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2.
Medicine (Baltimore) ; 99(10): e19240, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150060

RESUMO

BACKGROUND: With the improvement of anesthesia and surgical techniques, supraglottic device with assist ventilation under general anesthesia (GA) combined with nerve block is gradually applied to video-assisted thoracoscopic surgery. However, the safety of assist ventilation has not been fully confirmed, and a large number of samples should be studied in clinical exploration. METHODS: The subjects included 120 patients, undergoing elective thoracoscopic GA, with American Society of Anesthesiologists (ASA) physical status I or II, were randomly divided into 3 groups, 40 cases in each group. Group T: received double-lumen bronchial intubation, Group I: received intercostal nerve block using a supraglottic device, Group P: received paravertebral nerve block using a supraglottic device. Mean arterial pressure, heart rate, saturation of pulse oximetry and surgical field satisfaction, general anesthetic dosage and recovery time were recorded before induction of GA (T0), at the start of the surgical procedure (T1), 15 minutes later (T2), 30 minutes later (T3), and before the end of the surgical procedure (T4). Static and dynamic pain rating (NRS) and Ramsay sedation score were recorded 2 hours after surgery (T5), 12 hours after surgery (T6), 24 hours after surgery (T7), time to get out of bed, hospitalization time and cost, patient satisfaction and adverse reactions. RESULTS: There was no significant difference with the surgical visual field of the 3 groups (P > .05). The MAP, HR and SpO2 of the 3 groups were decreased from T2 to T3 compared with T0(P < .05). Compared with group T: the total dosage of GA was reduced in group I and group P, the recovery time was shorter, the time to get out of bed was earlier (P < .05), the hospitalization time was shortened, the hospitalization cost was lower, and the patient satisfaction was higher (P < .05). The static and dynamic NRS scores were lower from T5 to T7 (P < .05). Ramsay sedation scores were higher (P < .05), and the incidence of adverse reactions was lower (P < .05). Comparison between group I and group P: Dynamic NRS score of group P was lower from T6 to T7 (P < .05). CONCLUSION: Supraglottic device with assist ventilation under general anesthesia combined with nerve block in uniportal video-assisted thoracoscopic surgery is safe and feasible.


Assuntos
Anestesia Geral/instrumentação , Bloqueio Nervoso/instrumentação , Respiração Artificial , Cirurgia Torácica Vídeoassistida , Adulto , Período de Recuperação da Anestesia , Anestesia Geral/efeitos adversos , Anestésicos Gerais/administração & dosagem , Pressão Sanguínea , Procedimentos Cirúrgicos Eletivos , Estudos de Viabilidade , Feminino , Frequência Cardíaca , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Oximetria
3.
Surg Clin North Am ; 100(2): 237-248, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32169178

RESUMO

Minimally invasive surgery for diseases of the chest offsets the morbidity of painful thoracic incisions while allowing for meticulous dissection of major anatomic structures. This benefit translates to improved outcomes and recovery following the surgical management of benign and malignant esophageal pathologic condition, mediastinal tumors, and lung resections. This anatomic region is particularly amenable to a robotic approach given the fixed space and need for complex intracorporeal dissection. As robotic platforms continue to evolve, more complex thoracic surgical interventions will be facilitated, translating to improved outcomes for our patients.


Assuntos
Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Esofagectomia , Humanos , Doenças do Mediastino/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Pneumonectomia , Cirurgia Torácica Vídeoassistida
4.
Crit Care ; 24(1): 49, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32050985

