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1.
Medicine (Baltimore) ; 98(39): e17089, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574808

RESUMO

To determine if there are advantages to transitioning to Da Vinci robotics by a surgeon compared to the video-assisted thoracic surgical lobectomy.A systematic electronic search of online electronic databases: PubMed, Embase, and Cochrane library updated on December 2017. Publications on comparison Da Vinci-robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for non-small cell lung cancer were collected. Meta-analysis RevMan 5.3 software (The Cochrane collaboration, Oxford, UK) was used to analyze the combined pooled HRs using fixed or random-effects models according to the heterogeneity.Fourteen retrospective cohort studies were included. No statistical difference was found between the 2 groups with respect to conversion to open, dissected lymph nodes number, hospitalization time after surgery, duration of surgery, drainage volume after surgery, prolonged air leak, and morbidity (P > .05).Da Vinci-RATS lobectomy is a feasible and safe technique and can achieve an equivalent surgical efficacy when compared with VATS. There does not seem to be a significant advantage for an established VATS lobectomy surgeon to transition to robotics based on clinical outcomes.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Torácica Vídeoassistida/métodos , Conversão para Cirurgia Aberta , Humanos , Tempo de Internação , Excisão de Linfonodo , Duração da Cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Resultado do Tratamento
2.
J Stroke Cerebrovasc Dis ; 28(9): e139-e142, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31239222

RESUMO

Postoperative cerebral embolism after left upper or lower lobectomy caused by the thrombus in the pulmonary vein stump (PVS) is a rare complication. However, it is still unclear how the cerebral embolism develop after lobectomy, and how can we prevent further embolism after thrombus removal. We present a case of a 55-year-old man without cardiovascular disease history suffering cerebral embolism 2 days after left upper lobectomy. Patient underwent endovascular thrombectomy and discharged hospital 10 days later with proper recovery. No thrombus was detected in an enhanced pulmonary CT after 1 month of aspirin intake, but the length of PVS was measured.


Assuntos
Embolia Intracraniana/etiologia , Pneumonectomia/efeitos adversos , Veias Pulmonares/cirurgia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Imagem de Difusão por Ressonância Magnética , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/cirurgia , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Pneumonectomia/métodos , Veias Pulmonares/diagnóstico por imagem , Trombectomia , Fatores de Tempo , Resultado do Tratamento
3.
J Cardiothorac Surg ; 14(1): 116, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242948

RESUMO

BACKGROUND: Completion lobectomy long after segmentectomy in the same lobe is extremely difficult because of severe adhesions around hilar structures, especially in cases involving video-assisted thoracoscopic surgery (VATS) completion lobectomy. We report and compare the surgical outcomes of patients who underwent VATS or thoracotomy completion lobectomy long after radical segmentectomy for lung cancer. METHODS: We retrospectively evaluated the surgical outcomes of completion lobectomies performed at our institute long after radical segmentectomies for lung cancer in the same lobe. The efficacy and safety of VATS completion lobectomy was compared to that of thoracotomy completion lobectomy. RESULTS: Ten of 228 patients who underwent radical segmentectomy for lung cancer between 2009 and 2018 underwent completion lobectomy at least a month after segmentectomy; five patients underwent VATS completion lobectomy. None of the patients underwent VATS left upper completion lobectomy, and conversion to thoracotomy was required in one patient. There were no significant differences between VATS and thoracotomy completion lobectomies in the median operative times (VATS 295 min, thoracotomy 339 min, p = 0.55), intraoperative blood loss volumes (VATS 350 mL, thoracotomy 500 mL, p = 0.84), intervals between initial segmentectomy and completion lobectomy (VATS 40 months, thoracotomy 48 months, p = 0.55), and number of patients with pulmonary artery injury (VATS 1, thoracotomy 2, p = 0.49). There was no operation-related mortality. CONCLUSIONS: VATS completion lobectomy long after segmentectomy for lung cancer could be performed without fatal complications unless severe adhesions are observed around each main pulmonary artery.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida , Toracotomia , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pneumonectomia/efeitos adversos , Artéria Pulmonar/lesões , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracotomia/efeitos adversos , Resultado do Tratamento
6.
BMC Surg ; 19(1): 46, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035996

