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1.
Medicine (Baltimore) ; 99(36): e21691, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899001

RESUMO

This retrospective study explored the efficacy and safety of dexmedetomidine in treating early postoperative cognitive dysfunction (EPPNCD) after video-assisted thoracoscopic lobectomy (VATL) in elderly male patients with lung cancer (LC).This study included a total of 80 elderly male patients with LC who received VATL. All of them were equally assigned to a treatment group and a control group, with 40 patients each group. The primary outcome included cognitive dysfunction, as evaluated by mini-mental state examination scale. The secondary outcomes consisted of incidence of EPPNCD, lung function (as measured by forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, and maximal voluntary ventilation), and adverse events. All outcome data were analyzed before and 3 days after surgery.After surgery, all patients in the treatment group exerted better efficacy in mini-mental state examination scale (P < .01) and incidence of EPPNCD (P = .03), than patients in the control group. However, no significant differences were detected in forced vital capacity (P = .65), forced expiratory volume in 1 second (P = .50), peak expiratory flow (P = .73), and maximal voluntary ventilation (P = .27) between 2 groups. In addition, there is similar safety profile between 2 groups.The findings of this study showed that dexmedetomidine may benefit EPPNCD after VATL in elderly male patients with LC. Future studies are needed to warrant the present conclusions.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Dexmedetomidina/administração & dosagem , Neoplasias Pulmonares/cirurgia , Complicações Cognitivas Pós-Operatórias/tratamento farmacológico , Cirurgia Torácica Vídeoassistida/efeitos adversos , Idoso , Analgésicos não Entorpecentes/efeitos adversos , Estudos Controlados Antes e Depois , Dexmedetomidina/efeitos adversos , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Asian Cardiovasc Thorac Ann ; 28(7): 416-420, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32854515

RESUMO

Atrial fibrillation is a common clinical arrhythmia with high morbidity and a risk of stroke. The Cox-maze IV procedure that uses radiofrequency energy for ablation is established as an effective way to eliminate atrial fibrillation. Compared to the Cox-maze IV procedure, the video-assisted Wolf mini-maze procedure is associated with reduced surgical trauma, but still requires bilateral thoracotomies, and the ablation line connecting the right and left pulmonary vein isolations cannot be created with a bipolar ablation clamp. We have developed a novel video-assisted mini-maze technique that uses a unilateral (left chest) thoracoscopic approach (the Mei mini-maze procedure).


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Veias Pulmonares/cirurgia , Cirurgia Torácica Vídeoassistida , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Frequência Cardíaca , Humanos , Veias Pulmonares/fisiopatologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Resultado do Tratamento
3.
Surgery ; 168(4): 737-742, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32641277

RESUMO

BACKGROUND: We compared the clinical outcomes and cost-efficiency of surgical approaches (sternotomy-open, video assisted thoracoscopic surgery, and robotic assisted thoracic surgery) for thymectomy. METHODS: This is a retrospective review of 220 consecutive patients who underwent thymectomy between January 1, 2007, and January 31, 2017. Surgical approach was determined by the surgeon, but we only included cases that could be resected using any of the 3 approaches. RESULTS: Open approach was used in 69 patients, whereas minimally invasive technique was used in 151 (97, video assisted thoracoscopic surgery; 54, robotic assisted thoracic surgery). Open surgery was associated with greater total hospital cost ($22,847 ± $20,061 vs $14,504 ± $10,845, P < .001). Open group also revealed longer duration of intensive care unit (1.2 ± 2.8 vs 0.2 ± 1.3 days, P < .001) and hospital stay (4.3 ± 4.0 vs 2.0 ± 2.6 days, P < .001). There were no differences in major adverse clinical outcomes. Long-term recurrence-free survival after resection of thymoma was similar between the groups. CONCLUSION: Minimally invasive techniques were equally efficacious compared with the open approach in the resection of the thymus. Additionally, their use was associated with decreased hospital duration of stay and reduced cost. Hence the use of minimally invasive approaches should be encouraged in the resection of thymus.


Assuntos
Análise Custo-Benefício , Custos Hospitalares , Timectomia/economia , Timectomia/métodos , Adulto , Pesquisa Comparativa da Efetividade , Intervalo Livre de Doença , Feminino , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/economia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/economia , Timectomia/efeitos adversos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Resultado do Tratamento
4.
Health Qual Life Outcomes ; 18(1): 237, 2020 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-32682425

