa Y, Uchida H, Hinoki A, Shirota C, Tainaka T, Sumida W, Yokota K, Makita S, Fujiogi M, Okamoto M, Takimoto A, Yasui A, Takada S, Maeda T. Evaluation of minimally invasive surgical skills training: comparing a neonatal esophageal atresia/tracheoesophageal fistula model with a dry box. Surg Endosc 2022; 36:6035-6048. [PMID: 35312850 DOI: 10.1007/s00464-022-09185-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pediatric surgeons require highly advanced minimally invasive surgical skills to perform rare and complex surgeries in a very vulnerable population. We developed a neonatal esophageal atresia (EA) model to improve thoracoscopic surgical skills. This study aimed to evaluate the concurrent validity of the model by undertaking pre- and post-training skills assessments in two groups of students with no prior experience performing minimally invasive surgery, using the EA model and a dry box (DB). METHODS A pilot study was performed. The participants were randomly divided into two groups: one trained using the DB and one trained using the EA model. Both groups practiced a minimally invasive surgical suture task. The task completion time, 29-point checklist score, modified suturing error sheet score, and three-dimensional forceps movement in both groups were compared pre-and post-training by video analysis. RESULTS The EA model task was significantly more difficult than that of the DB. Both groups showed significant improvement in the task time, 29-point checklist score, and modified suturing error sheet score; however, the EA model training was more efficient in improving each error item. Regarding forceps movement, the EA model training significantly decreased wasted motion, whereas the DB was limited in this regard. CONCLUSIONS Short-term training on the EA model, which was more technically demanding than the DB, decreased technical error and wasted motion, and allowed learners to acquire surgical skills more efficiently than training with the DB model. These facts revealed the concurrent validity of the EA model.
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Affiliation(s)
- Kyoichi Deie
- Department of Pediatric Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kazuki Yokota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Michimasa Fujiogi
- Department of Pediatric Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masamune Okamoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Aitaro Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Akihiro Yasui
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shunya Takada
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Takuya Maeda
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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Cartledge R, Suwalski G, Witkowska A, Gottlieb G, Cioci A, Chidiac G, Ilsin B, Merrill B, Suwalski P. Standalone epicardial left atrial appendage exclusion for thromboembolism prevention in atrial fibrillation. Interact Cardiovasc Thorac Surg 2021; 34:548-555. [PMID: 34871377 PMCID: PMC8972304 DOI: 10.1093/icvts/ivab334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/21/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Most strokes associated with atrial fibrillation (AF) result from left atrial appendage thrombi. Oral anticoagulation can reduce stroke risk but is limited by complication risk and non-compliance. Left atrial appendage exclusion (LAAE) is a new surgical option to reduce stroke risk in AF. The study objective was to evaluate the safety and feasibility of standalone thoracoscopic LAAE in high stroke risk AF patients. METHODS This was a retrospective, multicentre study of high stroke risk AF patients who had oral anticoagulation contraindications and were not candidates for ablation nor other cardiac surgery. Standalone thoracoscopic LAAE was performed using 3 unilateral ports access and epicardial clip. Periprocedural adverse events, long-term observational clinical outcomes and stroke rate were evaluated. RESULTS Procedural success was 99.4% (174/175 patients). Pleural effusion occurred in 4 (2.3%) patients; other periprocedural complications were <1% each. One perioperative haemorrhagic stroke occurred (0.6%). No phrenic nerve palsy or cardiac tamponade occurred. Predicted annual ischaemic stroke rate of 4.8/100 patient-years (based on median CHA2DS2-VASc score of 4.0) was significantly higher than stroke risk observed in follow-up after LAAE. No ischaemic strokes occurred (median follow-up: 12.5 months), resulting in observed rate of 0 (95% CI 0-2.0)/100 patient-years (P < 0.001 versus predicted). Six all-cause (non-device-related) deaths occurred during follow-up. CONCLUSIONS Study proved that a new surgical option, standalone thoracoscopic LAAE, is feasible and safe. With this method, long-term stroke rate may be reduced compared to predicted for high-risk AF population.
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Affiliation(s)
- Richard Cartledge
- Cardiovascular and Thoracic Surgery, Lynn Heart and Vascular Institute Baptist Health South Florida Boca Raton Regional Hospital, Boca Raton, FL, USA
| | - Grzegorz Suwalski
- Department of Cardiac Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Anna Witkowska
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Gary Gottlieb
- Cardiovascular and Thoracic Surgery, Lynn Heart and Vascular Institute Baptist Health South Florida Boca Raton Regional Hospital, Boca Raton, FL, USA
| | - Anthony Cioci
- Florida Atlantic University College of Medicine, Boca Raton, FL, USA
| | - Gilbert Chidiac
- Cardiovascular and Thoracic Surgery, Lynn Heart and Vascular Institute Baptist Health South Florida Boca Raton Regional Hospital, Boca Raton, FL, USA
| | - Burak Ilsin
- Cardiovascular and Thoracic Surgery, Lynn Heart and Vascular Institute Baptist Health South Florida Boca Raton Regional Hospital, Boca Raton, FL, USA
| | - Barry Merrill
- Cardiovascular and Thoracic Surgery, Lynn Heart and Vascular Institute Baptist Health South Florida Boca Raton Regional Hospital, Boca Raton, FL, USA
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
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Yang S, Wang P, Yang Z, Li S, Liao J, Hua K, Zhang Y, Zhao Y, Gu Y, Li S, Chen Y, Huang J. Clinical comparison between thoracoscopic and thoracotomy repair of Gross type C esophageal atresia. BMC Surg 2021; 21:403. [PMID: 34809633 PMCID: PMC8607600 DOI: 10.1186/s12893-021-01360-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background To compare the clinical outcomes between thoracoscopic approach and thoracotomy surgery in patients with Gross type C Esophageal atresia (EA) and tracheoesophageal fistula (TEF). Methods Patients with Gross type C EA/TEF who underwent surgery from January 2007 to January 2020 at Beijing Children’s Hospital were retrospectively analyzed. The patients were divided into two groups according to surgical approaches. The perioperative factors and postoperative complications were compared among the two groups. Results One hundred and ninety patients (132 boys and 58 girls) with a median birth weight of 2975 (2600, 3200) g were included. The primary operations were performed via thoracoscopic (n = 62) and thoracotomy (n = 128) approach. After comparison of clinical characteristics between the two groups, we found that there were statistically significant differences in associated anomalies, method of fistula closure, duration of mechanical ventilation after surgery, feeding option before discharge, management of pneumothorax, and prognosis (all P < 0.05). To a certain extent, thoracoscopic surgery reduced the incidence of anastomotic leakage and increased the incidence of anastomotic stricture in this study. However, there were no statistically significant differences between the two groups in terms of operative time, postoperative pneumothorax, anastomotic leakage, anastomotic stricture, and recurrent tracheoesophageal fistula (all P > 0.05). Conclusions Thoracoscopy surgery for Gross type C EA/TEF is a safe and effective, minimally invasive technique with comparable operative time and incidence of postoperative complications. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01360-7.
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Affiliation(s)
- Shen Yang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, China
| | - Peize Wang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, China
| | - Zhi Yang
- Department of Neonatal Surgery, The Affiliated Children's Hospital of Nanchang University, Nanchang, 330006, China
| | - Siqi Li
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, China
| | - Junmin Liao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, China
| | - Kaiyun Hua
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, China
| | - Yanan Zhang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, China
| | - Yong Zhao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, China
| | - Yichao Gu
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, China
| | - Shuangshuang Li
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, China
| | - Yongwei Chen
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, China
| | - Jinshi Huang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, China. .,Department of Neonatal Surgery, The Affiliated Children's Hospital of Nanchang University, Nanchang, 330006, China.
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20
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Liu C, Wang W, Mei J, Zhu Y, Pu Q, Liu L. Uniportal Thoracoscopic Single-Direction Basal Subsegmentectomy (Left S10a+ci): Trans-Inferior-Pulmonary-Ligament Approach. Ann Surg Oncol 2021; 29:1389-1391. [PMID: 34766225 PMCID: PMC8724142 DOI: 10.1245/s10434-021-10806-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/31/2021] [Indexed: 02/05/2023]
Abstract
Thoracoscopic segmentectomy and subsegmentectomy have been widely accepted for the treatment of peripheral small lung cancers. Thoracoscopic basal subsegmentectomy, especially when performed through a uniportal procedure, is extremely technically challenging, and therefore there are seldom reports of its technical details. In this article, we present a uniportal thoracoscopic left S10a+ci subsegmentectomy following the single-direction strategy through the inferior pulmonary ligament approach.
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Affiliation(s)
- Chengwu Liu
- Department of Thoracic Surgery, West China Hospital, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Wenping Wang
- Department of Thoracic Surgery, West China Hospital, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Yunke Zhu
- Department of Thoracic Surgery, West China Hospital, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Chengdu, China. .,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China.
