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1.
Innovations (Phila) ; 17(2): 148-155, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35499922

RESUMO

Objective: We aimed to identify predictors of conversion to thoracotomy and test the hypothesis that conversion is associated with inferior perioperative outcomes in non-small cell lung cancer (NSCLC). Methods: We queried the National Cancer Database for patients with stage I to III NSCLC undergoing minimally invasive surgery (MIS) during 2010 to 2016. We compared clinicopathologic factors between patients undergoing MIS with and without conversion. We fitted multivariable regression models to identify independent predictors of conversion and compare perioperative outcomes between the 2 groups. Results: A rising trend in the use of MIS was accompanied by a declining trend in the rate of conversion to thoracotomy. A total of 11.3% of the 83,219 cases were converted. Conversion was associated with a higher Charlson-Deyo score, squamous histology, nodal involvement, high tumor grade, tumor size ≥5 cm, and a higher T stage (P < 0.05). Successful MIS without conversion was predicted by advanced age, sublobar resection, robotic approach, and treatment at an academic high-volume facility (P < 0.05). Conversion was linked to longer hospital stays, higher 30-day and 90-day mortality, and unplanned readmission (P < 0.05), irrespective of the type of MIS approach. Conclusions: Conversion rates for video-assisted and robot-assisted thoracoscopic surgery have seen a decline in recent years. Irrespective of the type of MIS approach, conversion was associated with inferior perioperative outcomes. The robotic approach and treatment at an academic high-volume facility were associated with a lower likelihood of conversion. Early recognition of the individual risk factors for conversion may help to counsel patients about the likelihood of, and detriments associated with, conversion and ultimately reduce conversion rates.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Estudos Retrospectivos , Fatores de Risco , Toracotomia/efeitos adversos
2.
Braz J Cardiovasc Surg ; 37(2): 273-276, 2022 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-35503701

RESUMO

Epicardial cysts are rarer benign tumors than pericardial cysts. There have been few reports on surgical management of epicardial cysts. A 17-year-old normotensive boy presented with chest pain and palpitations, which on evaluation was found to be a mediastinal mass (pericardial cyst). Surgical resection of the cyst via thoracotomy was planned. The cyst was diagnosed as an epicardial cyst intraoperatively. However, due to the epicardial origin of cyst and posterior adhesions, resection was done via midline approach. The base was formed by visceral pericardium and eroding into myocardium of left ventricle, so the resection was concluded with on-pump surgery. In case of erroneous diagnosis or undesirable finding, a safer midline approach with on-pump surgery, as an alternative to minimally invasive approach for complicated epicardial cysts (erosion into ventricle/lying in close proximity to important structures or near to coronary arteries) should be considered.


Assuntos
Cisto Mediastínico , Adolescente , Dor no Peito , Ventrículos do Coração/cirurgia , Humanos , Masculino , Cisto Mediastínico/diagnóstico por imagem , Cisto Mediastínico/cirurgia , Pericárdio/cirurgia , Toracotomia
4.
Artigo em Inglês | MEDLINE | ID: mdl-35470990

RESUMO

A right anterior minithoracotomy is a surgical approach that can be an excellent alternative to a median sternotomy. However, for aortic root interventions, the median sternotomy is still the gold standard. Most surgeons are slow to master this method because the visualization is poor and less convenient. These problems can be solved by careful selection of patients and using some technical tricks. The patient is a male with a severe aortic valve lesion and an aneurysm of the ascending aorta involving the proximal arch. We demonstrate step-by- step how to perform a minimally invasive Bio-Bentall procedure with a "hemiarch" replacement through a right anterolateral thoracotomy.


Assuntos
Implante de Prótese de Valva Cardíaca , Toracotomia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Esternotomia/métodos , Toracotomia/métodos , Resultado do Tratamento
5.
Port J Card Thorac Vasc Surg ; 29(1): 65-67, 2022 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-35471213

RESUMO

The tumours of the pleura are a vast and diverse field. One of the lesser known and less common tumour is the solitary fibrous tumour of the pleura, representing about 5% of these types of tumours. The authors present the case of a woman admitted to the emergency department with symptoms of dizziness and vomits. Imaging studies showed a giant thoracic mass on the left hemithorax, with a biopsy indicating a solitary fibrous tumour. The patient was referred for surgery, which was performed via thoracotomy. In the postoperative period she developed an acute pulmonary oedema secondary to lung reexpansion and fluid overload, with a good response to fluid restriction and intravenous diuretics.


