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1.
Khirurgiia (Mosk) ; (1): 15-21, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395507

RESUMO

OBJECTIVE: To improve the treatment of destructive tuberculosis of a single lung by using of collapse surgery. MATERIAL AND METHODS: The authors analyzed an experience of collapse surgery for destructive tuberculosis of a single lung. RESULTS: Collapse surgery was effective in 77.5% of patients. CONCLUSION: Endoscopic surgical collapse improves the outcomes in patients with destructive tuberculosis of a single lung and expands the possibilities for surgery in these patients when resection is not applicable.


Assuntos
Colapsoterapia , Pulmão/cirurgia , Tuberculose Pulmonar , Endoscopia , Humanos , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/cirurgia
3.
J Thorac Cardiovasc Surg ; 159(2): 691-702.e5, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-33003262

RESUMO

OBJECTIVE: We sought to identify whether chronic opioid users are at increased risk for complications or hospital readmission following lobectomy for non-small cell lung cancer. METHODS: The National Cancer Institute Surveillance, Epidemiology, and End Results-Medicare database was queried to identify patients older than age 65 years who received a lobectomy for non-small cell lung cancer. Chronic opioid users were identified through Medicare Part D records and were defined as those with >120 cumulative days of opioid supply for the year before surgery. A systematic 1:2 propensity matching was performed among chronic opioid users. RESULTS: Six thousand four hundred thirty-seven patients were identified, among whom 3627 (56%) were opioid naïve, 1866 (29%) were intermittent opioid users, and 944 (15%) were chronic opioid users. After propensity matching, 30-day mortality and 90-day mortality were nearly 2-fold higher among chronic opioid users compared with nonchronic users. In addition, length of stay and hospital charges were increased among chronic opioid users (median, 6 vs 7 days and mean increase, $12,526, respectively). Multivariable analysis revealed that intermittent opioid users and chronic opioid users were associated with an increased risk of 90-day hospital readmission compared with opioid-naïve patients (odds ratio, 1.35; 95% confidence interval, 1.07-1.71 and odds ratio, 1.72; 95% confidence interval, 1.40-2.12, respectively), predominantly burdened by infectious, renal, and pulmonary causes. CONCLUSIONS: Patients who chronically use opioids before lobectomy represent high-risk patients. The risk of 30- and 90-day mortality, length of stay, hospital charges, and 90-day readmission after lobectomy among chronic opioid users are substantially elevated.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Transtornos Relacionados ao Uso de Opioides/complicações , Pneumonectomia , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , Humanos , Pulmão/cirurgia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/cirurgia , Masculino , Readmissão do Paciente/estatística & dados numéricos , Pneumonectomia/efeitos adversos , Pneumonectomia/mortalidade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5252-5258, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019169

RESUMO

This paper presents results from long-term survival study where healthy swine were ablated with a novel technology designed for treating early-stage non-small cell lung cancer using an endobronchial flexible catheter.Methods - The radiofrequency ablation (RFA) system has been presented previously and consisted of an ablation catheter, radiofrequency generator, irrigation pump for infusion of hypertonic saline (HS) and a laptop. The catheter carried an occlusion balloon, a 5 mm long RF electrode, with irrigation holes, and a 1 mm long electrode for bipolar impedance measurements. The outer diameter (OD) was 1.4 mm for compatibility with current bronchoscopes, navigation systems and radial EBUS. Nine swine were treated in this study with survival times of 1, 4 and 12 weeks (N=3 at each time point). In all animals, the treatment sites consisted of one location in the upper right lung (RUL) and another one in the lower right lung (RLL). CTs were taken pre-op, immediately post-op and at every 2 weeks post treatment. Ablation times ranged from 6 to 8 min and average applied power was 68 W (range 63 - 72 W).Results - At 1-week survival, large zones of necrotic tissue were observed in all respective 6 ablations. Ablation volumes had an average diameter of 3.2 cm at RUL locations and 3.8 cm in RLLs (likely due to longer RLL ablation durations). As time progressed, the necrotic tissue was gradually replaced with fibrotic tissue. At 4-week survival, the replacement was almost complete in all respective 3 animals. As a result, ablation volumes decreased to an average diameter of 1.3 cm at RUL locations and 2.3 cm in RLLs (likely due to longer RLL ablation durations). At 12-week survival, as the replacement process continued, histopathology revealed zones of residual necrotic tissue that were further reduced in size. Ablation zones had been resorbed and contracted by fibrous scar tissue. The average volume of the treatment effect decreased to 1.1 cm (RUL) and to 1.6 cm (RLL) in equivalent diameter. There were no complications in any of the nine animals.Conclusion - In healthy swine lungs, RFA with a 1.4-mm OD, radial-EBUS-sheath-compatible, endobronchial catheter was effective and safe. This system and therapeutic approach may be considered for further evaluation in minimally invasive treatment of tumorous lung nodules.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Ablação por Cateter , Neoplasias Pulmonares , Animais , Eletrodos , Pulmão/cirurgia , Suínos
6.
Medicine (Baltimore) ; 99(30): e21368, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791745

