Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.734
Filtrar
1.
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
2.
Anticancer Res ; 40(3): 1587-1595, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132061

RESUMO

BACKGROUND/AIM: The purpose of this study was to evaluate the usefulness of minimally invasive esophagectomy (MIE) for stage II/III esophageal cancer (EC). PATIENTS AND METHODS: We compared surgical outcomes between MIE and open esohagectomy in EC patients with pStage II/III using the propensity scoring system. RESULTS: Fifty-seven patients were classified into the MIE group and 57 patients into the open esophagectomy (OE) group. The incidence of major complications was similar between the two groups. The 5-year OS was significantly better in the MIE group (69.0% vs. 35.5%; p=0.004) and no significant difference was observed in the 5-year recurrence-free survival (RFS, 52.2% vs. 29.2%; p=0.064). Multivariate analysis showed MIE was a prognostic factor of OS (p<0.001) and RFS (p=0.032). CONCLUSION: MIE was as safe and feasible as OE, and an independent prognostic factor for OS and RFS in patients with stage II/III EC.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Cirurgia Vídeoassistida/métodos , Idoso , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Feminino , Humanos , Masculino , Estadiamento de Neoplasias , Pontuação de Propensão , Taxa de Sobrevida , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(12): e19459, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195942

RESUMO

The competency in video-assisted thoracoscopic (VATS) lobectomy is expected to be achieved after surgeons practiced 30 to 50 cases according to previous reports. Does single port video-assisted thoracoscopic (SPVATS) lobectomy have a steeper learning curve and being harder to perform correctly, leading to long development times and high defect rates?From January, 2014 to February, 2017, 8 individual surgeons (3 were novices, 5 were pioneers in SPVATS surgery) submitted their cases chronologically to evaluate the learning curve of SPVATS lobectomy. Operating time (OT) was set as a surrogate marker for surgical competency. Postoperative outcomes and OT between the 2 groups were compared using propensity score matching (1:1 nearest neighbor). The learning curve for OT was evaluated using the cumulative sum (CUSUM) method.In the entire study cohort, a total of 356 cases were included (93 in junior consultant group [group A], 263 in senior consultant group [group B]). There were no significant differences between the 2 groups in operative time, conversion rate, postoperative complication rate, 30 and 90 days mortality rate. After propensity-score matching (86 pairs), operative time was longer in group A (214.33 ±â€Š62.18 vs 183.62 ±â€Š61.25 minutes, P = .001). Two-year overall survival rate was similar among 2 groups (P = .409). Competency was reached after junior surgeon completed 30th case of SPVATS lobectomy.SPVATS lobectomy is safe for the novice surgeon who wants to adopt this new surgical approach under well-developed training program. The learning curves for competence in SPVATS lobectomy are similar to VATS lobectomy in our series.


Assuntos
Competência Clínica , Neoplasias Pulmonares/cirurgia , Cirurgia Torácica Vídeoassistida/educação , Idoso , Perda Sanguínea Cirúrgica , Feminino , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pneumonectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Cirurgia Torácica Vídeoassistida/métodos
5.
Br J Radiol ; 93(1109): 20190571, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32017601