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21
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España MI, Sastre I, Franco CA, Emilia Q, Ceballos RJ, Bustos MEF. Video-assisted thoracoscopic diaphragmatic plication. Multimed Man Cardiothorac Surg 2021; 2021. [PMID: 35616985 DOI: 10.1510/mmcts.2021.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The authors demonstrate a video-assisted thoracoscopic surgical technique for diaphragmatic plication, which is used to treat acquired diaphragmatic paralysis resulting from injury to the phrenic nerve. The objective of the surgical procedure is to return the abdominal contents to their normal position and restore optimal lung expansion by reducing the size of the diaphragmatic surface. Successful diaphragmatic plication improves lung function, reduces dyspnea, and restores quality of life.
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Affiliation(s)
- Manuel Isaac España
- Hospital Privado Universitario de Cordoba General Surgeon Fellowship in Thoracic Surgery
| | - Ignacio Sastre
- Thoracic Surgery Department, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Carla A Franco
- Thoracic Surgery Department, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Quintana Emilia
- Thoracic Surgery Department, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Roberto Jorge Ceballos
- Thoracic Surgery Department, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Mario Eduardo F Bustos
- Thoracic Surgery Department, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
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22
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Takeda FR, Obregon CDA, Navarro YP, Moura DTH, Ribeiro Jr U, Aissar Sallum RA, Cecconello I. Thoracoscopic esophagectomy is related to better outcomes in early adenocarcinoma of esophagogastric junction tumors. World J Gastrointest Endosc 2021; 13:319-328. [PMID: 34512879 PMCID: PMC8394183 DOI: 10.4253/wjge.v13.i8.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/21/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thoracoscopic esophagectomy is related to an extended lymphadenectomy, and a high number of retrieved lymph nodes, compared to the transhiatal approach; however, its association with an improvement in overall survival (OS) is debatable.
AIM To compare thoracoscopic esophagectomy with transhiatal esophagectomy in patients with adenocarcinoma of the esophagogastric junction (AEGJ) in terms of survival, number of lymph nodes, and complications.
METHODS In total, 147 patients with AEGJ were selected retrospectively from 2002 to 2019, and divided into Group A for thoracoscopic esophagectomy, and group B for transhiatal esophagectomy. OS, disease-free survival, postoperative complications, and number of nodes, were similarly evaluated.
RESULTS One hundred and thirty (88%) were male; the mean age was 64 years. Group A had a mean age of 61.1 years and group B 65.7 years (P = 0.009). Concerning the extent of lymphadenectomy, group A showed a higher number of retrieved lymph nodes (mean of 31.89 ± 8.2 vs 20.73 ± 7; P < 0.001), with more perioperative complications, such as hoarseness, surgical site infections, and respiratory complications. Although both groups had similar OS rates, subgroup analysis showed better survival of transthoracic esophagectomy in patients with earlier diseases.
CONCLUSION Both methods are safe, having similar morbidity and mortality rates. Transthoracic thoracoscopic esophagectomy allows a more extensive resection of the lymph nodes and may have better oncological outcomes during earlier stages of the disease. Prospective studies are warranted to better evaluate these findings.
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Affiliation(s)
- Flavio Roberto Takeda
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo 05403-000, Brazil
| | | | - Yasmin Peres Navarro
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo 05403-000, Brazil
| | | | - Ulysses Ribeiro Jr
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo 05403-000, Brazil
| | | | - Ivan Cecconello
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo 05403-000, Brazil
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23
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Liu R, Wess A, Kidane B, Srinathan S, Tan L, Buduhan G. A simple "passive awareness" intervention to decrease the cost of thoracoscopic lobectomy. Updates Surg 2021. [PMID: 33813691 DOI: 10.1007/s13304-021-01048-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
In thoracic surgery, disposable instruments are significant drivers of cost. There is variation in disposable instrument use among surgeons. It was hypothesized that a "passive awareness" intervention (displaying a pricing list of disposable instruments in the operating theater) would decrease operative costs. A current price list of disposable instruments used in thoracoscopic lobectomy was displayed in the thoracic surgery operating theater. Consecutive patients who underwent thoracoscopic lobectomy 6 months prior to price list display (Period 1) and 6 months following price list display (Period 2) were analyzed. Descriptive statistics were used to describe case distribution and lobectomy costs. T test and linear regression were used to examine the impact of surgeon, lobe removed, and time period. Over the study period, 71 patients underwent thoracoscopic lobectomy (Period 1: n = 36, Period 2: n = 35). Median per-lobectomy disposables cost decreased from $2063.22 (Interquartile range [IQR] $788.49) in Period 1 to $1885.92 (IQR $552.26) in Period 2; p = 0.03. There was a significant reduction in the median number of "high cost disposables" between Periods 1 and 2 (5.5-5.0, respectively; p = 0.04). In multiple linear regression, there was a decrease in total per-lobectomy cost of $286.21 (p = 0.03) and a decrease in stapler cartridge cost of $266.89 (p = 0.03) when controlling for surgeon and lobe. There was a significant reduction in disposable instrument expenditure per thoracoscopic lobectomy following posting of instrument costs in the operating theater. These findings suggest that a simple passive awareness intervention is effective in influencing surgeon behavior to reduce disposable instrument costs.
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24
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Elsayed HH, Moharram AA. Tailored anaesthesia for thoracoscopic surgery promoting enhanced recovery: The state of the art. Anaesth Crit Care Pain Med 2021; 40:100846. [PMID: 33774262 DOI: 10.1016/j.accpm.2021.100846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/30/2020] [Accepted: 12/20/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE OF THE REVIEW The current review focuses on precise anaesthesia for video-assisted thoracoscopic surgery (VATS) with the goal of enhanced recovery. The main aim of an enhanced recovery program after thoracic surgery is to reduce postoperative stress response, protect from postoperative pulmonary complications, give hospitals a better financial option and improve overall patient outcome. This can ultimately reduce hospital stay and increase patient satisfaction. With advances in endoscopic, robotic and endovascular techniques, video-assisted thoracoscopic surgery (VATS) can be performed in a minimally invasive way in managing most pulmonary, pleural and mediastinal diseases. As a minimally invasive technique, video-assisted thoracoscopic surgery (VATS) represents an important element of enhanced recovery program in thoracic surgery as it can achieve most of its goals. Anaesthetic management during preoperative, intraoperative and postoperative period is essential for the establishment of a successful enhanced recovery program. In the era of enhanced recovery protocols, non-intubated thoracoscopic procedures present a step forward. This article focuses on the key anaesthetic elements of the enhanced recovery program during all phases of thoracoscopic surgery. Having reviewed recent literature, a systematic review of literature will highlight successful ERAS protocols published for thoracoscopic surgery.
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Affiliation(s)
| | - Assem Adel Moharram
- Department of Anaesthesia, Intensive Care and Pain Management, Ain Shams University, Cairo, Egypt
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25
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Liu B, Qiu ML, Wu XB, Yu MJ, Li X. Thoracoscopic total laryngo-pharyngo-oesophagectomy for the pharyngoesophageal junction cancer: a single-center experience of multidisciplinary team. Eur Arch Otorhinolaryngol 2021. [PMID: 33651150 DOI: 10.1007/s00405-021-06706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The aims of this study were to review the surgical experience and evaluate the feasibility of thoracoscopic total laryngo-pharyngo-oesophagectomy by multidisciplinary team in the patients with pharyngoesophageal junction cancer. METHODS A total of 31 patients with pharyngoesophageal junction cancer who underwent thoracoscopic total laryngo-pharyngo-oesophagectomy with gastric pull-up reconstruction performed by a collaborative thoracic surgery and otolaryngology surgery team in our department from January 2009 to January 2019 were retrospectively analysed. Surgical experience, Postoperative morbidity, overall survival were evaluated. RESULTS The median age was 62 years old. Among these patients, 20 had hypopharyngeal cancer, 11 had cervical oesophageal cancer. No patients died during the perioperative period, and the median operation time was 4 h 30 min. The mean hospital stay was 13 days. The rate of complications was 32.3%. There were two cases of anastomotic leakage, four cases of moderate pulmonary infection. The median follow-up period was 31 months. Four patients were lost to follow-up in the second and fourth years and were considered to have died at that time. The 3- and 5-year overall survival rates were 52.6% and 31.6%, respectively. CONCLUSION As a salvage surgery, thoracoscopic total laryngo-pharyngo-oesophagectomy by multidisciplinary team can be performed with an acceptable level of perioperative morbidity and mortality, relatively good recovery, and acceptable survival outcome for patients with pharyngoesophageal junction cancer.