RESUMO

BACKGROUND: The transthoracic thoracoscopic surgery is currently accepted as a favorable technique for bullectomy for primary spontaneous pneumothorax. Recently, uniportal subxiphoid thoracoscopic surgery has been proposed as an alternative to conventional transthoracic thoracoscopic surgery. METHODS: From November 2014 and January 2016, 127 consecutive patients who met the inclusion criteria were enrolled in this study. Among these patients, 32 were treated using subxipoid approach, whereas 95 were treated using transthoracic approach. Propensity score case-matching was performed to adjust for patient backgrounds. RESULTS: The two groups of 32 pairs were well matched for baseline and surgical characteristics. Patients who underwent subxipoid approach had a longer operation time than transthoracic approach (p = 0.004). The subgroup analysis showed that the operation time for bilateral bullectomy was similar between the groups (p = 0.986). There were no differences between the groups with respect to the hospital stay after surgery, chest drain duration, the number of the staples used for the operation, and postoperative recurrence. However, the provoked arrhythmias events during surgery were significantly higher in the subxiphoid approach group (p = 0.011). CONCLUSIONS: Although transthoracic thoracoscopic surgery for spontaneous pneumothorax is well established, uniportal subxiphoid thoracoscopic surgery may be a potentially alternative way to management of patients with spontaneous pneumothorax in selected cases, especially for bilateral surgery, but causions should be taked.


Assuntos
Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Toracoscopia/métodos , Adolescente , Adulto , Arritmias Cardíacas/etiologia , Drenagem , Feminino , Humanos , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias , Pontuação de Propensão , Recidiva , Grampeamento Cirúrgico , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracoscopia/efeitos adversos , Adulto Jovem
7.
Rev Col Bras Cir ; 46(2): e2157, 2019 May 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31141034

RESUMO

Thoracic sympathectomy has been effective in relieving hyperhidrosis in several patients, with quality of life improvement. The knowledge of the clinical picture of each patient, as well as the possible postoperative complications, are fundamental to obtain good results. Thus, we performed a review of articles from the PubMed database published between 2005 and 2019 that presented, as the main topic, thoracoscopy sympathectomy for the treatment of hyperhidrosis, with the objective of evaluating the current state of art referring to postoperative quality of life, surgical time and its complications. From this analysis, we verified the importance of the level of sympathetic ganglion chain section in relation to results. The complication, although occurring, did not reduced the postoperative level of satisfaction or patients' quality of life.


Assuntos
Hiperidrose/cirurgia , Qualidade de Vida , Simpatectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Humanos , Duração da Cirurgia , Satisfação do Paciente , Complicações Pós-Operatórias , Simpatectomia/efeitos adversos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Resultado do Tratamento
8.
Med Sci Monit ; 25: 3140-3145, 2019 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-31030206

