Siembra tumoral en herida quirúrgica tras culmenectomía pulmonar izquierda videotoracoscópica / Incisional tumoral recurrence after left lung videothoracoscopic culmenectomy

No disponible

[The benefits of digital chest drainage in pleural decortication in thoracic empyema. Prospective, randomized, control trial]. / Beneficios del drenaje torácico digital en pleurodecorticación por empiema. Estudio prospectivo, comparativo aleatorizado.

BACKGROUND: Prolonged air leak after pleural decortication is one of the most frequent complications. OBJECTIVE: The aim of this study is to compare the effects of prolonged air leak between the digital chest drainage (DCD) system and the classic drainage system in patients with empyema class IIB or III (American Thoracic Society classification) in pleural decortication patients. MATERIAL AND METHODS: A total of 37 patients were enrolled in a prospective randomized control trial over one year, consisting of 2blinded groups, comparing prolonged air leak as a main outcome, the number of days until removal of chest drain, length of hospital stay and complications as secondary outcomes. RESULTS: The percentage of prolonged air leak was 11% in the DCD group and 5% in the classic group (P=0.581); the mean number of days of air leak was 2.5±1.8 and 2.4±2.2, respectively (P=0.966). The mean number of days until chest tube removal was 4.5±1.8 and 5.1±2.5 (P=0.41), the length of hospital stay was 7.8±3.7 and 8.9±4.0 (P=0.441) and the complication percentages were 4 (22%) and 7 (36%), respectively (P=0.227). DISCUSSION: In this study, no significant difference was observed when the DCD was compared with the classic system. This was the first randomized clinical trial for this indication; thus, future complementing studies are warranted.

Right main bronchial fracture resolution by digital thoracic drainage system.

Tracheobronchial stenosis is common in the thoracic surgery service, and iatrogenic injury of the airway after manipulation is not infrequent. When a digital thoracic drainage system came onto the market, many advantages were evident. A 24-year-old woman with critical right main bronchial stenosis underwent airway dilation that was complicated by a tear with a massive air leak, resulting in a total right pneumothorax. We employed a pleural drain connected to a digital thoracic drainage system. The drain was removed 2 days after successful resolution of the air leak.

Thoracoscopic Excision of Migrated Kirschner Wire to Right Pulmonary Hilum.

Kirschner wires are often used for the stabilization of complex fractures. Wire migration is a rare but still recognized complication of its use. A 56-year-old man suffered a clavicle fracture at age 26 that was stabilized with one Kirschner wire, and for 30 years he was asymptomatic. Recently, he presented with cough and right thoracic pain. Chest radiographs revealed migration of the Kirschner wire, and thoracoscopic visualization revealed that the Kirschner wire had penetrated the middle lobe parenchyma and was in close contact with the right auricle. This case study reports the successful thoracoscopic treatment of a rare complication of Kirschner wire migration.

A randomized prospective study of analgesic quality after thoracotomy: paravertebral block with bolus versus continuous infusion with an elastomeric pump.

OBJECTIVES: Paravertebral block (PVB) with infusion of local anaesthetic (LA) through a paravertebral catheter is an effective alternative to epidural analgesia in the management of post-thoracotomy pain. PVB can be done in two ways: either through administration of a bolus dose of the LA or continuous infusion via an infusion pump; currently, there is no consensus on which route is best. Our objective was to compare the efficacy of the PVB for post-thoracotomy pain control using bolus doses versus a continuous infusion pump. METHODS: We performed a prospective randomized study of 80 patients submitted to thoracotomy. Patients were divided into two independent groups (anterior thoracotomy--ANT--and posterolateral thoracotomy-POST). At the conclusion of the surgery, a catheter was inserted under direct vision in the thoracic paravertebral space at the level of the incision. In each group, patients were randomized to receive levobupivacaine 0.5% every 6 h ('Bolus' group) or levobupivacaine 0.25% in continuous infusion at 5 ml/h through an elastomeric pump ('Continuous infusion' group). Patients in both groups received the same dosage of LA: 300 mg/day. Metamizole (every 6 h) was administered as an adjunct. Subcutaneous meperidine was employed as a rescue medication. Pain scores were measured using the visual analogue scale (VAS) at 1, 6, 24, 48 and 72 h after surgery. RESULTS: Thirteen (16.2%) patients required meperidine for rescue (8 in continuous infusion and 5 in the bolus group). Mean VAS scores were the following: all the cases (n = 80): 5.0 ± 1.6, ANT (n = 36): 4.4 ± 1.8, POST (n = 44): 5.4 ± 1.6, Bolus (n = 40): 4.7 ± 1.7, Continuous infusion (n = 40): 5.2 ± 1.8, ANT with bolus (n = 18): 4.1 ± 1.7, ANT with continuous infusion (n = 18): 4.7 ± 1.8, POST with bolus (n = 22): 5.2 ± 1.5, POST with continuous infusion (n = 22): 5.6 ± 1.6. CONCLUSIONS: Post-thoracotomy pain control using a combination of PVB and a non-steroidal anti-inflammatory drug is a safe and effective approach. Patients submitted to ANT experienced less pain than those with POST 4.4 vs 5.4 (P = 0.02). Since no statistical differences were observed, it was not possible to confirm differences between the LA administered in a bolus versus continuous infusion.

