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1.
Medicine (Baltimore) ; 99(9): e19312, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118757

RESUMO

BACKGROUND: Thoracotomy is a common surgical procedure used in cases such as trauma and cancer resection. It is an invasive procedure in which incisions are made in the chest wall to gain access to the chest. Therefore, it often produces intense postoperative pain. Electroacupuncture has been known for its analgesic effects in various conditions, including cases of postoperative pain. This protocol design is for a systematic review and meta-analysis to gather evidence and investigate the analgesic effects of electroacupuncture in pain after thoracotomy. METHODS: The studies for the systematic review will be searched with keywords on the following 10 databases: PubMed, Cochrane Library (CENTRAL), EMBASE, MEDLINE, Google Scholar, CNKI, KoreaMed, KMBASE, KISS, and OASIS. The search will be done without language restrictions. Only the randomized controlled trials that meet the eligibility criteria will be finally included in the study. The quality of the study will be assessed using the Cochrane Collaborations' risk-of-bias tool, and Cochrane's software RevMan 5.3 will be used for meta-analysis. RESULTS: The designed study will provide a systematic review and meta-analysis of the searched and randomized controlled trials that meet the eligibility criteria. Meta-analysis will be performed with pain scores as the main outcome measure, and they may also be performed with additional outcomes. The qualitative and quantitative data synthesis is expected to provide high quality evidence to judge the pain management effect of electroacupuncture for patients who underwent thoracotomy. CONCLUSION: The conclusion of this systematic review and meta-analysis will provide evidence to judge whether electroacupuncture is an effective analgesic treatment option for patients suffering with post-thoracotomy pain. PROSPERO REGISTRATION NUMBER: CRD42019142157.


Assuntos
Eletroacupuntura/normas , Dor Pós-Operatória/terapia , Toracotomia/efeitos adversos , Protocolos Clínicos , Eletroacupuntura/métodos , Humanos , Revisão Sistemática como Assunto , Toracotomia/métodos
3.
Khirurgiia (Mosk) ; (1): 85-88, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994505

RESUMO

Mini-thoracotomy is one of the most popular minimally invasive approaches. This approach is used in the treatment of congenital and acquired heart diseases and characterized less surgical trauma, intraoperative blood loss, pain syndrome severity, risk of infectious complications and better cosmetic results. Successful correction of atrial septal defect (ASD) through right-sided mini-thoracotomy is reported in the article.


Assuntos
Comunicação Interatrial/cirurgia , Veias Pulmonares/cirurgia , Toracotomia/métodos , Cardiopatias/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Veias Pulmonares/anormalidades , Resultado do Tratamento
4.
Mymensingh Med J ; 29(1): 97-103, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915343

RESUMO

This study was aimed to compare the long-term outcomes and survival rate among mitral valve replacement using thoracotomy and standard median sternotomy in a single surgeon's practice. Total 250 patients were evaluated; Group I (n=65) patients had anterolateral thoracotomy and Group II (n=185) had standard median sternotomy for valve replacement. Mean age was 25.1±5 years in Group I and 41.8±10.5 years in Group II. Female was predominant in Group I. Total operative time and bypass time was statistically significant in Group I (235.5±25.8 minutes; 84.2±12.75 minutes) in contrast to Group II (203.8±15.5 minutes; 71.5±10.5 minutes). Incision scar was not visible in females in Group I but full incision scar was visible in Group II. Post-operative ICU stay duration was significant high in Group II. Though, wound infection incidence was 0% in Group I; however, 9.73% patient had wound infection in Group II. Only 1.62% patient developed unstable sternum in Group II. Most of the patients from both study group were in regular follow up and 1-year mortality rate was 4.62% and 5.94% in Group I and Group II respectively. Mitral valve replacement through a right anterolateral thoracotomy is easy and safe to perform; while getting maximum benefits for the patients. Besides satisfactory cosmetic outcome especially in female, this approach provides better exposure to mitral apparatus even in patients with small left atrium, cost effectiveness, less duration of hospital stays and absence of the risk for unstable sternum.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Esternotomia/métodos , Esterno/cirurgia , Toracotomia/métodos , Adulto , Bangladesh/epidemiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Doenças das Valvas Cardíacas/mortalidade , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
5.
J Surg Res ; 246: 544-549, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31635832