RESUMO

BACKGROUND: Severe blunt chest injury sometimes induces acute respiratory failure (ARF), requiring ventilator use. We aimed to evaluate the effect of performing rib fixation with the addition of video-assisted thoracoscopic surgery (VATS) on patients with ARF caused by blunt thoracic injury with ventilator dependence. METHODS: This observational study prospectively enrolled patients with multiple bicortical rib fractures with hemothorax caused by severe blunt chest trauma. All patients received positive pressure mechanical ventilation within 24 h after trauma because of ARF. Some patients who received rib fixation with VATS were enrolled as group 1, and the others who received only VATS were designated as group 2. The length of ventilator use was the primary clinical outcome. Rates of pneumonia and length of hospital stay constituted secondary outcomes. RESULTS: A total of 61 patients were included in this study. The basic demographic characteristics between the two groups exhibited no statistical differences. All patients received operations within 6 days after trauma. The length of ventilator use was shorter in group 1 (3.19 ± 3.37 days vs. 8.05 ± 8.23, P = 0.002). The rate of pneumonia was higher in group 2 (38.1% vs. 75.0%, P = 0.005). The length of hospital stay was much shorter in group 1 (17.76 ± 8.38 days vs. 24.13 ± 9.80, P = 0.011). CONCLUSION: Rib fixation combined with VATS could shorten the length of ventilator use and reduce the pneumonia rate in patients with severe chest blunt injury with ARF. Therefore, this operation could shorten the overall length of hospital stay.


Assuntos
Respiração Artificial , Traumatismos Torácicos , Cirurgia Torácica Vídeoassistida , Desmame do Respirador , Ferimentos não Penetrantes , Adulto , Idoso , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Adulto , Costelas/cirurgia , Traumatismos Torácicos/cirurgia , Ferimentos não Penetrantes/cirurgia
5.
Zhonghua Wai Ke Za Zhi ; 58(2): 131-136, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32074813

RESUMO

Objective: To compare the short-term and long-term results of thoracoscopic and open pneumonectomy for non-small cell lung cancer. Methods: The clinical data of patients with non-small cell lung cancer who underwent pneumonectomy in the Department of Thoracic Surgery, Qingdao University Hospital from January 2008 to December 2016 were collected. Totally 142 patients (55 in the thoracoscopic group and 87 in the open group) were included in the study. A total of 29 pairs of patients were successfully matched by propensity score matching (PSM). Perioperative outcomes and overall survival were compared between the two groups using t test, χ(2) test, Kaplan-Meier curve and Log-rank test, respectively. Results: Camparion with open group, the thoracoscopic group had longer operative time ((209.7±70.2) minutes vs. (171.3±43.5) minutes, t=2.50, P=0.02), more mediastinal lymph node dissection (M(Q(R)): 17(9) vs. 11(10), W=388, P=0.02) and shorter postoperative hospital stay (7.0(3.5) vs. 9.0(3.0), W=285, P=0.03). There was no significant difference in estimated blood loss, postoperative drainage time, dissected lymph node number, dissected lymph node station and perioperative complications. After PSM, there were no signifificant differences found in 3-year survival (71.4% vs. 48.1%, P=0.10) and 3-year disease-free survival (67.4% vs. 47.2%, P=0.13) between the two groups. Conclusion: Thoracoscopic pneumonectomy is safe and feasible for the treatment of non-small cell lung cancer with more mediastinal lymph node dissection and accelerating recovery, and equivalent long-term prognosis when compared with open approach.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Pneumonectomia , Cirurgia Torácica Vídeoassistida , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo , Pneumonectomia/métodos , Complicações Pós-Operatórias , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
6.
Zhonghua Wai Ke Za Zhi ; 58(1): 57-60, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31902172

RESUMO

Minimally invasive surgery helps enhance postoperative recovery and improve quality of life of the patients by minimizing surgical trauma and decreasing incisional pain. Minimally invasive pulmonary resection, including both video-assisted thoracoscopic surgery and robotic surgery, is mainly used for surgical management of peripheral early stage lung cancers. Because of tumor location, lymph node involvement, and treatment modalities, surgery for central lung cancers is often technically demanding. Open thoracotomy is still the dominant approach for these tumors, especially when complex procedures such as sleeve lobectomy or pneumonectomy are needed. With the advent of surgical techniques, minimally invasive techniques have started to be tried in treatment of central lung cancers. Initial results have proven their feasibility and safety in sleeve lobectomy and pneumonectomy, showing a great potential of minimally invasive surgery in the future. Further study is necessary to prove its functionally superiority and oncological equivalence to open surgery, so that more lung cancer patients could benefit for minimally invasive surgery.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos
7.
Postgrad Med ; 132(1): 62-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31765233