RESUMO

Pulmonary metastasectomy is considered to be a feasible method for selected colorectal cancer (CRC) patients. This study aimed to optimize the individualized surgical strategy of pulmonary metastasectomy, especially in choice of surgery extent and systematic mediastinal lymph nodes dissection.Data of 267 CRC patients who underwent pulmonary metastasectomy from July 2011 to July 2017 in Shanghai Cancer Center Fudan University were reviewed. Recurrence-free survival (RFS), overall survival (OS) and other clinical characteristics were compared between patients who accepted different surgical strategy.A total of 93 (34.8%) patients underwent lobectomy, 162 (60.7%) wedge resection, and 12 (4.5%) segmentectomy. Mediastinal lymph nodes dissection or sampling was performed in 106 (39.7%) patients. The median follow-up phase was 32.5 months (range 7.2-104.7 months). Patients were divided into 2 groups according to the surgical extent, lobectomy group and sublobar resection group. The median RFS and OS were 46.4 and 76.5 months for patients underwent, respectively. In the patients whose tumor diameter was ≥ 1.5 cm, RFS (5-year; 44.9% vs 29.8%, log-rank P = .03; hazard ratio, 0.71; 95% CI 0.52-0.89, P = .026) was better in the lobectomy group; however, no difference was found in OS. Meanwhile, in the patients whose tumor size was <1.5 cm, no difference was observed in RFS, as well as in OS. In the patients with metastatic lesion size ≥1.5 cm, a trend towards better RFS was found in patients received lymph nodes dissection, but it did not reach statistical significance.Lobectomy has more curative significance for CRC patients with single pulmonary metastatic lesion ≥1.5 cm. Systematic mediastinal lymph nodes dissection did not improve clinical outcome for CRC patients occurred pulmonary metastasis.


Assuntos
Neoplasias Colorretais/patologia , Neoplasias Pulmonares/cirurgia , Pulmão/cirurgia , Pneumonectomia/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Neoplasias Colorretais/mortalidade , Feminino , Humanos , Pulmão/patologia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/secundário , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
Surgery ; 168(4): 743-752, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32680748

RESUMO

BACKGROUND: When pulmonary complications occur, postlobectomy patients have a higher mortality rate, increased length of stay, and higher readmission rates. Because of a lack of high-quality consolidated clinical data, it is challenging to assess and recognize at-risk thoracic patients to avoid respiratory failure and standardize outcome measures. METHODS: The National (Nationwide) Inpatient Sample for 2015 was used to establish our model. We identified 417 respiratory failure from a total of 4,062 patients who underwent pulmonary lobectomy. Risk factors for respiratory failure were identified, analyzed, and used in novel machine learning models to predict respiratory failure. RESULTS: Factors that contributed to increased odds of respiratory failure, such as preexisting chronic diseases, and intraoperative and postoperative events during hospitalization were identified. Two machine learning-based prediction models were generated and optimized by the knowledge accrued from the clinical course of postlobectomy patients. The first model, with high accuracy and specificity, is suited for performance evaluation, and the second model, with high sensitivity, is suited for clinical decision making. CONCLUSION: We identified risk factors for respiratory failure after lobectomy and introduced 2 machine learning-based techniques to predict respiratory failure for quality review and clinical decision-making settings. Such techniques can be used to not only provide targeted support but also standardize quality peer review measures.


