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Souza RCD, Morais LLSD, Ghefter MC, Franceschini JP, Pinto FCG. Comparison between use of a pleural drainage system with flutter valve and a conventional water-seal drainage system after lung resection: a randomized prospective study. SAO PAULO MED J 2024; 142:e2023224. [PMID: 38655983 DOI: 10.1590/1516-3180.2023.0224.r1.08022024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/08/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND There is still a debate regarding the most appropriate pleural collector model to ensure a short hospital stay and minimum complications. OBJECTIVES To study aimed to compare the time of air leak, time to drain removal, and length of hospital stay between a standard water-seal drainage system and a pleural collector system with a unidirectional flutter valve and rigid chamber. DESIGN AND SETTING A randomized prospective clinical trial was conducted at a high-complexity hospital in São Paulo, Brazil. METHODS Sixty-three patients who underwent open or video-assisted thoracoscopic lung wedge resection or lobectomy were randomized into two groups, according to the drainage system used: the control group (WS), which used a conventional water-seal pleural collector, and the study group (V), which used a flutter valve device (Sinapi® Model XL1000®). Variables related to the drainage system, time of air leak, time to drain removal, and time spent in hospital were compared between the groups. RESULTS Most patients (63%) had lung cancer. No differences were observed between the groups in the time of air leak or time spent hospitalized. The time to drain removal was slightly shorter in the V group; however, the difference was not statistically significant. Seven patients presented with surgery-related complications: five and two in the WS and V groups, respectively. CONCLUSIONS Air leak, time to drain removal, and time spent in the hospital were similar between the groups. The system used in the V group resulted in no adverse events and was safe. REGISTRATION RBR-85qq6jc (https://ensaiosclinicos.gov.br/rg/RBR-85qq6jc).
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Affiliation(s)
- Rodrigo Caetano de Souza
- MD, MSc. Thoracic surgeon, Preceptor of the Residency Program in Thoracic Surgery, Hospital do Servidor Público Estadual de São Paulo (IAMSPE) Francisco Morato Oliveira, São Paulo (SP), Brazil
| | - Lilianne Louise Silva de Morais
- MD, Thoracic surgeon, Hospital do Servidor Público Estadual de São Paulo (IAMSPE) Francisco Morato Oliveira, São Paulo (SP), Brazil
| | - Mario Claudio Ghefter
- MD. Thoracic surgeon, Director of the Thoracic Surgery Service, Hospital do Servidor Público Estadual de São Paulo (IAMSPE) Francisco Morato Oliveira, São Paulo (SP), Brazil
| | | | - Fernando Campos Gomes Pinto
- MD, PhD. Neurosurgeon, Head of the Cerebral Hydrodynamics Group, Functional Neurosurgery Division, Institute of Psychiatry, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo (USP), São Paulo (SP), Brazil
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Roodenburg SA, Pouwels SD, Klooster K, Touw DJ, Slebos DJ. Endobronchial Valve Treatment Does Not Cause Significant Nickel Deposition in Lung Tissue. Respiration 2023; 102:454-457. [PMID: 37231891 DOI: 10.1159/000529889] [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: 12/23/2022] [Accepted: 02/21/2023] [Indexed: 05/27/2023] Open
Abstract
Bronchoscopic lung volume reduction using endobronchial valves (EBVs) is a treatment option for patients with severe emphysema. These EBVs are made out of a nitinol mesh covered by a silicone layer. Nitinol is an alloy of nickel and titanium and is commonly used in implantable medical devices because of its biocompatibility and memory-shape properties. However, there are some concerns that nickel ions can be released from nitinol-containing devices which might cause adverse health effects, especially in patients with a known nickel hypersensitivity. In vitro, it was found that EBV release significant amounts of nickel in the first hours. Our aim was to assess the nickel concentration in lung tissue from a patient who previously underwent EBV treatment but, due to treatment failure, underwent lung volume reduction surgery and to compare this to a reference sample. We found no significant difference in the median nickel concentration between the EBV-treated patient and the non-EBV-treated patient (0.270 vs. 0.328 μg/g, respectively, p = 0.693) and these concentrations were also comparable to previously published nickel concentrations in human lung tissue samples not having any medically implanted devices in the lung. Our results suggest that there is no significant long-term nickel deposition in lung tissue after EBV treatment.
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Affiliation(s)
- Sharyn A Roodenburg
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Simon D Pouwels
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Klooster
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Hartman JE, Klooster K, Augustijn SWS, van Geffen WH, Garner JL, Shah PL, Ten Hacken NHT, Slebos DJ. Identifying Responders and Exploring Mechanisms of Action of the Endobronchial Coil Treatment for Emphysema. Respiration 2021; 100:443-451. [PMID: 33744899 PMCID: PMC8220926 DOI: 10.1159/000514319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/27/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND So far, 3 randomized controlled trials have shown that the endobronchial treatment using coils is safe and effective. However, the more exact underlying mechanism of the treatment and best predictors of response are unknown. OBJECTIVES The aim of the study was to gain more knowledge about the underlying physiological mechanism of the lung volume reduction coil treatment and to identify potential predictors of response to this treatment. METHODS This was a prospective nonrandomized single-center study which included patients who were bilaterally treated with coils. Patients underwent an extensive number of physical tests at baseline and 3 months after treatment. RESULTS Twenty-four patients (29% male, mean age 62 years, forced expiratory volume in 1 s [FEV1] 26% pred, residual volume (RV) 231% pred) were included. Three months after treatment, significant improvements were found in spirometry, static hyperinflation, air trapping, airway resistance, treated lobe RV and treated lobes air trapping measured on CT scan, exercise capacity, and quality of life. The change in RV and airway resistance was significantly associated with a change in FEV1, forced vital capacity, air trapping, maximal expiratory pressure, dynamic compliance, and dynamic hyperinflation. Predictors of treatment response at baseline were a higher RV, larger air trapping, higher emphysema score in the treated lobes, and a lower physical activity level. CONCLUSIONS Our results confirm that emphysema patients benefit from endobronchial coil treatment. The primary mechanism of action is decreasing static hyperinflation with improvement of airway resistance which consequently changes dynamic lung mechanics. However, the right patient population needs to be selected for the treatment to be beneficial which should include patients with severe lung hyperinflation, severe air trapping, and significant emphysema in target lobes.
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Affiliation(s)
- Jorine E Hartman
- Department of Pulmonary Diseases and Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
| | - Karin Klooster
- Department of Pulmonary Diseases and Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sonja W S Augustijn
- Department of Pulmonary Diseases and Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wouter H van Geffen
- Department of Pulmonary diseases, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Justin L Garner
- Royal Brompton Hospital, London, United Kingdom
- National Heart & Lung Institute, Imperial College, London, United Kingdom
- Chelsea & Westminster Hospital, London, United Kingdom
| | - Pallav L Shah
- Royal Brompton Hospital, London, United Kingdom
- National Heart & Lung Institute, Imperial College, London, United Kingdom
- Chelsea & Westminster Hospital, London, United Kingdom
| | - Nick H T Ten Hacken
- Department of Pulmonary Diseases and Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases and Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Dumanli A, Metin B, Gunay E. Endobronchial valve vs coil for lung volume reduction in emphysema: results from a tertiary care centre in Turkey. Ann Saudi Med 2020; 40:469-476. [PMID: 33307740 PMCID: PMC7733646 DOI: 10.5144/0256-4947.2020.469] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/25/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Bronchoscopic lung volume reduction (BLVR) by either the endobronchial valve (EBV) or coil (EBC) procedure is recommended for severe emphysematous patients. BLVR applications generally help healthy lung areas ventilate more comfortably by reducing the hyperinflation and improving the contraction capacity of diaphragm. OBJECTIVES Compare our experience with valve and coil BLVR devices. DESIGN Retrospective. SETTING Single tertiary care centre. PATIENTS AND METHODS Demographic data, vital signs, pulmonary function tests (PFTs), the six-minute walking test (6MWT), vital signs, arterial blood gases and complications were recorded. MAIN OUTCOME MEASURES Change in PFTs and completion of the 6MWT. SAMPLE SIZE 60 Turkish men with a diagnosis of chronic pulmonary lung disease. RESULTS Clinical and demographic characteristics were similar in patients who underwent EBV and EBC. Thirty (96.8%) EBV patients and 27 (93.1%) of the EBC patients were able to properly complete the PFT before the procedures, but all complied after the procedures. Significant improvement in PFTs were achieved after the procedure and there were no statistically significant differences in post-procedure performance. For the 6MWT, the completion rate improved from 15 (48.4%) to 19 (61.3%) patients in the EBV patients (P=.125) and from 19 (65.5%) to 21 (72.4%) patients in the EBC patients (P=.500). There was no significant difference in completion rates for the walking test for either group (median 32 meters in EBV patients and 37 meters in EBC patients; P=.652). Vital signs and arterial blood gases were similar in the two groups. The rates of complications were similar in both groups. CONCLUSION Endobronchial valves and coils are safe and effective methods for BLVR for patients with severe emphysema. LIMITATIONS Relatively small sample, retrospective design, single-centre retrospective study. CONFLICT OF INTEREST None.