RESUMO

Objectives: The aim of this research is by using sociological methods of scientific research for tracking the pain and satisfaction indicators to prove that decreasing the number of ports in the VATS (Video-assisted thoracic surgery) for Malignant Pleural Effusion reduces postoperative pain and improves patient's satisfaction.Methods: Our study included 117 VATS procedures performed in the period from 01 January 2013 to 31 September 2016. The sociological method used to measure the pain indicator was an interview. The severity of postoperative pain was determined and reported according to a ten-point pain visual analogue scale (VAS). The degree of satisfaction was determined and reported according to a six-point and ten-point grading systems on the basis of a research interview procedure.Results: In the single-port method, the verbal pain scale for all the days covered by the research study statistically showed significantly lower values (P Ë‚ 0.0001) in comparison with the conventional method (P Ë‚ 0.0001). With regard to the patient's satisfaction, determined on the basis of the six-point system, the results were as follows: conventional VATS approach - average 3.1 with a standard deviation of 1.1 and ranging from 0 to 5; single-port VATS approach - average 4.3 with a standard deviation of 1.0 and within the range from 0 to 6. Conventional VATS approach - 6.8 - neutral. Single-port VATS approach - 8.1 - prevailing satisfaction.Conclusions: Based on our study and the studies of other authors, it can be concluded that postoperative pain and satisfaction after VATS in patients with MPE (Malignant pleural effusion) are influenced by the number of ports and the one-port technique shows better results than the conventional three-port method.The research study was registered and approved by the Clinical Research and Ethics Committee at the 'Prof. Dr. Stoyan Kirkovich' AD University Multi-Profile Hospital for Active Treatment Hospital, Stara Zagora. According to Protocol No. 11, Ref. No. 12471/30.10.2015 approved are the methods used by the sociological research study which uses predefined indicators to track patients who have undergone conventional VATS and single-port VATS. Indicators: postoperative pain and satisfaction.


Assuntos
Dor Pós-Operatória/etiologia , Satisfação do Paciente , Derrame Pleural Maligno/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Medição da Dor
8.
Radiol Med ; 125(1): 24-30, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31531810

RESUMO

PURPOSE: The increasing number of computed tomography (CT) performed allows the more frequent identification of small, solid pulmonary nodules or ground-glass opacities. Video-assisted thoracic surgery (VATS) represents the standard in most lung resections. However, since VATS limit is the digital palpation of the lung parenchyma, many techniques of nodule localization were developed. The aim of this study was to determine the feasibility and safety of CT-guided microcoil insertion followed by uniportal VATS wedge resection (WR). MATERIALS AND METHODS: Retrospective study in a single institution, including patients undergone CT-guided microcoil insertion prior to uniportal VATS resection between May 2015 and December 2018. The lesion was identified using fluoroscopy. RESULTS: Forty-six consecutive patients were enrolled (22 male and 24 female). On CT: 5 cases of GGO, 2 cases of semisolid nodules, 39 cases of solid nodules. The median pathologic tumor size was 1.21 cm. Neither conversion to thoracotomy nor microcoil dislodgement was recorded. All patients underwent uniportal VATS WR (9/46 underwent completion lobectomy after frozen section). WR median time was 105 min (range 50-150 min). No patients required intraoperative re-resection for positive margins. After radiological procedure, 1 case of hematoma and 2 cases of pneumothorax were recorded. Four complications occurred in the postoperative period. The mean duration of chest drain and length of stay were 2.9 and 4.6 days, respectively. CONCLUSIONS: CT-guided microcoil insertion followed by uniportal VATS resection was a safe and feasible procedure having a minimal associated complications rate and offering surgeons the ease of localization of small intrapulmonary nodules.