RESUMO

OBJECTIVE: (1) To evaluate the value of CT-guided microcoil implantation for localizing pulmonary ground-glass nodules (GGNs) before video-assisted thoracoscopic surgery (VATS). (2) To evaluate the feasibility, safety and accuracy of cephalic-caudal oblique approach for lesions difficult to access on axial images owing to overlying bony structures, large vessels or interlober fissures. METHODS: From June 2016 to March 2019, all patients with GGNs resected by VATS after marking using CT-guided microcoil implantation in China-Japan friendship hospital were enrolled and clinical and imaging data were retrospectively analyzed. According to the microcoil marked path, the GGNs were divided into cephalic-caudal oblique group (oblique group) and non-oblique group. The success rate of marking, the time required for marking and the incidence of complications between the two groups were compared. RESULTS: 258 GGNs from 215 consecutive patients were included in this study. The diameter of GGNs was 1.22 ± 0.50 cm, and the shortest distance from GGNs to the pleura was 1.56 ± 1.09 cm. All 258 GGNs were successfully resected by VATS under the guidance of implanted microcoils, and no case was converted to thoracotomy. During CT-guided microcoil implantation, cephalic- caudal oblique approach was taken in 56 GGNs (oblique group) to avoid bone, interlobar fissure and blood vessels. The time required for marking was significantly longer for oblique group compared with non-oblique group (16.6 ± 2.4 vs. 13.1 ± 1.9 min, p<0.01). No significant differences in the success rate of marking (94.6% vs 91.6%), the incidence of pneumothorax (19.6% vs 17.8%), the bleeding rate (10.7% vs 8.9%), and the hemoptysis rate (1.8% vs 1.5%) were observed between the two groups. CONCLUSION: CT-guided microcoil implantation can effectively guide VATS to resect GGNs. For GGNs difficult to access on axial images, CT-guided cephalic-caudal oblique approach is feasible, safe, and accurate. ADVANCES IN KNOWLEDGE: CT-guided microcoil implantation can effectively guide VATS to resect GGNs. The marked path with cephalic-caudal obliquity can effectively avoid bone, interlobar fissure and blood vessels, successfully mark GGNs difficult to access on axial images, while keeping the distance from the pleura to the lesion on the marked path as short as possible at the same time.


Assuntos
Neoplasias Pulmonares/cirurgia , Nódulos Pulmonares Múltiplos/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Estudos de Viabilidade , Feminino , Marcadores Fiduciais , Humanos , Masculino , Pessoa de Meia-Idade , Implantação de Prótese , Radiografia Intervencionista , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
6.
Br J Radiol ; 93(1109): 20190938, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32023087

RESUMO

OBJECTIVE: To describe our clinical experience of using combination of fluorescent iodized emulsion, indocyanine green & lipiodol, and hook-wire in pre-operative CT localization of patients with subsolid lung lesions prior to video-assisted thoracoscopic surgery (VATS). METHODS: A retrospective review between June 2018 and July 2019 of consecutive Chinese patients whom underwent VATS for subsolid lung lesions with pre-operative CT localization done with combination of fluorescent iodized emulsion and hook-wire technique in a tertiary hospital (Tuen Mun Hospital, Hong Kong SAR). The duration and complications related to the localization procedure were recorded The clinical records, operative findings and pathology reports were retrieved from the hospital electronic clinical management system. RESULTS: Combination fluorescent iodized emulsion with hook-wire enabled accurate localization and resection of all subsolid lung lesions in VATS. No major complications were reported. CONCLUSION: Combination of fluorescent iodized emulsion and hook-wire placement under CT guidance is a simple, safe and cost- effective procedure that enabled accurate localization and resection of subsolid nodule in VATS. ADVANCES IN KNOWLEDGE: VATS has been the mainstay for indeterminate pulmonary nodules for diagnostic and/or curative purpose. The main problem that surgeons may encounter during operation is the difficulty in locating the target lesion particularly for subsolid lesions. Many pre-operative localization methods have been developed in this regard. With the novel technique that we described, we were able to overcome disadvantages of most described methods.


Assuntos
Neoplasias Pulmonares/cirurgia , Nódulos Pulmonares Múltiplos/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Emulsões , Óleo Etiodado , Feminino , Corantes Fluorescentes , Humanos , Verde de Indocianina , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/patologia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Carga Tumoral
7.
Acad Emerg Med ; 27(2): 100-108, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31957174