RESUMO

BACKGROUND: In early-stage Non-Small Cell Lung Cancer (NSCLC) patients, little is known about how to measure patient participation in Shared-Decision Making (SDM). We examined the psychometric properties and clinical acceptability of the Decision Self-Efficacy scale (DSE) in a cohort of patients undergoing to Stereotactic Ablative Radiotherapy (SABR) or Video-assisted Thoracoscopic Surgery (VATS) to capture patient involvement in treatment decisions. METHODS: In the context of a prospective longitudinal study (Life after Lung Cancer-LiLAC) involving 244 patients with early-stage NSCLC, 158 (64.7%) patients completed the DSE either on paper or electronically online prior to treatment with SABR or VATS pulmonary resection. DSE psychometric properties were examined using: principal components analysis of item properties and internal structure, and internal construct validity; we also performed a sensitivity analysis according to Eastern Cooperative Oncology Group Performance Status (ECOG PS), gender, age and treatment received (VATS or SABR) difference. RESULTS: Exploratory factor analysis using polychoric correlations substantiated that the 11 item DSE is one scale accounting for 81% of the variance. We calculated a value of 0.96 for Cronbach's alpha for the total DSE score. DSE scores did not differ by gender (p = 0.37), between the two treatment groups (p = 0.09) and between younger and older patients (p = 0.4). However, patients with an ECOG PS > 1 have a DSE mean of 73.8 (SD 26) compared to patients with a PS 0-1 who have a DSE mean of 85.8 (SD 20.3 p = 0.002). CONCLUSION: Findings provide preliminary evidence for the reliability and validity of the DSE questionnaire in this population. However, future studies are warranted to identify the most appropriate SDM tool for clinical practice in the lung cancer treatment field.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/psicologia , Tomada de Decisão Compartilhada , Neoplasias Pulmonares/psicologia , Medidas de Resultados Relatados pelo Paciente , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/terapia , Análise Fatorial , Feminino , Humanos , Estudos Longitudinais , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Radiocirurgia/efeitos adversos , Reprodutibilidade dos Testes , Cirurgia Torácica Vídeoassistida/efeitos adversos
5.
Rev. cir. (Impr.) ; 72(3): 195-202, jun. 2020. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1115542

RESUMO

Resumen Introducción: Uno de los mayores avances de las últimas décadas en la cirugía de tórax ha sido el desarrollo de la cirugía mínimamente invasiva. Objetivos: Describir la experiencia en videotoracoscopía (VATS) Uniportal de miembros del equipo de Cirugía de Tórax de la Universidad de Chile en 2 campos clínicos, (Clínica Las Condes y Hospital Clínico de la Universidad de Chile). Materiales y Método: Se estudiaron 105 pacientes sometidos a VATS uniportal entre enero de 2016 y enero de 2019. Los datos se analizaron de manera retrospectiva considerando variables demográficas (edad, sexo) y clínicas (diagnóstico, cirugía, estadía hospitalaria, días de pleurostomía, conversión y complicaciones). Resultados: De las 105 cirugías realizadas, 28 (26,6%) correspondieron a cirugías mayores complejas lobectomías y segmentectomías anatómicas. En 4 pacientes se agregó un 2° puerto, uno se convirtió a minitoracotomía y uno a toracotomía (5,7% conversión global). La estadía hospitalaria fue en promedio 3,07 ± 3,1 días y el promedio de mantención de pleurostomía de 2,67 ± 1,61 días. Siete pacientes (6,6%) presentaron complicaciones postoperatorias. Un paciente falleció por progresión de su enfermedad, no hubo mortalidad relacionada a la cirugía. Discusión: Las contraindicaciones de la VATS uniportal son las mismas que en la VATS multipuerto. En manos experimentadas, las complicaciones en cirugía por puerto único son bajas. Impresiona tener menos dolor postoperatorio, menor estadía hospitalaria y reintegración precoz a las actividades diarias comparado con la VATS tradicional. Conclusiones: Se presenta la primera serie de VATS uniportal publicada en Chile. Los resultados obtenidos son comparables a los observados en la literatura. Su implementación y desarrollo requiere de una curva de aprendizaje similar a cualquier nueva técnica quirúrgica.


Objective: To describe the initial results with uniportal Video-Thoracoscopic Surgery (VATS) performed in two campuses by members of the Section of Thoracic Surgery of the University of Chile ("Clínica Las Condes" and University of Chile Clinical Hospital). Materials and Method: Between January 2016 and January 2019, a total of 105 patients underwent uniportal VATS. Clinical data was collected retrospectively from digital records including demographic (age, sex) and clinical variables (diagnosis, surgery, duration of the chest tube, length of stay, conversion rate and postoperative complications). Results: Uniportal VATS was performed on 105 patients during the study period. Twenty-eight cases (26.6%) corresponded to lobectomy or anatomic segmentectomy. In 4 cases a 2nd port was required, 1 patient had to be converted to mini-thoracotomy and 1 to thoracotomy (5.8% global conversion). Overall, the median length of stay was 3.07 ± 3.1 days and the median duration of chest tube drainage was 2.67 ± 1.61 days. Seven patients (6.6%) presented complications. One patient died due to progression of his disease, there were no deaths related to the procedures. Discussion: Uniportal VATS has similar indications than multiportal VATS. On experienced hands, uniportal VATS has a low morbidity rate. Uniportal VATS appears to produce less post-operative pain, with shorter hospital stay and a faster return to normal life compared to standard VATS. Conclusion: We present the first uniportal VATS series in Chile. Results were similar to published series. Implementation and development of uniportal VATS requires a learning curve similar to any new surgical procedure.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Chile , Estudos Retrospectivos , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Torácicos/métodos , Cirurgia Torácica Vídeoassistida/instrumentação
6.
J Cardiothorac Surg ; 15(1): 89, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398115