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26
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Thakkar H, Mullassery DM, Giuliani S, Blackburn S, Cross K, Curry J, De Coppi P. Thoracoscopic oesophageal atresia/tracheo-oesophageal fistula (OA/TOF) repair is associated with a higher stricture rate: a single institution’s experience. Pediatr Surg Int 2021; 37:397-401. [PMID: 33550454 PMCID: PMC7900027 DOI: 10.1007/s00383-020-04829-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Thoracoscopic OA/TOF repair was first described in 1999. Currently, less than 10% of surgeons routinely employ minimally access surgery. Our primary aim was to review our immediate-, early- and long-term outcomes with this technique compared with the open approach. METHODS A retrospective review of all patients undergoing primary OA/TOF (Type C) repair at our institution from 2009 was conducted. Outcome measures included length of surgery, conversion rate from thoracoscopy, early complications such as anastomotic leak and post-operative complications such as anastomotic strictures needing dilatations. Fisher's exact and Kruskal-Wallis tests were used for statistical analysis. RESULTS 95 patients in total underwent OA/TOF repair during the study period of which 61 (64%) were completed via an open approach. 34 were attempted thoracoscopically of which 11 (33%) were converted. There was only one clinically significant anastomotic leak in our series that took place in the thoracoscopic group. We identified a significantly higher stricture rate in our thoracoscopic cohort (72%) versus open surgery (43%, P < 0.05). However, the median number of dilations (3) performed was not significantly different between the groups. There was one recurrent fistula in the thoracoscopic converted to open group. Our median follow-up was 60 months across the groups. CONCLUSION In our experience, the clinically significant leak rate for both open and thoracoscopic repair as well as recurrent fistula is much lower than has been reported in the literature. We do not routinely perform contrast studies and are, thus, reporting clinically significant leaks only. The use of post-operative neck flexion, ventilation and paralysis is likely to be protective towards a leak. Thoracoscopic OA/TOF repair is associated with a higher stricture rate compared with open surgery; however, these strictures respond to a similar number of dilatations and are no more refractory. Larger, multicentre studies may be useful to investigate these finding further.
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Affiliation(s)
- H Thakkar
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - D M Mullassery
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - S Giuliani
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - S Blackburn
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - K Cross
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - J Curry
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - Paolo De Coppi
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK.
- Stem Cells and Regenerative Medicine Section, Department of Paediatric Surgery, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, Holborn, London, WC1N 1EH, UK.
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27
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Schenk S, Zannis K, Nakagaki S, Fritzsche D. Left- thoracoscopic Convergent ablation for atrial fibrillation. Multimed Man Cardiothorac Surg 2020; 2020. [PMID: 33399286 DOI: 10.1510/mmcts.2020.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Epicardial Convergent ablation followed by endocardial touch-up and an additional ablation may be superior to catheter-based interventions in patients with persistent atrial fibrillation. We sought to extend the epicardial lesion set by changing the standard subxiphoid thoracotomy to a left-lateral, totally thoracoscopic approach. This tutorial depicts a closed-chest, beating-heart procedure, including ablation of the left atrial posterior wall, the left atrial dome, and the left pulmonary veins. The left atrial appendage is closed using an epicardial occlusion device.
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Affiliation(s)
- Soren Schenk
- Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | | | - Shota Nakagaki
- Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Dirk Fritzsche
- Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
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28
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Liu Z, Yang R, Sun Y. Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage. BMC Surg 2020; 20:301. [PMID: 33256711 PMCID: PMC7706205 DOI: 10.1186/s12893-020-00910-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/13/2020] [Indexed: 01/02/2023] Open
Abstract
Background To investigate whether tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage has better short-term outcomes than non-intubated approach with chest tube drainage. Methods Data were collected retrospectively from January 2017 and December 2019. Tubeless group included 55 patients with pulmonary nodules underwent tubeless uniportal thoracoscopic wedge resection, 211 patients underwent non-intubated uniportal thoracoscopic wedge resection with chest tube drainage were included in drainage group. Peri-operative outcomes between two groups were compared. Results After 1:1 matching, 110 patients remained for analysis, baseline demographic and clinical variables were comparable between the two groups. Mean incision size was 3 cm in both group. Mean operative time was 59.3 min in tubeless group and 52.8 min in drainage group. The detectable mean lowest SpO2 and mean peak EtCO2 during operation was acceptable in both groups. Conversion to intubated ventilation or thoracotomy was not required. No patient failed the air leak test and did not undergo a tubeless procedure. Mean postoperative hospital stay was 1.5 days in tubeless group and 2.5 days in drainage group. Residual pneumothorax or subcutaneous emphysema was not frequent and mild in tubeless group. Side effects were rare and mild, including cough and hemoptysis. No re-intervention or readmission occurred. The postoperative VAS score was significantly lower in tubeless group. Conclusions Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage is feasible and safe for selected patients with peripheral pulmonary nodules, it might reduce post-operation pain and lead to faster recovery.
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Affiliation(s)
- Zhengcheng Liu
- Department of Thoracic Surgery, Nanjing Chest Hospital, Treatment and Research Center for Pulmonary Nodule in Nanjing Medical University, Nanjing, 210029, Jiangsu, China.,Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Rusong Yang
- Department of Thoracic Surgery, Nanjing Chest Hospital, Treatment and Research Center for Pulmonary Nodule in Nanjing Medical University, Nanjing, 210029, Jiangsu, China. .,Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China.
| | - Yang Sun
- Department of Anaesthesia, Nanjing Chest Hospital, Nanjing, 210029, China
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29
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Zhao S, Pan Z, Li Y, An Y, Zhao L, Jin X, Fu J, Wu C. Surgical treatment of 125 cases of congenital diaphragmatic eventration in a single institution. BMC Surg 2020; 20:270. [PMID: 33148241 PMCID: PMC7640684 DOI: 10.1186/s12893-020-00928-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. METHODS We retrospectively analyzed the clinical data of 125 children with CDE (90 boys, 35 girls; median age: 12.2 months, range: 1 h-7 years; body weight: 1.99-28.5 kg, median body weight: 7.87 ± 4.40 kg) admitted to our hospital in the previous 10 years, and we statistically analyzed their clinical manifestations and surgical methods. RESULTS A total of 108 children in this group underwent surgery, of whom 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication. A total of 107 patients recovered well postoperatively, except for 1 patient who died due to respiratory distress after surgery. After 1-9.5 years of follow-up, 107 patients had significantly improved preoperative symptoms. During follow-up, the location of the diaphragm was normal, and no paradoxical movement was observed. Eleven of the 17 children who did not undergo surgical treatment did not have a decrease in diaphragm position after 1-6 years of follow-up. The index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P < 0.05). CONCLUSIONS The clinical symptoms of congenital diaphragmatic eventration vary in severity. Patients with severe symptoms should undergo surgery. Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of a short operation time, less trauma, and a rapid recovery. Thus, thoracoscopic diaphragmatic plication should be the first choice for children with congenital diaphragmatic eventration.
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Affiliation(s)
- Shengliang Zhao
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, People's Republic of China
| | - Yonggang Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, People's Republic of China
| | - Yong An
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, People's Republic of China
| | - Lu Zhao
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China
| | - Xin Jin
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China
| | - Jian Fu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China. .,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China. .,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China. .,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, People's Republic of China. .,, Room 806, Kejiao Building (NO. 6 Building), No. 136, 2nd Zhongshan Road, Yuzhong District, Chongqing, China.
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30
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Tandon V, Mallepally AR, Peddaballe AR, Marathe N, Chhabra HS. Mini-open thoracoscopic-assisted spinal thoracotomy for traumatic injuries: A technical note. Surg Neurol Int 2020; 11:265. [PMID: 33024603 PMCID: PMC7533086 DOI: 10.25259/sni_435_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/13/2020] [Indexed: 11/04/2022] Open
Abstract
Background Mini-open thoracoscopic-assisted thoracotomy (MOTA) has been introduced to mitigate disadvantages of conventional open anterior or conventional posterior only thoracoscopic procedures. Here, we evaluated the results of utilizing the MOTA technique to perform anterior decompression/fusion for 22 traumatic thoracic fractures. Methods There were 22 patients with unstable thoracic burst fractures (TBF) who underwent surgery utilizing the MOTA thoracotomy technique. Multiple variables were studied including; the neurological status of the patient preoperatively/postoperatively, the level and type of fracture, associated injuries, operative time, estimated blood loss, chest tube drainage (intercostal drainage), length of hospital stay (LOS), and complication rate. Results In 22 patients (averaging 35.5 years of age), T9 and T12 vertebral fractures were most frequently encountered. There were 20 patients who had single level and 2 patients who had two-level fractures warranting corpectomies. Average operating time and blood loss for single-level corpectomy were 91.5 ± 14.5 min and 311 ml and 150 ± 18.6 min and 550 ml for two levels, respectively. Mean hospital stay was 5 days. About 95.45% of cases showed fusion at latest follow-up. Average preoperative kyphotic angle corrected from 34.2 ± 3.5° to 20.5 ± 1.0° postoperatively with an average correction of 41.1% and correction loss of 2.4%. Conclusion We concluded that utilization of the MOTA technique was safe and effective for providing decompression/fusion of traumatic TBF.