Assuntos
Pulmão/cirurgia , Aprendizado de Máquina , Pneumonectomia/efeitos adversos , Insuficiência Respiratória/etiologia , Medição de Risco/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Fatores de Risco , Sensibilidade e Especificidade , Adulto Jovem
9.
Medicine (Baltimore) ; 99(28): e21046, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664116

RESUMO

RATIONALE: Although there have been several studies describing clinical and radiographic features about the novel coronavirus (COVID-19) infection, there is a lack of pathologic data conducted on biopsies or autopsies. PATIENT CONCERNS: A 56-year-old and a 70-year-old men with fever, cough, and respiratory fatigue were admitted to the intensive care unit and intubated for respiratory distress. DIAGNOSIS: The nasopharyngeal swab was positive for COVID-19 and the chest Computed Tomography (CT) scan showed the presence of peripheral and bilateral ground-glass opacities. INTERVENTIONS: Both patients developed pneumothoraces after intubation and was managed with chest tube. Due to persistent air leak, thoracoscopies with blebs resection and pleurectomies were performed on 23rd and 16th days from symptoms onset. OUTCOMES: The procedures were successful with no evidence of postoperative air-leak, with respiratory improvement. Pathological specimens were analyzed with evidence of diffuse alveolar septum disruption, interstitium thickness, and infiltration of inflammatory cells with diffuse endothelial dysfunction and hemorrhagic thrombosis. LESSONS: Despite well-known pulmonary damages induced by the COVID-19, the late-phase histological changes include diffused peripheral vessels endothelial hyperplasia, in toto muscular wall thickening, and intravascular hemorrhagic thrombosis.


Assuntos
Infecções por Coronavirus/patologia , Endotélio Vascular/patologia , Pulmão , Pandemias , Pleura , Pneumonia Viral/patologia , Trombose/patologia , Trombose/parasitologia , Idoso , Betacoronavirus/isolamento & purificação , Biópsia/métodos , Tubos Torácicos/efeitos adversos , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Humanos , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Masculino , Pessoa de Meia-Idade , Pleura/patologia , Pleura/cirurgia , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Pneumotórax/etiologia , Pneumotórax/terapia , Respiração Artificial/métodos , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Toracoscopia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
10.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 40(7): 1008-1012, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32701239

RESUMO

OBJECTIVE: To investigate the effect of inverse ratio ventilation (IRV) combined with positive end-expiratory pressure (PEEP) in infants undergoing thoracoscopic surgery with single lung ventilation (OLV) for lung cystadenomas. METHODS: A total of 66 infants undergoing thoracoscopic surgery with OLV for lung cystadenomas in our hospital from February, 2018 to February, 2019 were randomized into conventional ventilation groups (group N, n=33) and inverse ventilation group (group R, n=33). Hemodynamics and respiratory parameters of the infants were recorded and arterial blood gas analysis was performed at 15 min after two lung ventilation (TLV) (T1), OLV30 min (T2), OLV60 min (T3), and 15 min after recovery of TLV (T4). Bronchoalveolar lavage fluid was collected before and after surgery to detect the expression level of advanced glycation end product receptor (RAGE). RESULTS: Sixty-three infants were finally included in this study. At T2 and T3, Cdyn, PaO2 and OI in group R were significantly higher (P < 0.05) and Ppeak, PaCO2 and PA-aO2 were significantly lower than those in group N (P < 0.05). There was no significant difference in HR or MAP between the two groups at T2 and T3 (P > 0.05). The level of RAGE significantly increased after the surgery in both groups (P < 0.05), and was significantly lower in R group than in N group (P < 0.05). CONCLUSIONS: In infants undergoing thoracoscopic surgery with OLV for pulmonary cystadenoma, appropriate IRV combined with PEEP does not affect hemodynamic stability and can increases pulmonary compliance, reduce the peak pressure, and improve oxygenation to provide pulmonary protection.