RESUMO

BACKGROUND: Compared with traditional open surgery for thymectomy, video-assisted thoracoscopic surgery (VATS) reduces hospital stay, decreases postoperative pain, and recovers faster. VATS has become increasingly popular in the past decade. VATS techniques to perform a thymectomy include subxiphoid video-assisted thoracoscopic surgery (SVATS) or lateral video-assisted thoracoscopic surgery (LVATS). In this study, our objective was to systematically review on VATS thymectomy and draw a meta-analysis on the outcomes between the two approaches. METHODS: We searched online databases and identified studies from database inception to 2019 that compared SVATS to LVATS thymectomy. Study endpoints included operative time, operative blood loss, length of hospital stay, postoperative pleural drainage, postoperative complications, conversion to open, oncologic outcomes. RESULTS: Four hundred seventy-one patients were included in this study, for which 200 and 271 patients underwent SVATS and LVATS thymectomy, respectively. Patients in the SVATS group had significantly less operative time, operative blood loss, length of hospital stay, and postoperative complications were identified. There was no statistical difference in postoperative pleural drainage, conversion to open and oncologic outcomes. No hospital deaths were recorded for either procedure. CONCLUSIONS: While randomized controlled studies are required to make definitive conclusions, this meta-analysis suggests that SVATS thymectomy is safe and can achieve good and safe operative and perioperative outcomes similar or better to LVATS thymectomy.


Assuntos
Cirurgia Torácica Vídeoassistida/métodos , Timectomia/métodos , Perda Sanguínea Cirúrgica , Humanos , Tempo de Internação , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Timectomia/efeitos adversos , Resultado do Tratamento , Processo Xifoide
7.
Ann Thorac Surg ; 110(4): 1153-1159, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32442622

RESUMO

BACKGROUND: Ultrasound guidance has resulted in a continuous evolution in techniques for pain control for video-assisted thoracoscopic surgery (VATS). The objective of this study was to compare erector spinae plane block with intercostal block as multimodal analgesia to elucidate quality of postoperative pain control and preservation of pulmonary function after VATS. METHODS: A consecutive cohort of patients undergoing elective VATS was enrolled in the study and divided into erector spinae plane block and intercostal block groups. Spirometry and visual analog scale pain score exams were performed to measure forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, and forced expiratory flow in intervals of 25% to 75%. Chronic pain was assessed by reviewing surgical follow-up notes. RESULTS: Seventy-eight patients were included. Comparing the erector spinae plane block group with the intercostal block group found significant improvement in visual analog scale pain score (3.2 vs 6.4, P < .001), postanesthesia care unit length of stay (127.3 vs 189.5 minutes, P = .045), preservation in lung volume parameters at 2 hours (FVC: 40.5% vs 51.4%, P < .001; FEV1: 40.9% vs 53.8%, P < .001; and forced expiratory flow in intervals of 25%-75%: 39.7% vs 53.7%, P = .019) and at 24 hours (FVC: 37.8% vs 50.5%, P < .001; FEV1: 34.3% vs 51.9%, P < .001; forced expiratory flow in intervals of 25%-75%: 27.1% vs 56.3%, P < .001), respectively. CONCLUSIONS: Erector spinae plane block improves acute and chronic pain control and preserves lung function. Thus, it has the potential for enhanced recovery from VATS as part of a multimodal analgesia regimen.


Assuntos
Período de Recuperação da Anestesia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/terapia , Músculos Paraespinais/inervação , Ultrassonografia/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos
9.
Medicine (Baltimore) ; 99(17): e19599, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332606