Localización de nódulos pulmonares con arpón guiado por tomografía axial computarizada previa a la resección videotoracoscópica. Experiencia en 52 casos / Locating pulmonary nodules with a computed axial tomography-guided harpoon prior to videothoracoscopic resection. Experience with 52 cases

Introducción La resección videotoracoscópica (VTC) de los nódulos pulmonares (NP) periféricos requiere en ocasiones la práctica de una minitoracotomía para su localización mediante palpación. El objetivo de este estudio es evaluar la eficacia como método de localización preoperatoria de los NP de la colocación de un arpón guiado por TAC. Material y métodos Desde noviembre de 2004 hasta enero de 2011, 52 pacientes fueron programados para localización preoperatoria de 55 NP mediante la colocación de un arpón guiado por TAC. Resultados Un total de 52 pacientes (31 hombres y 21 mujeres) con edades entre 28 y 84 años (media: 62,2 años) con NP < 20mm (media: 9,57mm). De ellos, 35 tenían historia oncológica. Se colocaron 55 arpones (a 3 pacientes, 2 arpones simultáneos). En la VTC, 52 arpones fueron hallados correctamente anclados al NP. No se observaron complicaciones. En el grupo de 35 pacientes con antecedentes oncológicos, los nódulos resultaron ser malignos en 26 (74,3%). En los 17 no oncológicos fueron malignos el 70,6%. La estancia hospitalaria osciló entre 4 y 72 h, con 19 pacientes incluidos en un programa de cirugía ambulatoria (36,5%).Conclusiones La identificación preoperatoria de los NP permite su resección VTC directa. La colocación de un arpón guiado por TAC en los NP constituye un procedimiento seguro y efectivo que puede llevarse a cabo en un programa de cirugía ambulatoria (AU)

Objective Videothoracoscopic (VTC) resection of peripheral pulmonary nodules (PN) occasionally requires performing a mini-thoracotomy to locate them using palpation. The aim of this study is to evaluate the usefulness of inserting a CT-guided harpoon as a method for locating PN prior to surgery. Material and methods A study was conducted on a total of 52 patients who were scheduled for locating 55 PN prior to surgery by inserting a CT-guided harpoon, from November 2004 to January 2011.ResultsOf the 52 patients, of whom 35 had a history of cancer, 31 were male and 21 were female, with ages between 28 and 84 years (mean: 62.2 years) with a PN <20mm (mean: 9.57mm). A total of 55 harpoons were inserted (3 patients had 2 simultaneous harpoons). Using the VTC it was observed that 52 harpoons were correctly anchored to the PN. There were no complications. In the group of 35 patients with an oncology history, the nodules were malignant in 26 cases (74.3%), and there were 17 (70.6%) with malignant PN in those with no oncology history. The hospital stay varied between 4 and 72h, with 19 patients (36.5%) included in a one-day surgery program. Conclusions The preoperative identification of peripheral pulmonary nodules enables them to be removed directly with VTC. The insertion of a CT-guided harpoon in the PN is a safe and effective procedure that can be performed in a one-day surgery program (AU)

A prospective study comparing three-port video-assisted thoracoscopy with the single-incision laparoscopic surgery (SILS) port and instruments for the video thoracoscopic approach: a pilot study.

BACKGROUND: Single-incision laparoscopic surgery (SILS) has proved its advantages in several procedures, mainly a shorter hospital stay, improved aesthetic results, and less postoperative pain. The authors have used this approach for several thoracic surgical procedures. METHODS: This prospective study compared 20 cases between standard three-port video-assisted thoracic surgery (VATS) and the single-incision approach using a standard abdominal SILS system. In both groups, postsurgical analgesia was provided with 15 ml of bupivacaine 0.5% at 3 h intervals via a paravertebral catheter. The hospital length of stay and chest drain duration (in hours) were recorded as well as postoperative pain using an analogic visual pain scale (AVPS). A telephone survey was conducted for all the outpatients. The Mann-Whitney U test was used for statistical analysis. RESULTS: This study of 20 procedures included 11 lung biopsies, 6 pneumothorax procedures, 2 mediastinic cystectomies, and 1 catamenial pneumothorax procedure. No statistically significant difference was reported in hospital length of stay or chest drain duration between the two groups. However, postoperative pain at 24 h was significantly less in the SILS group (AVPS, 4.40) than in the VATS group (AVPS, 6.20) (p = 0.035). The SILS group reported two minor surgical wound complications and one catamenial pneumothorax recurrence that did not require drainage. The VATS group reported one case of skin rash with no identifiable cause. CONCLUSIONS: The use of the SILS port in thoracic surgery results in less postoperative pain. This is related to the port's protective effect over the periostium and the intercostal nerve, relieving them of direct contact with surgical instruments. However, the findings showed a higher incidence of surgical wound complications with the SILS port, which can be attributed to increased pressure on the skin and soft tissues surrounding the port and to the fact that this same incision was used for chest drain placement, thus increasing the risk for complications.