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Affiliation(s)
- Vikas Tandon
- Spine Services, Indian Spinal Injuries Centre, New Delhi, India
| | | | | | - Nandan Marathe
- Spine Services, Indian Spinal Injuries Centre, New Delhi, India
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Pearman CM, Redfern J, Williams EA, Snowdon RL, Modi P, Hall MCS, Modi S, Waktare JEP, Mahida S, Todd DM, Mediratta N, Gupta D. Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation. Europace 2020; 21:738-745. [PMID: 30753411 PMCID: PMC6479510 DOI: 10.1093/europace/euy303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/23/2019] [Indexed: 11/30/2022] Open
Abstract
Aims Video-assisted thoracoscopic surgery (VATS) ablation has been advocated as a treatment option for non-paroxysmal atrial fibrillation (AF) in recent guidelines. Real-life data on its safety and efficacy during a centre’s early experience are sparse. Methods and results Thirty patients (28 persistent/longstanding persistent AF) underwent standalone VATS ablation for AF by an experienced thoracoscopic surgeon, with the first 20 cases proctored by external surgeons. Procedural and follow-up outcomes were collected prospectively, and compared with 90 propensity-matched patients undergoing contemporaneous catheter ablation (CA). Six (20.0%) patients undergoing VATS ablation experienced ≥1 major complication (death n = 1, stroke n = 2, conversion to sternotomy n = 3, and phrenic nerve injury n = 2). This was significantly higher than the 1.1% major complication rate (tamponade requiring drainage n = 1) seen with CA (P < 0.001). Twelve-month single procedure arrhythmia-free survival rates without antiarrhythmic drugs were 56% in the VATS and 57% in the CA cohorts (P = 0.22), and 78% and 80%, respectively given an additional CA and antiarrhythmic drugs (P = 0.32). Conclusion During a centre’s early experience, VATS ablation may have similar success rates to those from an established CA service, but carry a greater risk of major complications. Those embarking on a programme of VATS AF ablation should be aware that complication and success rates may differ from those reported by selected high-volume centres.
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Affiliation(s)
- Charles M Pearman
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK.,Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, 3.14 Core Technology Facility, University of Manchester, Manchester, UK
| | - James Redfern
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Emmanuel A Williams
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Richard L Snowdon
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Paul Modi
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Mark C S Hall
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Simon Modi
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Johan E P Waktare
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Saagar Mahida
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Derick M Todd
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Neeraj Mediratta
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
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Rozeik AE, Elbarbary MM, Saleh AM, Khodary AR, Al-Ekrashy MA. Thoracoscopic versus conventional open repair of tracheoesophageal fistula in neonates: A short-term comparative study. J Pediatr Surg 2020; 55:1854-1859. [PMID: 31785836 DOI: 10.1016/j.jpedsurg.2019.09.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 08/26/2019] [Accepted: 09/23/2019] [Indexed: 11/15/2022]
Abstract
PURPOSE Esophageal atresia with or without a tracheo-esophageal fistula is a challenging anomaly in neonates. Thoracoscopic repair is gaining popularity now in pediatric surgery community. The present study aims at comparing the short term outcomes of thoracoscopy versus classic thoracotomy for repair of such conditions. METHODS Thirty neonates with tracheoesophageal fistula were randomly divided into two equal groups (n=15) after excluding patients with birth weight <2000g, multiple associated anomalies and cardiorespiratory instability. One group had conventional open repair while the other had thoracoscopic repair. Demographic data, intraoperative result and post-operative findings were recorded and compared between both groups. RESULTS Both groups showed similar results regarding demographic and patients' characteristics. Thoracoscopic repair had relatively longer, yet non-significant operative time but with highly significant difference in preserving azygos vein. There was low conversion rate with thoracoscopy (6.66%). Open repair resulted in a longer hospital stay (11.73±5.68 vs 9.2±2.95). Complication rate was comparable in both groups; however, thoracoscopy was associated with better cosmetic results as reported by parents and surgeons (p=0.00). CONCLUSION Compared to thoracotomy, thoracoscopic repair offers a less invasive, effective and safe technique with similar short term outcomes, but with superior cosmetic results and better ability to spare azygos vein. TYPE OF STUDY Therapeutic/Treatment study LEVEL OF EVIDENCE: Level II.
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Affiliation(s)
- Ahmed Ezzat Rozeik
- Pediatric Surgery Department, Zagazig University Hospitals, Zagazig, Egypt
| | - Mohamed Magdy Elbarbary
- Pediatric Surgery Department, Cairo University Children Hospital (Abu El-Reesh), Cairo, Egypt
| | - Amin Mohamed Saleh
- Pediatric Surgery Department, Zagazig University Hospitals, Zagazig, Egypt
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Yu W, Xu J, Sheng H, Cao J, Wang Z, Lv W, Hu J. [Clinical Evaluation of Absorbable Regenerated Oxidized Cellulose in Lung Cancer Surgery]. Zhongguo Fei Ai Za Zhi 2020; 23:492-495. [PMID: 32517454 PMCID: PMC7309556 DOI: 10.3779/j.issn.1009-3419.2020.101.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
背景与目的 胸腔镜下安全有效的止血是开展胸外科快速康复的重要条件,术中放置止血材料是肺癌腔镜手术中常用的方法,其中可吸收再生氧化纤维素是常用的止血材料。本研究旨在观察可吸收再生氧化纤维素在肺癌手术中的止血效果。 方法 回顾性分析2018年7月1日-2018年12月1日于浙江大学医学院附属第一医院胸外科行胸腔镜肺癌根治手术且术中使用可吸收再生氧化纤维素止血的42例患者的临床病理资料,选取围手术期指标作为结局事件进行统计分析。 结果 平均手术时间为(120.5±57.3)min,术中平均出血量为(26.8±21.6)mL,术后平均引流量为(513.6±359.5)mL,术后胸管平均留置时间为(2.6±1.2)d。 结论 胸腔镜肺癌根治术术中使用可吸收再生氧化纤维素具有良好的止血效果,适用于淋巴结清扫后创面填塞止血。
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Affiliation(s)
- Wenfeng Yu
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhejiang University, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jinming Xu
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhejiang University, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Hongxu Sheng
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhejiang University, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jinlin Cao
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhejiang University, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Zhitian Wang
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhejiang University, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Wang Lv
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhejiang University, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhejiang University, Zhejiang University School of Medicine, Hangzhou 310003, China
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Chandarana K, Caruana EJ. In patients undergoing video-assisted thoracic surgery for lung resection, does three-dimensional endoscopic vision provide superior clinical outcomes? Interact Cardiovasc Thorac Surg 2020; 30:588-592. [PMID: 31800043 DOI: 10.1093/icvts/ivz293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/08/2019] [Accepted: 10/27/2019] [Indexed: 11/13/2022] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether the use of 3-dimensional endoscopic vision provides superior clinical outcomes to patients undergoing video-assisted thoracic surgery for lung resection. Altogether 231 unique papers were found using the reported search, of which 6 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Four of the 6 papers demonstrated a statistically significant reduction in operative time, although this difference may not be of sufficient magnitude to be relevant clinically. There was no difference in any other outcomes assessed. We therefore conclude that, in patients undergoing video-assisted thoracic surgery for lung resection, 3-dimensional endoscopic vision has no demonstrable impact on perioperative or oncological outcomes, or cost, although it may reduce operative time.
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Affiliation(s)
| | - Edward J Caruana
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK.,NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
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Stauber A, Tanner H, Noti F, Roten L, Seiler J, Lam A, Medeiros-Domingo A, Servatius H, Tran VN, Carrel T, Weber A. Outcome of video-assisted thoracoscopic implantation of epicardial left ventricular leads with visual targeting for cardiac resynchronization therapy. Interact Cardiovasc Thorac Surg 2020; 30:373-379. [PMID: 31800041 DOI: 10.1093/icvts/ivz276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/05/2019] [Accepted: 10/23/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Our goal was to analyse the implantation and outcome of thoracoscopic epicardial leads after a failed endovascular approach or follow-up (FU) complications after endovascular implantation. METHODS We reviewed the records of patients with failed endovascular left ventricular (LV) lead placement or complications during FU, who were subsequently referred to cardiac surgeons for treatment with thoracoscopic LV lead implantation. We analysed the reasons for endovascular failure; the indications for the surgical procedures; and the clinical, echocardiographic and device FU results. RESULTS Between 2010 and 2013, a total of 23 patients were included. Among them, 17 of the patients had no previous cardiothoracic surgery, 13 (76%) had successful video-assisted thoracoscopy (VAT) LV lead implantation, 3 (18%) had a conversion to thoracotomy and 1 (6%) failed. Of the 6 patients with prior cardiothoracic surgery, 2 (33%) had VAT only, 3 (50%) had primary thoracotomies and 1 (17%) had a conversion. Two major complications occurred. The reasons for LV endovascular lead failure were subclavian vein occlusion (n = 2), implant failure (n = 13) and complications during the FU period (n = 8). FU information was available for 20 patients: 17 (85%) had improved symptoms. The median FU period was 33 months. A total of 78% of patients were in New York Heart Association (NYHA) functional class III-IV before the operation; 30% were in NYHA functional class III-IV at the last FU examination. The left ventricular ejection fraction increased from 25% before surgery to 31% at the last FU examination. Overall, sensing and pacing threshold values remained stable over time. In 1 patient, lead revision was necessary due to an increase in the pacing threshold. CONCLUSIONS VAT implantation of LV leads had an excellent response rate with an improvement in NYHA functional class and left ventricular ejection fraction. The lead measurements were mainly stable over time.