RESUMO

BACKGROUND: Epicardial radiofrequency ablation for stand-alone atrial fibrillation under total video-assisted thoracoscopy has gained popularity in recent years. However, severe cardiopulmonary disturbances during the surgery may affect cerebral perfusion and oxygenation. We therefore hypothesized that regional cerebral oxygen saturation (rSO2) would decrease significantly during the surgery. In addition, the influencing factors of rSO2 would be investigated. METHODS: A total of 60 patients scheduled for selective totally thoracoscopic ablation for stand-alone atrial fibrillation were enrolled in this prospective observational study. The rSO2 was monitored at baseline (T0), 15 min after anesthesia induction (T1), 15 minute after 1-lung ventilation (T2), after right pulmonary vein ablation (T3), after left pulmonary vein ablation (T4) and 15 minute after 2-lung ventilation (T5) using a near-infrared reflectance spectroscopy -based cerebral oximeter. Arterial blood gas was analyzed using an ABL 825 hemoximeter. Associations between rSO2 and hemodynamic or blood gas parameters were determined with univariate and multivariate linear regression analyses. RESULTS: The rSO2 decreased greatly from baseline 65.4% to 56.5% at T3 (P < .001). Univariate analyses showed that rSO2 correlated significantly with heart rate (r = -0.173, P = .186), mean arterial pressure (MAP, r = 0.306, P = .018), central venous pressure (r = 0.261, P = .044), arterial carbon dioxide tension (r = -0.336, P = .009), arterial oxygen pressure (PaO2, r = 0.522, P < .001), and base excess (BE, r = 0.316, P = .014). Multivariate linear regression analyses further showed that it correlated positively with PaO2 (ß = 0.456, P < .001), MAP (ß = 0.251, P = .020), and BE (ß = 0.332, P = .003). CONCLUSION: Totally thoracoscopic ablation for atrial fibrillation caused a significant decrease in rSO2. There were positive correlations between rSO2 and PaO2, MAP, and BE.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Circulação Cerebrovascular/fisiologia , Oxigênio/sangue , Cirurgia Torácica Vídeoassistida/métodos , Idoso , Ablação por Cateter/efeitos adversos , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Oximetria , Estudos Prospectivos , Espectroscopia de Luz Próxima ao Infravermelho , Cirurgia Torácica Vídeoassistida/efeitos adversos
10.
J Surg Res ; 253: 26-33, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32320894

RESUMO

BACKGROUND: A narrow-profile powered vascular stapler (PVS) was developed to provide superior access and precise staple placement in thoracic procedures. The objective of this study was to determine if the PVS would yield an equivalent rate of hemostatic interventions compared with standard of care (SOC) staplers in video-assisted thoracoscopic surgery lobectomy. MATERIALS AND METHODS: A randomized, controlled, multicenter study was conducted comparing PVS with SOC staplers in lobectomies performed for non-small cell lung cancer. The primary performance endpoint was the incidence of intraoperative hemostatic interventions, and the primary safety endpoint was the frequency of postoperative bleeding-related interventions. RESULTS: A total of 98 subjects participated in the SOC group and 103 in the PVS group. Rates of intraoperative hemostatic interventions were 5.3% and 8.3% for the SOC and PVS groups, respectively. These rates were not statistically different (P = 0.137), although the upper bound of the 95% confidence interval for the difference in intervention rates between PVC and SOC exceeded a predefined 3% criterion for equivalence. Simple compressions were performed more frequently in the PVS subjects, which accounted for the higher intervention rate in this group. Postoperative interventions for bleeding were required in one SOC subject (1.0%) and one subject from the PVS group (0.9%). Procedure-related adverse events occurred in 21 (21.9%) SOC subjects and 23 (21.9%) PVS subjects, with no adverse events related to use of the study devices. CONCLUSIONS: The PVS exhibited similar overall safety and effectiveness to SOC staplers in video-assisted thoracoscopic surgery lobectomy.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/instrumentação , Hemorragia Pós-Operatória/epidemiologia , Grampeamento Cirúrgico/instrumentação , Cirurgia Torácica Vídeoassistida/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Hemostasia Cirúrgica/estatística & dados numéricos , Humanos , Incidência , Cuidados Intraoperatórios/métodos , Cuidados Intraoperatórios/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pneumonectomia/efeitos adversos , Hemorragia Pós-Operatória/etiologia , Estudos Prospectivos , Padrão de Cuidado , Grampeamento Cirúrgico/efeitos adversos , Cirurgia Torácica Vídeoassistida/efeitos adversos
11.
J Card Surg ; 35(5): 1051-1056, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32293056

RESUMO

BACKGROUND: Resternotomy still carries an important risk for an already high-risk population. Re-entry injuries may lead to massive bleeding, which can be difficult to control due to poor accessibility. The aim of the study was to assess early outcomes of video-assisted thoracoscopic adhesiolysis, as well as safety and feasibility. METHODS: Forty-five patients received a video-assisted thoracoscopic adhesiolysis before resternotomy between April 1, 2016 and January 1, 2019. Records were reviewed for demographics, perioperative and early postoperative (Postop) outcomes. RESULTS: The median age of the population was 73 years with a EUROSCORE II of 8.322. Only 1 (2.22%) patient experienced a major and 2 (4.44%) a minor re-entry injury. This resulted in a mean peroperative and 24-hour Postop blood loss of, respectively, 675.72 (range: 5-2862) and 444.71 mL (range: 0-2100). There was no significant difference between the use of minimally invasive and classic extracorporeal circulation (P = .276 and P = .81, respectively). Twenty-nine patients (64%) were not in need of red blood cell transfusion. A survival rate of 93.33% could be achieved. No deaths (n = 3) were related to the video-assisted thoracoscopic adhesiolysis or re-entry injuries. Kidney function remained stale postoperatively with creatinine preoperative and Postop levels of 1.56 (95%confidence interval: 1.07-2.05) and 1.43 (95%CI, 1.05-1.81) mg/dL (P = .264). Despite high-risk surgery, the median length of stay was 8 days. CONCLUSION: A video-assisted thoracoscopic approach allows for a safe and effective adhesiolysis, due to increased visibility and accuracy. This approach may prevent major and minor re-entry injuries and consequently reduce perioperative morbidity and mortality of high-risk surgery.