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Affiliation(s)
- Ahmet Dumanli
- From the Department of Chest Surgery, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Bayram Metin
- From the Department of Chest Surgery, Acibadem Hospitals Group, Kayseri, Turkey
| | - Ersin Gunay
- From the Department of Pulmonology, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
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Dell'Amore A, Pangoni A, Bellini A, Giorgio C, Zuin A, Rea F. VATS right basal segmentectomy for NSCLC in a patient with systemic sclerosis. Multimed Man Cardiothorac Surg 2020; 2020. [PMID: 33155781 DOI: 10.1510/mmcts.2020.057] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In recent decades, the thoracoscopic approach has been accepted as the gold standard to treat early stage non-small-cell lung cancer because it reduces postoperative pain and results in a shorter hospital stay. More recently, several techniques for performing sublobar resection have been reported that achieve a radical resection while sparing as much parenchyma as possible. This video tutorial illustrates our technique for resecting the basal segments of the right lower lobe in a patient presenting with an adenocarcinoma in the right lower lobe. The patient also had systemic sclerosis, which led to pulmonary hypertension and fibrosis. Therefore, it was important to limit the parenchymal resection to save the apical segment of the lower lobe so as not to exacerbate the underlying conditions. The vascular and bronchial structures are readily identifiable, and the intersegmental plane can be easily accessed by clamping the associated bronchus while inflating the lung.
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Affiliation(s)
- Andrea Dell'Amore
- Department of Cardio-Thoracic Surgery Padua University Hospital, Via Giustiniani 1 Padua (PD), Italy
| | - Alessandro Pangoni
- Department of Cardio-Thoracic Surgery Padua University Hospital, Via Giustiniani 1 Padua (PD), Italy
| | - Alice Bellini
- Thoracic Surgery Unit, Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Cannone Giorgio
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Andrea Zuin
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Federico Rea
- Division of Thoracic Surgery University of Padua via Giustiniani 2 35128 Padua Italy
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Yao J, Chang Z, Zhu L, Fan J. Uniportal versus multiportal thoracoscopic lobectomy: Ergonomic evaluation and perioperative outcomes from a randomized and controlled trial. Medicine (Baltimore) 2020; 99:e22719. [PMID: 33080728 PMCID: PMC7571977 DOI: 10.1097/md.0000000000022719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To compare perioperative outcomes and surgeon physical and mental stress when performing lobectomy through uniportal and multiportal video-assisted thoracoscopic surgery (VATS) on patients with non-small-cell lung cancer (NSCLC). METHODS Patients aged 41 to 73 years with resectable NSCLC were randomly assigned via a computer-generated randomisation sequence to receive either uniportal VATS (UVATS) or multiportal VATS (MVATS) lobectomy and lymphadenectomy between December 2015 and October 2016. Overall, we randomly assigned 35 patients to the UVATS and 34 to the MVATS group. Patients and the investigators undertaking interventions, assessing short-term outcomes, performing ergonomic evaluations, and analyzing data were not masked to group assignment. RESULTS Patient demographics of the 2 groups were comparable. The ergonomic evaluation considered eye blink rate and the NASA Task Load Index (NASA-TLX), better results were observed in UVATS than in MVATS. The operative time, number of lymph nodes harvested, chest tube duration, length of hospital stay, and lung function were not significantly different between the groups. Compared with MVATS lobectomy, UVATS lobectomy was associated with less intraoperative blood loss and less volume of total drainage in the 24 hours. No conversion, no reoperation, and no in-hospital mortality occurred in either group. CONCLUSIONS UVATS lobectomy is a safe and programmable technique with some better perioperative outcomes and ergonomic results than MVATS. Further studies based on large numbers of patients and with long-term follow-up are required to confirm its benefits towards patients. TRIAL REGISTRATION ClinicalTrials.gov ID:NCT02462356. Registered May 27, 2015.
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Abstract
Among uncommon pulmonary segmentectomies, the lateral and posterior basal (S9+10) segmentectomy is one of the most challenging because it requires exposure and recognition of common basal pulmonary vein branches located deep in lung parenchyma. In order to achieve an optimal thoracoscopic S9+10 via a uniportal approach the surgeon must first select the most suitable uniportal method, because the angulation of surgical instruments is limited in this minimally invasive approach and this makes it especially difficult to perform. In this video tutorial, we demonstrate our technique for a uniportal thoracoscopic S9+10 segmentectomy; we discuss our successful results, and explain the nuances of performing the procedure.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery Maebashi Red Cross Hospital 3-21-36 Asahi-cho Maebashi, Gunma 371-0014 Japan
| | | | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital
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Park SY, Kim DJ, Mo Nam C, Park G, Byun G, Park H, Choi JH. Clinical and economic benefits associated with the use of powered and tissue-specific endoscopic staplers among the patients undergoing thoracoscopic lobectomy for lung cancer. J Med Econ 2019; 22:1274-1280. [PMID: 31210074 DOI: 10.1080/13696998.2019.1634081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 10/26/2022]
Abstract
Background: Thoracoscopic lobectomy for lung cancer is a complex procedure where endoscopic staplers play a critical role in transecting the lung parenchyme, vasculature, and bronchus. This retrospective study was performed to investigate the economic benefits of powered and tissue-specific endoscopic staplers such as gripping surface technology (GST) and powered vascular stapler (PVS) compared to standard staplers.Methods: Two hundred and seventy-five patients who received a thoracoscopic lobectomy between 2008 and 2016 were included. Group 1 (n = 117) consisted of patients who received the operation with manual endoscopic staplers, whereas Group 2 (n = 158) consisted of patients who received the operation with GST and PVS.Results: Patient demographics and clinical characteristics were comparable, except smoking history, pulmonary function, and pleural adhesion. All patients received the operation successfully without mortalities and broncho-pleural fistula. Operation time and blood loss were higher in Group 1. Pleurodesis was performed less in Group 2 than in Group 1 (18.0% vs 3.8%, p < 0.0001). Group 2 had statistically significant lower adjusted hospital costs (Korean Won, 14,610,162 ± 4,386,628 vs 12,876,111 ± 5,010,878, p < 0.0001), lower adjusted hemostasis related costs (198,996 ± 110,253 vs 175,291 ± 191,003, p = 0.0101); lower cartridge related adjusted costs (1,105,091 ± 489,838 vs 839,011 ± 307,894, p < 0.0001) compared to Group 1. As well, Group 2 showed ∼12% lower adjusted total hospital costs compared to Group 1. Multivariable analysis revealed that Group 1 was related to increased hospital costs.Conclusions: This study showed that thoracoscopic lobectomy with powered and tissue-specific endoscopic staplers were associated with better clinical outcomes and reduced adjusted hospital costs when compared in Korean real-world settings.
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Affiliation(s)
- Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Goeun Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Goeun Byun
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - HyeJin Park
- HEMA, Johnson & Johnson Medical Korea, Seoul, Republic of Korea
| | - Ji Heon Choi
- HEMA, Johnson & Johnson Medical Korea, Seoul, Republic of Korea
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Muranishi Y, Sato T, Ueda Y, Yutaka Y, Nakamura T, Date H. A novel suction-based lung-stabilizing device in single-port video-assisted thoracoscopic surgical procedures. Gen Thorac Cardiovasc Surg 2019; 68:503-507. [PMID: 31728836 DOI: 10.1007/s11748-019-01249-6] [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: 08/22/2019] [Accepted: 11/06/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Single-port video-assisted thoracoscopic surgery (SPVATS) has become a subject of interest for thoracic surgeons in recent years; however, it has not been fully accepted partly because the procedure is technically demanding. We speculate that the most critical problem of SPVATS is that significant interferences of the instruments may occur during the procedure because all the instruments share only a single incisional port. The purpose of this study was to evaluate the usability of a new suction-based lung-stabilizing device during SPVATS procedure. METHODS We developed a novel suction-based lung-stabilizing device equipped with three hemispheric silicon suction cups. Ten cases of canine's lower lobectomies were performed. Five cases were performed without this device and designated as the control cases. The remaining cases were performed using this device and were designated as the experimental cases. RESULTS A significantly fewer number of interruption times were noted in the novel lung-stabilizing device group than in the control group (average, 0.4 vs. 4.4; P = 0.0031). Although the differences did not reach statistical significance, the device tended to demonstrate better performance compared with the control group regarding the operation time, organ damage, and accomplishment of SPVATS. CONCLUSION Our study indicates that the novel lung-stabilizing device has potentially useful applications in SPVATS procedures.