Assuntos
Cistadenoma , Ventilação Monopulmonar , Respiração com Pressão Positiva , Cistadenoma/cirurgia , Humanos , Lactente , Pulmão/cirurgia , Toracoscopia , Resultado do Tratamento
11.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 40(7): 1013-1017, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32701242

RESUMO

OBJECTIVE: To investigate the effect of dexmedetomidine combined with pulmonary protective ventilation against lung injury in patients undergoing surgeries for esophageal cancer with one-lung ventilation (OLV). METHODS: Forty patients with undergoing surgery for esophageal cancer with OLV were randomly divided into pulmonary protective ventilation strategy group (F group) and dexmedetomidine combined with protective ventilation strategy group (DF group; n=20). In F group, lung protective ventilation strategy during anesthesia was adopte, and in DF group, the patients received intravenous infusion of dexmedetomidine hydrochloride (0.3 µg · kg-1 ·h-1) during the surgery starting at 10 min before anesthesia induction in addition to protective ventilation strategy. Brachial artery blood was sampled before ventilation (T0), at 30 and 90 min after the start of OLV (T1 and T2, respectively) and at the end of the surgery (T3) for analysis of superoxide dismutase (SOD), malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), arterial oxygenation pressure (PaO2), oxygenation index (OI) and lung compliance (CL). RESULTS: At the time points of T1, T2 and T3, SOD level was significantly higher and IL-6 level was significantly lower in the DF group than in F group (P < 0.05). The patients in DF group showed significantly higher PaO2, OI and CL index than those in F group at all the 3 time points. CONCLUSIONS: Dexmedetomidine combined with pulmonary protective ventilation strategy can reduce perioperative lung injury in patients undergoing surgery for esophageal cancer with OLV by suppressing inflammation and oxidative stress to improve lung function and reduce adverse effects of the surgery.


Assuntos
Dexmedetomidina , Neoplasias Esofágicas , Ventilação Monopulmonar , Analgésicos não Entorpecentes/farmacologia , Analgésicos não Entorpecentes/uso terapêutico , Dexmedetomidina/farmacologia , Dexmedetomidina/uso terapêutico , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/cirurgia , Humanos , Pulmão/efeitos dos fármacos , Pulmão/cirurgia , Estresse Oxidativo/efeitos dos fármacos , Resultado do Tratamento
12.
Thorac Surg Clin ; 30(3): 241-247, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32593357

RESUMO

Preoperative evaluation before thoracic surgery aims to separate those patients who will tolerate surgery and those who are not surgical candidates. Predicted postoperative pulmonary function testing helps make this distinction. The preoperative period represents a time for patient engagement and physical optimization to improve postoperative outcomes.


Assuntos
Pulmão/fisiologia , Cuidados Pré-Operatórios , Testes de Função Respiratória , Procedimentos Cirúrgicos Torácicos , Comorbidade , Humanos , Pulmão/cirurgia , Complicações Pós-Operatórias
13.
Thorac Surg Clin ; 30(3): 293-304, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32593362

RESUMO

Robotic thoracic surgery continues to gain momentum and is emerging as the optimal method for minimally invasive thoracic surgery. As a rapidly advancing field, continued review of the surgical and anesthetic concerns unique to robotic thoracic operations is necessary to maintain safe and efficient practice. In this review, we discuss the intraoperative concerns as they pertain to pulmonary, esophageal, and mediastinal thoracic robotic operations.