RESUMO

BACKGROUND: Teamwork is a critical element of trauma resuscitation. Assessment tools such as T-NOTECHS (Trauma NOn-TECHnical Skills) exist, but correlation with patient outcomes is unclear. Using emergency department thoracotomy (EDT), we sought to describe T-NOTECHS scores during resuscitations. We hypothesized that patients undergoing EDT whose resuscitations had better scores would be more likely to have return of spontaneous circulation (ROSC). METHODS: Continuously recording video was used to review all captured EDTs over a 24-mo period. We used a modification of the validated T-NOTECHS instrument to measure five domains on a 3-point scale (1 = best, 2 = average, 3 = worst). A total T-NOTECHS score was calculated by one of three reviewers. The primary outcome was ROSC. ROSC was defined as an organized rhythm no longer requiring internal cardiac compressions. Associations between variables and ROSC were examined using univariate regression. RESULTS: Sixty-one EDTs were captured. Nineteen patients had ROSC (31%) and 42 (69%) did not. The median T-NOTECHS score for all resuscitations was 8 [IQR 6-10]. As demographic and injury data (age, gender, mechanism, signs of life) were not associated with ROSC in univariate analysis, they were not considered for inclusion in a multivariable regression model. The association between overall T-NOTECHS score and ROSC did not reach statistical significance, but examination of the individual components of the T-NOTECHS score demonstrated that, compared to resuscitations that had "average" (2) or "worst" (3) scores on "Assessment and Decision Making," resuscitations with a "best" score were 5 times more likely to lead to ROSC. CONCLUSIONS: Although the association between overall T-NOTECHS scores and ROSC did not reach statistical significance, better scores in the domain of assessment and decision making are associated with improved rates of ROSC in patients arriving in cardiac arrest who undergo EDT. LEVEL OF EVIDENCE: Level IV Therapeutic/Care Management.


Assuntos
Tomada de Decisão Clínica/métodos , Parada Cardíaca/terapia , Equipe de Assistência ao Paciente/organização & administração , Gravação em Vídeo , Ferimentos e Lesões/terapia , Adulto , Competência Clínica , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Pennsylvania , Ressuscitação/métodos , Toracotomia/métodos , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico
6.
Ann R Coll Surg Engl ; 102(3): e73-e74, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31845821

RESUMO

Lung herniation is a rare entity, defined as a protrusion of the lung above the normal confines of thorax; it is caused by increased intrathoracic pressure and defects or weakness of the chest wall. Intercostal lung hernia can occur spontaneously or following thoracic trauma or surgery. Postoperative hernias are more commonly associated with less extensive surgical procedures, such as thoracoscopic surgery or mini-thoracotomy incisions, rather than with major thoracic procedures. We describe the first reported case of postoperative intercostal lung hernia following two-stage totally minimally invasive oesophagectomy for cancer, together with its successful surgical repair.


Assuntos
Esofagectomia/efeitos adversos , Hérnia/etiologia , Pneumopatias/etiologia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Complicações Pós-Operatórias , Adenocarcinoma/cirurgia , Idoso , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Hérnia/terapia , Herniorrafia/métodos , Humanos , Pneumopatias/cirurgia , Masculino , Reoperação , Toracotomia/métodos
7.
Einstein (Sao Paulo) ; 18: eAO4409, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31618286

RESUMO

OBJECTIVE: To compare the chest tube drainage by the same thoracotomy intercostal space with the traditional approach in patients undergoing muscle-sparing thoracotomy. METHODS: We evaluated 40 patients aged ≥18 years who underwent elective muscle sparing thoracotomies. Patients were divided into two groups of 20 patients. One group underwent thoracic drainage by the same intercostal space of thoracotomy and the other by traditional chest drainage approach. RESULTS: The mean length of hospital stay for the intercostal drainage group in the intensive care unit was 1.5 day (1.0 to 2.0 days) and 2.0 days (25.1 to 3.0 days) for the traditional chest drainage group (p=0.060). The intercostal drainage group had mean length of hospital stay (p=0.527) and drainage (p=0.547) of 4 days, and the traditional chest drainage group and 2 and 5.5 days, respectively. Dipirona and tramadol doses did not differ between groups (p=0.201 and p=0.341). The mean pain scale values on first postoperative was 4.24 in the drainage by the same intercostal group and 3.95 in the traditional chest drainage (p=0.733). In third postoperative day, mean was 3.18 for the first group and 3.11 for the traditional group (p=0.937). In the 15th day after surgery, drainage by the incision was 1.53 and the traditional chest drainage was 2.11 (p=0.440), 30th days after drainage by incision was 0.71 and traditional chest drainage was 0.84 (p=0.787). Complications, for both groups were similar with 30% in proposed drainage and 25% in traditional approach (p=0.723). CONCLUSION: Drainage by the same thoracotomy intercostal space was feasible and results 30 days after surgery were not inferior to those of the traditional chest drainage approach.