RESUMO

BACKGROUND Regional anesthesia provides excellent analgesic effects after surgery. However, the effects of regional anesthesia on nociceptive levels during surgery under general anesthesia have not been quantitatively evaluated. To reveal the effects of thoracic paravertebral block (PVB) on nociceptive levels after skin incision during general anesthesia, we performed a retrospective cohort study in patients without serious preoperative conditions or comorbidities undergoing elective video-assisted thoracoscopic surgery (VATS). Nociceptive levels during general anesthesia were calculated using our previously determined Nociceptive Response (NR) equation, which utilizes common hemodynamic parameters. MATERIAL AND METHODS Data on 77 adult patients who underwent VATS from May 2018 to August 2018 were retrospectively obtained from our institutional database. We then performed propensity score matching between patients who received thoracic PVB (PVB group: n=29) and those who did not (Control group: n=48). The averaged values of systolic blood pressure (SBP), heart rate (HR), perfusion index (PI), bispectral index (BIS), and NR from 10 to 5 minutes before skin incision (T0), 5 to 10 minutes (T1), 10 to 15 minutes (T2), 15 to 20 minutes (T3), and 20 to 25 minutes after skin incision (T4), were calculated. RESULTS Twenty-four propensity score-matched patients in each group were analyzed. Mean NR values at T1 and T2 in the PVB group were significantly lower than those in the Control group. SBP, HR, PI, and BIS, however, showed no significant differences between the 2 groups, except for SBP at T2. CONCLUSIONS Thoracic PVB prevented an increase in NR values, which quantitatively represent nociceptive levels under general anesthesia, in patients undergoing VATS.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Procedimentos Cirúrgicos Dermatológicos/métodos , Bloqueio Nervoso/métodos , Dor Nociceptiva/prevenção & controle , Dor Pós-Operatória/prevenção & controle , Idoso , Anestesia por Condução/métodos , Anestesia Geral/métodos , Estudos de Coortes , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Monitorização Intraoperatória/métodos , Medição da Dor , Pontuação de Propensão , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos
9.
J Cardiothorac Surg ; 14(1): 71, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971282

RESUMO

BACKGROUND: Rapid rehabilitation surgery has become a widely accepted approach. Thoracic surgeons have attempted in many ways to make surgery less invasive. We combined tubeless technology, single-port technology and mediastinum approach for the treatment of simultaneous bilateral primary spontaneous pneumothorax(PSP)or pulmonary bullae. And we evaluated its therapeutic effect. This study aimed to investigate if tubeless single-port video-assisted thoracic surgery (Tubeless-SPVATS) via anterior mediastinum can be used as an alternative surgical treatment for bilateral lung diseases, especially for concurrent or contralateral recurrence PSP. METHODS: From November 2014 to December 2016, 18 patients with simultaneous bilateral PSP or pulmonary bullae were treated with tubeless -SPVATS via anterior mediastinum. They were 13 males and 5 females with an average age of 20.2 ± 2.3 years (17 to 24 years). They all had preoperative chest CT and were diagnosed with simultaneous bilateral PSP or pulmonary bullae. RESULTS: Fifteen patients underwent bilateral bullae resection with Tubeless-SPVATS via anterior mediastinum. Three patients underwent bilateral single-port video-assisted thoracic surgery. No thoracotomy was performed. No death and grade 3-4 mobidity were found. All the patients started eating 6 hours after surgery. The average operation time was 44.56±17.8min. The patients were discharged 3. 5±1.0 days postoperatively. CONCLUSIONS: Tubeless-SPVATS via anterior mediastinum is a safe and feasible treatment for patients with simultaneous bilateral PSP or pulmonary bullae. However,contralateral thoracic is not explored fully enough. And when contralateral lung bullae are located near the hilum, endoscopic linear stapler cannot be easily used to conduct suture. Thus, the recurrence rate after performing Tubeless-SPVATS may be increased compared to performing thoracotomy. However, compared to bilateral thoracic surgery, this method reduced postoperative pain. And it took significantly less time than bilateral thoracic surgery. Thus, this method has some clinic value.


Assuntos
Pneumopatias/cirurgia , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Vesícula/diagnóstico por imagem , Vesícula/cirurgia , Feminino , Humanos , Pneumopatias/diagnóstico por imagem , Masculino , Mediastino/cirurgia , Duração da Cirurgia , Dor Pós-Operatória , Pneumotórax/diagnóstico por imagem , Recidiva , Cirurgia Torácica Vídeoassistida/efeitos adversos , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
J Cardiovasc Surg (Torino) ; 60(4): 526-531, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30916521