Assuntos
Anestesia/métodos , Pulmão/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Humanos , Complicações Intraoperatórias , Fístula do Sistema Respiratório/prevenção & controle , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Nódulo Pulmonar Solitário/diagnóstico por imagem
14.
Thorac Surg Clin ; 30(3): 305-314, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32593363

RESUMO

Postoperative prolonged air leaks (PALs) occur after thoracic surgery in which lung parenchyma is resected, divided, or manipulated. These air leaks can place patients at risk for intensive care unit readmissions, longer hospital length of stay, and infectious complications. Studies have been conducted to identify patients who are at risk for air leak and several methods have been examined for the prevention and treatment of PALs. A standard method of air leak prevention or treatment has not been established. This article discusses the prophylactic measures that have been studied for the prevention of PALs following lung surgery.


Assuntos
Pneumonectomia/efeitos adversos , Pneumotórax/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Humanos , Pulmão/cirurgia , Pneumonectomia/instrumentação , Pneumonectomia/métodos , Pneumotórax/etiologia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Procedimentos Cirúrgicos Torácicos/métodos
15.
J Cardiothorac Surg ; 15(1): 151, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32576201

RESUMO

BACKGROUND: The incidence of the iatrogenic foreign body retained after surgery is extremely low. Iatrogenic foreign body retained is surrounded by normal tissue, which responds to foreign matter to form inflammatory pseudotumors. Surgical sponge or swap is the most common type of foreign body. There were no reports of medical sutures remaining as foreign bodies in the lung parenchyma to form inflammatory pseudotumors. CASE PRESENTATION: A CT scan of a 50-year-old female showed an irregular soft tissue mass in the left upper lobe with rough edge and spiculation. After 20 months, the size increased from 2.8 × 1.9 cm to 3.2 × 2.2 cm. The patient underwent a ventricular septal repair surgery for congenital Fallot tetralogy 35 years ago and a left breast surgery for breast cancer. She had a family history of lung cancer. Evaluation of this mass highly suggested a lung malignant lesion. The patient underwent video-assisted thoracoscopic surgery (VATS) lobectomy and her pathology revealed an intrapulmonary inflammatory pseudotumor caused by a medical prolene suture. Based on her medical history and other reports of iatrogenic foreign bodies, we believe that this suture retained from the heart surgery 35 years ago entered the pulmonary artery, moved to the distal branch, and eventually formed an inflammatory pseudotumor in the lung parenchyma. Here we reported and analyze this rare case. CONCLUSION: We reported a rare case of inflammatory pseudotumor in the lung parenchyma caused by a medical suture, and determined it was a prolene suture retained in the body during a cardiac surgery 35 years ago. Diagnosis of this rare disease required sufficient imaging experience. Besides, appropriate surgical exploration can help with the diagnosis and treatment.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Reação a Corpo Estranho/complicações , Granuloma de Células Plasmáticas/etiologia , Pneumopatias/etiologia , Suturas/efeitos adversos , Feminino , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Reação a Corpo Estranho/diagnóstico por imagem , Reação a Corpo Estranho/cirurgia , Granuloma de Células Plasmáticas/diagnóstico por imagem , Granuloma de Células Plasmáticas/cirurgia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Pneumopatias/diagnóstico por imagem , Pneumopatias/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Cirurgia Torácica Vídeoassistida , Fatores de Tempo , Tomografia Computadorizada por Raios X
16.
Artigo em Inglês | MEDLINE | ID: mdl-32597049

RESUMO

Early-stage lung cancer is increasingly being managed by sublobar resection, which offers equivalent oncological results to lobectomy for lesions of less than 2 cm. However, isolated resection of the laterobasal segment (S9) is a difficult procedure and has rarely been reported via a uniportal video-assisted thoracoscopic (VATS) approach. The two key challenges are, first, the segmental arterial supply is deeply located in the lung parenchyma, making the dissection difficult, and second, the cuboidal shape of the lateral basilar segment hampers the identification of the intersegmental plane.