Assuntos
Marcadores Fiduciais , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/cirurgia , Radiografia Intervencionista/métodos , Cirurgia Torácica Vídeoassistida , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/patologia , Duração da Cirurgia , Pneumotórax/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Adulto Jovem
9.
J Surg Res ; 246: 19-25, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31550671

RESUMO

BACKGROUND: Some surgeons have adopted the use of video-assisted thoracoscopic surgery (VATS) or robotic surgery to perform resections for lung cancer. VATS is associated with less pain and a decrease in pulmonary complications compared with open thoracotomies. Long-acting liposomal bupivacaine (LB) intercostal nerve blocks are reported to provide superior pain relief compared with epidural catheters in the first 3 d after a thoracotomy. This study examined whether LB improves pain after VATS and if it provides effective analgesia after a thoracotomy. MATERIALS AND METHODS: A retrospective review was performed on 151 consecutive patients undergoing a VATS or thoracotomy who received paravertebral nerve blocks. VATS patients received paravertebral nerve blocks with LB (VATS-LB) or 0.25% bupivacaine with epinephrine (BE; VATS-BE). Thoracotomy patients received paravertebral nerve blocks via LB injections. Pain scores, narcotic utilization, complications, and hospital length of stay were examined. RESULTS: Fifty patients underwent a VATS-LB, 53 underwent a VATS-BE, and 32 underwent a thoracotomy. Thoracotomy and VATS-LB patients had pain scores lower than VATS-BE patients in the first 48 h after surgery (P < 0.004). Opioid use was not significantly different between the thoracotomy and VATS-LB patients throughout the first 2 wk postoperatively. CONCLUSIONS: LB paravertebral blocks significantly improve postoperative pain in comparison with 0.25% BE blocks in VATS patients. LB paravertebral blocks also provide effective analgesia in patients undergoing thoracotomies.


Assuntos
Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracotomia/efeitos adversos , Idoso , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Epinefrina/administração & dosagem , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Nervos Espinhais/efeitos dos fármacos , Vértebras Torácicas/inervação , Resultado do Tratamento , Vasoconstritores/administração & dosagem
10.
Ann R Coll Surg Engl ; 102(2): e26-e28, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31418283

RESUMO

Superior mesenteric artery syndrome, a rare cause of duodenal obstruction, occasionally requires surgery. Bowel emphysema might also require surgery and might be an ominous sign of a serious condition. We report the case of a 69-year-old Japanese man with left pneumothorax who was also diagnosed as having bowel emphysema and superior mesenteric artery syndrome simultaneously without serious infection after surgery for the pneumothorax. Following gastric decompression via a nasogastric tube, his general condition resolved quickly with no need for surgical intervention. Prompt and precise diagnosis by computed tomography and both adequate judgment and treatment can avoid surgery in such cases.


Assuntos
Enfisema/etiologia , Intubação Gastrointestinal , Enfisema Pulmonar/cirurgia , Síndrome da Artéria Mesentérica Superior/etiologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Idoso , Duodeno/diagnóstico por imagem , Enfisema/diagnóstico , Enfisema/terapia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Masculino , Enfisema Pulmonar/complicações , Enfisema Pulmonar/diagnóstico por imagem , Síndrome da Artéria Mesentérica Superior/diagnóstico , Síndrome da Artéria Mesentérica Superior/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Thorac Surg Clin ; 30(1): 101-110, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761278

RESUMO

Nonintubated video-assisted thoracoscopic surgery programs have gradually spread all over the world. The benefits are based on less invasiveness and earlier recovery. However, complications may appear. For the correct prevention and management of all these potentially critical situations, the principles of crisis resource management (CRM) must be followed. They should also include clinical simulation as a tool to generate different scenarios to improve teamwork. The purpose of this special issue is to appraise and summarize the design, implementation, and efficacy of simulation-based CRM training programs for a specific surgery, including the management of specific surgical and medical critical scenarios.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Treinamento por Simulação/métodos , Cirurgia Torácica Vídeoassistida , Humanos , Gestão de Riscos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/educação , Cirurgia Torácica Vídeoassistida/métodos
12.
Thorac Surg Clin ; 30(1): 111-120, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761279

RESUMO

Nonintubated thoracic surgery arose as supplemental evolution of minimally invasive surgery and is gaining popularity. A proper nonintubated thoracic surgery unit is mandatory and should involve surgeons, anesthesiologists, intensive care physicians, physiotherapists, psychologists, and scrub and ward nurses. Surgical training should involve experienced and young surgeons. It deserves a step-by-step approach and consolidated experience on video-assisted thoracic surgery. Due to difficulty in reproducing lung and diaphragm movements, training with simulation systems may be of scant value; instead, preceptorships and invited proctorships are useful. Preoperatively, patients must be fully informed. Effective intraoperative communication with patients and among the surgical team is pivotal.