Assuntos
Neoplasias Pleurais , Tumor Fibroso Solitário Pleural , Feminino , Humanos , Pleura/patologia , Neoplasias Pleurais/diagnóstico , Tumor Fibroso Solitário Pleural/complicações , Toracotomia , Tórax/patologia
7.
Bratisl Lek Listy ; 123(4): 291-298, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35294216

RESUMO

OBJECTIVES: Analysing the results of patients with odontogenic descending necrotising mediastinitis (DNM) treated predominantly by transcervical approach. BACKGROUND: Odontogenic DNM is a rare but serious complication of dental disease and dental procedures. METHODS: Retrospective evaluation of 20 patients who underwent surgery for odontogenic DNM. RESULTS: The mean age was 33.95±12.24 years, and 18 patients (90 %) were men. Type I and diffuse form of DNM were identified in 8 (40 %) and 12 (60 %) patients, respectively. The mean time between the onset of symptoms and surgery was 7.16±4.23 days. The transcervical approach was used in 16 patients, combined cervicotomy and subxiphoid incision in three patients, and cervicotomy and posterolateral thoracotomy was used in one patient. Four patients were reoperated. The mean mediastinal drainage duration and postoperative length of stay (LOS) were 17.05±10.27 days and 20.70±10.87 days, respectively. Fourteen (70 %) patients received mechanical ventilation with a mean duration of 8.86±9.55 days. Comorbidities were present in five (26 %) patients; there were complications in 17 (85 %) patients. In-hospital mortality reached 5 % (1 patient). Thirty-five teeth were extracted. Lower mandibular molars represented 21 (62 %) of extracted teeth. Submandibular and submental spaces were the most affected by the presence of deep neck infection (five and four cases, respectively). CONCLUSION: This study supports the role of transcervical mediastinal drainage as an alternative approach in the surgical treatment of odontogenic DNM (Tab. 4, Fig. 2, Ref. 30).


Assuntos
Mediastinite , Adulto , Drenagem/efeitos adversos , Humanos , Masculino , Mediastinite/etiologia , Mediastinite/cirurgia , Pessoa de Meia-Idade , Necrose , Estudos Retrospectivos , Toracotomia/efeitos adversos , Adulto Jovem
8.
J Cardiothorac Surg ; 17(1): 37, 2022 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-35292061

RESUMO

BACKGROUND: Giant lung bullae (GLB) are rare, and the only currently available management involves either an open surgical resection (thoracotomy) or the newer minimally invasive resection consisting of video-assisted thoracoscopic surgery (VATS). The aim of our study was to evaluate the possible influence of GLBs pulmonary attachment on patient's post-operative complications. METHODS: A retrospective analysis included all consecutive patients with GLBs who underwent bullae's surgical resection from 7/2007 to 12/2018. GLBs patient's individual characteristics, including demographics, comorbidities, and clinical pre-operative, surgical intra-operative and post-operative data were evaluated. RESULTS: 20 patients with GLBs, 15 males and 5 females with average age of 48.9 years (range, 22-67 years) underwent 21 surgical procedures. The GLBs were located in the right lung in 12 patients, in the left lung in seven patients, and in both lungs in one patient. Fifteen patients (75%) were symptomatic on admission and underwent urgent surgery. Five asymptomatic patients (25%) were operated on electively. Thirteen from 21 surgical procedures (61.9%) were VATS bullectomy, while the other eight were thoracotomies (38.1%). Complications included pneumonia successfully treated with intravenous antibacterial therapy in two thoracotomy patients and in one VATS patient (three patients, 14.2%) and a prolonged air leak in two thoracotomy and four VATS patients (six patients, 28.5%). Out of 21 GLBs, eight had a wide attachment with lung parenchyma (wide-based bullae's) and 13 had a short attachment (short-based bullae's). Two re-operated patients, with prolonged air leak complicated with empyema, had a wide-based GLBs. The median hospital stay was nine days. All patients completed the 24-month follow-up. CONCLUSIONS: Minimally invasive video-assisted thoracoscopic surgery as an open thoracotomy surgery is a safe and effective for giant lung bullae (GLB). Patients with wide-based GLBs were more likely to develop postoperative prolonged air leak that requiring re-operation.