Assuntos
Adenocarcinoma de Pulmão , Neoplasias Pulmonares , Pneumonectomia , Cirurgia Torácica Vídeoassistida , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Idoso , Feminino , Humanos , Achados Incidentais , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Estadiamento de Neoplasias , Posicionamento do Paciente , Pneumonectomia/instrumentação , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/instrumentação , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento
17.
Artigo em Inglês | MEDLINE | ID: mdl-32597050

RESUMO

Uniportal VATS posterolateral segmentectomy (S9 and S10) can be an option for treatment of early-stage lung cancer or in cases of central metastases.  Lower lobe segmentectomy is challenging because the pyramidal shape of the basilar segments makes the identification of the intersegmental plane difficult, and the segmental arterial and venous supply is highly variable. Although identifying the segmental arterial branches is easier with a fissure-based technique, the ligamentum-based approach has emerged as a valid and safe alternative in cases of fused fissure.  This video tutorial illustrates the technical aspects of the uniportal VATS ligamentum-based S9+10 segmentectomy of the right lower lobe.


Assuntos
Adenocarcinoma de Pulmão , Broncoscopia/métodos , Neoplasias Pulmonares , Pulmão , Pneumonectomia , Cirurgia Torácica Vídeoassistida , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Idoso , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/instrumentação , Pneumonectomia/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Cirurgia Torácica Vídeoassistida/instrumentação , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
18.
Artigo em Inglês | MEDLINE | ID: mdl-32597051

RESUMO

Posterolateral bisegmentectomies of the lower lobe (segments 9 and 10) are challenging procedures when performed by uniportal VATS, primarily for the following reasons: first, the cuboidal shape of the basilar segments makes the identification of the intersegmental plane difficult, and second, the segmental arterial and venous supplies are deeply located and highly variable.  The fissure-based dissection, combined with the intersegmental tunneling method, emerges as the safest approach to accomplish accurate identification of the vascular pattern and radical removal of interlobar lymph nodes. The purpose of this video tutorial is to illustrate the technical aspects of the fissure-based uniportal left S9+10 segmentectomy using the intersegmental tunneling method.


Assuntos
Adenocarcinoma de Pulmão , Broncoscopia/métodos , Neoplasias Pulmonares , Pulmão , Pneumonectomia , Nódulo Pulmonar Solitário/diagnóstico , Cirurgia Torácica Vídeoassistida , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Idoso de 80 Anos ou mais , Humanos , Achados Incidentais , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirurgia , Masculino , Estadiamento de Neoplasias , Pneumonectomia/instrumentação , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/instrumentação , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
19.
Artigo em Inglês | MEDLINE | ID: mdl-32597052

RESUMO

Anatomic segmentectomy is a form of sublobar resection that can be both diagnostic and therapeutic in the context of an indeterminate pulmonary nodule, suspected metastasis, or small peripheral cancer.  This video tutorial demonstrates our technique for an apicoposterior anatomical segmentectomy performed by video-assisted thoracoscopy, using two ports, for resection of an undiagnosed pulmonary nodule. The steps performed by the surgical team are shown, and we pay particular attention to the recognition of vascular anatomy. To perform this type of sublobar resection, it is necessary to understand both the normal anatomy and the different variants.  This tutorial will provide a thorough grounding in the anatomy of the apicoposterior segment as well as demonstrating the optimal approach for this type of resection.


Assuntos
Hamartoma , Neoplasias Pulmonares , Pulmão , Metástase Neoplásica/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Pneumonectomia , Nódulo Pulmonar Solitário , Cirurgia Torácica Vídeoassistida , Diagnóstico Diferencial , Hamartoma/diagnóstico , Hamartoma/cirurgia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Pneumonectomia/instrumentação , Pneumonectomia/métodos , Nódulo Pulmonar Solitário/diagnóstico , Nódulo Pulmonar Solitário/cirurgia , Cirurgia Torácica Vídeoassistida/instrumentação , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
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