RESUMO

BACKGROUND: Robotic lobectomies for pulmonary pathologies, such as lung cancer, have seen increased usage over the past 10 years. Previous studies have shown that robotic lung surgery is safe and can lead to improved outcomes for patients. The purpose of this study was to compare postoperative complications associated with robotic lobectomy and video-assisted thoracoscopic surgery (VATS) lobectomy using the National Inpatient Sample (NIS) database in the USA. The use of this large, nationwide database may help clarify differences in outcomes of these two operative approaches. METHODS: Patients who underwent VATS and robotic lobectomy from 2010-2013 were identified using the NIS database. A propensity score matched analysis was applied in a 1:1 ratio to minimize imbalance between preoperative comorbidities. RESULTS: Final analysis included a total of 2868 patients: 1434 were VATS and 1434 were robotic cases. Postoperatively, the rate of overall morbidity was not statistically different in the VATS versus the robotic group (39.9% vs. 43.0%, P=0.084). Specific complications that were higher in the robotic group included: rates of accidental puncture or laceration (1.8% vs. 0.8%, P=0.016), pneumonia (5.7% vs. 4.1%, P=0.048), and bleeding complications (2.4% vs. 1.1%, P=0.012). Total costs were lower for the VATS group than the robotic group ($77,940.54 vs. $102,057.07, P<0.001). CONCLUSIONS: Overall morbidity between the two groups was not statistically different. Patients that underwent robotic versus VATS lobectomy were significantly more likely to experience accidental puncture or laceration, pneumonia, and bleeding complications. Robotic surgery also incurred more cost.


Assuntos
Pneumonectomia/métodos , Procedimentos Cirúrgicos Robóticos , Cirurgia Torácica Vídeoassistida , Idoso , Feminino , Hemorragia/etiologia , Humanos , Lesão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Pneumonia/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/economia , Cirurgia Torácica Vídeoassistida/efeitos adversos
11.
Medicine (Baltimore) ; 98(10): e14646, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855453

RESUMO

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is a kind of minimally invasive surgery with the advantages of small surgical incision, less surgical bleeding, and fewer hospitalization days. However, traditional thoracotomy has advantages in lymph node dissection and radical resection of tumors and the benefits of VATS compared with thoracotomy for lung cancer are controversial. This systematic review and meta-analysis will be conducted to evaluate the advantages and disadvantages of the 2 different surgical methods. METHODS AND ANALYSIS: PubMed (Medline), Embase, Cochrane Central Register of Controlled Trials, and Google Scholar will be searched for relevant randomized controlled trials (RCTs), quasi-RCTs, and Hi-Q (high quality) prospective cohort trials published or unpublished in any language before March 1, 2019. Subgroup analysis will be performed in type of operation, tumor pathological stage, and ethnicity. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: As far as we know, this study will be the first time to compare and meta-analyze the efficacy of thoracoscopic lung cancer resection and thoracotomy. This study will provide high-quality and reliable evidence for clinicians' decision-making by comparing published or completed but unpublished trials data. Because of the characteristics of disease and intervention methods, large sample size and RCTs may be insufficient. We will carefully consider the inclusion of small sample RCTs, but this may lead to high heterogeneity and affect the reliability of research results. PROSPERO REGISTRATION NUMBER: CRD42018118427.


Assuntos
Neoplasias Pulmonares/cirurgia , Metanálise como Assunto , Revisão Sistemática como Assunto , Cirurgia Torácica Vídeoassistida , Toracotomia , Protocolos Clínicos , Humanos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/efeitos adversos , Toracotomia/métodos , Resultado do Tratamento
12.
Trials ; 20(1): 149, 2019 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-30813955