Assuntos
Tubos Torácicos , Drenagem/métodos , Toracotomia/métodos , Analgesia Epidural , Analgésicos/uso terapêutico , Fibrilação Atrial/etiologia , Dipirona/uso terapêutico , Drenagem/estatística & dados numéricos , Dispneia/etiologia , Humanos , Tempo de Internação , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Período Pós-Operatório , Estudos Prospectivos , Toracotomia/efeitos adversos , Tramadol/uso terapêutico
8.
J Cardiothorac Surg ; 14(1): 213, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31806039

RESUMO

BACKGROUND: Minimally invasive mitral valve surgery is becoming a gold standard and provides many advantages for patients. A learning curve is required for a surgeon to become proficient, and the exact number to overcome this curve is controversial. Our study aimed to define this number for mitral valve surgery in general, for replacement and repair separately. METHODS: A total of 204 mitral valve surgeries were performed via the right minithoracotomy approach from October 2014 to January 2019 by a single surgeon who isexperienced in conventional mitral valve surgery. Learning curves were analysed based on the trend of important variables (cross-clamp time, CPB time, ventilation time, ICU time, composite technical failure) over time, and the number of operations required was calculated by CUSUM method. RESULTS: MIMVS provided an excellent outcome in the carefully selected patients, with low mortality of 0.5% and low rate of complications. The decreasing trend of the important variables were observed over the years and as the cumulative number of procedures increased. The number of operations required to overcome the learning curve was 75 to 100 cases. When considered separately, the quantity for mitral valve replacement was 60 cases, whereas valve repair necessitated at least 90 cases to have an acceptable technical complication rate. CONCLUSION: MIMVS is an excellent choice for mitral valve surgery. However, this approach required a long learning curve for a surgeon who is experienced in conventional mitral valve surgery. TRIAL REGISTRATION: The research was registered and approved by the ethical board of the University of Medicine and Pharmacy at Ho Chi Minh City, number 141/DHYD-HDDD, on April 11th 2018.


Assuntos
Implante de Prótese de Valva Cardíaca/educação , Curva de Aprendizado , Insuficiência da Valva Mitral/cirurgia , Toracotomia/educação , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Toracotomia/métodos , Resultado do Tratamento , Vietnã
9.
Khirurgiia (Mosk) ; (12): 121-125, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825352

RESUMO

Minimally invasive approach in mitral valve surgery has been applied since the late 1990s. Considerable experience of mini-thoracotomy in cardiac surgery has been gained over this period. Stages of the development of minimally invasive cardiac surgery are reviewed in the article. Features of mitral valve surgery through right-sided mini-thoracotomy are discussed. Surgical outcomes of these procedures are reported considering data of various cardiac surgery centers. Moreover, the authors determined indications and limitations of this technique.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Toracotomia/métodos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do Tratamento
10.
Artigo em Inglês | MEDLINE | ID: mdl-31872984

RESUMO

As the outcomes of the repair of congenital heart defects have improved, minimizing the long-term morbidity associated with these repairs has become more important. Avoiding a midline incision and hiding the incision in the axilla allows a virtual "non-visible scar" repair, which can be beneficial for avoiding future psychological morbidity. In this tutorial, we present our technique for right axillary incision for the repair of a partial common atrioventricular defect.