[Locating pulmonary nodules with a computed axial tomography-guided harpoon prior to videothoracoscopic resection. Experience with 52 cases]. / Localización de nódulos pulmonares con arpón guiado por tomografía axial computarizada previa a la resección videotoracoscópica. Experiencia en 52 casos.

OBJECTIVE: Videothoracoscopic (VTC) resection of peripheral pulmonary nodules (PN) occasionally requires performing a mini-thoracotomy to locate them using palpation. The aim of this study is to evaluate the usefulness of inserting a CT-guided harpoon as a method for locating PN prior to surgery. MATERIAL AND METHODS: A study was conducted on a total of 52 patients who were scheduled for locating 55 PN prior to surgery by inserting a CT-guided harpoon, from November 2004 to January 2011. RESULTS: Of the 52 patients, of whom 35 had a history of cancer, 31 were male and 21 were female, with ages between 28 and 84 years (mean: 62.2 years) with a PN <20mm (mean: 9.57mm). A total of 55 harpoons were inserted (3 patients had 2 simultaneous harpoons). Using the VTC it was observed that 52 harpoons were correctly anchored to the PN. There were no complications. In the group of 35 patients with an oncology history, the nodules were malignant in 26 cases (74.3%), and there were 17 (70.6%) with malignant PN in those with no oncology history. The hospital stay varied between 4 and 72h, with 19 patients (36.5%) included in a one-day surgery program. CONCLUSIONS: The preoperative identification of peripheral pulmonary nodules enables them to be removed directly with VTC. The insertion of a CT-guided harpoon in the PN is a safe and effective procedure that can be performed in a one-day surgery program.

Simultaneous bilateral posterior thoracotomy with the patient in the prone position for resection of bilateral posterior lung metastases.

Lung metastases limited to posterior segments can be removed through a posterior thoracotomy with the patient in the prone position. When these metastases are bilateral, a simultaneous approach can be performed. We present three cases of bilateral lung metastases of colorectal carcinoma removed through a simultaneous bilateral posterior thoracotomy with the patient in the prone position.

Bilateral thoracoscopic sympathetic block by clipping.

Main cause of dissatisfaction after videothoracoscopic (VATS) sympathectomy in the treatment of hyperhidrosis (HH) and facial blushing (FB) is compensatory sweating (CS). Sympathetic nerve (SN) clipping obtains the same results as sympathectomy in terms of efficacy and safety and levels of CS are similar or lesser than with the standard procedure, with the advantage that if necessary - massive intolerable CS-, this technique theoretically allows to revert the sympathetic block by removing the clips. The surgical procedure is performed through two incisions of 10 mm at the mid axillary and anterior axillary lines (third and fifth intercostal spaces). Through two ports a 30° camera and a diathermy hook are introduced into the pleural cavity. After the identification of the SN, parietal pleura is opened and the chain is isolated. Under video assistance the SN is clipped at the correspondent level with a right-angled endoscopic clip applier. This surgical procedure is illustrated and an overview of the literature is presented.

Beneficios del uso de dispositivos digitales para medir la fuga aérea después de una resección pulmonar: estudio prospectivo y comparativo / The benefits of digital air leak assessment after pulmonary resection: Prospective and comparative study