RESUMO

OBJECTIVE: The objective was to compare first-attempt intubation success using direct laryngoscopy augmented by laryngeal manipulation, ramped patient positioning, and use of a bougie (A-DL) with unaided video laryngoscopy (VL) in adult emergency department (ED) intubations. METHODS: This study was a secondary analysis of a multicenter prospective observational database of ED intubations from the National Emergency Airway Registry (NEAR). We compared all VL procedures to seven exploratory permutations of A-DL using multivariable regression models. We further stratified by blade shape into hyperangulated VL (HA-VL) and standard-geometry VL (SG-VL). We report differences in first-attempt intubation success and peri-intubation adverse events with cluster-adjusted odds ratios (ORs) with 95% confidence intervals (CIs). We report univariate comparisons in patient characteristics, difficult airway attributes, and intubation methods using descriptive statistics and OR with 95% CI. RESULTS: We analyzed 11,714 intubations performed from January 1, 2016, through December 31, 2017. Of these encounters, 6,938 underwent orotracheal intubation with either A-DL or unaided VL on first attempt. A-DL was used first in 3,936 (56.7%, 95% CI = 46.9 to 66.5) versus unaided VL in 3,002 (43.3%, 95% CI = 33.5 to 53.1). Of the A-DL first intubations 1,787 (45.4%) employed ramped positioning alone, 1,472 (37.4%) had external laryngeal manipulation (ELM), and 365 (9.3%) used a bougie. Rapid sequence intubation (RSI) was the most common method used in 5,602 (80.8%, 95% CI = 77.0 to 84.5) cases. First-attempt success was significantly higher with all VL (90.9%, 95% CI = 88.7 to 93.1) versus all A-DL (81.1%, 95% CI = 78.7 to 83.5) despite the VL group having more patients with reduced mouth opening, neck immobility, and an initial impression of airway difficult. Multivariable regression analyses controlling for indication, method, operator specialty and year of training, center clustering, and all registry-recorded difficult airway predictors revealed first-attempt success was higher with all unaided VL compared with any A-DL (adjusted OR [AOR] = 2.8, 95% CI = 2.4 to 3.3), DL with bougie (AOR = 2.7, 95% CI = 2.1 to 3.5), DL with ELM (AOR = 1.8, 95% CI = 1.5 to 2.2), DL with ramped positioning (AOR = 2.8, 95% CI = 2.3 to 3.3), or DL with ELM plus bougie (AOR = 2.8, 95% CI = 2.3 to 3.3). Subgroup analyses of HA-VL and SG-VL compared with any A-DL yielded similar results (AOR = 3.2, 95% CI = 2.6 to 3.0; and AOR = 2.4, 95% CI = 1.9 to 3.0, respectively). The propensity score-adjusted odds for first-attempt success with VL was also 2.8 (95% CI = 2.4 to 3.3). Fewer esophageal intubations were observed in the VL cohort (0.4% vs. 1.3%, AOR = 0.2, 95% CI = 0.1 to 0.5). CONCLUSIONS: Video laryngoscopy used without any augmenting maneuver, device, or technique results in higher first-attempt success than does DL that is augmented by use of a bougie, ELM, ramping, or combinations thereof.


Assuntos
Laringoscopia/métodos , Indução e Intubação de Sequência Rápida/métodos , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Estudos de Casos e Controles , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Prospectivos , Indução e Intubação de Sequência Rápida/efeitos adversos , Indução e Intubação de Sequência Rápida/estatística & dados numéricos , Sistema de Registros
8.
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
9.
Ann Thorac Surg ; 109(3): 887-893, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31843633

RESUMO

BACKGROUND: Although drainage tube placement after thoracoscopic pulmonary resection is considered mandatory, the drainless approach after pulmonary resections may be feasible in selected patients. We aimed to determine whether a drainless approach is safe and associated with shorter hospital stay after thoracoscopic surgery for peripheral lung nodules. METHODS: This single-center, open-label, parallel-group, prospective, randomized, controlled trial enrolled patients with peripheral lung nodules treated with uniportal thoracoscopic wedge resection. After confirming the absence of air leaks and before closing the wound, patients were allocated to receive or not receive drainage using a chest tube, according to a preestablished randomization sequence provided in sealed envelopes. The primary end point was the length of postoperative hospital stay. RESULTS: Of 107 patients who agreed to participate in the study between August 2016 and September 2017, 100 were randomized to the drainage group (n = 50) or drainless group (n = 50) for intention-to-treat analysis. Patients in the drainless group had shorter postoperative hospital stay (mean, 1.2 versus 2.6 days; P < .001), shorter surgery duration (mean, 59.0 versus 73.7 minutes; P = .001), and lower pain on postoperative day 1 (mean, 0.9 versus 1.2 points; P = .011). In the drainless group, residual pneumothorax was noted in 31 patients at 6 hours (62%), in 18 patients at 1 day (36%), and in 1 patient at 10 to 14 days after surgery (2%). Medical costs were also substantially lower in the drainless group. CONCLUSIONS: Uniportal thoracoscopic wedge resection without drainage is feasible and safe for selected patients with peripheral lung nodules.