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Affiliation(s)
- Yusuke Muranishi
- Department of Thoracic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Toshihiko Sato
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Japan.
| | - Yuichiro Ueda
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Japan
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
- Department of Organ and Tissue Reconstruction, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Yojiro Yutaka
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
- Department of Organ and Tissue Reconstruction, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Tatsuo Nakamura
- Department of Organ and Tissue Reconstruction, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
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Abu-Hijleh M, Styrvoky K, Anand V, Woll F, Yarmus L, Machuzak MS, Nader DA, Mullett TW, Hogarth DK, Toth JW, Acash G, Casal RF, Hazelrigg S, Wood DE. Intrabronchial Valves for Air Leaks After Lobectomy, Segmentectomy, and Lung Volume Reduction Surgery. Lung 2019; 197:627-633. [PMID: 31463549 DOI: 10.1007/s00408-019-00268-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/06/2019] [Accepted: 08/21/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Air leaks are common after lobectomy, segmentectomy, and lung volume reduction surgery (LVRS). This can increase post-operative morbidity, cost, and hospital length of stay. The management of post-pulmonary resection air leaks remains challenging. Minimally invasive effective interventions are necessary. The Spiration Valve System (SVS, Olympus/Spiration Inc., Redmond, WA, US) is approved by the FDA under humanitarian use exemption for management of prolonged air leaks. METHODS This is a prospective multicenter registry of 39 patients with air leaks after lobectomy, segmentectomy, and LVRS managed with an intention to use bronchoscopic SVS to resolve air leaks. RESULTS Bronchoscopic SVS placement was feasible in 82.1% of patients (32/39 patients) and 90 valves were placed with a median of 2 valves per patient (mean of 2.7 ± 1.5 valves, range of 1 to 7 valves). Positive response to SVS placement was documented in 76.9% of all patients (30/39 patients) and in 93.8% of patients when SVS placement was feasible (30/32 patients). Air leaks ultimately resolved when SVS placement was feasible in 87.5% of patients (28/32 patients), after a median of 2.5 days (mean ± SD of 8.9 ± 12.4 days). Considering all patients with an intention to treat analysis, bronchoscopic SVS procedure likely contributed to resolution of air leaks in 71.8% of patients (28/39 patients). The post-procedure median hospital stay was 4 days (mean 6.0 ± 6.1 days). CONCLUSIONS This prospective registry adds to the growing body of literature supporting feasible and effective management of air leaks utilizing one-way valves.
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Affiliation(s)
- Muhanned Abu-Hijleh
- Division of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, POB Building II, Dallas, TX, 75390, USA.
| | - Kim Styrvoky
- Division of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vikram Anand
- Division of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Fernando Woll
- Division of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care, Section of Interventional Pulmonology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Michael S Machuzak
- Department of Pulmonary, Allergy, Critical Care Medicine and Transplant Center, Interventional Pulmonology, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel A Nader
- Department of Medicine, Pulmonary and Critical Care Medicine, Interventional Pulmonology, Cancer Treatment Centers of America, Tulsa, OK, USA
| | - Timothy W Mullett
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Jennifer W Toth
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ghazwan Acash
- Department of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Lahey Hospital and Medical Center, Tufts University School of Medicine, Burlington, MA, USA
| | - Roberto F Casal
- Department of Pulmonary Medicine, Interventional Pulmonology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Stephen Hazelrigg
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Douglas E Wood
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
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Abstract
Drainage of the thorax postoperatively using chest tubes is a standard procedure in thoracic surgery. However, chest tubes can induce pain and immobilization, increase risk of infection, deteriorate the ventilation capacity, and increase difficulty of postoperative management, particularly in children. This study aimed to investigate the safety and effect of excluding chest tubes after performing thoracoscopic lobectomy in selected children.A retrospective review of medical records was performed in West China Hospital of Sichuan University from January 2014 to June 2018. Patients who underwent thoracoscopic lobectomy without chest tubes were recorded. Patients with accompanying severe pulmonary infection, extensive thoracic adhesions, or undeveloped interlobar fissure were excluded.In total, 246 patients underwent thoracoscopic lobectomy without a chest tube, and none required chest drain insertion or reintervention during hospitalization and follow-up at 90 days postoperatively. Among them, 2 (0.81%) patients developed a delayed pneumothorax which was found after being discharged, and resolved spontaneously in 2 weeks. No hemothorax, atelectasis, and bronchial fistula were found. Furthermore, 202 (82.1%) patients developed subcutaneous emphysema, which was asymptomatic and spontaneously resolved within 3 to 7 days. The length of postoperative hospital stay was 2 days; patients were discharged in the 3rd day postoperatively. Patients could recover to free mobilization and resume regular diet at 6 hours postoperatively. All patients were followed up for at least 3 months; no other complications were found, and all patients recovered well.This study showed that chest tube placement in selected patients may be unnecessary in children undergoing thoracoscopic lobectomy. The minimally invasive procedure and meticulous resection have been the preconditions of this procedure, which may contribute to a rapid recovery and can avoid the chest tube-related complications effectively.
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Sawabata N, Hyakutaka T, Kawaguchi T, Yasukawa M, Kawai N, Tojo T, Taniguchi S. A no-touch technique for pulmonary wedge resection of lung cancer. Gen Thorac Cardiovasc Surg 2017; 66:161-167. [PMID: 29128899 DOI: 10.1007/s11748-017-0863-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 09/13/2017] [Accepted: 11/07/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Many of the surgical patients with lung cancer die by metastasis originated from circulating tumor cells (CTCs) which are seeds of metastases. A ring-shaped catching forceps, which generates the great pressure by compression, may reduce the risk of tumor cell spreading. Here, we investigated the efficacy of such forceps based on CTC occurrence. METHODS Twenty-three patients with clinical stage IA lung cancer who underwent a pulmonary wedge resection were investigated in a clinical-pathological manner. They were divided into those treated using ring forceps catching without tumor release (R group) (n = 16) and non-complete use of ring forceps (N group) (n = 7), then were determined circulating tumor cells (CTCs). RESULTS Radiographic findings, tumor location, pathological diagnosis, and stapling method were not significantly different between the groups. The risk of detection of CTCs after surgery was significantly lower in group R (12.5 vs. 85.7%, p = 0.02), whereas there were no significant differences found in risk of negative-stapled margin cytology, pre-OP CTC detection, V (+), Ly (+), and Pl (+). CONCLUSIONS Patients who underwent pulmonary wedge resection of lung cancer had low chance of CTC detection after surgery when they were treated with ring forceps without tumor release, which might become a no-touch isolation technique.
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Affiliation(s)
- Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521, Japan.
- Division of General Thoracic Surgery, Hoshigaoka Medical Center, Hirakata, Japan.
| | - Takeru Hyakutaka
- Division of General Thoracic Surgery, Hoshigaoka Medical Center, Hirakata, Japan
| | - Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521, Japan
| | - Motoaki Yasukawa
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521, Japan
| | - Norikazu Kawai
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521, Japan
| | - Takashi Tojo
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521, Japan
| | - Shigeki Taniguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521, Japan
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Abstract
The GIA Radial Reload is a surgical stapler with a curved cut line that is perpendicular to the direction of instrument insertion. We used the GIA Radial Reload in three cases of single-port thoracoscopic lung wedge resection. The operations were performed through a 3.0-4.5-cm incision. For the first stapler, we selected the GIA Radial Reload. The orientation of this device's cut line enabled us to easily cut the lung behind the lesion during single-port thoracoscopic surgery.
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Affiliation(s)
- Atsushi Sano
- Department of Thoracic Surgery, Chigasaki Municipal Hospital, Honson 5-15-1, Chigasaki, Kanagawa, 253-0042, Japan.
| | - Takuma Yotsumoto
- Department of Thoracic Surgery, Chigasaki Municipal Hospital, Honson 5-15-1, Chigasaki, Kanagawa, 253-0042, Japan
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Abstract
Pulmonary morphology, physiology, and respiratory functions change in both physiological and pathological conditions. Internal lung surface area (ISA), representing the gas-exchange capacity of the lung, is a critical criterion to assess respiratory function. However, observer bias can significantly influence measured values for lung morphological parameters. The protocol that we describe here minimizes variations during measurements of two morphological parameters used for ISA calculation: internal lung volume (ILV) and mean linear intercept (MLI). Using ISA as a morphometric and functional parameter to determine the outcome of alveolar regeneration in both pneumonectomy (PNX) and prosthesis implantation mouse models, we found that the increased ISA following PNX treatment was significantly blocked by implantation of a prosthesis into the thoracic cavity1. The ability to accurately quantify ISA is not only expected to improve the reliability and reproducibility of lung function studies in injured-induced alveolar regeneration models, but also to promote mechanistic discoveries of multiple pulmonary diseases.
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Affiliation(s)
- Zhe Liu
- Department of Life Sciences, Peking University; National Institute of Biological Sciences, Beijing
| | - Siling Fu
- National Institute of Biological Sciences, Beijing; Graduate School of Peking Union Medical College
| | - Nan Tang
- National Institute of Biological Sciences, Beijing;
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15
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Pagès PB, Abou Hanna H, Bertaux AC, Serge Aho LS, Magdaleinat P, Baste JM, Filaire M, de Latour R, Assouad J, Tronc F, Jayle C, Mouroux J, Thomas PA, Falcoz PE, Marty-Ané CH, Bernard A. Medicoeconomic analysis of lobectomy using thoracoscopy versus thoracotomy for lung cancer: a study protocol for a multicentre randomised controlled trial (Lungsco01). BMJ Open 2017; 7:e012963. [PMID: 28619764 PMCID: PMC5541439 DOI: 10.1136/bmjopen-2016-012963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 11/29/2016] [Accepted: 12/06/2016] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In the last decade, video-assisted thoracoscopic surgery (VATS) lobectomy for non-small cell lung cancer (NSCLC) has had a major effect on thoracic surgery. Retrospective series have reported benefits of VATS when compared with open thoracotomy in terms of postoperative pain, postoperative complications and length of hospital stay. However, no large randomised control trial has been conducted to assess the reality of the potential benefits of VATS lobectomy or its medicoeconomic impact. METHODS AND ANALYSIS The French National Institute of Health funded Lungsco01 to determine whether VATS for lobectomy is superior to open thoracotomy for the treatment of NSCLC in terms of economic cost to society. This trial will also include an analysis of postoperative outcomes, the length of hospital stay, the quality of life, long-term survival and locoregional recurrence. The study design is a two-arm parallel randomised controlled trial comparing VATS lobectomy with lobectomy using thoracotomy for the treatment of NSCLC. Patients will be eligible if they have proven or suspected lung cancer which could be treated by lobectomy. Patients will be randomised via an independent service. All patients will be monitored according to standard thoracic surgical practices. All patients will be evaluated at day 1, day 30, month 3, month 6, month 12 and then every year for 2 years thereafter. The recruitment target is 600 patients. ETHICS AND DISSEMINATION The protocol has been approved by the French National Research Ethics Committee (CPP Est I: 09/06/2015) and the French Medicines Agency (09/06/2015). Results will be presented at national and international meetings and conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02502318.