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Affiliation(s)
- Annina Stauber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Lam
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Helge Servatius
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Van Nam Tran
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alberto Weber
- Department of Cardiovascular Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
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Zobel MJ, Ewbank C, Mora R, Idowu O, Kim S, Padilla BE. The incidence of neuropathic pain after intercostal cryoablation during the Nuss procedure. Pediatr Surg Int 2020; 36:317-324. [PMID: 31760443 DOI: 10.1007/s00383-019-04602-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE Intercostal nerve cryoblation during the Nuss procedure for pectus excavatum decreases pain, opiate requirement, and hospital length of stay (LOS) compared to thoracic epidural analgesia. However, long-term complications of cryoablation, including neuropathic pain development, are not well studied. METHODS We conducted a multi-institutional retrospective review of patients following intercostal nerve cryoablation during Nuss bar insertion (11/2015-7/2018). Patients completed the Leeds Assessment of Neuropathic Symptoms and Signs, a validated questionnaire for detecting neuropathic symptoms. Primary outcome was neuropathic pain development. Secondary outcomes included duration of chest numbness and LOS. T test was performed; p < 0.05 is significant. RESULTS 43 patients underwent intercostal cryoablation during the Nuss procedure. Ages at repair ranged 11-47 years (median 16). Patients were grouped by age: ≤ 21 years (30 patients) or older (13 patients). Mean LOS was shorter for the younger group, 2.0 versus 3.9 days (p = 0.03). No patients in the younger group, and three in the older, experienced neuropathic pain. Mean time to numbness resolution was shorter for the younger group, 3.4 versus 10.8 months (p = 0.003). CONCLUSION In pediatric patients, intercostal cryoablation provides effective analgesia following the Nuss procedure with minimal risk of post-operative neuropathic pain. Adult patients are at greater risk of experiencing neuropathic pain and prolonged numbness.
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Affiliation(s)
- Michael J Zobel
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, 550 16th Street, Fifth Floor, San Francisco, CA, 94158-0570, USA
| | - Clifton Ewbank
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, 550 16th Street, Fifth Floor, San Francisco, CA, 94158-0570, USA
| | - Roberta Mora
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, 550 16th Street, Fifth Floor, San Francisco, CA, 94158-0570, USA
| | - Olajire Idowu
- Division of Pediatric Surgery, Department of Surgery, UCSF Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA
| | - Sunghoon Kim
- Division of Pediatric Surgery, Department of Surgery, UCSF Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA
| | - Benjamin E Padilla
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, 550 16th Street, Fifth Floor, San Francisco, CA, 94158-0570, USA.
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Ohsawa M, Hamai Y, Emi M, Tanabe K, Okada M. Thoracoscopic double-flap reconstruction for esophagogastric junction cancer: A case report. Int J Surg Case Rep 2020; 67:102-5. [PMID: 32058305 DOI: 10.1016/j.ijscr.2020.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background An anti-reflux anastomosis “double-flap technique” was recently used to resolve severe reflux esophagitis after intrathoracic esophagogastrostomy performed following proximal gastrectomy and lower esophagectomy, for esophagogastric junction (EGJ) cancer. We describe thoracoscopic reconstruction procedure performed by using the “double-flap” technique, which involves the creation of seromuscular flap under direct vision. This case report aimed to report the usefulness of this intrathoracic anastomosis procedure, as it may be difficult to perform double-flap technique with intraperitoneal manipulation in EGJ cancer cases. Presentation of case A 58-year-old man was diagnosed with Siewert type II EGJ cancer. We performed laparoscopic proximal gastrectomy, lower esophagectomy, and thoracoscopic esophagogastrostomy using the anti-reflux double-flap technique in the prone position. This was achieved after careful dissection in the plane between the muscular and submucosal layers prior to replacing the remnant stomach into the abdominal cavity. The postoperative course was uneventful, with no symptoms of esophageal reflux after 21 months of surgery, even without medications. Discussion This procedure offers the advantage of minimal invasiveness and ensures adequate surgical margins when lower esophageal incisions are required. This minimally invasive procedure achieves anastomosis using the complete hand-sewn method to prevent reflux, under a good surgical field of view for dissection of the lower esophagus and mediastinal lymph nodes. Conclusions This procedure is very useful due to its minimal invasiveness, ease of thoracic procedure, and prevention of reflux in patients with EGJ cancer. To our knowledge, this is the first report of thoracoscopic esophagogastrostomy performed using the double-flap technique for EGJ cancer.
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Wong ZH, Hewitt R, Cross K, Butler C, Yeh YT, Ramaswamy M, Blackburn S, Giuliani S, Muthialu N, De Coppi P. Thoracoscopic aortopexy for symptomatic tracheobronchomalacia. J Pediatr Surg 2020; 55:229-233. [PMID: 31826817 DOI: 10.1016/j.jpedsurg.2019.10.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/26/2019] [Indexed: 11/19/2022]
Abstract
AIM Symptomatic tracheobronchomalacia can be fatal. Successful treatment includes aortopexy. We report outcomes of the thoracoscopic approach in a single centre. METHODS All patients undergoing thoracoscopic aortopexies from 2009 to 2018 were retrospectively reviewed. Data was reported as median (interquartile range). Risk factors for subsequent tracheostomy were analyzed with logistics regression model, p < 0.05 as significant. RESULTS Twenty-one patients with mid to distal tracheomalacia (n = 17) and bronchial involvement (n = 4) were determined on bronchoscopy, tracheobronchogram, or CT thorax. Preoperative patient demographics and comorbidities, e.g., gastro-oesophageal reflux disease, prematurity, and cardiac anomalies were recorded. Indications for thoracoscopic aortopexy were apparent life-threatening event(s) (n = 14), recurrent chest infections (n = 5), and failure to wean invasive ventilation (n = 2). Thoracoscopic aortopexies (n = 20) with conversion to open (n = 1) were performed. Intraoperative bleeding (n = 2) occurred, and chest tube (n = 1) was inserted for monitoring. Intraoperative bronchoscopy (n = 17) confirmed improvement of tracheomalacia. Anesthetic time was 140 (90-160) minutes. Postoperatively, 2 patients had dehiscence of the aorta from the sternum. They underwent redo open aortopexy with posterior tracheopexy, and 1 required subsequent tracheostomy. Another 2 patients required tracheostomies. Potential risk factors for subsequent tracheostomy were investigated, and only the association of tracheobronchomalacia was close to significance (OR 16 (95% CI 0.95-267.03), p = 0.05). Follow up duration was 365 (72-854) days. Symptoms resolution occurred in n = 17 (81%) of patients. CONCLUSION Different modalities were used to delineate the site of tracheobronchomalacia and its etiology. Tracheomalacia with bronchial involvement may be a risk factor for subsequent tracheostomy. LEVEL OF EVIDENCE Level 3 (Case Series).
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Affiliation(s)
- Zeng Hao Wong
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom; Paediatric Surgery, Mount Alvernia Hospital, Singapore
| | - Richard Hewitt
- Tracheal Team, Great Ormond Street Hospital, London, United Kingdom; Department of Otolaryngology, Great Ormond Street Hospital, London, United Kingdom
| | - Kate Cross
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Colin Butler
- Tracheal Team, Great Ormond Street Hospital, London, United Kingdom; Department of Otolaryngology, Great Ormond Street Hospital, London, United Kingdom; Stem Cell and Regenerative Medicine Section, DBC, University College London, Great Ormond Institute of Child Health, London, United Kingdom
| | - Yi-Ting Yeh
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom; Paediatric Surgery, National Yang Ming University, School of Medicine, Taiwan
| | | | - Simon Blackburn
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Stefano Giuliani
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Paolo De Coppi
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom; Stem Cell and Regenerative Medicine Section, DBC, University College London, Great Ormond Institute of Child Health, London, United Kingdom.