Introducción La fuga aérea persistente es una de las más frecuentes complicaciones después de una resección pulmonar. Debido a las diferencias de parámetros subjetivos para la retirada del drenaje en el postoperatorio, nosotros diseñamos un estudio prospectivo, comparativo y consecutivo para evaluar de una manera objetiva cómo los dispositivos digitales (Thopaz® y Digivent®) pueden medir la fuga aérea comparándolos entre ellos y, a su vez, con Pleur-Evac®, en beneficio de una retirada precoz del drenaje torácico. Método Estudio prospectivo, comparativo y consecutivo de 75 pacientes a los que se les había realizado de manera electiva una resección pulmonar debido a cáncer de pulmón no microcítico. Comparamos los 2 dispositivos digitales entre sí y, a su vez, con el dispositivo no digital. Resultados Los resultados poblaciones no fueron significativos entre los 3 grupos. La retirada del drenaje torácico fue el siguiente: Thopaz® a los 2,4 días, Digivent® a los 3,3 días y Pleur-Evac® a los 4,5 días. Los pacientes y el personal de Enfermería se encontraron subjetivamente más cómodos con el dispositivo digital. Los cirujanos obtuvimos información objetiva con el dispositivo digital. Los sistemas de alarma de Thopaz® fueron efectivos para el uso de un paciente de manera ambulatoria. Conclusión El sistema digital y continuo de medición de la fuga aérea reduce el día de la retirada del drenaje torácico, así como los días de estancia intrahospitalaria. El sistema de alarmas de Thopaz® es muy útil para prevenir las deficiencias del sistema. Hace innecesaria la aspiración desde un sistema centralizado. Las curvas de medición de presión intrapleural y extrapleural pueden hacer predecible la necesidad de un tipo de drenaje para cada paciente según su enfermedad (AU)

Introduction Persistent air leaks represent the most common pulmonary complication after elective lung resection. Since there are insufficient data in the literature regarding variability in the withdrawal of postoperative pleural drainages, we have designed a prospective, consecutive and comparative study to evaluate if the use of digital devices (Thopaz and DigiVent) to measure postoperative air leak compared to a Pleur-Evac varies on deciding when to withdraw chest tubes after lung resection. Methods A prospective, consecutive and comparative trial was conducted in 75 patients who underwent elective pulmonary resection for non small cell lung cancer. This study compared two digitals devices with the current analogue version in 75 patients. The digital and analogue groups had 26, 24, and 25 patients, respectively. Results Clinical population data were not statistically different between the groups. The withdrawal of the chest tube was Thopaz, 2.4 days; Digivent, 3.3 days and PleurEvac, 4.5days. Patients and nurses were subjectively more comfortable with digital devices. Surgeons obtained more objective information with digital devices. The safety mechanism of the Thopaz was also subjectively better, and one patient was discharged home without complications after one week. Conclusions The digital and continuous measurement of air leak instead of the currently used static analogue systems reduced the chest tube withdrawal and hospital stay by more accurately and reproducibly measuring air leak. Intrapleural pressure curves from the Digivent may also help predict the optimal chest tube setting for each patient. Conclusions The Thopaz alarm mechanism is very useful to prevent deficiencies in the mechanism and do not required wall suction (AU)

[The benefits of digital air leak assessment after pulmonary resection: prospective and comparative study]. / Beneficios del uso de dispositivos digitales para medir la fuga aérea después de una resección pulmonar: estudio prospectivo y comparativo.

INTRODUCTION: Persistent air leaks represent the most common pulmonary complication after elective lung resection. Since there are insufficient data in the literature regarding variability in the withdrawal of postoperative pleural drainages, we have designed a prospective, consecutive and comparative study to evaluate if the use of digital devices (Thopaz and DigiVent) to measure postoperative air leak compared to a Pleur-Evac varies on deciding when to withdraw chest tubes after lung resection. METHODS: A prospective, consecutive and comparative trial was conducted in 75 patients who underwent elective pulmonary resection for non small cell lung cancer. This study compared two digitals devices with the current analogue version in 75 patients. The digital and analogue groups had 26, 24, and 25 patients, respectively. RESULTS: Clinical population data were not statistically different between the groups. The withdrawal of the chest tube was Thopaz, 2.4 days; Digivent, 3.3 days and PleurEvac, 4.5 days. Patients and nurses were subjectively more comfortable with digital devices. Surgeons obtained more objective information with digital devices. The safety mechanism of the Thopaz was also subjectively better, and one patient was discharged home without complications after one week. CONCLUSIONS: The digital and continuous measurement of air leak instead of the currently used static analogue systems reduced the chest tube withdrawal and hospital stay by more accurately and reproducibly measuring air leak. Intrapleural pressure curves from the Digivent may also help predict the optimal chest tube setting for each patient. The Thopaz alarm mechanism is very useful to prevent deficiencies in the mechanism and do not required wall suction.

Outpatient thoracic surgery.

In summary, from the different alternatives to conventional hospitalization developed in the last decades, outpatient surgery has been the one with the greatest growth. However, only few studies have been reported on thoracic surgery and there is still great potential for an increase in outpatient thoracic surgery. The aim of this article has been to evaluate the clinical aspects, results, and economical impact of an outpatient thoracic surgery program (OTSP). Video-assisted mediastinoscopy, lung biopsy, and bilateral thoracic sympathectomy can be accomplished safely in a significant percentage of cases as ambulatory patients. The impact of the economical benefit of outpatient thoracic surgical program over the conventional hospitalization depends on the previous department's policy on hospital stay. Further experience is needed to increase the substitution index and expand the OTSP to other procedures.