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Affiliation(s)
| | - Halim Abou Hanna
- Department of Thoracic and Cardiovascular Surgery, CHU Dijon, Dijon, France
| | | | | | | | | | - Marc Filaire
- Department of Thoracic and Cardiovascular Surgery, Centre Jean Perrin, Clermont-Ferrand, France
| | - Richard de Latour
- Department of Thoracic and Cardiovascular Surgery, CHU Rennes, Rennes, France
| | - Jalal Assouad
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, AP-HP, Paris, France
| | - François Tronc
- Department of Thoracic Surgery, HCL, Hôpital Louis Pradel, Bron, France
| | - Christophe Jayle
- Department of Thoracic and Cardiovascular Surgery, CHU Poitiers, Poitiers, France
| | - Jérome Mouroux
- Department of Thoracic and Cardiovascular Surgery, Hôpital Pasteur, CHU Nice, Nice, France
| | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery and Diseases of Oesophagus, Assistance Publique des Hôpitaux de Marseille, North Hospital, Marseille, France
| | | | - Charles-Henri Marty-Ané
- Department of Thoracic and Cardiovascular Surgery, Hôpital Arnaud de Villeneuve, CHU Montpellier, Montpellier, France
| | - Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, CHU Dijon, Dijon, France
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Hashimoto S, Yamasaki N, Doi R, Hatachi G, Kamohara R, Miyazaki T, Matsumoto K, Tsuchiya T, Hashisako M, Tabata K, Nagayasu T. [Granuloma by Foreign Body Reaction to the Stapler Used for Partial Resection of the Lung]. Kyobu Geka 2017; 70:187-190. [PMID: 28293004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 66-year-old woman underwent right lower lobectomy and partial resection of the middle lobe for Stage I A double lung cancer. Five years after the operation, a routine computed tomography (CT) scan showed a mass on the staple line at the middle lobe. The mass was enlarged on CT scan after 6 months. A definitive diagnosis could not be made by bronchoscopic examination and fluoro-2-deoxy-glucose(FDG)/positron emission tomography( PET)-CT showed FDG uptake in the mass( early phase:SUVmax=3.24, late phase:SUVmax=4.31). Local recurrence of lung cancer was not completely denied, and right middle lobectomy was performed. Histopathologically, the resected specimen revealed granuloma with foreign body reaction. We should keep in mind the possibility of granuloma as differential diagnosis of lung cancer when using stapler.
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Affiliation(s)
- Shintaro Hashimoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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17
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Onuki T. [SIMULATION AND NAVIGATION OF PULMONARY SEGMENTECTOMY WITH HOMEMADE SOFTWARE]. Nihon Geka Gakkai Zasshi 2017; 118:19-24. [PMID: 30176132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pulmonary segmentectomy-level variations in the three-dimensional (3D) architecture of the bronchi and pulmonary vessels are much wider than those at the lobectomy level. Presurgical simulation with sharing of necessary information is believed to reduce the surgical time and number of detachment procedures required. For such simulations, the author’s group developed homemade software that: 1) reconstructs the shapes of the bronchi, vessels, lung, and tumors as simplified 3D images such as sequentially connected cylinders with branches and membranes from digital-imaging data on a personal computer screen; 2) allows surgeons to input data on the initial and terminal points, diameters of cylinders, etc. continuously by moving computed tomography (CT) images up and down; and 3) permits these data to be read by modeler shareware on the Internet. Although conventional 3D images from CT data are reconstructed by a volume-rendering method, those of the software developed by the author’s group are made using a surface-rendering method. This article explains the present status of and future trends in the actual processes of simulated surgery including segmentectomy and navigation, applications of newly developed operative procedures, and results of data analysis of more than 500 cases.
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18
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Opanasenko NS, Kshanovskiy AE, Tereshkovich AV, Konik BN, Levanda LI. [[Video-assisted pulmonary resection application for pulmonary tuberculosis].]. Klin Khir 2016:40-43. [PMID: 28661603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Results of application of video-assisted (video-assisted thoracic surgery VATS) pulmonary resection for pulmonary tuberculosis in 63 patients in 2008 - 2016 yrs were analyzed. Typical lobectomy was done in 28 (44.4%) patients, pulmonectomy - in 1 (1.6%), lower bilobectomy - in 1 (1.6%), combined resection of upper lobe and the Cv segment - in 1 (1.6%), typical segmentectomy - in 23 (36.5%), atypical one - in 9 (14.3%). Intraoperative complications have occurred in 4,(6.3%) patients, and postop- erative - in 8 (12.7%). Total efficacy of performance of pulmonary VATS-resection have constituted 98.4%. VATS-pulmonary resection is a miniinvasive and perspective treatment procedure. Meticulous selection of patients is needed for such intervention be applied.
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19
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Hartman JE, Klooster K, Slebos DJ, Ten Hacken NHT. Improvement of physical activity after endobronchial valve treatment in emphysema patients. Respir Med 2016; 117:116-21. [PMID: 27492521 DOI: 10.1016/j.rmed.2016.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/03/2016] [Accepted: 06/08/2016] [Indexed: 11/18/2022]
Abstract
RATIONALE Bronchoscopic lung volume reduction using endobronchial valves is a promising treatment for severe emphysema patients without collateral ventilation. Physical activity is an important contributing factor for the autonomy, morbidity and mortality of these patients. OBJECTIVE We investigated the impact of endobronchial valve treatment on physical activity in severe emphysema patients. METHODS Physical activity was measured for 7 days by a triaxial accelerometer at baseline and 6 months follow-up after EBV treatment, and compared with standard medical care in a randomized controlled trial. RESULTS Forty-three patients (77%female, age 59 ± 9years, FEV1 30 ± 7%pred, steps 3563 ± 2213per/day) wore the accelerometer and were included in the analysis. Nineteen patients received EBV treatment and 24 standard medical care. At baseline, physical activity level was comparable between groups. After 6 months, the endobronchial valve group significantly improved compared to the controls in steps/day (+1252vs-148) and locomotion time (+17vs-2 min/day). Change in sit duration (0vs + 27 min/day) did not significantly differ. CONCLUSIONS Physical activity significantly improved after endobronchial valve treatment in severe emphysema patients. This improvement was without any specific encouragement on physical activity. CLINICAL TRIAL NUMBER Dutch trial register: NTR2876.
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Affiliation(s)
- Jorine E Hartman
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands.
| | - Karin Klooster
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Nick H T Ten Hacken
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
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20
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Kawaguchi T, Yasukawa M, Kawai N, Tojo T. [Application of Curved Stapler for Pulmonary Wedge Resection]. Kyobu Geka 2016; 69:317-320. [PMID: 27210260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
End stapler is one of the indispensable devices for pulmonary resections. Various surgical staplers are now available and appropriate types are selected to dissect pulmonary parenchyma, vessel, or bronchus. In this study, we retrospectively reviewed the patients who received pulmonary wedge resections using newly released curved stapler (Endo GIA Radial Reload with Tri-Staple technology). Between April 2013 and October 2014, 10 lesions from the 9 patients were resected using the curved staplers. The reasons for the application of the staplers were pleuro-pulmonary adhesion in 3 lesions and centrally location in 7 lesions. There was no intraoperative complication. After the operations, temporary residual lobe congestion caused by the pulmonary vein stenosis was developed in 1 patient.
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Affiliation(s)
- Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Japan
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21
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DE LA Torre M, González-Rivas D, Fernández R, Delgado M, Fieira E, Méndez L. Uniportal VATS lobectomy. MINERVA CHIR 2016; 71:46-60. [PMID: 26606690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Uniportal Video-Assisted Thoracic Surgery (uniportal VATS) lobectomy represents the last evolution of minimally invasive techniques for the surgical treatment of lung cancer. Uniportal VATS was developed from two-ports approach, with two main advantages: only one intercostal space is damaged and the direct view to the target tissue. Improvements in camera systems, instruments and stapler technology have facilitated this development. The operative technique is well defined for the different lobectomies and for the mediastinal lymphadenectomy. The parallel instrumentation achieved during the single port approach mimics the inside maneuvers performed during open surgery, together with the direct view facilitates the dissection and division of the hilar structures and the fissure. This makes possible the direct transition from open surgery to uniportal VATS. Uniportal VATS is feasible and reproducible. This is why its use is spreading in many centers in Spain, Europe and Asia, with good results. Training at centers with major experience or in wetlabs, and the proper patient selection are the best recommendations for the learning curve. In our center, as we gain experience with the approach, we performed advanced cases with similar results to the initial stages. Segmentectomies, bronchovascular reconstructions and selected cases that need chest wall resection were also carried out by uniportal VATS. The last advance is the uniportal VATS lobectomy in non-intubated patients with spontaneous breathing, the less invasive surgical approach in combination with a less invasive anesthetic management.
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22
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White A, Kucukak S, Lee DN, Swanson SJ. Energy-Based Ligation of Pulmonary Vessels: A Six-Year Experience With Ultrasonic Shears in Video-Assisted Thoracoscopic Lobectomy and Segmentectomy. Ann Thorac Surg 2016; 101:1334-7. [PMID: 26794898 DOI: 10.1016/j.athoracsur.2015.10.070] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/05/2015] [Accepted: 10/26/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mechanical staplers are widely employed in minimally invasive anatomic lung resections, but have limitations when managing smaller pulmonary arterial and venous branches. Published data is lacking regarding the safety and efficacy of pulmonary vessel ligation using ultrasonic shears. We describe a single-surgeon experience employing ultrasonic shears for the ligation of pulmonary vasculature during lobectomy and segmentectomy, primarily in the setting of video-assisted thoracic surgery (VATS) resection. METHODS A retrospective chart review was conducted for all patients, who underwent anatomic resection, between 2008 and 2014. Charts were divided into 2 groups based on method of ligation (energy based or conventional). Dictated operative reports were reviewed and patient demographics, tumor characteristics, and complications were recorded. RESULTS Ultrasonic shears were used for pulmonary vessel ligation (5 to 6 mm) in 82 of 283 anatomic resections. A total of 118 vessels were ligated with ultrasonic shears. The majority of patients (83%) in the energy-based ligation group underwent VATS resection. There were fewer complications in the energy-based ligation group (26% vs 38%; p = 0.05); however, rates of intraoperative transfusion, prolonged air leak, empyema, and return to the operating room were similar across the 2 groups, and no statistically significant difference was found. There were no postoperative complications directly attributable to ultrasonic vessel ligation. CONCLUSIONS Energy-based ligation of small-diameter pulmonary vessels is a safe and useful adjunct in anatomic VATS resection and a viable alternative to mechanical stapling. Its narrow profile and thin blades make it ideal for ligation of pulmonary vasculature, particularly where the size and necessary clearance of mechanical staplers prohibit safe dissection.
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Affiliation(s)
- Abby White
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Suden Kucukak
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel N Lee
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Scott J Swanson
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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23
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Licht PB, Ribaric G, Crabtree T, Lanuti M, Molins L, Knippenberg S, Schwiers M, Yoo A. Prospective Clinical Study to Evaluate Clinical Performance of a Powered Surgical Stapler in Video-assisted Thoracoscopic Lung Resections. Surg Technol Int 2015; 27:67-75. [PMID: 26680381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Video-assisted thoracic surgery (VATS) research often focuses on postoperative air leak, with special consideration for prolonged air leak. There is limited clinical data regarding how stapling devices might affect performance and postoperative outcomes, including air leak. This prospective research evaluates intraoperative and postoperative data associated with VATS, using a new surgical stapling device, in two different geographic regions (the U.S. and Europe). A total of 226 subjects across 10 institutions were enrolled in this study. The primary endpoint was occurrence and duration of postoperative air leaks, including prolonged air leak. Additional data collected included intraoperative details and postoperative outcomes. Prolonged air leak occurred in 22 subjects (10.3%) across procedures (152 lobectomies, 63 wedge resections, and 11 occurrences of wedge resection plus lobectomy). There were no significant differences in occurrence or duration of PAL between the U.S. and Europe. Regional differences were observed for intraoperative leak testing and cartridge selection relative to tissue type. Despite differences in surgical technique between continents, no major or significant difference in air leak or other clinical outcome was detected. Additional research is needed to characterize optimal cartridge selection to tissue properties and how these may potentially impact clinical outcomes.
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Affiliation(s)
- Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Traves Crabtree
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Lanuti
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Laureano Molins
- Department of Thoracic Surgery, University of Barcelona, Barcelona, Spain
| | | | | | - Andrew Yoo
- Johnson & Johnson, New Brunswick, New Jersey
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Abstract
King George VI underwent an operation for pneumonectomy in September 1951. Part of the operation anaesthetic record has survived. With conjecture, on a typical scenario of a 55-year-old male undergoing pulmonary resection for carcinoma in the early 1950s and other facts in the public domain, the King's anaesthetic has been reconstructed to give an approximation of the events that in the last few months of his life caused his speech to change from that achieved by his personal voice coach and recently portrayed on celluloid in the film 'The King's Speech'. The popularity and success of the film 'The King's Speech' brought to mind that King George VI died of bronchogenic carcinoma, a result, not recognised at the time, of the cigarette smoking habit that is a prominent feature of the story in celluloid.
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Affiliation(s)
- I D Conacher
- Aldham House, Barmoor Lane, Ryton, Tyne & Wear, UK
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25
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Bezzi M, Mondoni M, Sorino C, Solidoro P. Emphysema: coiling up the lungs, trick or treat? Minerva Med 2015; 106:9-16. [PMID: 27427120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Lung volume reduction coil (LVRC) treatment is a minimally-invasive technique planned to achieve an improvement of exercise capacity and pulmonary function in subjects with advanced emphysema and hyperinflation. It has been proposed together with other bronchoscopic lung volume reduction approaches to reduce lung hyperinflation in emphysema as less invasive alternatives to LVRS and are currently under clinical investigation. Following the successful early experiences in previous pilot trials, recent studies allow further investigation into the feasibility, safety and efficacy of LVR coil treatment in a multi-center setting in a larger group of patients. According to this studies we can state that LVR coil treatment results in significant clinical improvements in patients with severe emphysema, in multicenter analysis, with a good safety profile and sustained results for up to 1 year. The literature on endobronchial coils continues to look promising with an acceptable safety profile, and positive long-term follow-up data are certainly more and more available. However, further well-designed, blinded, placebo (or sham) controlled trials, and even randomized trials against LVRS (lung volume reduction surgery), are needed before routine clinical use can be recommended. This is true not only for endobronchial coils, but also for the whole field of bronchoscopic lung volume reduction.
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Affiliation(s)
- M Bezzi
- Centre of Respiratory Endoscopy and Laser‑Theraphy, A.O. Spedali Civili di Brescia, Brescia, Italy -
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26
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Ismail NA, Elsaegh M, Dunning J. Novel Techniques in Video-assisted Thoracic Surgery (VATS) Lobectomy. Surg Technol Int 2015; 26:206-209. [PMID: 26055011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Twenty years ago, thoracic surgery witnessed the leap from thoracotomy to the first video-assisted thoracic surgery (VATS) lobectomy. Gradually VATS lobectomy has become widely accepted and practiced worldwide. As the idea of less-invasive, fewer, and smaller incisions is taken up by surgeons, thoracic surgery has witnessed the progress of the conventional three-port VATS lung resection to two-port VATS and finally the birth of uniportal VATS lobectomy. Incisions have also become much smaller over the years, such as those seen in total port access lobectomy or microlobectomy. A modified version of the uniportal VATS lobectomy through the subxiphoid incision has also recently been used. The movement toward less-invasive surgery has no doubt driven the innovation of sophisticated instruments and technology to cope with the demanding need of working through a restricted incision. Reported outcomes and results of these new developments are encouraging.
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Affiliation(s)
- Nur A Ismail
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Mohamed Elsaegh
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
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27
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Kiriliuk AA, Shipulin PP, Severgin VE, Tronina EI. [Method for video-assisted atypical lung resection]. Klin Khir 2015:72. [PMID: 25842689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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28
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Oizumi H. [Application of medical imaging to general thoracic surgery]. Kyobu Geka 2014; 67:697-701. [PMID: 25138941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Medical imaging technology is rapidly progressing. Positron emission tomography (PET) has played major role in the staging and choice of treatment modality in lung cancer patients. Magnetic resonance imaging (MRI) is now routinely used for mediastinal tumors and the use of diffusion-weighted images (DWI) may help in the diagnosis of malignancies including lung cancers. The benefits of medical imaging technology are not limited to diagnostics, and include simulation or navigation for complex lung resection and other procedures. Multidetector row computed tomography (MDCT) shortens imaging time to obtain detailed and precise volume data, which improves diagnosis of small-sized lung cancers. 3-dimensional reconstruction of the volume data allows the safe performance of thoracoscopic surgery. For lung lobectomy, identification of the branching structures, diameter, and length of the arteries is useful in selecting the procedure for blood vessel treatment. For lung segmentectomy, visualization of venous branches in the affected segments and intersegmental veins has facilitated the preoperative determination of the anatomical intersegmental plane. Therefore, the application of medical imaging technology is useful in general thoracic surgery.
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Affiliation(s)
- Hiroyuki Oizumi
- Department of Surgery 2, Faculty of Medicine, Yamagata University, Yamagata, Japan
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29
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Murakawa T, Nakajima J. [Overview of surgical stapling devices]. Kyobu Geka 2014; 67:737-740. [PMID: 25138948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Surgical stapler allows surgeons to do simultaneous cut and suture quickly in excellent quality. Surgical stapler is currently used widely and has become indispensable tool for thoracic surgery, especially for endoscopic surgery such as thoracoscopic lung lobectomy, although there was some reluctance for use at the dawn of the era of mechanical stapling device. Devices should be used for right place in right manner. There are various kinds of stapling devices and surgeons should follow manufactures' instruction appropriately to avoid possible malfunctions of the devices. Surgeons must be aware of possible risks in use of stapling devices and must learn pitfalls. Stapling devices do and will continue to be evolved, and surgeons have to keep the know-how updated.
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Abstract
Lobectomy with systematic lymph node sampling or dissection remains the mainstay of treatment of early stage non-small cell lung cancer. The use of video-assisted thoracic surgery (VATS) to perform lobectomy was first reported in 1992. Advantages of VATS include less trauma and pain, shorter chest drainage duration, decreased hospital stay, and preservation of short-term pulmonary function. However, VATS is characterized by loss of binocular vision and a limited maneuverability of thoracoscopic instruments, an unstable camera platform, and poor ergonomics for the surgeon. To overcome these limitations, robotic systems were developed during the last decades. This article reviews the technical aspects of robotic lobectomy using a VATS-based approach.
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Affiliation(s)
- Franca M A Melfi
- Division of Thoracic Surgery, Department of Cardio-Thoracic and Vascular Surgery, University Hospital of Pisa, Via Paraisa 2, Pisa 56124, Italy.
| | - Olivia Fanucchi
- Division of Thoracic Surgery, Department of Cardio-Thoracic and Vascular Surgery, University Hospital of Pisa, Via Paraisa 2, Pisa 56124, Italy
| | - Federico Davini
- Division of Thoracic Surgery, Department of Cardio-Thoracic and Vascular Surgery, University Hospital of Pisa, Via Paraisa 2, Pisa 56124, Italy
| | - Alfredo Mussi
- Division of Thoracic Surgery, Department of Cardio-Thoracic and Vascular Surgery, University Hospital of Pisa, Via Paraisa 2, Pisa 56124, Italy
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31
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Nakamura H. [Lobectomy for lung cancer using the Da Vinci surgical system]. Nihon Geka Gakkai Zasshi 2014; 115:147-150. [PMID: 24946522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Robot-assisted surgery using the da Vinci surgical system has attracted attention because of excellent operability without shaking by joint forceps under the clear vision of a three-dimensional high-definition camera in lung cancer surgery. Although this form of advanced medical care is not yet approved for insurance coverage, it is at the stage of clinical research and expected to be useful in hilar exposure, lymph node dissection, and suturing of the lung parenchyma or bronchus. Lung cancer surgery with the da Vinci system has the advantage of combining thoracotomy and minimally invasive surgery in video-assisted thoracic surgery. However, safety management, education, and significant cost are problems to be resolved. Several important issues such as sharing knowledge and technology of robotic surgery, education, training, development of new instruments, and acquisition of advanced medical insurance are discussed for the future development of robotic surgical systems.
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Satoh Y, Hayashi S, Yamazaki H, Mikubo M, Naito M, Shiomi K. [Ultra powered stapling system for general lung surgery]. Kyobu Geka 2014; 67:225-228. [PMID: 24743535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Stapling systems can significantly improve lung tissue approximation during open and video-assisted thoracic surgery. We here evaluated an iDrive Ultra powered stapling system for lung resection. MATERIALS AND METHODS The iDrive Ultra powered stapling system( Covidien) is the powered version of the EndoGIA stapling system. It comprises hand-held control unit combined with a loading unit,which is a powered EndoGIA- cartridges, for use in open and minimally invasive thoracic surgery. The mounted control unit has uses as follows:controlling the accurate placement of the cartridge by orientating the tip of the rigid shaft;and controlling the closure of the stapler and the firing. From April to July 2013, the system was used for a consecutive series of 15 patients during thoracic lung surgery. RESULTS There were 6 women and 9 men, with a mean age of 62 years. The following procedures were performed:lobectomies, segmentectomies, and wedge resections. The system was used for stapling lung parenchyma for wedge resection(5 patients), segmentectomy( 2 patients), or fissure division (9 patients). There were no stapling failures and no complications related to use of the staplers. CONCLUSIONS The new powered and handy stapling system is safe and efficient for lung resection.
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Affiliation(s)
- Yukitoshi Satoh
- Department of Thoracic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Rochat T, Chappuis-Gisin E, Ongaro G, Janssens JP, Soccal PM. [Pulmonary. High tech in pulmonary medicine: GeneXpert, coils and bronchial thermoplasty]. Rev Med Suisse 2014; 10:123-126. [PMID: 24558916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We discuss here three recent applications of high technology in pulmonary medicine. GeneXpert has considerably improved the diagnosis of active tuberculosis. However, the test has also its limits so that clinical assessment, radiology, and sputum microscopy remain fundamental. Treatment of severe emphysema by lung volume reduction is no longer confined to surgical approach, but is now possible by bronchoscopy. Implantation of Nitinol coils in the most diseased parts of the emphysematous lung is a promising technique. Finally, several clinical trials on bronchial thermoplasty have been reported for intractable asthma. The recent publication of the long term effects of this technique is the occasion to update on this matter.
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Affiliation(s)
- Thierrry Rochat
- Service de Pneumologie Centre Antituberculeux, Service de Médecine Interne Générale, HUG, Genève.
| | - Emilie Chappuis-Gisin
- Service de Pneumologie Centre Antituberculeux, Service de Médecine Interne Générale, HUG, Genève
| | - Gioele Ongaro
- Service de Pneumologie Centre Antituberculeux, Service de Médecine Interne Générale, HUG, Genève
| | - Jean-Paul Janssens
- Service de Pneumologie Centre Antituberculeux, Service de Médecine Interne Générale, HUG, Genève
| | - Paola M Soccal
- Service de Pneumologie Centre Antituberculeux, Service de Médecine Interne Générale, HUG, Genève
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Kirschbaum A, Steinfeldt T, Gockel A, Di Fazio P, Quint K, Bartsch DK. Airtightness of lung parenchyma without a closing suture after atypical resection using the Nd:YAG Laser LIMAX 120. Interact Cardiovasc Thorac Surg 2014; 18:92-5. [PMID: 24087831 PMCID: PMC3867037 DOI: 10.1093/icvts/ivt420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 02/07/2023] Open
Abstract
OBJECTIVES Lung metastases can be non-anatomically resected with a Nd:YAG Laser. It is recommended that the resected lung surface be sealed by slowly resorbable sutures. However, the lung tissue may be restricted by the sutures once it is re-ventilated. Thus, it was analysed whether the lung parenchyma is airtight after laser resection without suturing the defect. METHODS The pulmonary artery of unimpaired paracardial lung lobes of freshly slaughtered pigs (mean weight 46 g) was cannulated and rinsed out via a hypotonic saline-heparin solution (5000 IE) until the perfusate was clear of body fluid. The lobular bronchus was connected to an airtight ventilation tube (Fa. VYGON 520 3.5 oral tube) and ventilated pressure-controlled (PEEP + 5 cm H₂O, P₁ = 20 cm H₂O, frequency = 10/min) via a respirator. All lobes were perfused with Ringer solution at 42°C at normothermia and normotonia. In group 1 (n = 8), an atypical peripheral parenchymal resection (average resected surface: 2 × 2 cm(2)) and in group 2 (n = 8), a deep atypical parenchymal resection (average resected surface: 4 × 4 cm(2)) were performed with the Nd:YAG Laser LIMAX 120 (output power at 100 watts). After post-resection ventilation of 15 min, the resection surface was tested for airtightness and burst pressure. RESULTS All group 1 lobes tested airtight under pressure-controlled ventilation. The mean burst pressure was 34.4 mbar (SD ± 3.2 mbar). Six lobes of group 2 were also completely airtight. The remaining two lobes, however, revealed a serious parenchymal leak (score 3). This was caused by the cross-opening of a segmental bronchus, although the surrounding lung parenchyma was also airtight. The mean burst pressure of these lobes was 31.7 mbar (SD ± 4.08 mbar). There was no significant difference between the two groups (P = 0.12). CONCLUSIONS Peripheral lung defects after Nd:YAG Laser resection might not be sutured, since the laser-induced vaporization of the lung parenchyma seems to be initially airtight. These experimental data warrant confirmation in a controlled clinical study.
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Affiliation(s)
- Andreas Kirschbaum
- Department of Visceral, Thoracic- and Vascular Surgery, Philipps University Marburg, Marburg, Germany
- Corresponding author. Department of Visceral, Thoracic- and Vascular Surgery, UKGM, Baldingerstrasse, 35033 Marburg, Germany. Tel: +49-6421-5861738; fax: +49-6421-5866593; e-mail: (A. Kirschbaum)
| | - Thorsten Steinfeldt
- Department of Anaesthesiology, Philipps University Marburg, Marburg, Germany
| | - Andreas Gockel
- Department of Anaesthesiology, Philipps University Marburg, Marburg, Germany
| | - Pietro Di Fazio
- Department of Visceral, Thoracic- and Vascular Surgery, Philipps University Marburg, Marburg, Germany
| | - Karl Quint
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Detlef K. Bartsch
- Department of Visceral, Thoracic- and Vascular Surgery, Philipps University Marburg, Marburg, Germany
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35
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Ohki T, Washio K. [Clinical experience of the articulating needle-holder for completely video-assisted thoracoscopic surgery]. Kyobu Geka 2013; 66:1149-1151. [PMID: 24322355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The autonomy Laparo-angle needle holder is a flexible device which has several articulating parts facilitating some traditionally difficult way of suture passage. This device is often used for laparoscopic surgery, and there have been few reports for video-assisted thoracic surgery (VATS). We used this device for complete VATS lobectomy and segmentectomy, and it enables us to suture a bronchus with the optimal direction even in the deep surgical field on complete VATS lobectomy and segmentectomy. Although some training may be needed to freely manipulate this device, it can be useful for minimallyinvasive video-assisted thoracic surgery.