RESUMO

BACKGROUND: Although general anaesthesia (GA) with one-lung ventilation is the current standard of care, minor thoracoscopic surgery, i.e. treatment of pleural effusions, biopsies and small peripheral pulmonary wedge resections, can also be performed using local anaesthesia (LA), analgosedation and spontaneous breathing. Whilst the feasibility and safety of LA have been demonstrated, its impact on patient satisfaction remains unclear. Most studies evaluating patient satisfaction lack control groups or do not meet psychometric criteria. We report the design of the PASSAT trial (PAtientS' SATisfaction in thoracic surgery - general vs. local anaesthesia), a randomised controlled trial with a non-randomised side arm. METHODS: Patients presenting for minor thoracoscopic surgery and physical eligibility for GA and LA are randomised to surgery under GA (control group) or LA (intervention group). Those who refuse to be randomised are asked to attend the study on the basis of their own choice of anaesthesia (preference arm) and will be analysed separately. The primary endpoint is patient satisfaction according to a psychometrically validated questionnaire; secondary endpoints are complication rates, capnometry, actual costs and cost effectiveness. The study ends after inclusion of 54 patients in each of the two randomised study groups. DISCUSSION: The PASSAT study is the first randomised controlled trial to systematically assess patients' satisfaction depending on LA or GA. The study follows an interdisciplinary approach, and its results may also be applicable to other surgical disciplines. It is also the first cost study based on randomised samples. Comparison of the randomised and the non-randomised groups may contribute to satisfaction research. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00013661 . Registered on 23 March 2018.


Assuntos
Anestesia Geral , Anestesia Local , Satisfação do Paciente , Cirurgia Torácica Vídeoassistida , Anestesia Geral/efeitos adversos , Anestesia Geral/economia , Anestesia Local/efeitos adversos , Anestesia Local/economia , Análise Custo-Benefício , Custos Hospitalares , Humanos , Psicometria , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e Questionários , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/economia , Resultado do Tratamento
13.
J Laparoendosc Adv Surg Tech A ; 29(3): 415-419, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30735092

RESUMO

AIM: Thoracoscopic pulmonary lobectomy (TPL) is extremely challenging in cases where severe incomplete fissure causes densely fused pulmonary lobes (DFPL) since pulmonary arteries (PAs) are buried and completely concealed by DFPL. We describe TPL for DFPL including a technical tip to prevent pitfalls. MATERIALS AND METHODS: Four congenital pulmonary airway malformation (CPAM) and DFPL (left-upper: 2, left-lower: 1, right-middle: 1) were treated. During TPL, DFPL prevent interlobar PAs from being identified and searching for them only promotes bleeding and air leakage, serious pitfalls that affect the safety and success of TPL. Our tip is to ligate and divide the pulmonary veins (PVs) at the pulmonary hilum and the hilar PA supplying the CPAM lobe to expose the bronchus of the lobe, which is then ligated and divided. The main PA supplying the lobe running underneath the DFPL is exposed and visible from the pulmonary hilum allowing the PA supplying the lobe to be ligated and divided safely. A line demarcating the fused fissure becomes apparent, and an endoscopic stapler or EnSeal® device can be used to divide the DFPL along the line taking great care not to injure the main PA or interlobar PAs. RESULTS: There were no intra-/postoperative complications in any case. All patients performed well without respiratory tract-related symptoms after a mean follow-up of 4.6 years. CONCLUSIONS: TPL for DFPL in children with CPAM can be performed safely and successfully as a virtually bloodless procedure and without incidence of air leakage by ligating and dividing the PA after dividing the PVs and bronchus to the lobe.


Assuntos
Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Pulmão/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Pré-Escolar , Humanos , Lactente , Pulmão/patologia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Cirurgia Torácica Vídeoassistida/efeitos adversos
14.
Rev Mal Respir ; 36(2): 129-134, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30686557