Assuntos
Complicações Pós-Operatórias/cirurgia , Reoperação/efeitos adversos , Esternotomia/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Aderências Teciduais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Estudos de Viabilidade , Feminino , Humanos , Masculino , Mediastino/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Risco , Segurança , Esterno/cirurgia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Aderências Teciduais/etiologia , Resultado do Tratamento , Adulto Jovem
12.
J Thorac Cardiovasc Surg ; 160(2): 555-567.e15, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32245668

RESUMO

OBJECTIVE: The oncologic efficacy of minimally invasive thymectomy for thymoma is not well characterized. We compared short-term outcomes and overall survival between open and minimally invasive (video-assisted thoracoscopic and robotic) approaches using the National Cancer Data Base. METHODS: Perioperative outcomes and survival of patients who underwent open versus minimally invasive thymectomy for clinical stage I to III thymoma from 2010 to 2014 in the National Cancer Data Base were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis. Predictors of minimally invasive use were evaluated using multivariable logistic regression. Outcomes of surgical approach were evaluated using an intent-to-treat analysis. RESULTS: Of the 1223 thymectomies that were evaluated, 317 (26%) were performed minimally invasively (141 video-assisted thoracoscopic and 176 robotic). The minimally invasive group had a shorter median length of stay when compared with the open group (3 [2-4] days vs 4 [3-6] days, P < .001). In a propensity score-matched analysis of 185 open and 185 minimally invasive (video-assisted thoracoscopic + robotic) thymectomy, the minimally invasive group continued to have a shorter median length of stay (3 vs 4 days, P < .01) but did not have significant differences in margin positivity (P = .84), 30-day readmission (P = .28), 30-day mortality (P = .60), and 5-year survival (89.4% vs 81.6%, P = .20) when compared with the open group. CONCLUSIONS: In this national analysis, minimally invasive thymectomy was associated with shorter length of stay and was not associated with increased margin positivity, perioperative mortality, 30-day readmission rate, or reduced overall survival when compared with open thymectomy.


Assuntos
Procedimentos Cirúrgicos Robóticos , Cirurgia Torácica Vídeoassistida , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Idoso , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Readmissão do Paciente , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/mortalidade , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/mortalidade , Timectomia/efeitos adversos , Timectomia/mortalidade , Timoma/mortalidade , Timoma/patologia , Neoplasias do Timo/mortalidade , Neoplasias do Timo/patologia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
13.
Rev Mal Respir ; 37(4): 293-298, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-32273117

RESUMO

INTRODUCTION: Due to an increase in life expectancy, onco-pulmonologists and thoracic surgeons are more frequently faced with octogenarian patients with lung cancer. In this age group, treatment modalities may need to be revised because of the increasing presence of comorbidities. Surgery remains the reference treatment for early stage disease, but mortality rates and postoperative complications are higher in this group of patients. One of the solutions to reduce the operative risk would be to develop videoassisted thoracoscopic pulmonary resection surgery. The aim of this study was to evaluate the results of this form of lung cancer surgery in octogenarians. METHODS: All patients 80 years old or more who underwent videoassisted lung cancer surgery from 2014 to 2018 at Lyon University Hospital were included. Wedge resections and diagnostic procedures were excluded. RESULTS: Nineteen patients (13 men, 6 women) were included. The median age was 82 years old. All patients had undergone videoassisted lobectomy. Three patients required conversion to thoracotomy (15.8%). All patients underwent complete resection (R0). One patient had N1 lymph node involvement, all others were N0. The postoperative complication rate was 68.4%, the majority of which were grade II of the Clavien classification. Perioperative mortality was 5.3%. CONCLUSIONS: Videoassisted lung cancer resection in a selected population of octogenarians is associated with satisfactory short-term results. It is reasonable to favour minimally invasive techniques in this population, even if the proof of their superiority has not yet been firmly established.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Cirurgia Torácica Vídeoassistida , Idade de Início , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Feminino , França/epidemiologia , Mortalidade Hospitalar , Humanos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/mortalidade , Masculino , Morbidade , Mortalidade , Pneumonectomia/efeitos adversos , Pneumonectomia/mortalidade , Pneumonectomia/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/mortalidade , Cirurgia Torácica Vídeoassistida/estatística & dados numéricos , Toracotomia/efeitos adversos , Toracotomia/mortalidade , Toracotomia/estatística & dados numéricos
14.
Medicine (Baltimore) ; 99(13): e19629, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32221089