Assuntos
Neoplasias Pulmonares/cirurgia , Nódulos Pulmonares Múltiplos/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Tubos Torácicos , Feminino , Seguimentos , Humanos , Tempo de Internação/tendências , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico , Estadiamento de Neoplasias , Seleção de Pacientes , Estudos Prospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
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
11.
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
12.
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
13.
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
14.
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
15.
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
16.
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
17.
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
18.
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
19.
Zhongguo Fei Ai Za Zhi ; 22(12): 767-771, 2019 Dec 20.
Artigo em Chinês | MEDLINE | ID: mdl-31874672

RESUMO

BACKGROUND: Lung segmentectomy is increasingly used to resect lung nodules. Video-assisted thoracic surgery (VATS) is widely chosen to performing lung segmentectomy, while robotic assisted thoracoscopic (RATS) was also one useful and practical method. There article was intended to compared the short-time outcomes of RATS and VATS in lung segmentectomy. METHODS: The patients with lung nodules underwent segmentectomy by either RATS or VATS from January 2016 to April 2017 were studied. Baseline characteristics and short-time outcomes (dissected lymph nodes, postoperative duration of drainage, postoperative hospital stay, incidence of pro-longed air leak, atrial fibrillation and pneumonia) were compared. RESULTS: 166 patients were included in this study: 81 patients underwent RATS segmentectomy while 85 underwent VATS segmentectomy. The number of lymph nodes dissected in RATS group was more than in VATS group ï¼»(13.07±5.08) vs (10.81±5.74), P=0.010ï¼½. The incidence of some postoperative complications such as pro-longed air leak, atrial fibrillation was not significant different between the two approaches. CONCLUSIONS: Compared with VATS, RATS has similar safety and operability, and the number of lymphadenectomy is significantly more than that of VATS.


Assuntos
Neoplasias Pulmonares/cirurgia , Mastectomia Segmentar/métodos , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Feminino , Humanos , Tempo de Internação , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade
20.
Medicine (Baltimore) ; 98(50): e18208, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852077

RESUMO

In non-small cell lung cancer (NSCLC) patients, the recommended minimum requirement for an endoscopy-based mediastinal staging procedure is sampling the largest lymph node (LN) in right and left inferior paratracheal, and subcarinal stations. We aimed to analyze the percentage of cases where the largest LN in each mediastinal station was malignant in a cohort of NSCLC patients with mediastinal metastases diagnosed in the lymphadenectomy specimen. Furthermore, we investigated the sensitivity of a preoperative staging procedure in a hypothetical scenario where only the largest LN of each station would have been sampled.Prospective data of patients with mediastinal nodal metastases diagnosed in the lymphadenectomy specimens were retrospectively analyzed. The long-axis diameter of the maximal cut surface of all LNs was measured on hematoxylin and eosin-stained sections.Seven hundred seventy five patients underwent operation and 49 (6%) with mediastinal nodal disease were included. A total of 713 LNs were resected and 119 were involved. Sixty seven nodal stations revealed malignant LNs: in these, the largest LN was malignant in 39 (58%). In a "per patient" analysis, a preoperative staging procedure that sampled only the largest LN would have attained a sensitivity of 0.67; and if the largest and the second largest were sampled, sensitivity would be 0.87.In patients with NSCLC, nodal size ranking is not reliable enough to predict malignancy. In clinical practice, regardless of the preoperative staging method, systematic thorough sampling of all visible LNs is to be recommended over selective random samplings.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Excisão de Linfonodo/métodos , Linfonodos/patologia , Mediastinoscopia/métodos , Estadiamento de Neoplasias , Cirurgia Torácica Vídeoassistida/métodos , Carcinoma Pulmonar de Células não Pequenas/secundário , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/cirurgia , Metástase Linfática , Masculino , Mediastino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA