Factors related to post-thoracotomy pain following robotic-assisted thoracic surgery.

BACKGROUND: Robotic-assisted thoracic surgery (RATS) is a minimally invasive procedure; however, some patients experience persistent postoperative pain. This study aimed to investigate factors related to postoperative pain following RATS. METHODS: The data of 145 patients with lung cancer, who underwent RATS with a four-port (one in the sixth intercostal space [ICS] and three in the eighth ICS) lobectomy or segmentectomy between May 2019 and December 2022, were retrospectively analyzed. Factors associated with analgesic use for at least 2 months following postoperative pain (PTP group) were analyzed. RESULTS: Patients who underwent preoperative pain control for any condition or chest wall resection were excluded. Among the 138 patients, 45 (32.6%) received analgesics for at least 2 months after surgery. Patient height and transverse length of the thorax correlated with PTP in the univariate analysis (non-PTP vs. PTP; height, 166 vs. 160 cm; p < .001; transverse length of the thorax, 270 vs. 260 mm, p = .016). In the multivariate analysis, height was correlated with PTP (p = .009; odds ratio, 0.907; 95% confidence interval, 0.843-0.976). Height correlated with the transverse length of the thorax (r = .407), anteroposterior length of the thorax (r = .294), and width of the eighth ICS in the middle axillary line (r = .210) using Pearson's correlation coefficients. When utilizing a 165-cm cutoff value for height to predict PTP using receiver operating characteristic curve analysis, the area under the curve was 0.69 (95% confidence interval, 0.601-0.779). CONCLUSION: Short stature is associated with a high risk of postoperative pain following RATS.

Pneumothorax in teenagers: reducing recurrence through resection of superior segment of lower lobe.

BACKGROUND: Spontaneous pneumothorax in young patients is characterized by a high recurrence rate. We retrospectively investigated causes of recurrence and effective surgical methods to improve this statistic, in particular through resection of the superior segment of the lower lung lobe (S6a). METHODS: From April 2011 to September 2017, we performed 146 operations for 126 lateral side pneumothoraces in patients 20 years of age or younger (105 males and 7 females, mean age 17.2 years) at our institution. Two groups-one with patients who underwent both apical bullectomy and S6a resection (the S6a group), and the other with patients who underwent only apical bullectomy with apical reinforcement using an absorbable mesh sheet (the AB group)-were statistically compared in terms of recurrence rate. RESULTS: A significant difference was found between the S6a group and the AB group in terms of the number of S6a recurrences (0 vs. 8 cases, respectively; P=0.025), although there was no significant difference between the two groups in terms of the total recurrence rate (16.1% vs.18.6%, respectively). Pathological examination revealed that 55 of the 56 (98.2%) S6a specimens already contained asymptomatic, non-ruptured bullae or microscopic bullous lesions at the time of the initial operation. CONCLUSIONS: In addition to the apex, the S6a often involves lesions responsible for pneumothorax recurrence. To reduce this recurrence in teenage patients, we suggest that S6a resection be concomitantly performed in the initial operation-even if there are no macroscopically visible blebs on the S6a.

Medullar impairment resolves hiccups.

BACKGROUND: In a previous article we reported the time that hiccups stop as the instant when CO2 levels in both expiratory gas (EtCO2) and inspiratory gas (InspCO2) reach approximately 50 mmHg. To support our findings, in this article we aim to clarify the precise values of the CO2 level in arterial blood (PaCO2) and venous blood (PvCO2) during plastic bag rebreathing. METHODS: A healthy male volunteer was asked to perform a rebreathing experiment using a 20 L air-filled plastic bag. During the experiment, his blood oxygen saturation level (SpO2), EtCO2 and InspCO2 were measured until the volunteer gave up. PaCO2 and PvCO2 were measured at the following four points: P0, when the rebreathing started; P1, when both EtCO2 and InspCO2 indicated the same value; P2, when both reached 50 mmHg; and P3, when SpO2 dropped to 90%. RESULTS: InspCO2 increased from the beginning and showed the same value as EtCO2 at P1. PaCO2 at P1 was almost the same value as both InspCO2 and EtCO2. After P1, InspCO2, EtCO2 and PaCO2 increased at the same rate, and at P2, they reached the level of PvCO2. After P2, all four markers continued to show the same value as they gradually increased. CONCLUSIONS: Creating conditions inside the body in which PaCO2 increases to the same level as PvCO2 will stop hiccups consistently. Although other physiological pathways to stop hiccups may exist, for a successful outcome it is important that the balance of power between the cerebellum and the medulla is drastically altered.