RESUMO

Acute postsurgical pain, probably including acute neuropathic pain (ANeP), starts at the early postoperative period, and chronic postsurgical pain including chronic neuropathic pain (CNeP) persists at least 3 months after surgery. Although it must be important for prevention and treatment of acute and chronic postoperative pain to reveal the time course of postoperative neuropathic characteristics, a neuropathic pain profile after surgery has not been evaluated.Pain status at the surgical site in adult patients who underwent video-assisted thoracic surgery (VATS) for lung cancer was prospectively assessed until 12 months after surgery. Neuropathic characteristics were assessed using the Douleur Neuropathique 4 (DN4) questionnaire until 6 days after surgery and the DN2 questionnaire throughout the study.Twenty-seven patients were enrolled in this study. Pain intensity at surgical sites were significantly higher at 1 and 6 days after surgery during resting state, and were also significantly higher at 3, 6, and 12 months after surgery during movement than those before surgery. The incidence of ANeP was 33.3% at 1 day, and 18.5% at 6 days after surgery. The incidence of CNeP decreased to 12.5% at 3 months, 5.0% at 6 months, and 0.0% at 12 months after surgery. The number of neuropathic characteristics, assessed by DN2 scores, significantly increased at 1 and 6 days after surgery, compared to those before surgery. DN2 scores at 3, 6, and 12 months after surgery, however, showed no significant differences compared to those before surgery.In patients with acute postsurgical pain, 20% to 30% of patients show ANeP characteristics, and the incidence of CNeP gradually decreases after VATS in patients with chronic postsurgical pain.


Assuntos
Neuralgia/etiologia , Dor Pós-Operatória/epidemiologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Dor Aguda , Idoso , Idoso de 80 Anos ou mais , Dor Crônica , Feminino , Humanos , Incidência , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Assistência Perioperatória , Estudos Prospectivos , Fatores de Risco
15.
J Laparoendosc Adv Surg Tech A ; 30(5): 508-513, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32004095

RESUMO

Objectives: The subxiphoid thoracoscopic approach may be an alternative to the lateral transthoracic approach in the treatment of thymic diseases. This study aimed to assess the safety and efficacy of subxiphoid video-assisted thoracoscopic surgery and compare this approach with the lateral transthoracic variation in terms of short-term perioperative outcomes. Methods: Data for 107 consecutive adult patients who underwent transthoracic or subxiphoid video-assisted thoracic surgery for thymic diseases from July 2015 to February 2019 were retrospectively reviewed. The patients were stratified according to whether they had accompanying myasthenia gravis (MG). Perioperative outcomes were compared between the two cohorts. Results: A total of 107 patients were identified, including 37 patients who underwent subxiphoid video-assisted thoracoscopic thymectomy (S-VATT) and 70 patients who underwent transthoracic video-assisted thoracoscopic thymectomy (T-VATT). The S-VATT group exhibited less operative blood loss (112.14 ± 117.01 versus 58.81 ± 48.67, P = .003), a shorter duration of chest tube usage (3.77 ± 1.83 versus 2.18 ± 1.88, P = .000), lower postoperative pain scores (4.99 ± 0.99 versus 1.57 ± 0.55, P = .000), and a shorter length of postoperative hospital stay (5.83 ± 1.38 versus 4.38 ± 1.26, P = .000) than the T-VATT group. For MG patients, the median operative time was significantly shorter in the S-VATT group than in the T-VATT group (141.46 ± 54.17 versus 95.63 ± 31.25, P = .004). Conclusions: S-VATT is a safe approach for patients with thymic diseases and has potential advantages of a shorter operative time, less intraoperative bleeding, and less postoperative pain compared with the lateral transthoracic approach, especially for patients with MG.


Assuntos
Cirurgia Torácica Vídeoassistida/métodos , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica , Tubos Torácicos , Drenagem , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/complicações , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Timoma/complicações , Neoplasias do Timo/complicações , Fatores de Tempo , Processo Xifoide
16.
J Pediatr Surg ; 55(3): 418-424, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32063368