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Abah U, Casali G, Batchelor TJP, Internullo E, Krishnadas R, Joshi N, Egbulonu S, Warden F, Bruno VD, West DG. Pathological lymph node involvement is not a predictor of adverse outcomes in patients undergoing thoracoscopic lobectomy for lung cancer†. Eur J Cardiothorac Surg 2019; 53:342-347. [PMID: 28958031 DOI: 10.1093/ejcts/ezx297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/21/2017] [Accepted: 07/24/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES As the practice of video-assisted thoracoscopic surgery (VATS) lobectomy gains widespread acceptance, the complexity of procedures attempted increases and the stage of tumour that may be safely approached remains controversial. We examined the impact of nodal involvement with respect to perioperative outcomes after VATS lobectomy. METHODS All patients listed for VATS lobectomy for non-small-cell lung cancer at our institution from 2012 to 2016 were analysed. Bronchoplastic or chest wall resections and tumours over 7 cm were considered a contraindication to a thoracoscopic approach. RESULTS Of the 489 patients identified, 97 (19.8%) patients had pathological nodal involvement. The overall conversion rate was 6.1%, reoperation rate was 5.3% and readmission rate was 5.9%. Median hospital stay was 5 days, 30-day mortality was 0.6% and 90-day mortality was 1.6%. No significant difference was identified between the nodal-negative or -positive groups in terms of preoperative demographics, hospital stay, postoperative complications, conversion rate, reoperation rate or readmission rate. Univariate logistic regression identified gender, Thoracoscore, dyspnoea score, performance status, chronic obstructive pulmonary disease, previous stroke, preoperative lung function and non-adenocarcinoma as predictors of postoperative complications. A multivariate model including nodal status identified Thoracoscore (odds ratio 1.57, 95% confidence interval 1.16-2.18; P < 0.001) and preoperative transfer factor (odds ratio 0.97, 95% confidence interval 0.96-0.98; P < 0.001) as the only predictors of complications. CONCLUSIONS In non-small-cell lung cancer patients with pathological hilar or mediastinal lymph node involvement, VATS lobectomy can be safely performed, as there does not appear to be an adverse effect on the incidence of perioperative complications, length of stay or readmissions.
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Affiliation(s)
- Udo Abah
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Gianluca Casali
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Eveline Internullo
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rakesh Krishnadas
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Natasha Joshi
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Samson Egbulonu
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Frances Warden
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Douglas George West
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Decaluwé H, Petersen RH, Brunelli A, Pompili C, Seguin-Givelet A, Gust L, Aigner C, Falcoz PE, Rinieri P, Augustin F, Sokolow Y, Verhagen A, Depypere L, Papagiannopoulos K, Gossot D, D'Journo XB, Guerrera F, Baste JM, Schmid T, Stanzi A, Van Raemdonck D, Bardet J, Thomas PA, Massard G, Fieuws S, Moons J, Dooms C, De Leyn P, Hansen HJ. Multicentric evaluation of the impact of central tumour location when comparing rates of N1 upstaging in patients undergoing video-assisted and open surgery for clinical Stage I non-small-cell lung cancer†. Eur J Cardiothorac Surg 2019; 53:359-365. [PMID: 29029062 DOI: 10.1093/ejcts/ezx338] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/12/2017] [Accepted: 07/30/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Large retrospective series have indicated lower rates of cN0 to pN1 nodal upstaging after video-assisted thoracic surgery (VATS) compared with open resections for Stage I non-small-cell lung cancer (NSCLC). The objective of our multicentre study was to investigate whether the presumed lower rate of N1 upstaging after VATS disappears after correction for central tumour location in a multivariable analysis. METHODS Consecutive patients operated for PET-CT based clinical Stage I NSCLC were selected from prospectively managed surgical databases in 11 European centres. Central tumour location was defined as contact with bronchovascular structures on computer tomography and/or visibility on standard bronchoscopy. RESULTS Eight hundred and ninety-five patients underwent pulmonary resection by VATS (n = 699, 9% conversions) or an open technique (n = 196) in 2014. Incidence of nodal pN1 and pN2 upstaging was 8% and 7% after VATS and 15% and 6% after open surgery, respectively. pN1 was found in 27% of patients with central tumours. Less central tumours were operated on by VATS compared with the open technique (12% vs 28%, P < 0.001). Logistic regression analysis showed that only tumour location had a significant impact on N1 upstaging (OR 6.2, confidence interval 3.6-10.8; P < 0.001) and that the effect of surgical technique (VATS versus open surgery) was no longer significant when accounting for tumour location. CONCLUSIONS A quarter of patients with central clinical Stage I NSCLC was upstaged to pN1 at resection. Central tumour location was the only independent factor associated with N1 upstaging, undermining the evidence for lower N1 upstaging after VATS resections. Studies investigating N1 upstaging after VATS compared with open surgery should be interpreted with caution due to possible selection bias, i.e. relatively more central tumours in the open group with a higher chance of N1 upstaging.
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Affiliation(s)
- Herbert Decaluwé
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Alex Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Cecilia Pompili
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | | | - Lucile Gust
- Department of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, North University Hospital, Marseille, France
| | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Essen, Germany
| | - Pierre-Emmanuel Falcoz
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Philippe Rinieri
- Department of Thoracic Surgery, University Hospital of Rouen, Rouen, France
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Youri Sokolow
- Department of Thoracic Surgery, Université Libre de Bruxelles, Brussels, Belgium
| | - Ad Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lieven Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Dominique Gossot
- Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Xavier Benoit D'Journo
- Department of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, North University Hospital, Marseille, France
| | - Francesco Guerrera
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean-Marc Baste
- Department of Thoracic Surgery, University Hospital of Rouen, Rouen, France
| | - Thomas Schmid
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Alessia Stanzi
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jeremy Bardet
- Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, North University Hospital, Marseille, France
| | - Gilbert Massard
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Steffen Fieuws
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium
| | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Dooms
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Henrik Jessen Hansen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Johnkoski J, Miles B, Sudbury A, Osman M, Munir MB, Balla S, Benjamin MM. Safety and long-term efficacy of thoracoscopic Epicardial ablation in patients with paroxysmal atrial fibrillation: a retrospective study. J Cardiothorac Surg 2019; 14:188. [PMID: 31694695 PMCID: PMC6836534 DOI: 10.1186/s13019-019-1018-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/28/2019] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study is to report the long-term efficacy and safety of thoracoscopic epicardial left atrial ablation (TELA) in patients with paroxysmal atrial fibrillation (AF). Methods This was a retrospective review of medical records. We included all patients diagnosed with paroxysmal AF who underwent TELA at our institution between 04/2011 and 06/2017. TELA included pulmonary vein isolation, LA dome lesions and LA appendage exclusion. All (n = 55) patients received an implantable loop recorder (ILR), 30 days post-operatively. Antiarrhythmic and anticoagulation therapy were discontinued at 90 and 180 days postoperatively, respectively, if patients were free of AF recurrence. Failure was defined as ≥two minutes of continuous AF, or atrial tachycardia. Results Fifty-five patients (78% males, mean age = 61.6 years) qualified for the study. The average duration in AF was 3.64 +/− 3.4 years, mean CHA2DS2-VASc Score was 2.0 +/− 1.6. The procedure was attempted in 57 patients and completed successfully in 55 (96.5%). Two patients experienced a minor pulmonary vein bleed that was managed conservatively. Post procedure, one patient experienced pulmonary edema, another experienced a pneumothorax requiring a chest tube and another experienced acute respiratory distress syndrome resulting in longer hospitalization. Otherwise, there were no major procedural complications. Success rates were 89.1% (n = 49/55), 85.5% (n = 47/55) and 76.9% (n = 40/52) at 6, 12 and 24 months, respectively. In the multivariate cox-proportional hazard model, survival at the mean of covariates was 86 and 74% at 12 and 24 months, respectively. Conclusion In this single center experience, TELA was a safe and efficacious procedure for patients with paroxysmal AF.
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Affiliation(s)
- John Johnkoski
- Department of Cardiothoracic Surgery, Aspirus Wausau Hospital, 2400 Pine Ridge Blvd, Wausau, WI, 54401, USA
| | - Bryan Miles
- School of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, USA
| | - Anna Sudbury
- School of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, USA
| | - Mohammed Osman
- Department of Internal Medicine (Division of Cardiovascular Medicine), West Virginia University Hospitals, 1 Medical Center Dr, Morgantown, WV, 26506, USA
| | - Muhammad Bilal Munir
- Department of Internal Medicine (Division of Cardiovascular Medicine), West Virginia University Hospitals, 1 Medical Center Dr, Morgantown, WV, 26506, USA
| | - Sudarshan Balla
- Department of Internal Medicine (Division of Cardiovascular Medicine), West Virginia University Hospitals, 1 Medical Center Dr, Morgantown, WV, 26506, USA
| | - Mina M Benjamin
- Department of Internal Medicine (Division of Cardiovascular Medicine), West Virginia University Hospitals, 1 Medical Center Dr, Morgantown, WV, 26506, USA.