Assuntos
Pneumopatias , Cirurgia Torácica Vídeoassistida , Feminino , Humanos , Pulmão/cirurgia , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Toracotomia
9.
Heart Surg Forum ; 25(1): E097-E100, 2022 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-35238315

RESUMO

OBJECTIVE: To summarize the experience in the treatment of repair ventricular septal defect with left superior vena cava (LSVC) through right axillary thoracotomy. To explore the surgical strategy of treating VSD with LSVC through right axillary thoracotomy. METHODS: right axillary thoracotomy and median sternotomy were performed in 73 cases of ventricular septal defect with LSVC in our center from 2018 to 2019. Perioperative data and surgical information were analyzed retrospectively. RESULTS: There were 54 cases of R-group and 19 cases of S-group with median age of 0.8 years (0.5-1.6years). In the 73 patients, 21(38.9%) were men and 52 (61.1%) women. The operation time of R-group was shorter than S-group, p<0.05. The postoperative drainage in R-group was less than S-group, p<0.05. The mechanical ventilation time was longer in the S-group than in the R-group, p<0.05. There were no deaths, serious complications and readmission in the follow-up 6 months(3-10months). CONCLUSION: Right axillary thoracotomy is a safe procedure with excellent cosmetic and clinical results for ventricular septal defect with left superior vena cava. It has the advantages of short operation time, less bleeding and short postoperative time.


Assuntos
Comunicação Interventricular , Veia Cava Superior , Feminino , Comunicação Interventricular/diagnóstico , Comunicação Interventricular/cirurgia , Humanos , Lactente , Masculino , Estudos Retrospectivos , Toracotomia/métodos , Resultado do Tratamento , Veia Cava Superior/cirurgia
10.
Rev Col Bras Cir ; 49: e20223146, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35319564

RESUMO

OBJECTIVE: the study aims to analyze the performance and outcome of resuscitation thoracotomy (TR) performed in patients victims of penetrating and blunt trauma in a trauma center in southern Brazil during a 7 years period. METHODS: retrospective study based on the analysis of medical records of patients undergoing TR, from 2014 to 2020, in the emergency service of the Hospital do Trabalhador, Curitiba - Paraná, Brazil. RESULTS: a total of 46 TR were performed during the study period, of which 89.1% were male. The mean age of patients undergoing TR was 34.1±12.94 years (range 16 and 69 years). Penetrating trauma corresponded to the majority of indications with 80.4%, of these 86.5% victims of gunshot wounds and 13.5% victims of knife wounds. On the other hand, only 19.6% undergoing TR were victims of blunt trauma. Regarding the outcome variables, 84.78% of the patients had declared deaths during the procedure, considered non-responders. 15.22% of patients survived after the procedure. 4.35% of patients undergoing TR were discharged from the hospital, 50% of which were victims of blunt trauma. CONCLUSION: the data obtained in our study are in accordance with the world literature, reinforcing the need for a continuous effort to perform TR, respecting its indications and limitations in patients victims of severe penetrating or blunt trauma.


Assuntos
Toracotomia , Ferimentos por Arma de Fogo , Adolescente , Adulto , Idoso , Brasil , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Traumatologia , Adulto Jovem
11.
J Cardiothorac Surg ; 17(1): 28, 2022 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-35246198

RESUMO

BACKGROUND: The common femoral artery is usually the preferred access route for thoracic endovascular aortic repair (TEVAR). However, if access from the common femoral artery is challenging, other routes must be considered. We report a case of TEVAR performed by approaching the descending thoracic aorta with a right thoracotomy and using the descending thoracic aorta as an access route. CASE PRESENTATION: A 70-year-old female was diagnosed with a descending thoracic aortic aneurysm (65 mm in diameter), a thoracoabdominal aneurysm (54 mm in diameter), and an abdominal aortic aneurysm (49 mm in diameter). Since the patient had severe chronic obstructive pulmonary disease, one-stage replacement of the thoracoabdominal aortic aneurysm was contraindicated and TEVAR on the descending aorta was selected. A strong tortuous section of the aorta-from the descending aorta to the abdominal aorta-hampered endovascular access to the site from the common femoral artery. A TEVAR approach from the abdominal aorta was also considered; however, an abdominal aortic aneurysm and a transverse colon loop stoma from an earlier surgery presented challenges to this technique. We chose to access the descending thoracic aorta with a thoracotomy from the right 6th intercostal space for TEVAR, because the access route that is not affected by the meandering of the aorta is considered to be the descending aorta with a right thoracotomy. The patient's postoperative course was uneventful after the stent graft was placed. No complications were detected with postoperative contrast-enhanced computed tomography (CT). CONCLUSIONS: Our findings suggest that TEVAR can be performed by approaching the descending aorta from a right thoracotomy, if variations of vascular anatomy interfere with the more commonly used femoral artery approach.


