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1.
J Cardiothorac Surg ; 16(1): 187, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215289

RESUMO

BACKGROUND: Open window thoracostomy (OWT) is indicated for patients with bronchopleural fistula (BPF) or trapped lung in the setting of empyema refractory to non-surgical interventions. We investigated the role of OWT in the era of minimally invasive surgeries, endobronchial valves and fibrinolytic therapy. METHODS: A retrospective chart review of all patients who underwent OWT at a single institution from 2010 to 2020 was performed. Indications for the procedure as well as operative details and morbidity and mortality were evaluated to determine patient outcomes for OWT. RESULTS: Eighteen patients were identified for the study. The most common indication for OWT was post-resectional BPF (n = 9). Prior to OWT, n = 11 patients failed other surgical or minimally invasive interventions. Patient comorbidities were quantified with the Charlson Comorbidity index (n = 11 score ≥ 5, 10-year survival ≤21%). Three (16.7%) patients died < 30 days post-operatively and 12 (66%) patients were deceased by the study's end (overall survival 24.0 ± 32.2 months). Mean number of ribs resected were 2.5 ± 1.2 (range 1-6) with one patient having 6 ribs removed. Patients were managed with negative pressure wound therapy (n = 9) or Kerlix packing (n = 9). Eleven patients (61.6%) underwent delayed closure (mean time from index surgery to closure 4.8 ± 6.7 months). CONCLUSIONS: Our study illustrates the significant comorbidities of patients undergoing OWT, the poor outcomes therein, and pitfalls associated with this procedure. We show that negative pressure wound therapy can be utilized as potential way to obliterate the pleural space and manage an open chest in the absence of an airleak; however, OWT procedures continue to be extremely morbid.


Assuntos
Fístula Brônquica/cirurgia , Empiema Pleural/cirurgia , Toracostomia , Adulto , Idoso , Fístula Brônquica/complicações , Comorbidade , Empiema Pleural/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Tratamento de Ferimentos com Pressão Negativa , Pneumonectomia/efeitos adversos , Reoperação , Estudos Retrospectivos , Costelas/cirurgia , Taxa de Sobrevida , Toracostomia/efeitos adversos , Toracostomia/métodos , Toracotomia/efeitos adversos , Terapia Trombolítica , Resultado do Tratamento
2.
PLoS One ; 16(7): e0254093, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34234358

RESUMO

BACKGROUND: Thoracotomy is an invasive surgical procedure that produces intense postoperative pain. Electroacupuncture has been used to induce analgesia in various situations, including after surgery. The aim of the following systematic review and meta-analysis was to evaluate the effect of electroacupuncture on post-thoracotomy pain. METHODS: The studies for the systematic review were searched using the following 9 databases: PubMed, Cochrane Library, EMBASE, MEDLINE Complete, Google Scholar, China National Knowledge Infrastructure (CNKI), Korean Medical Database (KMBASE), Koreanstudies Information Service System (KISS), and OASIS, without language restriction. Randomized controlled trials (RCTs) that met the inclusion criteria were selected. The quality assessment was performed using the Cochrane risk-of-bias tool, and RevMan 5.3 was used for meta-analysis. The review protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42019142157. RESULTS: Eleven randomized controlled trials were included in the systematic review. The meta-analysis was performed for two outcome measures: pain score 24 hours after surgery and total dose of opioid analgesics. A subgroup analysis was performed according to the control group: sham acupuncture and conventional analgesia group. Pain score 24 hours after surgery of electroacupuncture group showed a standard mean difference of -0.98 (95% CI: -1.62 to -0.35) compared to sham acupuncture. The standard mean difference was -0.94 (95% CI: -1.33 to -0.55) compared to conventional analgesia. The total dose of opioid analgesics of electroacupuncture group showed a standard mean difference values of -0.95 (95% CI: -1.42 to -0.47) compared to sham acupuncture. The standard mean difference was -1.96 (95% CI: -2.82 to -1.10) compared to conventional analgesia. CONCLUSION: Current evidence suggests that electroacupuncture might provide useful pain relieving effect on post-thoracotomy patients. However, due to low quality and high heterogeneity of existing data, further rigorously designed studies should be performed to confirm the safety and efficacy.