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Graves CE, Moyer J, Zobel MJ, Mora R, Smith D, O'Day M, Padilla BE. Intraoperative intercostal nerve cryoablation During the Nuss procedure reduces length of stay and opioid requirement: A randomized clinical trial. J Pediatr Surg 2019; 54:2250-2256. [PMID: 30935731 PMCID: PMC6920013 DOI: 10.1016/j.jpedsurg.2019.02.057] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/29/2019] [Accepted: 02/22/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Minimally-invasive repair of pectus excavatum by the Nuss procedure is associated with significant postoperative pain, prolonged hospital stay, and high opiate requirement. We hypothesized that intercostal nerve cryoablation during the Nuss procedure reduces hospital length of stay (LOS) compared to thoracic epidural analgesia. DESIGN This randomized clinical trial evaluated 20 consecutive patients undergoing the Nuss procedure for pectus excavatum between May 2016 and March 2018. Patients were randomized evenly via closed-envelope method to receive either cryoanalgesia or thoracic epidural analgesia. Patients and physicians were blinded to study arm until immediately preoperatively. SETTING Single institution, UCSF-Benioff Children's Hospital. PARTICIPANTS 20 consecutive patients were recruited from those scheduled for the Nuss procedure. Exclusion criteria were age < 13 years, chest wall anomaly other than pectus excavatum, previous repair or other thoracic surgery, and chronic use of pain medications. MAIN OUTCOMES AND MEASURES Primary outcome was postoperative LOS. Secondary outcomes included total operative time, total/daily opioid requirement, inpatient/outpatient pain score, and complications. Primary outcome data were analyzed by the Mann-Whitney U-test for nonparametric continuous variables. Other continuous variables were analyzed by two-tailed t-test, while categorical data were compared via Chi-squared test, with alpha = 0.05 for significance. RESULTS 20 patients were randomized to receive either cryoablation (n = 10) or thoracic epidural (n = 10). Mean operating room time was 46.5 min longer in the cryoanalgesia group (p = 0.0001). Median LOS decreased by 2 days in patients undergoing cryoablation, to 3 days from 5 days (Mann-Whitney U, p = 0.0001). Cryoablation patients required significantly less inpatient opioid analgesia with a mean decrease of 416 mg oral morphine equivalent per patient (p = 0.0001), requiring 52%-82% fewer milligrams on postoperative days 1-3 (p < 0.01 each day). There was no difference in mean pain score between the groups at any point postoperatively, up to one year, and no increased incidence of neuropathic pain in the cryoablation group. No complications were noted in the cryoablation group; among patients with epidurals, one patient experienced a symptomatic pneumothorax and another had urinary retention. CONCLUSIONS AND RELEVANCE Intercostal nerve cryoablation during the Nuss procedure decreases hospital length of stay and opiate requirement versus thoracic epidural analgesia, while offering equivalent pain control. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
| | | | | | | | | | | | - Benjamin E. Padilla
- Corresponding author at: University of California, San Francisco Department of Surgery Division of Pediatric Surgery 550 16th St, Fifth Floor San Francisco, CA 94158-0570 United States. (B.E. Padilla)
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Marrufo AS, Boyd WD, Leshikar DE. Minimally invasive surgical management of penetrating chest injury from kinetic impact bean bag projectile. Trauma Case Rep 2019; 22:100210. [PMID: 31338405 PMCID: PMC6610230 DOI: 10.1016/j.tcr.2019.100210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2019] [Indexed: 11/11/2022] Open
Abstract
Bean bag guns are considered “non-lethal” weapons used by law enforcement. There are emerging reports in the medical literature on management of penetrating, intrathoracic injuries and none were found that involve potential cardiac complications. We present a case of a penetrating bean bag involving the pericardium. A young, adult man was shot in the left axillary region by law enforcement and presented hemodynamically stable. Computed Tomography (CT) demonstrated a bean bag anterolateral to the pericardium, associated with a small pulmonary contusion and hemopneumothorax. He underwent a left tube thoracostomy and sub-xiphoid pericardial window with cardiopulmonary bypass on standby. The diagnostic pericardial window showed no pericardial effusion and the foreign body extraction was successfully performed through the subxiphoid incision via Video Assisted Thoracoscopic Surgery. There were no intra-operative or post-operative complications.
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Affiliation(s)
| | - W Douglas Boyd
- Division of Cardiothoracic Surgery, UC Davis Health, Sacramento, CA, United States of America
| | - David E Leshikar
- Department of General Surgery, Division of Trauma and Acute Care Surgery, UC Davis Health, Sacramento, CA, United States of America
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Rampersad R, Singh M, Parikh D. Foregut duplications in the superior mediastinum: beware of a common wall with the tracheo-bronchial tree. Pediatr Surg Int 2019; 35:673-677. [PMID: 30838439 DOI: 10.1007/s00383-019-04466-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Foregut duplication cysts (FD) with a common muscular wall with the oesophagus are well recognised. Our case series highlights the existence of a common wall between superior mediastinal FD and the tracheo-bronchial tree. MATERIALS AND METHODS Over the last 15 years, we have thoracoscopically resected 41 FD. Five cases were identified to have a common wall with the tracheo-bronchial tree at operation. The clinical history, radiology, findings at operation and pathology were evaluated to highlight learning points. RESULTS Five superior mediastinal cysts with a common wall were identified, with two antenatally and three postnatally diagnosed. All three postnatal cases and one antenatal case presented with symptoms of respiratory compromise and stridor. Only one neonate was relatively asymptomatic before resection. CT similarities in all cases were: separation of trachea and oesophagus by the cyst, oesophageal deviation to the right or compression and compression of trachea/bronchus. Thoracoscopically, two cysts were resected without injury to the airway, while three had inadvertent tracheo-bronchial injury. Repair of the tracheal injury was possible in one case thoracoscopically, while two cases required conversions, as adequate oxygenation could not be maintained despite on-table endotracheal tube advancement beyond the injury and thoracoscopic manoeuvres. All cases had excellent outcomes at follow-up (median 25months, range 4-39months) with resolution of symptoms and no recurrences. CONCLUSIONS Our report highlights the existence of a common wall between the superior mediastinal FD and the tracheo-bronchial tree. Thoracoscopic resections are feasible including repair of inadvertent airway injury, provided adequate oxygenation can be maintained.
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Affiliation(s)
- Rajay Rampersad
- Department of Paediatric Surgery, Centenary Hospital for Women and Children, Hospital Road, Garran, ACT, 2605, Australia.
| | - Michael Singh
- Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Dakshesh Parikh
- Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
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Little JP, Loch-Wilkinson TJ, Sundberg A, Izatt MT, Adam CJ, Labrom RD, Askin GN. Quantifying Anterior Chest Wall Deformity in Adolescent Idiopathic Scoliosis: Correlation With Other Deformity Measures and Effects of Anterior Thoracoscopic Scoliosis Surgery. Spine Deform 2019; 7:436-444. [PMID: 31053314 DOI: 10.1016/j.jspd.2018.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/22/2018] [Accepted: 09/23/2018] [Indexed: 10/26/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study investigated how anterior chest wall deformity is affected by thoracoscopic anterior scoliosis fusion (TASF) surgery in adolescent idiopathic scoliosis patients. We aimed to determine correlations pre- and postoperatively with other clinical and radiological scoliosis measures. BACKGROUND DATA Scoliosis surgery aims to halt progression of the deformity, and to reduce its severity. Currently, deformity correction is clinically measured in terms of Cobb angle and rib hump (RH); however, a significant cosmetic concern for patients is anterior chest wall deformity. METHODS Pre- and postoperative CT scans of 28 female, Lenke type 1 patients with a mean preoperative Cobb angle of 50.2° ± 7.1° were retrieved from the Research Group's surgical database. Using ImageJ, 3D reconstructions of the thorax were created. Two observers measured the anterior chest wall deformity as a chest wall angle (CWA) and posterior deformity as a posterior apical deformity angle (PDA). We investigated pre- to postoperative changes in CWA, PDA, RH, and Cobb angle as well as their interrelationship. RESULTS All deformity parameters (Cobb angle, RH, CWA, and PDA) showed statistically significant improvement post TASF. Correlation was found between RH and Cobb angle pre- and postoperatively, Cobb angle and CWA preoperatively and between postoperative change in Cobb angle and CWA. No relationship was found between CWA and RH or PDA. CONCLUSIONS Anterior chest wall deformity is independent from the posterior chest wall measures RH and PDA, indicating that the anterior chest wall deformity is not reflected in the posterior rib cage. The correlation between Cobb angle and CWA indicates that the deformity in the spine and the deformity in the ribs are related, and shows that the anterior chest wall deformity is improved post thoracoscopic anterior scoliosis fusion surgery as the lateral deviation of the spine is corrected. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- J P Little
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane 4101, Queensland, Australia.