Assuntos
Aneurisma da Aorta Abdominal , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Idoso , Aorta Torácica/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares/métodos , Feminino , Humanos , Stents , Toracotomia , Resultado do Tratamento
12.
Rev Med Liege ; 77(3): 137-138, 2022 Mar.
Artigo em Francês | MEDLINE | ID: mdl-35258860

RESUMO

Following surgey for esophageal atresia, orthopedic complications can sometimes appear late in childhood, hence the importance of regular monitoring. These complications include rib fusion secondary to thoracic surgery and possible infectious complications. Undiagnosed, this condition can lead to severe scoliosis in adolescence.


Après une chirurgie thoracique pour une atrésie de l'œsophage, les complications orthopédiques peuvent apparaître parfois tardivement durant l'enfance, d'où l'importance d'un suivi régulier. Parmi ces complications figure la fusion costale secondaire à l'intervention chirurgicale et aux éventuelles complications infectieuses. Non diagnostiquée et traitée, cette complication peut être responsable d'une scoliose sévère à l'adolescence.


Assuntos
Atresia Esofágica , Escoliose , Cirurgia Torácica , Adolescente , Atresia Esofágica/complicações , Atresia Esofágica/cirurgia , Humanos , Escoliose/complicações , Escoliose/cirurgia , Toracotomia/efeitos adversos , Resultado do Tratamento
13.
Port J Card Thorac Vasc Surg ; 28(4): 55-57, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-35334173

RESUMO

INTRODUCTION: Osteosarcoma is the most common primary bone tumor in children and young adults. Although osteosarcoma is a tumor with a great metastatic potential, mainly to the lung; pleural metastasis in patients with osteosarcoma are rarely reported. We present a case of 16 years-old male with a pleural metastasis of a tibial osteosarcoma diagnosed 4years earlier. He was submitted to a left thoracotomy and intra-operatively a pleural mass and a left upper lobe lesion was identified. Video-assisted resection of the extra-pulmonary mass and a wedge resection of the left upper lobe lesion was performed. The surgery was uneventful. The patient is clinically well, asymptomatic, maintains active surveillance.


Assuntos
Neoplasias Ósseas , Neoplasias Pulmonares , Osteossarcoma , Adolescente , Neoplasias Ósseas/cirurgia , Criança , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Osteossarcoma/cirurgia , Toracotomia , Adulto Jovem
14.
Ann Ital Chir ; 92: 27-32, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35342098

RESUMO

AIM: Paraplegia is an infrequent although fearsome complication of anesthesia and surgical procedures, such as epidural anesthesia and thoracotomy. It may occur in both adults and children and a medullary lesion may be confirmed by magnetic resonance imaging, rather than computed tomography. The aim of this study is to describe the experience of two pediatric tertiary centers, contextualizing it with the other cases reported in literature. MATERIAL AND METHODS: We reported three pediatric cases of post-operative paraplegia in oncological patients, focusing on the potential causes and underling the possible strategies to prevent this complication. RESULTS: From our study, two principal features emerged: 1) Epidural anesthesia may expose children to a greater risk of spinal cord permanent damage due to the execution of the procedure under general anesthesia, which deprives the anesthesiologist of an important feedback about the position of the device; 2) In thoracotomy, the risk of paraplegia tends to increase along with the proximity to the costo-vertebral angle, especially if electrocautery or hemostatic materials are used. CONCLUSIONS: A prompt post-surgical neurological status routine assessment in pediatric patients undergoing epidural anesthesia or thoracotomy should be mandatory and, associated with the correct imaging study, may lead to the most appropriate therapeutic pathway and to a better prognosis. KEY WORDS: Anesthesia, Children, Epidural, Thoracotomy, Paraplegia.