RESUMO

OBJECTIVE: Several factors that could influence the efficacy and satisfaction of patients after bilateral thoracic sympathectomy (VATS) in the treatment of hyperhidrosis (HH) have been studied, but no studies in the literature have specifically analyzed the effectiveness of treatment and variations in the quality of life of adolescents patients compared to those of adult patients (18-40 years). METHODS: We retrospectively analyzed 2431 hyperhidrosis patients who underwent bilateral VATS and divided the patients into the following groups: adolescents (472 patients) and adult group (1760 patients). Variables included quality of life prior to surgery, improvement in quality of life after surgery, clinical improvement in sweating, presence of severe compensatory hyperhidrosis and general satisfaction at one month after surgery. RESULTS: We observed that all surgical patients presented with poor or very poor quality of life before surgery, with similar proportions in both groups. In the postoperative period, we observed improvement in quality of life in more than 90% of the patients, with no significant difference noted between the two groups of patients. We observed that all patients undergoing surgery presented poor or very poor quality of life before surgery; however, the two groups were statistically different. The quality of life of the ADOLESCENT group before surgery was statistically worse than that of the ADULT group. More than 90% of the patients in this series had great clinical improvement in the main hyperhidrosis site, with no significant difference between the two groups. Severe compensatory hyperhidrosis occurred in 23.8% of the patients in this series, with no significant difference between the two groups. CONCLUSIONS: Adolescent patients benefit just as much as adult patients from VATS performed to treat primary hyperhidrosis, presenting excellent, significant surgical results. TYPE OF STUDY: Clinical research. LEVELS OF EVIDENCE: Level III.


Assuntos
Hiperidrose/cirurgia , Simpatectomia , Cirurgia Torácica Vídeoassistida , Adolescente , Humanos , Satisfação do Paciente , Complicações Pós-Operatórias , Qualidade de Vida , Estudos Retrospectivos , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Simpatectomia/estatística & dados numéricos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Cirurgia Torácica Vídeoassistida/estatística & dados numéricos
17.
Interact Cardiovasc Thorac Surg ; 30(4): 573-581, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31971231

RESUMO

OBJECTIVES: There is no consensus on the risk of thrombotic events following video-assisted thoracoscopic surgery (VATS) versus open thoracotomy (OT), despite multiple studies. In fact, the estimates for the overall thrombotic risk for VATS versus OT are inconclusive. In this systematic review and meta-analysis, we endeavoured to ascertain the best estimate of thrombotic risk in VATS versus OT. METHODS: Relevant studies were searched through PubMed and Cochrane Library database. Outcomes of interests were myocardial infarction (MI), pulmonary embolism (PE) and deep vein thrombosis (DVT). Data were pooled using random-effects model. The results were presented as odds ratio (OR) with the corresponding 95% confidence interval (CI). RESULTS: Nineteen studies were meta-analysed: 17 observational studies and 2 randomized controlled trials. Using propensity-matched data, in comparison with OT, VATS was associated with a statistically significant, postoperative reduction in MI (OR 0.60, 95% CI 0.39-0.91; P = 0.017), DVT/PE (OR 0.52, 95% CI 0.44-0.61; P < 0.001), PE (OR 0.59, 95% CI 0.43-0.82; P = 0.001) and DVT (OR 0.47, 95% CI 0.35-0.64; P < 0.001). Unadjusted data showed no statistical differences for all outcomes. The risk of DVT/PE (OR 0.55, 95% CI 0.42-0.72; P < 0.001), but not the other outcomes, remained significantly lower following the exclusion of the sole large study. There is no significant statistical heterogeneity between the included studies. CONCLUSIONS: Overall, the postoperative thrombotic risk following VATS is significantly lower than OT. Further prospective randomized controlled trials with large sample sizes are warranted to corroborate our findings.


Assuntos
Neoplasias Pulmonares/cirurgia , Complicações Pós-Operatórias/epidemiologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracotomia/efeitos adversos , Trombose/epidemiologia , Saúde Global , Humanos , Incidência , Fatores de Risco
18.
J Surg Res ; 249: 13-17, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31918325

RESUMO

BACKGROUND: Preoperative anxiety is a common psychological state in cancer patients before surgery, inducing stress responses after surgery. Associations between preoperative anxiety and intraoperative nociception, however, have not been evaluated well. In the present study, we investigated the relationship in patients with lung cancer undergoing thoracic surgery. MATERIALS AND METHODS: In this prospective study, 27 adult patients were enrolled. Intraoperative nociception during surgery was calculated as mean values of the nociceptive response (NR) throughout surgery. Associations between intraoperative nociception and preoperative patient characteristics including anxiety in addition to intraoperative variables were analyzed using univariate and multivariate regression analyses. RESULTS: Multiple linear regression analysis revealed that mean NR values during surgery showed a negative correlation with preoperative anxiety (ß = -0.353; P = 0.041) after adjustment for body mass index, depression, and total amount of fentanyl used during surgery. Body mass index was a confounder positively associated with mean NR during surgery. CONCLUSIONS: Intraoperative nociception is likely associated with preoperative patient characteristics, having an inverse relationship with preoperative anxiety.