RESUMO

BACKGROUND: Until now, the traditional procedure to treat intralobar pulmonary sequestration (ILS) in adults has been a lobectomy performed by open thoracotomy. We have reviewed our data to observe if the surgical management of these lesions has evolved over the last years. METHODS: We retrospectively reviewed the records of the patients who were operated for an ILS either by posterolateral thoracotomy (PLT group), or by thoracoscopy (TS group) between 2000 and 2016. RESULTS: Eighteen patients were operated for a SIL during this period. Prior to 2011, all resections were performed by thoracotomy (n=6) and after 2011 the surgical approach was either a thoracotomy (n=5) or a thoracoscopy (n=7). There was one conversion because of dense pleural adhesions and this patient was integrated in the PLT group for further analysis. ILS were more frequently encountered on the left side (n=12, 66.6 %) than on the right one (n=6, 33.3 %) and exclusively in the lower lobes. All patients of the PLT group underwent a lobectomy. In the TS group, 5 patients underwent a sublobar resection (2 segmentectomiesS9+10, 1 basilar segmentectomy and 2 atypical resections). There was no mortality. In the PLT group, 5 patients (45 %) had complications versus one patient (14 %) in the TS group. The mean hospital stay was 7.4 days in the PLT group versus 5.4 days in the TS group. CONCLUSIONS: These data confirm that ILS can be safely treated by a sublobar resection that should be performed, whenever possible, thoracoscopically.


Assuntos
Sequestro Broncopulmonar/cirurgia , Pneumonectomia/tendências , Adolescente , Adulto , Sequestro Broncopulmonar/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Pneumonectomia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Cirurgia Torácica Vídeoassistida/tendências , Toracotomia/efeitos adversos , Toracotomia/métodos , Toracotomia/estatística & dados numéricos , Toracotomia/tendências , Resultado do Tratamento , Adulto Jovem
15.
Int J Surg ; 67: 13-17, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30677529

RESUMO

BACKGROUND: Thymectomy is increasingly being performed via minimally invasive approaches. The present study aimed to assess the safety and feasibility of the subxiphoid approach to video-assisted thoracic surgery (VATS) compared with the lateral intercostal approach VATS. METHODS: Patients who underwent VATS thymectomy via subxiphoid and lateral intercostal approaches in our hospital between 2015 and 2018 were retrospectively analyzed. A series of perioperative outcomes, including clinical and surgical results, postoperative pain scores and cosmetic results, was compared in a propensity score matching analysis. RESULTS: A total of 98 patients diagnosed with non-myasthenic early-stage thymoma underwent complete thymectomy by VATS. Propensity score analysis revealed that 28 patients treated with the subxiphoid approach and 28 patients treated with the lateral intercostal approach had the same baseline characteristics. Compared with those in the lateral intercostal approach group, patients in the subxiphoidapproach group yielded lower pain scores and shorter postoperative hospital stays. Other advantages of the subxiphoid approach included decreased inflammatory cytokine response and superior cosmesis. There were no significant differences in postoperative complications between the two groups. All these patients recovered well when discharged. There were no perioperative deaths. CONCLUSIONS: Our data suggest that subxiphoid and subcostal arch thoracoscopic radical thymectomy is a less invasive procedure for the treatment of non-myasthenic early-stage thymoma and provides a satisfactory cosmetic effect. Owing to the limitation ofour retrospective study, further prospective studies are needed to evaluate long-term and oncologic outcomes of subxiphoid approach VATS thymectomy.


Assuntos
Músculos Intercostais/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Pontuação de Propensão , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Timectomia/efeitos adversos , Resultado do Tratamento , Adulto Jovem
16.
BMC Cancer ; 19(1): 8, 2019 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-30611231