Assuntos
Eletroacupuntura , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/terapia , Toracotomia/efeitos adversos , Analgésicos Opioides/uso terapêutico , Humanos , Avaliação de Resultados em Cuidados de Saúde , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco
3.
J Cardiothorac Surg ; 16(1): 182, 2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167559

RESUMO

BACKGROUND: The timing for heart surgery following cerebral embolization after cardiac valve vegetation is vital to postoperative recovery being uneventful, additionally Covid-19 may negatively affect the outcome. Minimally invasive methods and upgraded surgical instruments maximize the benefits of surgery also in complex cardiac revision cases with substantial perioperative risk. CASE PRESENTATION: A 68 y.o. patient, 10 years after previous sternotomy for OPCAB was referred to cardiac surgery on the 10th postoperative day after neurosurgical intervention for intracerebral bleeding with suspected mitral valve endocarditis. Mitral valve vegetation, tricuspid valve insufficiency and coronary stenosis were diagnosed and treated by minimally invasive revision cardiac surgery on the 14th postoperative day after neurosurgery. CONCLUSION: The present clinical case demonstrates for the first time that the minimally invasive approach via right anterior mini-thoracotomy can be safely used for concomitant complex mitral valve reconstruction, tricuspid valve repair and aorto-coronary bypass surgery, even as a revision procedure in the presence of florid endocarditis after recent neurosurgical intervention. The Covid-19 pandemic and prophylactic patient isolation slow down the efficacy of pulmonary weaning and mobilisation and prolong the need for ICU treatment, without adversely affecting long-term outcome.


Assuntos
Ponte de Artéria Coronária/métodos , Estenose Coronária/cirurgia , Endocardite/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Cirurgia Vídeoassistida/métodos , Idoso , COVID-19/epidemiologia , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/instrumentação , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Pandemias , Complicações Pós-Operatórias , Reoperação , SARS-CoV-2 , Toracotomia/efeitos adversos , Toracotomia/instrumentação , Toracotomia/métodos , Cirurgia Vídeoassistida/efeitos adversos
5.
Artigo em Inglês | MEDLINE | ID: mdl-34019747

RESUMO

A vertical right axillary thoracotomy is a favorable alternative to a median sternotomy for surgical correction of common congenital heart defects in patients of all ages. The right-sided heart structures can be approached through a 4- to 5-cm vertical incision in the midaxillary line. In contrast to a midline sternotomy, osseous thoracic structures can be preserved through a muscle-sparing approach simply by retracting the ribs. Consequently, recovery is usually faster, and the resulting scar is completely hidden under the resting arm. In addition, there is no need for special equipment. The entire operation can be performed with established techniques. Operative outcome and long-term results have been shown by several research groups to be comparable to those obtained with a median sternotomy. This tutorial demonstrates the stepwise performance of an axillary thoracotomy and the extracorporeal circulation setup by the example of the closure of an atrial septal defect.


Assuntos
Comunicação Interatrial/cirurgia , Toracotomia/métodos , Adulto , Axila/cirurgia , Criança , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Esternotomia/efeitos adversos , Toracotomia/efeitos adversos , Resultado do Tratamento
6.
J Cardiothorac Surg ; 16(1): 142, 2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34030698

RESUMO

BACKGROUND: Recently adopted mini-thoracotomy approach for surgical aortic valve replacement has shown benefits such as reduced pain and shorter recovery, compared to more conventional mini-sternotomy access. However, whether limited exposure of the heart and ascending aorta resulting from an incision in the second intercostal space may lead to increased intraoperative cerebral embolization and more prominent postoperative neurologic decline, remains inconclusive. The aim of our study was to assess potential neurological complications after two different minimal invasive surgical techniques for aortic valve replacement by measuring cerebral microembolic signal during surgery and by follow-up cognitive evaluation. METHODS: Trans-cranial Doppler was used for microembolic signal detection during aortic valve replacement performed via mini-sternotomy and mini-thoracotomy. Patients were evaluated using Addenbrooke's Cognitive Examination Revised Test before and 30 days after surgical procedure. RESULTS: A total of 60 patients were recruited in the study. In 52 patients, transcranial Doppler was feasible. Of those, 25 underwent mini-sternotomy and 27 had mini-thoracotomy. There were no differences between groups with respect to sex, NYHA class distribution, Euroscore II or aortic valve area. Patients in mini-sternotomy group were younger (60.8 ± 14.4 vs.72 ± 5.84, p = 0.003), heavier (85.2 ± 12.4 vs.72.5 ± 12.9, p = 0.002) and had higher body surface area (1.98 ± 0.167 vs. 1.83 ± 0.178, p = 0.006). Surgery duration was longer in mini-sternotomy group compared to mini-thoracotomy (158 ± 24 vs. 134 ± 30 min, p < 0.001, respectively). There were no differences between groups in microembolic load, length of ICU or total hospital stay. Total microembolic signals count was correlated with cardiopulmonary bypass duration (5.64, 95%CI 0.677-10.60, p = 0.027). Addenbrooke's Cognitive Examination Revised Test score decreased equivalently in both groups (p = 0.630) (MS: 85.2 ± 9.6 vs. 82.9 ± 11.4, p = 0.012; MT: 85.2 ± 9.6 vs. 81.3 ± 8.8, p = 0.001). CONCLUSION: There is no difference in microembolic load between the groups. Total intraoperative microembolic signals count was associated with cardiopulmonary bypass duration. Age, but not micorembolic signals load, was associated with postoperative neurologic decline. TRIAL REGISTRY NUMBER: clinicaltrials.gov , NCT02697786 14.


Assuntos
Disfunção Cognitiva/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Embolia Intracraniana/etiologia , Esternotomia/efeitos adversos , Toracotomia/efeitos adversos , Fatores Etários , Idoso , Valva Aórtica/cirurgia , Ponte Cardiopulmonar/efeitos adversos , Estudos de Coortes , Estudos Transversais , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Embolia Intracraniana/diagnóstico por imagem , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Prospectivos , Esternotomia/métodos , Toracotomia/métodos , Fatores de Tempo , Ultrassonografia Doppler
7.
A A Pract ; 15(5): e01469, 2021 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-33999865

RESUMO

Thoracotomies are classified as moderate to high-risk surgeries due to the preponderance of complex anatomic structures, cardiac dysrhythmias, and respiratory insufficiency. The right vagus nerve innervates the sinoatrial node and controls the heart rate. The parasympathetic activation of the sinoatrial node can lead to bradyarrhythmias. The anatomic aortopulmonary window contains lymph nodes and the left vagus nerve. The occurrence of sudden asystole due to left vagus nerve stimulation is extremely rare. We report an unusual case of intraoperative asystole related to electrosurgical stimulation of the left vagus nerve that required cardiopulmonary resuscitation and cardiac massage.


Assuntos
Parada Cardíaca , Toracotomia , Bradicardia/etiologia , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Frequência Cardíaca , Humanos , Toracotomia/efeitos adversos , Nervo Vago
8.
Int J Artif Organs ; 44(12): 972-979, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33971762

RESUMO

BACKGROUND: We analyzed patients with left ventricular assist device (LVAD) related and specific infection, and aimed to determine whether surgical technique implantation affect the frequency of infection. METHODS: We retrospectively analyzed the data of 99 patients who received LVAD at our department between June 2013 and June 2019. Patients were divided into two groups according to the surgical technique. Group A (n = 58) was conventional sternotomy (CS) and group B (n = 41) was on-pump minimally invasive left thoracotomy (MILT). Demographics, preoperative risk factors, LVAD infections, surgical incision site, driveline site, and outcomes were compared between these two groups. RESULTS: Mean follow up time was 589 ± 480 (31-2171) days. Infection was detected in 34% (41/99) of LVAD patients. Admission to emergency department and intensive care unit (ICU) in last 6 months were significantly higher in MILT group. There was no difference between the two groups in terms of driveline exit site infection (CS: 28%, MILT: 27%) (p > 0.05). Seven (17%) patients had infection in the thoracotomy incision site area in the MILT group. The rate of ICU hospitalization in the last 6 months was seen as the only independent risk factor increasing the frequency of infection (R = 0.30; p = 0.016). Survival analysis at 60 days, 1 year and 2 years showed no difference between the two groups (p = 0.09). CONCLUSIONS: Despite advances in pump technology and surgical technique, infection is still an important cause of mortality and morbidity.


Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Procedimentos Cirúrgicos Minimamente Invasivos , Infecções Relacionadas à Prótese/epidemiologia , Insuficiência Cardíaca/cirurgia , Humanos , Infecções Relacionadas à Prótese/prevenção & controle , Estudos Retrospectivos , Esternotomia/efeitos adversos , Toracotomia/efeitos adversos
9.
Niger J Clin Pract ; 24(5): 651-659, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34018973

RESUMO

Objectives: We aimed to evaluate the efficacy of continuous local anesthetic infusion to the incision site with the On-Q elastomeric pump system in postoperative acute pain control after thoracotomy. Methods: A retrospective comparative analysis of of sixty patients who underwent thoracotomy for lung cancer by the same surgical team was performed between January 2016 and December 2017. The patients were divided into two groups according to postoperative pain management, those who were traditionally received tramadolol (15 mg/h) by intravenous continuous infusion (Group IVT, n = 30) and those who were administered continuous local anesthetic (0.5% bupivacaine, 4 ml/h) infusion to the incision site through an elastomeric pump in addition to the traditional treatment (Group LA, n = 30). The primary outcomes were postoperative acute pain scores on the numeric rating scale and postoperative rescue opioid consumption for 72 hours following surgery reported as pethidine equivalents. The secondary outcomes were frequency of analgesia related adverse events/complications, ICU and hospital stay, drug and total hospital cost. Results: The mean pain scores at 2, 12, 24, 48 and 72th hours at rest and during coughing were found to be significantly lower in group LA (p < 0.05). Rescue opioid consumption on postoperative 0, 1, 2 and 3rd days and in total was found to be significantly lower in Group LA (p < 0.05). In Group LA, postoperative length of hospital stay was significantly shorter (5.8 ± 2.1 days vs. 8.0 ± 3.1 days; p = 0.034), drug costs (95.24 vs. 160.08 Euro; p = 0.023) and total hospital costs were lower (434.26 vs. 685.75 Euro; p = 0.014) than Group IVT. Conclusions: We believe that continuous local anesthetic infusion to the incision site in addition to systemic analgesic treatment for multimodal acute pain management after thoracotomy is an effective and safe method.


Assuntos
Dor Aguda , Toracotomia , Dor Aguda/tratamento farmacológico , Dor Aguda/etiologia , Analgésicos Opioides , Anestésicos Locais , Bupivacaína , Humanos , Manejo da Dor , Dor Pós-Operatória/tratamento farmacológico , Estudos Retrospectivos , Toracotomia/efeitos adversos
10.
Artigo em Inglês | MEDLINE | ID: mdl-33914420

RESUMO

Minimally invasive esophagectomy is increasingly becoming the surgical treatment of choice for esophageal cancer. The goal of this technique is to reduce the rate of respiratory complications associated with thoracotomy while taking advantage of the benefits of reduced mortality associated with minimally invasive techniques. However, minimally invasive esophagectomy is still not considered the gold standard for resectable esophageal cancer worldwide because it is a highly technical and complex procedure. The goal of this video tutorial is to present an easy step-by-step approach to a  minimally invasive esophagectomy and to address technical considerations and potential pitfalls.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias , Adenocarcinoma/patologia , Idoso de 80 Anos ou mais , Neoplasias Esofágicas/patologia , Esofagectomia/efeitos adversos , Esofagectomia/métodos , Esofagectomia/mortalidade , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Toracotomia/efeitos adversos
11.
BMC Pulm Med ; 21(1): 82, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33706735

RESUMO

PURPOSE: The purpose of this study is to evaluate the potential advantages of thoracoscopic versus open resection for symptomatic congenital pulmonary airway malformation (CPAM) in neonates. METHODS: A retrospective review of the medical records of neonates (age ≤ 28 days) who underwent surgery for symptomatic CPAM from 2010 to 2020. RESULTS: Of the 24 patients, 14 patients underwent thoracoscopic resection and 10 patients underwent open resection. 4 patients with CPAM located in the upper or middle lobes underwent lobectomy, and 20 underwent lung-preserving wedge resection in the lower lobe. Between the two groups, there were no statistically significant differences in related preoperative variables, including gestational age at birth, body weight, head circumference, lesion size, cystic adenomatoid malformation volume ratio (CVR), and age at operation (P > .05). The differences in intraoperative variables were statistically significant. The length of the surgical incision was significantly shorter in thoracoscopic resection group than in open resection group (1.4 cm [1.3-1.8] vs. 6.0 cm [5.0-8.0], P = .000), along with significantly less operative blood loss (3 ml [1-6] vs. 5 ml [2-10], P = .030) but significantly longer operation time (159 min [100-220] vs. 110 min [70-170], P = .003). Regarding postoperative variables, ventilator days, duration of chest tube use and length of hospital stay were not statistically significant (P > .05). CONCLUSION: Both thoracoscopic and open resection for symptomatic CPAM achieve good clinical outcomes, even in neonates. Thoracoscopic resection has minimal aesthetic effects and does not increase the risk of surgical or postoperative complications. Lung-preserving resection may be feasible for neonatal CPAM surgery.


Assuntos
Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Tempo de Internação/estatística & dados numéricos , Toracoscopia/métodos , Toracotomia/métodos , Perda Sanguínea Cirúrgica , Feminino , Humanos , Recém-Nascido , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Toracoscopia/efeitos adversos , Toracotomia/efeitos adversos , Resultado do Tratamento
12.
Minerva Surg ; 76(1): 80-89, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33754591

RESUMO

BACKGROUND: Thoracotomy, video-assisted thoracoscopic surgery (VATS) and robotic assisted thoracoscopic surgery (RATS)-lobectomy are widely accepted procedures for the surgical treatment of clinical (c)stage I non- small cell lung cancer (NSCLC). In the current literature which procedure gives more benefits is still debated. We present a comparison between these three procedures in term of advantages and postoperative outcomes. METHODS: A multicentric study about 259 lobectomies from 2013 to 2019: 128 patients underwent TL, 96 VATS and 35 RATS. Different variables were retrospectively analyzed among these three cohorts of patients with diagnosis of cStage I NSCLC. RESULTS: Rate of major complications comparable in VATS, RATS and TL; Advantages for RATS in minor complications (TL 34.4% vs. VATS 18.75% vs. RATS 8.57%. P=0.0015), postoperative days in Intensive Care Unit, days to chest tube removal, length of postoperative hospitalization (P<0.0001) and number of lymph nodes dissected (P=0.0257). Operating times are shorter in VATS than RATS (P<0.05). Pain (NRS Scale) is comparable. CONCLUSIONS: TL remains the conventional approach for stage II-IIIA(N2) NSCLC. RATS showed great advantages, but its higher operating time and costs, mostly, today don't justify its adoption as gold standard for the surgical treatment of cStage I NSCLC, instead of VATS.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Procedimentos Cirúrgicos Robóticos , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Tempo de Internação , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo , Pneumonectomia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Toracotomia/efeitos adversos
13.
Anesth Analg ; 133(1): 176-186, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33721874

RESUMO

BACKGROUND: The association between cerebral desaturation and postoperative delirium in thoracotomy with one-lung ventilation (OLV) has not been specifically studied. METHODS: A prospective observational study performed in thoracic surgical patients. Cerebral tissue oxygen saturation (Scto2) was monitored on the left and right foreheads using a near-infrared spectroscopy oximeter. Baseline Scto2 was measured with patients awake and breathing room air. The minimum Scto2 was the lowest measurement at any time during surgery. Cerebral desaturation and hypersaturation were an episode of Scto2 below and above a given threshold for ≥15 seconds during surgery, respectively. The thresholds based on relative changes by referring to the baseline measurement were <80%, <85%, <90%, <95%, and <100% baseline for desaturation and >105%, >110%, >115%, and >120% baseline for hypersaturation. The thresholds based on absolute values were <50%, <55%, <60%, <65%, and <70% for desaturation and >75%, >80%, >85%, and >90% for hypersaturation. The given area under the threshold (AUT)/area above the threshold (AAT) was analyzed. Delirium was assessed until postoperative day 5. The primary analysis was the association between the minimum Scto2 and delirium using multivariable logistic regression controlled for confounders (age, OLV time, use of midazolam, occurrence of hypotension, and severity of pain). The secondary analysis was the association between cerebral desaturation/hypersaturation and delirium, and between the AUT/AAT and delirium using multivariable logistic regression controlled for the same confounders. Multiple testing was corrected using the Holm-Bonferroni method. We additionally monitored somatic tissue oxygen saturation on the forearm and upper thigh. RESULTS: Delirium occurred in 35 (20%) of 175 patients (65 ± 6 years old). The minimum left or right Scto2 was not associated with delirium. Cerebral desaturation defined by <90% baseline for left Scto2 (odds ratio [OR], 5.82; 95% confidence interval [CI], 2.12-19.2; corrected P =.008) and <85% baseline for right Scto2 (OR, 4.27; 95% CI, 1.77-11.0; corrected P =.01) was associated with an increased risk of delirium. Cerebral desaturation defined by other thresholds, cerebral hypersaturation, the AUT/AAT, and somatic desaturation and hypersaturation were all not associated with delirium. CONCLUSIONS: Cerebral desaturation defined by <90% baseline for left Scto2 and <85% baseline for right Scto2, but not the minimum Scto2, may be associated with an increased risk of postthoracotomy delirium. The validity of these thresholds needs to be tested by randomized controlled trials.


Assuntos
Circulação Cerebrovascular/fisiologia , Delírio/etiologia , Ventilação Monopulmonar/efeitos adversos , Complicações Cognitivas Pós-Operatórias/etiologia , Toracotomia/efeitos adversos , Idoso , Estudos de Coortes , Delírio/diagnóstico , Delírio/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ventilação Monopulmonar/tendências , Complicações Cognitivas Pós-Operatórias/diagnóstico , Complicações Cognitivas Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Toracotomia/tendências
14.
Vet Surg ; 50(6): 1227-1236, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33586796

RESUMO

OBJECTIVE: To assess and compare the magnitude of lameness and level of pain after muscle-sparing lateral thoracotomy (MSLT) and standard lateral thoracotomy (SLT) in dogs. STUDY DESIGN: Randomized, blinded, prospective clinical study. ANIMALS: Twenty-eight client-owned dogs. METHODS: The latissimus dorsi muscle was retracted in the MSLT group and was transected in the SLT group. Gait was analyzed with a force plate, and the peak vertical force symmetry index (SI) was calculated within 24 hours before surgery, 3 days postoperatively, and 8 to 12 weeks postoperatively. Symmetry index and pain scores as measured by the Glasgow Composite Measure Pain Scale - Short Form were assessed as primary outcome measures. RESULTS: The SI 3 days postoperatively was lower compared with the preoperative SI value in all dogs, consistent with lameness of the ipsilateral thoracic limb (P < .001). The absolute differences in preoperative and 3-day-postoperative SI provided evidence that this change was 3.1-fold greater after SLT compared with after MSLT (P = .009). Pain scores 1 day after surgery were lower after MSLT (1) compared with after SLT (2.5, P < .001). CONCLUSION: Lateral thoracotomies caused postoperative pain and ipsilateral forelimb lameness, and both were reduced by sparing the latissimus dorsi. CLINICAL SIGNIFICANCE: Sparing the latissimus dorsi should be considered to decrease immediate postoperative morbidity in dogs undergoing lateral thoracotomy.


Assuntos
Doenças do Cão , Coxeadura Animal , Toracotomia , Animais , Doenças do Cão/cirurgia , Cães , Marcha , Coxeadura Animal/cirurgia , Músculos , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/veterinária , Estudos Prospectivos , Toracotomia/efeitos adversos , Toracotomia/veterinária
15.
J Cardiothorac Vasc Anesth ; 35(10): 2937-2944, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33593650

RESUMO

OBJECTIVE: Investigate differences in the prevalence and severity of chronic postsurgical pain (CPSP) after cardiac surgery via thoracotomy versus sternotomy are not well-understood. DESIGN: An observational cohort study. SETTING: A tertiary care hospital. PARTICIPANTS: Four hundred twenty-eight patients (sternotomy: 192 patients, thoracotomy: 236 patients) who underwent mitral valve repair. INTERVENTIONS: A questionnaire about the severity of surgical wound pain evaluated with a numerical rating scale (NRS) was sent. NRS responses for current pain, peak pain in the last four weeks, and average pain in the last four weeks were evaluated. MEASUREMENTS AND MAIN RESULTS: The main outcomes were the severity of CPSP evaluated using NRS and the prevalence of CPSP. CPSP was defined as pain >0 that developed after a surgical procedure. During the median follow-up of 29 months, 79 patients complained of CPSP. (sternotomy: 15 patients, thoracotomy: 64 patients). Multivariate ordinal logistic regression showed that NRS responses for current pain (adjusted odds ratio [aOR], 3.17; 95% confidence interval [CI] 1.64-6.12; p = 0.001), peak pain in the last four weeks (aOR, 2.00; 95% CI 1.11-3.61; p = 0.021), and average pain in the last four weeks (aOR, 2.21; 95% CI 1.31-3.72; p = 0.003) were significantly higher in patients who underwent thoracotomy. Multivariate logistic regression showed that thoracotomy was an independent predictor of CPSP (aOR, 3.63; 95% CI 1.67-7.88; p = 0.001). CONCLUSIONS: The prevalence and severity of CPSP were higher among patients who underwent mitral valve repair via thoracotomy than sternotomy.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Esternotomia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Estudos de Coortes , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Valva Mitral/cirurgia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Prevalência , Esternotomia/efeitos adversos , Toracotomia/efeitos adversos , Resultado do Tratamento
17.
J Pediatr Surg ; 56(10): 1732-1736, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33551147

RESUMO

BACKGROUND: It has been postulated that video-assisted thoracoscopic surgery (VATS) is superior than conventional thoracotomy for resection of congenital pulmonary airway malformation (CPAM) in terms of shorter hospital length of stay, reduced post-operative complication and better long-term pulmonary outcome. However, there is limited available data concerning the effect of VATS and conventional thoracotomy on musculoskeletal aspects in patients with CPAM. This study aims to compare the long-term effects of both surgical techniques on musculoskeletal outcomes in this group of patients. METHODS: Thirty-five patients with mean age of 11.38 years old who underwent VATS or conventional thoracotomy for CPAM resection were recruited in this study. The mean follow-up time was 10.42 years (5.48 to 17.71 years). Musculoskeletal examination included screening of musculoskeletal deformities (elevation of shoulder, asymmetry of nipple level, breast/ pectoral muscle maldevelopment, winging of scapula, scoliosis), measurement of bilateral chest wall in relation to anatomical parameter, and testing of shoulder range of motion and power. RESULTS: The prevalence of winged scapula was significantly lower in patients who underwent VATS than thoracotomy (13% vs 58%, p = 0.008). There is also a smaller reduction in operated-side chest wall vertical distance in VATS patients (0.982 vs 0.956, p = 0.058). There were no significant difference in prevalence of other musculoskeletal deformities, other chest wall measurements, shoulder range of motion and power between two groups. CONCLUSION: Thoracoscopy decreases the incidence of scapular winging but has no effect on effect on other musculoskeletal deformities.


Assuntos
Malformação Adenomatoide Cística Congênita do Pulmão , Neoplasias Pulmonares , Escoliose , Criança , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Humanos , Tempo de Internação , Pulmão/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Toracoscopia , Toracotomia/efeitos adversos
18.
J Am Coll Surg ; 232(5): 690-698, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33556502

RESUMO

BACKGROUND: A recurrent tracheo-esophageal fistula can complicate esophageal atresia and tracheo-esophageal fistula (TEF) repair in children. Therapeutic approaches and the rate of recurrence vary widely. Most reports are limited by small cohorts and short-term follow-up, and rates of re-recurrence are substantial, making it difficult to select the treatment of choice. We aimed to review our experience with the treatment of recurrent TEF using posterior tracheopexy, focusing on operative risks and long-term outcomes. STUDY DESIGN: We conducted a retrospective review of patients with esophageal atresia TEF with recurrent TEF treated at 2 institutions from 2011 to 2020. We approach recurrent TEFs surgically. Once the TEF is divided and repaired, the membranous trachea is sutured to the anterior longitudinal ligament of the spine (posterior tracheopexy) and the esophagus is rotated into the right chest (rotational esophagoplasty), separating the suture lines widely. To detect re-recurrence, patients undergo endoscopic surveillance during follow-up. RESULTS: Sixty-two patients with a recurrent TEF were surgically treated (posterior tracheopexy/rotational esophagoplasty) at a median age of 14 months. All had significant respiratory symptoms. On referral, 24 had earlier failed endoscopic and/or surgical attempts at repair. Twenty-nine required a concomitant esophageal anastomotic stricturoplasty or stricture resection. Postoperative morbidity included 3 esophageal leaks, and 1 transient vocal cord dysfunction. We have identified no recurrences, with a median follow-up of 2.5 years, and all symptoms have resolved. CONCLUSIONS: The surgical treatment of recurrent TEFs that incorporates a posterior tracheopexy and rotational esophagoplasty is highly effective for preventing re-recurrence with low perioperative morbidity.


Assuntos
Fístula Anastomótica/epidemiologia , Atresia Esofágica/cirurgia , Prevenção Secundária/métodos , Toracotomia/métodos , Fístula Traqueoesofágica/cirurgia , Disfunção da Prega Vocal/epidemiologia , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/etiologia , Criança , Pré-Escolar , Atresia Esofágica/diagnóstico , Esofagoscopia , Esôfago/diagnóstico por imagem , Esôfago/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Laringoscopia , Masculino , Recidiva , Estudos Retrospectivos , Técnicas de Sutura/efeitos adversos , Toracotomia/efeitos adversos , Traqueia/diagnóstico por imagem , Traqueia/cirurgia , Fístula Traqueoesofágica/diagnóstico , Resultado do Tratamento , Disfunção da Prega Vocal/etiologia
19.
ASAIO J ; 67(8): 845-855, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-33620165

RESUMO

The use of lateral thoracotomy (LT) for implanting left ventricular assist devices (LVADs) is worldwide increasing, although the available evidence for its positive effects compared with conventional sternotomy (CS) is limited. This systematic review and meta-analysis analyzes the outcomes of LT compared with CS in patients undergoing implantation of a centrifugal continuous-flow LVAD. Four databases and 1,053 publications were screened until December 2019. Articles including patients undergoing implantation of a centrifugal continuous-flow LVAD through LT were included. A meta-analysis to compare LT and CS was performed to summarize evidences from studies including both LT and CS patients extracted from the same population. Primary outcome measure was in-hospital or 30-day mortality. Eight studies reporting on 730 patients undergoing LVAD implantation through LT (n = 242) or CS (n = 488) were included in the meta-analysis. Left thoracotomy showed lower in-hospital/30-day mortality (odds ratio [OR]: 0.520, 95% confidence interval [CI]: 0.27-0.99, p = 0.050), shorter intensive care unit (ICU) stay (mean difference [MD]: 3.29, CI: 1.76-4.82, p < 0.001), lower incidence of severe right heart failure (OR: 0.41; CI: 0.19-0.87, p = 0.020) and postoperative right ventricular assist device (RVAD) implantation (OR: 0.27, CI: 0.10-0.76, p = 0.010), fewer perioperative transfusions (MD: 0.75, CI: 0.36-1.14, p < 0.001), and lower incidence of renal failure (OR: 0.45, CI: 0.20-1.01, p = 0.050) and device-related infections (OR: 0.45, CI: 0.20-1.01, p = 0.050), respectively. This meta-analysis demonstrates that implantation of a centrifugal continuous-flow LVAD system via LT benefits from higher short-term survival, less right heart failure, lower postoperative RVAD need, shorter ICU stay, less transfusions, lower risk of device-related infections and kidney failure. Prospective studies are needed for further proof.


Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Insuficiência Cardíaca/cirurgia , Coração Auxiliar/efeitos adversos , Humanos , Estudos Retrospectivos , Esternotomia , Toracotomia/efeitos adversos , Resultado do Tratamento
20.
Ann Palliat Med ; 10(3): 2849-2858, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33549006

RESUMO

BACKGROUND: Whether challenging video-assisted thoracoscopic surgery (VATS) is a minimal invasive surgery remains controversial. This study aimed to analyze causes of challenging conventional multiple-port VATS (CVATS) and conversion to thoracotomy and postoperative pain to provide indications for VATS. METHODS: This was a two-center retrospective study. Challenging VATS was defined as CVATS with operation time ≥5 hours and it was converted to thoracotomy. This study included patients who were admitted to Joetsu General Hospital (Joetsu, Niigata, Japan) and Toyama University Hospital (Toyama, Japan) for elective CVATS between April 2013 and March 2019. The exclusion criteria were as follows: a planned thoracotomy, uniportal VATS, robot-assisted thoracoscopic surgery, and simultaneous resection of extrathoracic organs. RESULTS: A total of 911 (91.6%) patients underwent CVATS. Of these cases, 876 (96.2%) were suitable VATS cases. On the contrary, 35 cases (3.8%) were recognized as challenging VATS. In 21 (2.3%) cases, VATS took ≥5 hours, and 14 (1.5%) VATS cases were converted to thoracotomy. The causes were severe adhesions (62.9%), air leak (45.7%), body position changes (22.9%), large tumor (14.3%), bronchoplasty or angioplasty (8.6%), and bleeding (2.9%). The minimum diameter of large tumors was 61.4 mm (53-67 mm). In 15 (71.4%) patients, VATS took ≥5 hours, and 10 (71.4%) patients who were converted to thoracotomy developed postoperative neuropathic pain. CONCLUSIONS: In this study, VATS ≥5 hours and conversion from VATS to thoracotomy were complicated by postoperative neuropathic pain. In case of bronchoplasty, angioplasty, and large tumor with minimum diameter ≥5 cm, a thoracotomy approach would be appropriate depending on the skill and experience of the surgeon. In cases of local or vascular sheath adhesion, if operation progress is delayed, it may be necessary to set a time limit and decide to convert to thoracotomy, considering patient's safety first.


Assuntos
Neuralgia , Cirurgia Torácica Vídeoassistida , Humanos , Japão , Neuralgia/etiologia , Estudos Retrospectivos , Toracotomia/efeitos adversos
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