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Affiliation(s)
- Takashi Ohki
- Department of Surgery, Chugoku Central Hospital, Fukuyama, Japan
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36
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Affiliation(s)
- Pallav L Shah
- The NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, , London, UK
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37
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Krüger M, Zinne N, Höffler H, Zhang R, Kropivnitskaja I, Schmitto J, Ciubotaru A, Haverich A. [Ex situ tracheobronchoplastic operations using the organ care system]. Chirurg 2013; 84:208-13. [PMID: 23354560 DOI: 10.1007/s00104-012-2444-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
First clinical experiences with the organ care system (OCS) in lung transplantation showed that this device allows perfusion and ventilation of the lungs under practically physiological conditions. Some pulmonary pathologies necessitate ex situ operations, e.g. to avoid pneumonectomy. The objective of this work was to investigate the feasibility of ex situ pulmonary surgery within the OCS.In the first procedure a large tracheobronchial leakage was covered with a pericardial patch. The procedure was authorized by the local committee of animal welfare. In the second surgery a replacement of the distal trachea using an aortic graft was performed after removal of the heart-lung segment from a pig from the slaughterhouse. The postoperative ventilation of both lungs was free of problems. The mean pressure of the pulmonary artery remained steady during the whole experiment. The setup to prevent lung edema was basically successful.Performing thoracic surgery with the OCS is feasible; however, this approach is reserved for very special indications. Further investigations to optimize technical details of the OCS setup for this purpose are necessary.
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Affiliation(s)
- M Krüger
- Klinik für Herz-, Transplantations-, Thorax- und Gefäßchirurgie, Medizinische Hochschule Hannover, Deutschland.
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Sakuragi T, Ohteki H. The utility of BiClamp(®) for intraoperative air leakage control in video-assisted thoracic surgery for pulmonary lobectomy. Gen Thorac Cardiovasc Surg 2012; 60:781-3. [PMID: 22790900 DOI: 10.1007/s11748-012-0028-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 08/08/2011] [Indexed: 11/29/2022]
Abstract
We describe a simple technique of controlling air leakage from the lung parenchyma using BiClamp(®). The device creates appropriate protein coagulation at an air leakage point of the lung parenchyma. The leakage point and adjacent area are grasped with BiClamp(®) forceps and coagulated without tissue carbonization. After the procedure, no air leakage was recognized under airway pressure test of 15-20 cmH(2)O. This method is easy to handle, especially in video-assisted thoracic surgery lobectomy with an economical advantage as "Ecosurgery".
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Affiliation(s)
- Tohru Sakuragi
- Department of General Thoracic Surgery, Saga Prefectural Hospital Koseikan, Saga, Japan.
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39
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Prasad SM. Robotic thoracic surgery: an evolution in progress for the treatment of lung cancer. Mo Med 2012; 109:307-311. [PMID: 22953595 PMCID: PMC6179787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The field of robotic thoracic surgery has exploded in the last five years. Robotic technology allows the surgeon to perform complex operations with smaller incisions. As robotic systems become smaller, more efficient and the surgeons gain more experience, the results will continue to improve. The goal is less trauma to the patient which will decrease hospital stay, complications and lower health care costs, while allowing faster healing and productivity.
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Affiliation(s)
- Sunil M Prasad
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, USA.
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Krueger T, Perentes JY, Peters S, Ris HB, Gonzalez M. [VATS lobectomy for early-stage primary lung cancer]. Rev Med Suisse 2012; 8:1337-1341. [PMID: 22792599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Lobectomy via video-assisted thoracoscopic surgery (VATS) is now considered as a valid alternative to conventional thoracotomy for early-stage primary lung cancer. Various studies have reported that VATS lobectomy is a safe technique associated with fewer postoperative complications and better post-operative recovery than open thoracotomy. Furthermore, studies suggest oncological equivalence between VATS and open lobectomy.
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Affiliation(s)
- T Krueger
- Service de chirurgies thoracique et vasculaire, CHUV, 1011 Lausanne.
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41
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Zhestkov KG, Esakov IS. [The sutureless lung resection with Ligasure device: the possibilities and perspectives]. Khirurgiia (Mosk) 2012:30-35. [PMID: 22810342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The experimental study of the durability of the "collagen" suture of the lung, performed with the use of the Ligasure device, was conducted. 17 patients, whom 21 lung resection was performet took part in the study. In the experimental part of the study the average rupture pressure of the collagen plomb was 413±99.4 mm Hg for the intact lung parenchyma and 212±66.7 mm Hg for the emphisematously changed tissue. The prolonged aerostatic insufficiency was registered only in two cases. The Ligasure suturing device proved to be the highly effective and safe for the use in thoracic surgery.
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Abstract
Emphysema is disabling and progressive and hallmarked by decreased exercise tolerance and impaired quality of life. Surgical interventions that reduce lung volume have been the focus of multiple interventions for decades; however, until recently, limited evidence has documented their effectiveness. Lung volume reduction surgery (LVRS) underwent rigorous study in the National Emphysema Treatment Trial (NETT), which demonstrated its short-term and long-term effectiveness, associated morbidity and mortality, and the essential factors that predict LVRS success or failure. This article summarizes the major results of the NETT and briefly reviews newer bronchoscopic lung volume reduction techniques that show promise as alternative treatments for select patients with COPD undergoing consideration for lung transplantation.
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Affiliation(s)
- Gerard J Criner
- Division of Pulmonary and Critical Care Medicine and Temple Lung Center, Temple University School of Medicine, Philadelphia, PA 19140, USA.
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Asakura K, Izumi Y, Kohno M, Ohtsuka T, Okui M, Hashimoto K, Nakayama T, Nomori H. Effect of cutting technique at the intersegmental plane during segmentectomy on expansion of the preserved segment: comparison between staplers and scissors in ex vivo pig lung. Eur J Cardiothorac Surg 2011; 40:e34-8. [PMID: 21450477 DOI: 10.1016/j.ejcts.2011.02.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/06/2011] [Accepted: 02/10/2011] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Cutting the intersegmental plane by using a stapler during segmentectomy might interfere with the expansion of the preserved lung due to visceral pleura caught in a staple line, especially in a large regional segmentectomy, such as left upper division or basal segmentectomy. We compared the preserved lung volume after segmentectomy among the methods using stapler, sharp dissection, and their combination for cutting the intersegmental plane in ex vivo pig lungs. We also examined a covering effect of polyglycolic acid mesh and fibrin glue. METHODS To assume a large regional segmentectomy in clinical practice, segments of the left caudal lobe except the lateral segment 2 (L2 segment) were resected, and the lung volume of the preserved L2 segment was measured. The intersegmental plane was cut by the following three methods: (1) stapler (n = 8); (2) scissors (n = 8); and (3) the combined method, that is, cutting the shallow lung tissue with scissors and the deep one with stapler (n = 8). The opened intersegmental plane was covered with polyglycolic acid mesh and fibrin glue. The air leakage was checked by injecting air through the bronchus at pressures of up to 30 cmH(2)O. Thereafter, normal saline was injected through the bronchus at pressures of 10, 20, and 30 cmH(2)O, to measure lung volumes by the volume-displacement method. RESULTS Polyglycolic acid mesh and fibrin glue prevented air leakage completely at up to 30 cmH(2)O. At the saline injection pressures of 10, 20, and 30 cmH(2)O, the mean volumes of L2 segment were 72 ± 14, 96 ± 14, and 109 ± 26 ml with the stapler; 86 ± 11, 117 ± 19, and 135 ± 39 ml with scissors; and 98 ± 10, 140 ± 20, and 155 ± 40 ml with the combined methods, respectively. The volume of the preserved L2 segment was significantly lower with the stapler method than with either the scissors or combined method at each pressure (p < 0.01). The difference was not significant between the scissors and combined methods. CONCLUSIONS Coverage with polyglycolic acid mesh and fibrin glue prevented air leakage from the opened intersegmental plane. The stapler interferes with the expansion of preserved lung in comparison to scissors or combined methods in a large regional segmentectomy.