Assuntos
Anestesia Epidural , Toracotomia , Adulto , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Anestesia Geral/efeitos adversos , Criança , Humanos , Imageamento por Ressonância Magnética , Paraplegia/etiologia , Paraplegia/prevenção & controle , Toracotomia/efeitos adversos , Toracotomia/métodos
17.
J Healthc Eng ; 2022: 2011062, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35340236

RESUMO

In this article, we have explored the feasibility and safety of Da Vinci's robotic surgery system in the radical resection of lung cancer. For this purpose, 73 cases of patients with lung cancer who underwent radical resection in the thoracic surgery of our hospital, particularly from July to September 2020, were collected, of which 22 cases operated with the Da Vinci robot were the Da Vinci robot group, including 11 men and 11 women. The 51 patients who underwent thoracoscopic surgery were in the thoracoscopic group, including 24 males and 27 females. All 22 patients in the Da Vinci robot group completed the operation under the Da Vinci robot operation system without conversion to thoracotomy. In the thoracoscopic group, 49 patients successfully completed the operation under thoracoscopy, and 2 patients were converted to thoracotomy. There was a significant difference between the two groups in the average operation time and the number of lymph nodes, but there was no significant difference in the amount of intraoperative bleeding and postoperative hospital stay. Compared with thoracoscopic radical lung cancer surgery, Da Vinci's robotic surgery system is equally safe and effective, and more lymph nodes are cleaned during surgery.


Assuntos
Neoplasias Pulmonares , Procedimentos Cirúrgicos Robóticos , Robótica , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Toracoscopia , Toracotomia
18.
Innovations (Phila) ; 17(2): 127-135, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35341368

RESUMO

Objective: Our objective was to evaluate for any changes in quality or cost when robotic lung resection is used with significant trainee participation. Methods: All anatomic lung resections between January 2006 and June 2016 were identified from a prospectively maintained database. Clinical data were recorded by double entry. Cost and cancer-related data were gathered from the business analytics department and tumor registry. Robotic outcomes were compared to an ongoing thoracotomy and video-assisted thoracic surgery (VATS) experience. Propensity scores using age, sex, and comorbidities were assigned for statistical analysis. Survival was evaluated using the Kaplan-Meier method. Results: Of 523 consecutive cases, 483 were included (211 robotic, 210 thoracotomy, 62 VATS). There were 74 robotic cases (35%) performed by trainees as the console surgeon. Length of stay was shortest for robotics (3 days) compared to thoracotomy (7 days, P < 0.001) and VATS (5 days, P = 0.010). Complications occurred in 33% of robotic cases, 42% of VATS cases (P = 0.854), and 52% of thoracotomy cases (P < 0.001). Stage I non-small cell lung cancer 3-year overall survival for robotics, thoracotomy, and VATS was 79.5%, 74.3%, and 74.0%, respectively (P > 0.25). There was no significant difference in negative margin rates. Total cost related to the hospitalization for surgery was $5,721 less for robotics compared to thoracotomy (P = 0.003) but comparable to VATS. Trainees served as console surgeon in 0% of cases in the first 2 years of robotics but increased to 79% in the last year of the study. Conclusions: Robotic lung resection can be safely performed and taught in an academic medical center without sacrificing quality or cost.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Análise Custo-Benefício , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia , Resultado do Tratamento
19.
Clin Imaging ; 85: 74-77, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35248891

RESUMO

Intercostal schwannomas can present incidentally and lead to compressive thoracic symptoms. These slow-growing and benign tumors typically arise from intercostal nerves and are supplied by intercostal arteries, which may increase the risk of hemorrhagic complications with surgical resection. Due to the rarity of intercostal schwannomas, there exists no standardized management algorithms. Pre-operative angiography and embolization can supplement surgical thoracotomy and resection by decreasing intra-operative hemorrhage and minimizing the risk of anterior spinal cord hypoperfusion.


Assuntos
Embolização Terapêutica , Neurilemoma , Angiografia , Seguimentos , Humanos , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Toracotomia
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