RESUMO

BACKGROUND: In this retrospective study, we aimed to demonstrated that three-port single-intercostal (SIC) thoracoscopic lobectomy is an effective choice for lung cancer by comparing the perioperative outcomes of patients with non-small-cell lung cancer treated with three-port SIC and conventional multiple-intercostal (MIC) thoracoscopic lobectomy. METHODS: From January 2013 to January 2018, 642 non-small-cell lung cancer patients underwent thoracoscopic lobectomy via a three-port SIC or MIC technique. Propensity-matched analysis incorporating preoperative clinical variables was used to compare the perioperative outcomes between the two groups. RESULTS: The first 20 patients were excluded to account for the learning curve effect in the SIC group. Propensity matching yielded 186 patients in each group. A small percentage of patients had major morbidity, including 4.8% in the SIC group and 6.5% in the MIC group; there was no significant difference between the two groups. Although the total number of lymph nodes harvested (25.3 vs. 23.8, p = 0.160) and stations removed (6.5 vs. 6.7, p = 0.368) were similar between the two groups, more subcarinal lymph nodes were removed (6.9 vs. 5.2, p < 0.001) in the SIC group than in the MIC group. Furthermore, other perioperative outcomes in the SIC group were not fewer than those in the MIC group. CONCLUSIONS: Both techniques are acceptable for the treatment of non-small-cell lung cancer. Three-port SIC VATS lobectomy can provide an alternative procedure in thoracoscopic surgery.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pulmão/cirurgia , Pneumonectomia , Adulto , Idoso , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Tempo de Internação , Pulmão/patologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento
17.
Asian Cardiovasc Thorac Ann ; 27(3): 180-186, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30661376

RESUMO

BACKGROUND: Pneumothorax is a common condition with various management options. We aimed to determine the current surgical practice in the United Kingdom. METHOD: An online questionnaire regarding surgical strategy was sent to all consultants who were members of the Society for Cardiothoracic Surgery (80 thoracic). RESULTS: Fifty-six consultants, mainly thoracic, responded to the survey. Video-assisted thoracoscopic surgery was unanimously the preferred approach, the majority (59%) using 3 ports. Regarding the timing of surgery, 53 (95%) surgeons would intervene at first presentation with persistent air leak and/or lung collapse, 41 (73%) for a first bilateral pneumothorax, 22 (39%) only for recurrent pneumothorax, and 18 (32%) for the first computed tomography evidence of bullae. Apical bullectomy + pleurectomy was the preferred technique for 26 (46%) surgeons, and apical bullectomy + apical pleurectomy + pleural abrasion was the choice for 13 (23%). Some surgeons were concerned about talc and avoid it. The majority (70%) used a single apical drain with or without 24-48 h suction. Regarding chest radiography, the response was variable but 48% performed immediate postoperative and/or daily chest radiographs. Currently, most surgeons (59%) use digital drains and feel it monitors air leaks better. The perceived chronic pain (1%-3%) and recurrence rates (0%-3%) were stated by 59% and 86%, respectively. CONCLUSION: There is variability in the surgical management of pneumothorax among surgeons across the UK, but they all use video-assisted thoracoscopic surgery as the intervention of choice for pneumothorax surgery, and there is a shift towards early surgical intervention.


Assuntos
Pneumotórax/cirurgia , Padrões de Prática Médica/tendências , Cirurgiões/tendências , Cirurgia Torácica Vídeoassistida/tendências , Tempo para o Tratamento/tendências , Drenagem/tendências , Pesquisas sobre Serviços de Saúde , Disparidades em Assistência à Saúde/tendências , Humanos , Irlanda , Pleurodese/tendências , Pneumotórax/diagnóstico por imagem , Pneumotórax/fisiopatologia , Complicações Pós-Operatórias/etiologia , Recidiva , Cirurgia Torácica Vídeoassistida/efeitos adversos , Fatores de Tempo , Tomografia Computadorizada por Raios X/tendências , Resultado do Tratamento , Reino Unido
18.
Eur J Surg Oncol ; 45(5): 857-862, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30661924