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Affiliation(s)
- Keisuke Asakura
- Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
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Schuchert MJ, Abbas G, Pettiford BL, Luketich JD, Landreneau RJ. Preliminary results of anatomic lung resection using energy-based tissue and vessel coagulative fusion technology. J Thorac Cardiovasc Surg 2010; 140:1168-73. [PMID: 20850801 DOI: 10.1016/j.jtcvs.2010.06.064] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Revised: 06/02/2010] [Accepted: 06/20/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Mechanical stapling devices have been established as the mainstay of therapy in the selective isolation and division of bronchial and vascular structures during anatomic lung resection. Few data are available regarding the application of energy-based tissue fusion technology during anatomic lung resection. In the present study, we evaluated the use of energy-based instruments for the division of the pulmonary arterial and venous branches during anatomic lung resection. METHODS Anatomic lung resection (segmentectomy or lobectomy) was performed using energy-based coagulative fusion technology. A low-profile jaw can be used to facilitate dissection in both open and video-assisted thoracic surgery cases, applying a seal 6 mm wide by 22 mm in length. Two energy applications were applied to the arterial and venous branches before vessel division. RESULTS The bipolar tissue fusion system was used in 211 patients between 2008 and 2010 (104 lobectomies and 107 anatomic segmentectomies). Initially, we used a device with a smaller, curved jaw (n = 12), producing a 3.3- to 4.7-cm seal. No arterial dehiscences and 2 partial venous dehiscences that were recognized and controlled intraoperatively occurred. For the remaining cases, we used a new device with a larger jaw that applied a seal 6 mm wide by 22 mm in length. No arterial or venous dehiscences (vessel size range, 0.4-1.2 cm) occurred. CONCLUSIONS The bipolar tissue fusion system provided safe and reliable control of pulmonary arterial and venous branches during anatomic lung resection. The use of energy-based tissue fusion technology represents a reasonable alternative to mechanical stapling devices during anatomic lung resection.
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Affiliation(s)
- Matthew J Schuchert
- Division of Thoracic and Foregut Surgery, Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center Health System, Pittsburgh, PA 15232, USA.
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Takagi K, Hata Y, Sasamoto S, Tamaki K, Fukumori K, Otsuka H, Hasegawa C, Shibuya K. Late onset postoperative pulmonary fistula following a pulmonary segmentectomy using electrocautery or a harmonic scalpel. Ann Thorac Cardiovasc Surg 2010; 16:21-25. [PMID: 20190705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 01/27/2009] [Indexed: 05/28/2023] Open
Abstract
PURPOSE The purpose of this study is to retrospectively examine the postoperative pulmonary fistula as a complication after the use of either electrocautery or a harmonic scalpel without stapling devices. PATIENTS AND METHODS The subjects of this study consisted of 28 patients who received a segmentectomy for a pulmonary malignant tumor, 25 cases of lung cancer and 3 of metastatic lung tumor. The electrocautery was used in 17 patients (EC group) and the harmonic scalpel in 11 (HS group). The levels of postoperative air leakage and postoperative complications were examined among the two groups retrospectively. The histological findings of the cut surface of the segmentectomy by electrocautery and harmonic scalpel were also examined. RESULTS Hemostasis and air leakage both were well controlled during the operation, and the postoperative drainage period was short. No major postoperative complications occurred, and all patients began walking in the early postoperative days. However, 1 to 3 postoperative months after discharge, 8 patients showed late onset of a pulmonary fistula, 3 of the 17 (18%) in the EC group and 5 of the 11 (45%) in the HS group. The histological findings of the cut surface of the segmentectomy showed that most of the layer of coagulation necrosis by the harmonic scalpel measured 2 mm thick, and it was denser than that cut from electrocautery. The lumen of the bronchus markedly decreased in size, but it remained, as it also did under the effects of electrocautery. CONCLUSIONS In the months following the operation, the incidence of the late onset of a pulmonary fistula was higher when the harmonic scalpel was used. It was believed that the small bronchial stump could not tolerate the airway pressure because the thick coagulation necrosis delayed healing of the postoperative wound. It was necessary to ligate the stump of a small bronchus, even though the stump had been temporally closed by coagulation necrosis with the electrocautery or harmonic scalpel during the operation.
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Affiliation(s)
- Keigo Takagi
- Department of Chest Surgery, Toho University Medical Center Omori Hospital, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
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Shipulin PP, Baĭdan VV, Martyniuk VA, Baĭdan VI, Kiriliuk AA, Koziar ON, Severgin VE, Poliak SD. [Possibilities of videothoracoscopic pulmonary resection in thoracic surgery]. Klin Khir 2009:43-46. [PMID: 20218403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The experience of videothoracoscopic pulmonary resection performance in various diseases in 183 patients was summarized. The methods of endoscopic and videoassisted pulmonary resection, including those conducted for peripheral cancer, using home-made and foreign suture apparatuses, were depicted. The indications were adduced for performance of diagnostic and curative videothoracoscopic operations, possibilities of their application, advantages in comparison with open operative procedures were adduced.
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Rathinam S, Naidu BV, Nanjaiah P, Loubani M, Kalkat MS, Rajesh PB. BioGlue and Peri-strips in lung volume reduction surgery: pilot randomised controlled trial. J Cardiothorac Surg 2009; 4:37. [PMID: 19615062 PMCID: PMC2722608 DOI: 10.1186/1749-8090-4-37] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 07/17/2009] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Both tissue sealants and buttressing have been advocated to reduce alveolar air leaks from staple lines following Lung Volume Reduction Surgery (LVRS). However, the long term detrimental effects of buttressing material are increasingly apparent. We performed a pilot prospective randomised self controlled trial in patients undergoing LVRS comparing BioGlue and Peri-strips as adjuncts in preventing alveolar air-leaks. METHODS A pilot prospective self controlled clinical trial was conducted in patients undergoing LVRS. Each patient was treated with BioGlue on one side and pericardial buttress on the other side as an adjunct to the staple line. The sides were randomised for adjuncts with each patient acting as his own control. Duration of air leak, intercostal drainage and time to chest drain removal were the study end points. RESULTS 10 patients undergoing the procedure were recruited between December 2005 and October 2007. There were 6 men and the mean age was 59.8 +/- 4.9 years. There was one mortality due to multi-organ failure. The BioGlue treated side had a shorter mean duration of air-leak (3.0 +/- 4.6 versus 6.5 +/- 6.9 days), lesser chest drainage volume (733 +/- 404 ml versus 1001 +/- 861) and shorter time to chest drain removal (9.7 +/- 10.6 versus 11.5 +/- 11.1 days) compared with Peri-strips. CONCLUSION This study demonstrates comparable efficacy of BioGlue and Peri-strips, however there is a trend favouring the BioGlue treated side in terms of reduction in air-leak, chest drainage volumes, duration of chest drainage and significant absence of complications. A larger sample size is needed to validate this result.
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Affiliation(s)
- Sridhar Rathinam
- Regional Department of Thoracic Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, UK
| | - Babu V Naidu
- Regional Department of Thoracic Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, UK
| | - Prakash Nanjaiah
- Regional Department of Thoracic Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, UK
| | - Mahmoud Loubani
- Regional Department of Thoracic Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, UK
| | - Maninder S Kalkat
- Regional Department of Thoracic Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, UK
| | - Pala B Rajesh
- Regional Department of Thoracic Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, UK
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Tanaka R, Nakazato Y, Yoshida T. [Development of fusion instruments (NT forceps) for video-assisted thoracic surgery]. Kyobu Geka 2009; 62:465-467. [PMID: 19522206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A lobectomy is a standard surgical operation for lung cancer. Recently, the general surgical approach for this operation has been the use of a video-assisted procedure (video-assisted thoracic surgery: VATS). Almost all thoracoscopic instruments have been developed from classical instruments, scissors or forceps. We think that thoracoscopic instruments are often limited about the handling for the procedures, because the procedures are widely demanded to understand anatomical variations in an intrathoracic space. Fusion instruments (NT forceps) with atraumatic dispositions have been developed on our device, and they are so useful tools in all technical handlings for standard operations, lobectomy. And the forceps with a new device (such as LigaSure and Harmonic Scalpel) especially show a good combination technique.
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Affiliation(s)
- R Tanaka
- Department of Thoracic Surgery, Gunma Prefectural Cancer Center, Ota, Japan
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Abstract
Because local therapies directed toward a specific tumor mass are known to be effective for treating early-stage cancers, it should be no surprise that there has been considerable historical experience using local therapies for metastatic disease. In more recent years, increasing interest in the use of local therapy for metastases likely has arisen from improvements in systemic therapy. In the absence of effective systemic therapies, such local treatments were often considered futile given both the difficulty in eliminating all sites of identifiable metastatic disease as well as realities regarding the rapid natural history of uncontrolled tumor dissemination. However, with a higher likelihood of patients surviving longer after effective systemic therapy, even if not cured, the goal of the eradication of residual metastases via potent local therapies can be rationalized. However, this rationalization should be evidence-based so as to avoid harming patients for no established benefit. Although surgical metastectomy remains the most common and first-line standard among local therapies, nonsurgical alternatives, including thermal ablation and stereotactic body radiotherapy, have become increasingly popular because they are generally less invasive than surgery and have demonstrated considerable promise in eradicating macroscopic tumor. Rather than eliminating the need for local therapies, improvements in systemic therapies appear to be increasing the prudent utilization of modern local therapies in patients presenting with more advanced cancer.
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Affiliation(s)
- Robert D Timmerman
- University of Texas Southwestern Medical Center, Dallas, TX 75390-9183, USA.
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Abstract
Ninety-eight emphysema patients were treated at 13 international sites during a 3-year series of single-arm, open-label studies with the IBV valve and a multi-lobar treatment approach. Fifty six percent of subjects had a clinically meaningful improvement in health-related quality of life, but standard pulmonary function and exercise studies were insensitive effectiveness measures. Quantitative CT analyses of regional lung changes showed lobar volume changes in over 85% of subjects. Lung volume reduction was an uncommon mechanism for a treatment response with bilateral upper lobe treatment. A redirection of inspired air, an interlobar shift to health-ier lung tissue, was the most common mechanism for a valve treatment response.
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