| | - T J Loch-Wilkinson
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane 4101, Queensland, Australia
| | - A Sundberg
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane 4101, Queensland, Australia
| | - M T Izatt
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane 4101, Queensland, Australia
| | - C J Adam
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane 4101, Queensland, Australia
| | - R D Labrom
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane 4101, Queensland, Australia
| | - G N Askin
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane 4101, Queensland, Australia
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Chen L, Liu F, Wang B, Wang K. Subxiphoid vs transthoracic approach thoracoscopic surgery for spontaneous pneumothorax: a propensity score-matched analysis. BMC Surg 2019; 19:46. [PMID: 31035996 PMCID: PMC6489176 DOI: 10.1186/s12893-019-0503-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The transthoracic thoracoscopic surgery is currently accepted as a favorable technique for bullectomy for primary spontaneous pneumothorax. Recently, uniportal subxiphoid thoracoscopic surgery has been proposed as an alternative to conventional transthoracic thoracoscopic surgery. METHODS From November 2014 and January 2016, 127 consecutive patients who met the inclusion criteria were enrolled in this study. Among these patients, 32 were treated using subxipoid approach, whereas 95 were treated using transthoracic approach. Propensity score case-matching was performed to adjust for patient backgrounds. RESULTS The two groups of 32 pairs were well matched for baseline and surgical characteristics. Patients who underwent subxipoid approach had a longer operation time than transthoracic approach (p = 0.004). The subgroup analysis showed that the operation time for bilateral bullectomy was similar between the groups (p = 0.986). There were no differences between the groups with respect to the hospital stay after surgery, chest drain duration, the number of the staples used for the operation, and postoperative recurrence. However, the provoked arrhythmias events during surgery were significantly higher in the subxiphoid approach group (p = 0.011). CONCLUSIONS Although transthoracic thoracoscopic surgery for spontaneous pneumothorax is well established, uniportal subxiphoid thoracoscopic surgery may be a potentially alternative way to management of patients with spontaneous pneumothorax in selected cases, especially for bilateral surgery, but causions should be taked.
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Affiliation(s)
- Liang Chen
- Department of Thoracic Surgery, Nanjing Chest Hospital, 215 Guangzhou Road, Nanjing City, Jiangsu Province, China.
| | - Feng Liu
- Department of Thoracic Surgery, Nanjing Chest Hospital, 215 Guangzhou Road, Nanjing City, Jiangsu Province, China
| | - Bin Wang
- Department of Thoracic Surgery, Nanjing Chest Hospital, 215 Guangzhou Road, Nanjing City, Jiangsu Province, China
| | - Keping Wang
- Department of Thoracic Surgery, Nanjing Chest Hospital, 215 Guangzhou Road, Nanjing City, Jiangsu Province, China.
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Al-Jazairi MIH, Rienstra M, Klinkenberg TJ, Mariani MA, Van Gelder IC, Blaauw Y. Hybrid atrial fibrillation ablation in patients with persistent atrial fibrillation or failed catheter ablation. Neth Heart J 2019; 27:142-51. [PMID: 30715671 DOI: 10.1007/s12471-019-1228-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Combined ‘hybrid’ thoracoscopic and percutaneous atrial fibrillation (AF) ablation is a strategy used to treat AF in patients with therapy-resistant symptomatic AF. We aimed to study efficacy and safety of single-stage hybrid AF ablation in patients with symptomatic persistent AF, or paroxysmal AF with failed endocardial ablation, and assess determinants of success and quality of life. Methods We included consecutive patients undergoing single-stage hybrid AF ablation. First, we performed epicardial ablation, via thoracoscopic access, to isolate the pulmonary veins and superior caval vein and to create a posterior left atrial box. Thereafter, isolation was assessed endocardially and complementary endocardial ablation was performed, followed by cavotricuspid isthmus ablation. Efficacy was assessed by 12-lead electrocardiography and 72-hour Holter monitoring after 3, 6 and 12 months. Recurrence was defined as AF/atrial flutter/tachycardia recorded by electrocardiography or Holter monitoring lasting >30 s during 1‑year follow-up. Results Fifty patients were included, 57 ± 9 years, 38 (76%) men, 5 (10%) paroxysmal, 34 (68%) persistent and 11 (22%) long-standing persistent AF. At 1‑year 38 (76%) maintained sinus rhythm off antiarrhythmic drugs. Majority of recurrences were atrial flutter (9/12 patients). Success was associated with type of AF (p = 0.039). Patients with paroxysmal AF had highest success, patients with longstanding persistent AF had lowest success. Seven (14%) patients had procedure-related complications. Quality of life improved after ablation in patients who maintained sinus rhythm. Conclusion Success of single-stage hybrid AF ablation was 76% off antiarrhythmic drugs, being associated with type of AF. Quality of life improved significantly, Procedure-related complications occurred in 14%.
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Abstract
Spinal fusion in young children for treatment of early onset scoliosis is not optimal because it limits growth and contributes to long-term lung compromise. Various types of growth-friendly spinal implants and newer technologies have been introduced in the past few years. Similarly, in adolescent idiopathic scoliosis, fusion decreases spinal mobility and may lead to development of adjacent level disc degeneration. A variety of different new technologies have been developed for alternative surgical approaches that halt curve progression while maintaining spinal mobility.
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Affiliation(s)
- Yasser Ibrahim Alkhalife
- Division of Orthopaedic Surgery, IWK Health Centre, PO Box 9700, 5850 University Avenue, Halifax, Nova Scotia, B3K-6R8 Canada
| | - Kedar Prashant Padhye
- Division of Orthopaedic Surgery, IWK Health Centre, PO Box 9700, 5850 University Avenue, Halifax, Nova Scotia, B3K-6R8 Canada
| | - Ron El-Hawary
- Division of Orthopaedic Surgery, IWK Health Centre, PO Box 9700, 5850 University Avenue, Halifax, Nova Scotia, B3K-6R8 Canada.
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Mc Loughlin JB, O'Sullivan KE, Brown RH, Eaton DA. Limax Nd:YAG laser-assisted thoracoscopic resection of pulmonary metastases; a single centre's initial experience. Ir J Med Sci 2019; 188:771-6. [PMID: 30382512 DOI: 10.1007/s11845-018-1924-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 10/25/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Pulmonary metastasectomy and indeed redo-pulmonary metastasectomy are now commonly performed thoracic surgical procedures. The air-sealant, haemostatic, and necrotic properties of the KLS Martin Limax Nd:YAG laser at 1.318 μm make it an ideal tool for limited lung resection such as metastasectomy. We present our initial experience of thoracoscopic laser metastasectomy. METHODS We reviewed data from the first seven patients in our unit to undergo thoracoscopic laser metastasectomy, in particular, patient age, gender, primary malignancy, primary treatment, complications, length of stay (LOS), and final histopathology. All procedures were performed using a two- or three-port thoracoscopic technique with some lesions requiring CT-guided wire localisation. A single drain was inserted via the camera port site and was removed upon confirmation that there was no air leak. RESULTS Seven patients underwent thoracoscopic laser wedge metastasectomy of eight lesions in our centre between February 2017 and October 2017. The median age was 61 years. The primary disease was colorectal carcinoma in five cases, eccrine carcinoma in one case, and high-grade uterine leiomyosarcoma in one case. Only one patient had a prolonged air leak in the other six cases; the drain was removed on post-operative day 1. The median post-operative LOS was 1 day. All patients had confirmed metastatic disease with clear resection margins on histopathology. CONCLUSION In our early experience, thoracoscopic laser wedge metastasectomy is a safe and efficient method for performance of pulmonary metastasectomy. We experienced a low complication rate and a short post-operative stay.
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Abstract
Over the last decade, driven in part by the favorable adult experience and a crescendoing number of case series and retrospective reports in the pediatric surgical literature, minimally invasive surgical (MIS) approaches are increasingly used as adjunctive or definitive surgical treatments for an ever-expanding list of pediatric tumors. Although most current treatment protocols lack surgical guidelines regarding the use of MIS, this growing body of MIS literature provides a framework for the development of multicenter trial groups, prospective registries, and further centralization of subspecialist services. This article highlights the current available data on MIS approaches to a variety of pediatric malignancies.
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Affiliation(s)
- Emily R Christison-Lagay
- Department of Surgery, Section of Pediatric Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT 06520, USA.
| | - Daniel Thomas
- Department of Surgery, Yale School of Medicine, 330 Cedar Street, FMB 107, New Haven, CT 06520, USA
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