Assuntos
Equipe de Assistência ao Paciente , Preceptoria , Cirurgia Torácica Vídeoassistida , Humanos , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Preceptoria/métodos , Preceptoria/organização & administração , Cirurgia Torácica Vídeoassistida/educação , Cirurgia Torácica Vídeoassistida/métodos
13.
Thorac Surg Clin ; 30(1): 15-24, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761280

RESUMO

Nonintubated video-assisted thoracoscopic surgery for the treatment of primary and secondary pneumothorax was first reported in 1997 by Nezu. However, studies on this technique are few. Research in the past 20 years has focused on the perioperative outcomes, including the surgical duration, length of hospital stay, and postoperative morbidity and respiratory complication rates, which appear to be better than those of surgery under intubated general anesthesia. This study provides information pertaining to the physiologic, surgical, and anesthetic aspects and describes the potential benefits of nonintubated thoracoscopic surgery for the management of primary and secondary spontaneous pneumothorax.


Assuntos
Administração dos Cuidados ao Paciente/métodos , Pneumotórax/cirurgia , Complicações Pós-Operatórias , Cirurgia Torácica Vídeoassistida , Anestesia Geral/métodos , Humanos , Pneumotórax/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos
14.
Thorac Surg Clin ; 30(1): 25-32, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761281

RESUMO

Video-assisted thoracic surgery has considerably improved the care of the thoracic surgical patient. Patients are able to leave the hospital sooner and experience less pain with equal oncologic outcomes when compared with open surgery. Nonintubated thoracic surgery has more recently been applied in the management of both benign and malignant pleural effusions. This article provides the general thoracic surgeon a detailed description on how to manage pleural effusions using video-assisted thoracoscopic surgery in a nonintubated patient. Surgical techniques and pearls are also presented.


Assuntos
Administração dos Cuidados ao Paciente/métodos , Derrame Pleural , Cirurgia Torácica Vídeoassistida/métodos , Humanos , Derrame Pleural/etiologia , Derrame Pleural/cirurgia
15.
Thorac Surg Clin ; 30(1): 33-39, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761282

RESUMO

Chest infection is a health care problem in many regions of the world, and pleural empyema is the most common type of surgical chest infection. In the past decennium, the introduction of nonintubated surgery and uniportal video-assisted thoracic surgery changed considerably surgical treatment of pleural empyema. Although the advantages seem evident, the need for randomized controlled trials is necessary to confirm the usefulness. Moreover, in the future, an education and training program for thoracic surgeons and anesthesiologists would allow increasing the number of awake surgical options in caring for patients with stages II to III empyema.


Assuntos
Empiema Pleural/cirurgia , Abscesso Pulmonar/cirurgia , Administração dos Cuidados ao Paciente/métodos , Cirurgia Torácica Vídeoassistida/métodos , Humanos , Resultado do Tratamento
16.
Thorac Surg Clin ; 30(1): 41-48, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761283

RESUMO

Interstitial lung diseases are a heterogeneous group with diffuse parenchymal lung disease. Because most patients with interstitial lung diseases have impaired pulmonary function, the risks of thoracic surgery are an important issue when considering surgical lung biopsy. The nonintubated video-assisted thoracoscopic surgery lung biopsy for interstitial lung disease is a safe and feasible option in carefully selected patients with interstitial lung disease.


Assuntos
Biópsia Guiada por Imagem/métodos , Doenças Pulmonares Intersticiais/diagnóstico , Pulmão , Cirurgia Torácica Vídeoassistida/métodos , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Risco Ajustado
17.
Thorac Surg Clin ; 30(1): 49-59, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761284

RESUMO

Wedge resection in peripheral lung cancer is considered a suboptimal procedure. However, in elderly and/or frail patients it is a reliable and safer alternative. This procedure can be easily performed under nonintubated anesthesia, allowing the recruitment of patients considered otherwise marginal for a surgical treatment. Nonintubated anesthesia can reduce lung trauma, operative time, postoperative morbidity, hospital stay, and global expenses. Furthermore, nonintubated anesthesia produces less immunologic impairment and this may affect postoperative oncological long-term results. Wedge lung resection through nonintubated anesthesia can be performed for diagnosis with higher effectiveness given the similar invasiveness of computed tomography-guided biopsy.