Assuntos
Ansiedade/epidemiologia , Neoplasias Pulmonares/cirurgia , Nociceptividade/fisiologia , Dor Pós-Operatória/diagnóstico , Cirurgia Torácica Vídeoassistida/psicologia , Idoso , Ansiedade/fisiopatologia , Ansiedade/psicologia , Pressão Sanguínea/fisiologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/psicologia , Período Pré-Operatório , Estudos Prospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos
19.
Semin Thorac Cardiovasc Surg ; 32(3): 416-423, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31972301

RESUMO

To describe our endoscopic aortic valve replacement (E-AVR) technique and to evaluate its early results regardless of the type of prosthetic valve implanted and the patients' characteristics. From July 2013 to September 2018, 125 patients (76 males, mean age 68.8 ± 10.9 years, mean EuroScore II 1.51 ± 1.39) underwent isolated E-AVR due to a severe stenosis in 99 cases and insufficiency in 26 cases. The surgical access was a 3-4 cm working port in the second right intercostal space with no rib-spreading and 3 additional 5 mm miniports for the introduction of a 30-degree thoracoscope, the Chitwood clamp, and the vent line. Cardiopulmonary bypass (CPB) was achieved through a femoro-femoral cannulation. All patients successfully underwent E-AVR. Stended bioprostheses were implanted in 56 cases, Rapid Deployment and Sutureless valves in 23 and 46 cases, respectively. Mean cross-clamping and CPB times were 87.5 ± 22.1 and 126.1 ± 28.4 minutes, respectively, and a significant difference between the types of prostheses was observed: 69.1 ± 15.1 and 106.2 ± 21.8 minutes (Sutureless) vs 93.2 ± 15.1 and 135.5 ± 21.8 minutes (Rapid Deployment) vs 100.6 ± 17.2 and 138.9 ± 21.9 minutes (Stented). Mean ventilation and ICU times and hospital stay were 10.9 ± 39.3 hours, 45.9 ± 58.4 hours, and 8.3 ± 9.3 days, respectively. Thirty-day mortality was 0.8%. One patient (0.8%) needed a re-exploration for bleeding and 3 patients (2.4%) required a new permanent pacemaker implantation. No major neurologic events were observed. No paravalvular leakage was detected at discharge. E-AVR is associated with low mortality and few complications. Sutureless bioprostheses significantly reduce cross-clamping and CPB times. In dedicated centers, this approach may become a valid alternative to other minimally invasive techniques.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Procedimentos Cirúrgicos sem Sutura , Cirurgia Torácica Vídeoassistida , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Bioprótese , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Desenho de Prótese , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Procedimentos Cirúrgicos sem Sutura/efeitos adversos , Procedimentos Cirúrgicos sem Sutura/instrumentação , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/instrumentação , Fatores de Tempo , Resultado do Tratamento
20.
Ann Thorac Surg ; 109(5): 1591-1597, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31953045

RESUMO

BACKGROUND: There is still controversy whether full lung palpation is required for patients undergoing pulmonary metastasectomy. We aimed to compare pulmonary ipsilateral recurrence (IR) after video-assisted thoracic surgery (VATS) or open surgery. METHODS: A retrospective study of all patients who underwent surgery for colorectal cancer lung metastases between 2003 and 2012 was performed. IR rate was compared between the 2 groups after adjusting for a propensity score matching based on age, sex, disease-free interval, number of metastases, type of resection, presence of a cardiovascular risk factor, presence of a respiratory risk factor, as well as the interaction between the number of metastases and the disease-free interval. The propensity score was used for matched and weighted comparisons of VATS and open patients. RESULTS: A total of 211 patients underwent surgery for colorectal cancer lung metastases. Of these, 75 (35.5%) were performed via VATS and 136 (64.5%) via open surgery. Before matching, 118 (55.9%) were male and the median age at the time of metastases diagnosis was 61 (range, 49.8-72.2) years. Median disease free-interval was 20 (19.7 ± 28.3) months; 22 (21.6 ± 28.5) months in VATS and 19 (19.0 ± 28.3) months in open surgery. In total, 19 (25.3%) developed IR in VATS, and 39 (28.7%) in open surgery. Five-year overall survival was 53.1% (61.9% VATS; 49.2% open). In the matched sample, IR was 23.6% in VATS vs 26.2% in open surgery (95% confidence interval for risk reduction with VATS: -22.6% to 17.5%; P = .80). CONCLUSIONS: No significant difference was observed in IR rates between VATS and open surgery in the treatment of colorectal cancer lung metastases.


Assuntos
Neoplasias Colorretais/patologia , Neoplasias Pulmonares/cirurgia , Metastasectomia/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Pneumonectomia/efeitos adversos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracotomia/efeitos adversos , Feminino , Seguimentos , Humanos , Incidência , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Masculino , Metastasectomia/métodos , Pessoa de Meia-Idade , Metástase Neoplásica , Ontário/epidemiologia , Pneumonectomia/métodos , Estudos Retrospectivos
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