RESUMO

OBJECTIVES: Vascular injuries are among the most severe causes of unplanned conversion during VATS lobectomies. The study aimed to analyse the incidence of vascular injuries and their risk factors during VATS lobectomy. METHODS: The Italian VATS lobectomy Registry was used to collect data from 66 Thoracic Surgery Units. From 2013 to October 2016 (out of more than 3,700 patients enrolled) only information from Units with an enrollment >100 VATS lobectomies were retrospectively analysed. Logistic regression analysis was performed on selected variables of the univariate analysis. RESULTS: Ten institutions contributed a total of 1,679 patients. Vascular injuries leading to conversion occurred in 44 (2.6%) patients. Years of experiences were inversely related to the risk of vascular injuries. Univariate analysis showed age, gender, surgical activity, Charlson Index Score and number of resected lymph nodes like significantly associated variables. Multivariate analysis revealed that number of resected lymph nodes, VATS experience ratio (number of VATS lobectomies/total lobectomies performed in the same year at same centre), and surgical activity of the centre were significantly associated with the risk of conversion. Unplanned thoracotomy was correlated with postoperative morbidity. CONCLUSION: Vascular injuries in VATS lobectomies represented a rare complication which could directly affect the postoperative outcomes. The predictive factors for conversion were multifactorial and depended on characteristics of centres and surgeons' seniority. Minimally invasive VATS lobectomy approaches did not influence the risk of vascular damages.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracotomia/métodos , Lesões do Sistema Vascular/epidemiologia , Idoso , Feminino , Humanos , Doença Iatrogênica , Itália , Masculino , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
19.
J Cardiothorac Surg ; 14(1): 20, 2019 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-30674336

RESUMO

BACKGROUND: To investigate the development of neogenetic bullae or blebs on 1-year postoperative chest computed tomography after video-assisted thoracic surgery (VATS) in young patients with primary spontaneous pneumothorax (PSP). METHODS: In this prospective study, 10- to 20-year-old patients with PSP were treated via VATS with additional procedures (bullectomy, cold coagulation, coverage, pleural abrasion, or chemical pleurodesis). All patients underwent the additional procedures and computed tomography of the chest 1 year postoperatively for the assessment of neogenetic bullae. Postoperative PSP recurrence was monitored, and recurrence-free survival was evaluated using Kaplan-Meier analysis. RESULTS: Fifty-seven patients (66 cases) aged 17 ± 2 years underwent VATS for PSP and were followed up for 938 ± 496 days. Of the 36 cases at 1-year follow-up, 23 (63.9%) showed neogenetic bullae, which were adjacent to the staple lines in 16 cases (69.6%). The 1- and 2-year recurrence-free survival rates were 88.9 and 85.1%, respectively. Nine of the 66 cases (13.6%) showed recurrence after 869 ± 542 days. A history of contralateral PSP was significantly associated with recurrence. CONCLUSIONS: VATS, combined with additional procedures, provides acceptable long-term results in young patients with PSP. Additional procedures reduce the recurrence rate of PSP but do not prevent the occurrence of neogenetic bullae. A history of contralateral PSP is a potential risk factor for post-VATS recurrence in young patients.


Assuntos
Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Adolescente , Adulto , Criança , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Pulmão/patologia , Pulmão/cirurgia , Masculino , Pneumotórax/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Recidiva , Fatores de Risco , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
20.
Intern Med ; 58(9): 1349-1354, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30568150

RESUMO

Cerebral embolism after left upper lobectomy caused by a thrombus in the pulmonary vein stump (PVS) is a serious complication. However, it is unclear if cerebral embolism can develop after other types of lobectomy. We present a case of a 68-year-old man with cerebral embolism after left lower lobectomy with a longer PVS than normal. There were no clinically suspected sources for the thrombus except for the PVS. This thrombus seemed to have formed in the PVS. The endovascularly removed thrombus contained scattered nuclear debris around neutrophils, suggesting a physiological response caused by tissue injury.


Assuntos
Embolia Intracraniana/etiologia , Veias Pulmonares/cirurgia , Trombose Venosa/etiologia , Adenocarcinoma/cirurgia , Idoso , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Embolia Pulmonar/complicações , Cirurgia Torácica Vídeoassistida/efeitos adversos , Fatores de Tempo
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