Assuntos
Cicatriz/cirurgia , Comunicação Interventricular/cirurgia , Toracotomia/métodos , Axila/cirurgia , Cardiopatias Congênitas/cirurgia , Defeitos dos Septos Cardíacos/cirurgia , Humanos
12.
Pan Afr Med J ; 33: 256, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692849

RESUMO

A rare case series of traumatic right diaphragmatic rupture with hepatothorax in Ghana is reported. The first case involved a middle-aged man who sustained a penetrating chest injury following an unprovoked attack by a wild bull. The second case was a young woman who sustained a blunt chest injury after being knocked down by a moving vehicle whiles crossing the road. Both presented with ruptured right diaphgramatic rupture and had to undergo repair through thoracotomy after stabilization and the two had been well one year after surgery without any complications or sequelae.


Assuntos
Diafragma/lesões , Fígado/patologia , Ferimentos não Penetrantes/complicações , Ferimentos Penetrantes/complicações , Adulto , Diafragma/cirurgia , Feminino , Gana , Hérnia Diafragmática Traumática/etiologia , Hérnia Diafragmática Traumática/cirurgia , Humanos , Masculino , Ruptura , Traumatismos Torácicos/complicações , Traumatismos Torácicos/cirurgia , Toracotomia/métodos , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/cirurgia
13.
Medicine (Baltimore) ; 98(48): e17983, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770207

RESUMO

BACKGROUND: The anesthetic-sparing effect of dexmedetomidine has led to its use as a general adjuvant. The present study aimed to determine intravenous infusion of dexmedetomidine to epidural analgesia after open thoracotomy. METHODS: Forty-four patients scheduled for admission to the intensive care unit after open thoracotomy were divided into 2 groups. An epidural catheter was placed at T4 to T7. Thirty minutes before the end of thoracotomy, group D was injected with 0.3 µg/kg/h of dexmedetomidine and group C received an equal dose of normal saline. For patient-controlled epidural analgesia (PCEA), 150 mL of levobupivacaine 300 mg was infused at a rate of 1 mL/h, plus a bolus dose of 3 mL with a lockout time of 30 minutes. The primary outcome evaluated was analgesic efficacy using a visual analog scale (VAS) 48 hours postoperatively. Other outcomes included additional analgesic use, total consumed local analgesia via PCEA, sedation score, blood pressure, heart rate, arterial blood gases, patient satisfaction, and adverse effects. RESULTS: The VAS scores in group D were significantly lower than that in group C immediately, 1, 4, 12, 36, and 48 hours after admission to the intensive care unit (P = .016, .009, .015, .002, .001, and .042, respectively). The total dose of additional analgesic was also significantly lower in group D (P = .011). Patient satisfaction was higher in group D (P < .05). There were no significant differences in the other outcomes between groups. CONCLUSION: Intravenous infusion of dexmedetomidine amplifies thoracic epidural analgesic effect after open thoracotomy.


Assuntos
Analgesia Epidural/métodos , Analgésicos não Entorpecentes/administração & dosagem , Dexmedetomidina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Toracotomia/efeitos adversos , Idoso , Analgesia Controlada pelo Paciente/métodos , Método Duplo-Cego , Feminino , Humanos , Infusões Intravenosas , Levobupivacaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Vértebras Torácicas , Toracotomia/métodos , Resultado do Tratamento
15.
Niger J Clin Pract ; 22(10): 1412-1416, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607732

RESUMO

Aim: This study's aim is to define the clinicopathological and surgical outcomes, clinical courses, and results of long-term follow-up of cases that underwent surgical treatment for solitary fibrous tumors of the pleura (SFTp). Subjects and Methods: Clinical and long-term follow-up records of 16 consecutive patients who had surgery for SFTp between 2006 and 2016 were reviewed in the retrospective chart review. There were nine males (56%) and seven (44%) females with an average age of 60.5 ± 17.1 (range 30-87 years). Etiological factors, diagnostic procedures, clinical and surgical outcomes, 5-year overall survival (OS), and disease-free survival (DFS) in these patients were researched. Results: There was no remarkable common etiological factor. Nine of the cases were asymptomatic. Other symptoms were chest pain, dyspnea, cough and hypertrophic osteoarthropathy, respectively. Thoracotomy for the removal of pleural mass was carried out in 15 (94%) cases. Additional resection procedures included the chest wall resection in two cases and lobectomy in two. Video-assisted thoracoscopic surgery (VATS) resection was performed in one (6%) case. Complete surgical excision was performed in 74% of cases. Nineteen percent of cases were malignant SFTp (mSFTp). One of the mSFTp cases died in the 19th month after the diagnosis. The mean follow-up time was 50.6 ± 34.2 months (2--114 months). Mean survival of mSFTp patients was 40.6 ± 19.08 months (19--55 months) and that for benign SFTp (bSFTp) was 52.9 ± 37.05 months (2--114 months). Five-year OS--DFS were 93.5% and 74%, respectively. Conclusion: SFTp is an uncommon benign neoplasm but it can have malignant features. Even in the case of recurrence, the main treatment is total surgical excision. Oncologic treatments can be tried in unresectable and metastatic cases. VATS can be used in surgical total excision for small diameter and appropriate tumors. Understanding the nature of these tumors, immunohistochemical, and genetic studies may be a guide in future.


Assuntos
Neoplasias de Tecido Fibroso/patologia , Neoplasias de Tecido Fibroso/cirurgia , Tumor Fibroso Solitário Pleural/patologia , Tumor Fibroso Solitário Pleural/cirurgia , Cirurgia Torácica Vídeoassistida , Toracotomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Dor no Peito/etiologia , Tosse/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias de Tecido Fibroso/mortalidade , Estudos Retrospectivos , Tumor Fibroso Solitário Pleural/mortalidade , Análise de Sobrevida , Toracotomia/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
BMC Surg ; 19(1): 144, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615490

RESUMO

BACKGROUND: It has been widely accepted that video-assisted thoracoscopic surgery (VATS) lobectomy is superior to conventional open thoracotomy lobectomy in many aspects. However, the direct comparison between VATS and Muscle-sparing thoracotomy (MST) has not been widely conducted. We aimed to compare the perioperative outcomes in non-small cell lung cancer (NSCLC) patients following VATS and MST. METHODS: PubMed, EMBASE, the Cochrane Library and Web of Science were searched for relevant studies. The retrieval time was up to April 24, 2019. Studies investigating the comparison of video-assisted thoracoscopy and muscle-sparing thoracotomy were included in our meta-analysis. Odds ratio and mean differences with 95% confidential interval were applied to determine the effectiveness of dichotomous or continuous variables respectively. RESULTS: A total of 10 studies were included with 1514 patients. Compared with MST, the incidence of postoperative complications in VATS [OR = 0.54; 95%CI(0.4, 0.73); P < 0.001] and the hospital stay [MD = -1.5; 95%CI(- 2.28, - 0.73); P = 0.0001] decreased significantly, chest tube drainage time [MD = -0.71; 95%CI(- 1.18, - 0.24); P = 0.003] were shorter and the intraoperative blood loss [MD = - 43.87; 95%CI(- 73.66, - 14.08); P = 0.004] were less in VATS group. VATS also showed a relatively longer operative time [MD = 17.11; 95%CI(2.38, 31.85); P = 0.02]. However, no significant differences were observed in numbers of resected lymph nodes, postoperative mortality, postoperative pneumonia and postoperative bleeding. CONCLUSION: Compared with MST, VATS was associated with lower incidence of postoperative complications, shorter length of hospital stay, less intraoperative blood loss and less chest tube drainage, which showed that VATS was a comparable method to MST. Meanwhile, these results should be further conformed by more randomized control trials.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodos , Perda Sanguínea Cirúrgica , Drenagem/efeitos adversos , Humanos , Tempo de Internação , Excisão de Linfonodo/efeitos adversos , Duração da Cirurgia , Pneumonectomia/métodos , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Heart Surg Forum ; 22(5): E390-E395, 2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31596718

RESUMO

BACKGROUND: The development of minimally invasive mitral valve surgery has created the motivation for using this approach in young patients with chronic rheumatic valve disease. We report our recent experience with patients undergoing minimally mitral valve surgery in this group of patients. METHODS: Between July 2014 and June 2018, 142 patients with rheumatic mitral valve dysfunction underwent minimally invasive surgery through a right thoracotomy approach at the University Medical Center of Ho Chi Minh City in Vietnam. Diagnosis was confirmed with transthoracic and transesophageal echocardiography (TTE and TEE). We analyzed the in-hospital and midterm follow-up outcomes of this group. RESULTS: The mean age was 42.6 ± 9.6 years. Sixty patients (42.3%) were male. Sixty-three patients were diagnosed with functional severe tricuspid regurgitation, 29 patients were identified with moderate tricuspid regurgitation, and tricuspid annulus was more than 21 mm/m²). Mitral valve repair was performed in 16 patients (11.3%), and 126 patients underwent mitral valve replacement. Mitral valve repair techniques included annuloplasty, leaflet peeling, and commissurotomy. Thirty-day mortality was 0.7%. Two patients had to be converted to conventional sternotomy, due to left atrial appendage laceration and mitral annular rupture. The overall survival rate was 98.6%. Freedom from reoperation was 97.1%. CONCLUSIONS: In patients with rheumatic valve disease, minimally invasive mitral surgery safely and effectively can be performed with few perioperative complications and good midterm results.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Cardiopatia Reumática/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Adulto , Conversão para Cirurgia Aberta/estatística & dados numéricos , Ecocardiografia Transesofagiana , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Masculino , Ilustração Médica , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/diagnóstico por imagem , Valva Mitral/lesões , Cardiopatia Reumática/diagnóstico por imagem , Esternotomia , Taxa de Sobrevida , Toracotomia/métodos , Insuficiência da Valva Tricúspide/diagnóstico
19.
Thorac Surg Clin ; 29(4): 437-446, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31564401

RESUMO

The transthoracic approach to PEH repair has been displaced by the laparoscopic methods of repair for valuable reasons. Despite the pressures of performing minimally invasive surgery, the experienced esophageal surgeon will appreciate the benefits of the transthoracic repair in select circumstances as outlined in this article. In this writing, we discussed our indications, the salient anatomy and important steps in performing a successful transthoracic PEH repair.


Assuntos
Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Toracotomia/métodos , Esôfago/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
20.
Magy Seb ; 72(3): 98-102, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31544482

RESUMO

Introduction: Authors present their 7-year experience since the introduction of minimal-invasive (VATS) lobectomies for lung cancer in regard to their surgical technique, results and oncological follow-up. Method: 173 VATS lobectomies were performed between June 2011 and December 2017, 105 men and 68 women. The mean age of patients was 64.1 years. Duration of surgery was 130 minutes on average. Results: Conversion to thoracotomy was required in 8 cases (3 bleedings, 3 pulmonary vessel lymph node infiltrations, 2 bronchial suture insufficiencies). Twenty persistent air leaks developed postoperatively, requiring 10 re-drainages and 10 re-operations: 7 re-VATS and 3 thoracotomies. Two hematomas were evacuated by re-VATS, 1 postoperative atrial fibrillation required cardioversion. There were no perioperative deaths. The 164 malignant cases were: 110 adenocarcinomas, 32 squamous cell carcinomas, 6 small cell neuroendocrine carcinomas, 4 undifferentiated carcinomas, 4 carcinoid tumours, 1 synchronous adenocarcinoma and squamous cell carcinoma, 1 synchronous adenocarcinoma and small cell carcinoma, 1 carcinosarcoma and 5 metastasis from other primary tumours. 118 patients received adjuvant chemotherapy. Tumour staging distribution was: IA 40, IB 53, IIA 29, IIB 16 and IIIA 21 cases. During an average follow-up time of 19.5 months, 9 local tumour recurrence and 27 distant metastasis evaluated, of which 11 were pulmonary (3 multiplex), 10 bone, 6 cerebral, 3 hepatic (1 multiplex), and 3 suprarenal gland. Conclusion: Our results correlate with published literature. During the period of this review, VATS lobectomies became a routine surgical technique in our department. Our experience proved that axillary thoracotomy is an advantage to learn the anterior VATS lobectomy technique.


Assuntos
Tumor Carcinoide/cirurgia , Carcinoma de Células Pequenas/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Pulmonares/cirurgia , Pulmão/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/estatística & dados numéricos , Toracotomia/métodos , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Analgesia Controlada pelo Paciente , Tumor Carcinoide/patologia , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Escamosas/patologia , Quimioterapia Adjuvante , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/patologia , Masculino , Recidiva Local de Neoplasia , Duração da Cirurgia , Reoperação/estatística & dados numéricos , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento
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