Assuntos
Carcinoma Broncogênico , Neoplasias Pulmonares , Complicações Pós-Operatórias/prevenção & controle , Cirurgia Torácica Vídeoassistida , Idoso , Carcinoma Broncogênico/patologia , Carcinoma Broncogênico/cirurgia , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Risco Ajustado , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos
18.
Thorac Surg Clin ; 30(1): 61-72, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761285

RESUMO

Thoracic surgery has evolved into minimally invasive surgery, in terms of not only surgical approach but also less aggressive anesthesia protocols and lung-sparing resections. Nonintubated anatomic segmentectomies are challenging procedures but can be safely performed if some essentials are considered. Strict selection criteria, previous experience in minor procedures, multidisciplinary cooperation, and the 4 cornerstones (deep sedation, regional analgesia, oxygenation support and vagal blockade) should be followed. Better outcomes in postoperative recovery, including resumption of oral intake, chest tube duration, and hospital stay, and low complication and conversion rates, are encouraging but should be checked in larger multicenter prospective randomized trials.


Assuntos
Neoplasias Pulmonares , Pneumonectomia , Complicações Pós-Operatórias/prevenção & controle , Cirurgia Torácica Vídeoassistida/métodos , Humanos , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Estadiamento de Neoplasias , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Risco Ajustado
19.
Thorac Surg Clin ; 30(1): 73-82, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761286

RESUMO

Nonintubated video-assisted thoracoscopic surgery (VATS) lobectomy to treat lung cancer has gained attention in recent decades, but there is very little literature on this topic. This review aims to explore the state-of-the-art, recent progress, and future prospects of this method. Its feasibility and safety have been demonstrated, and its potential benefits are faster postoperative recovery and fewer intubation-related complications. Nonintubated VATS lobectomy is a feasible and safe alternative for lung cancer treatment. This work provides information for those who would like to start using this technique and want a more comprehensive understanding of nonintubated VATS lobectomy.


Assuntos
Neoplasias Pulmonares , Pneumonectomia , Cirurgia Torácica Vídeoassistida/métodos , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Estadiamento de Neoplasias , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Risco Ajustado
20.
Medicine (Baltimore) ; 98(49): e18282, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804370

RESUMO

RATIONALE: Fetal adenocarcinoma of the lung (FLAC) with fetal lung-like morphology is a rare entity of pulmonary adenocarcinoma. Well-differentiated fetal adenocarcinoma (WDFA) belongs to its the low-grade form, which possesses a relatively favorable prognosis. Tuberculosis (TB) is an aggressive infectious disease that has been ranked as one of the top 10 causes of death worldwide. There may be a connection between the 2 and attention should be paid to the differential diagnosis. PATIENT CONCERNS: A 28-year-old non-smoking female was admitted with signs of hemoptysis, and she had been coughing up phlegm for 5 years. The patient was previously diagnosed with TB in another hospital, and underwent an anti-TB regimen. DIAGNOSIS: The co-existence of WDFA and TB was confirmed via histopathological evaluation of postoperative samples. INTERVENTIONS: The patient was subjected to a right lower lobectomy together with a wedge resection of the right upper lobe using video-assisted thoracoscopic surgery, with systemic lymphadenectomy. OUTCOMES: The patient tolerated the surgical procedure well and underwent an uneventful postoperative course. LESSONS: To our knowledge, no previous reports exist of cases with WDFA accompanied by TB. The present case indicated that a prior diagnosis of TB might predispose to lung cancer regardless of smoking history. It is also essential to distinguish WDFA from TB because of the similarity in clinical features and sites of pathological changes. Patients with WDFA usually have a better prognosis and surgery is the preferred treatment.


Assuntos
Adenocarcinoma de Pulmão/complicações , Tuberculose Pulmonar/complicações , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/cirurgia , Adulto , Antituberculosos/uso terapêutico , Feminino , Humanos , Biópsia Guiada por Imagem , Excisão de Linfonodo , Pneumonectomia , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/tratamento farmacológico
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