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1.
J Cardiothorac Vasc Anesth ; 37(8): 1433-1441, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37105852

RESUMO

OBJECTIVES: To evaluate the efficacy of a single preoperative dose of S-ketamine for chronic postsurgical pain (CPSP) in patients undergoing video-assisted thoracoscopic surgical lung lesion resection (VATS). DESIGN: A prospective randomized, double-blind controlled study. SETTING: Patients were enrolled from March 17, 2021, to November 18, 2021, at a single tertiary academic hospital. PARTICIPANTS: Patients were 18-to-65 years of age and undergoing VATS. INTERVENTIONS: The experiment was divided into an S-ketamine group (0.5 mg/kg intravenous injection before anesthesia induction) or a placebo group (the same volume of normal saline). MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the incidence of CPSP and its neuropathic component. The secondary endpoints included acute postoperative pain, the use of postoperative analgesics, anxiety and sleep quality scores, and the occurrence of adverse effects. There were no significant differences between the 2 groups in the incidences of CPSP, neuropathic pain, acute postoperative pain, and postoperative use of analgesics. The sleep quality scores on the first postoperative day differed significantly between the groups (47.45 ± 27.58 v . 52.97 ± 27.57, p = 0.049), but not the anxiety scores. In addition, adverse effects were similar between the 2 groups. CONCLUSIONS: A single preoperative dose of S-ketamine in patients who underwent VATS had no significant effect on acute and chronic postoperative pain or the consumption of analgesics after surgery. A single preoperative dose of S-ketamine could improve sleep on the first day after surgery, whereas it had no significant effect on anxiety levels.


Assuntos
Analgésicos , Cirurgia Torácica Vídeoassistida , Humanos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Estudos Prospectivos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Pulmão
2.
J Perianesth Nurs ; 37(6): 889-893, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35623994

RESUMO

PURPOSE: Postoperative analgesia following minimally invasive video assisted thoracoscopic surgery (VATS) in pediatric patients may involve intravenous opioid analgesics and continuous local anesthetic infusions via an epidural infusion catheter. The use of epidural catheters may avoid systemic side effects of intravenous opioids in this vulnerable population. DESIGN: Our primary aim was to compare total morphine equivalents (MEQ) required, and pain scores between local anesthetic epidural infusion catheters combined with intravenous opioids, versus intravenous opioids alone in pediatric patients following VATS procedure. METHODS: Following Institutional Review Board approval, we performed a retrospective chart review of children (ages 1 month to 18 years) who underwent VATS procedure for noncardiac thoracic surgery. Based on the postoperative analgesic technique used, the study population was divided into two groups that is, epidural group and nonepidural group. Both groups received intravenous systemic opioids. The primary outcome variables were total MEQ required and pain scores in the perioperative period. FINDINGS: Ninety-two patients were included in the study. Of these, 22 patients belonged to the epidural group versus 70 patients to the nonepidural group. There was no statistical difference in MEQ requirements or pain scores between the groups intraoperatively (P = .304), in the postanesthesia care unit (P = .166), or at postoperative time intervals of 24 hours (P = .805) and 48 hours (P = .844). The presence of infection or empyema was a significant factor for the avoidance of epidural placement by providers (P = .003). CONCLUSIONS: There was no significant difference in the perioperative MEQ or postoperative pain scores between the epidural catheter group and the nonepidural group. More research is necessary to determine if this could be due to epidural catheter malposition and/or inadequate dermatomal coverage of surgical chest tubes.


Assuntos
Analgesia Epidural , Anestesia Epidural , Humanos , Criança , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Cirurgia Torácica Vídeoassistida/métodos , Estudos Retrospectivos , Analgesia Epidural/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Morfina/uso terapêutico , Catéteres
3.
Rozhl Chir ; 100(12): 576-583, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35042342

RESUMO

INTRODUCTION: The use of video-assisted (VATS) and robotic-assisted (RATS) thoracoscopic surgery for anatomical pulmonary resections has been rapidly increasing. This study aimed to analyze our results of minimal invasive lobectomies to safely introduce these techniques to our practice. METHODS: Starting these new programs we followed the recommended steps including case observations and a proctoring. We retrospectively analyzed the data of our 7-year experience with VATS lobectomies and 1-year experience with RATS lobectomies. RESULTS: 128 minimal invasive lobectomies were performed between 4/2015 and 4/2021 in our center. The mean age of our patients was 64.7±10.5 years; 61 (47.7%) were women and 67 (52.3%) were men. Pulmonary malignancy was the main indication in 116 (90.6%) patients, including 2 patients with localized small cell lung cancer (SCLC). In 12 (9.4%) cases we operated for bronchiectasis and benign lung lesions. Stage I lung cancer was found in 57 (66.3%), stage II in 22 (25.6%) and stage III in 7 (8.1%) patients. We performed 110 VATS and 18 RATS lobectomies with a clear shift from triportal VATS to uniportal VATS and RATS in the last years. The mean operative time was 166±55.5 minutes and a conversion was approached in 8 (6.2%) cases (4 bleedings - less than 300 ml in all cases, 3 oncological cases, 1 case for a technical reason). The median postoperative length of stay was 4 days. CONCLUSION: VATS and RATS lobectomy has become a standard approach for early stages of lung cancer. Respecting the rules of introducing VATS and RATS including proctoring offers safety without any negative impact on survival or oncological radicality.


Assuntos
Neoplasias Pulmonares , Procedimentos Cirúrgicos Robóticos , Humanos , Pulmão , Neoplasias Pulmonares/cirurgia , Pneumonectomia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida
4.
J Surg Res ; 263: 274-284, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33309173

RESUMO

BACKGROUND: The magnitude of association and quality of evidence comparing surgical approaches for lung cancer resection has not been analyzed. This has resulted in conflicting information regarding the relative superiority of the different approaches and disparate opinions on the optimal surgical treatment. We reviewed and systematically analyzed all published data comparing near- (30-d) and long-term mortality for minimally invasive to open surgical approaches for lung cancer. METHODS: Comprehensive search of EMBASE, MEDLINE, and the Cochrane Library, from January 2009 to August 2019, was performed to identify the studies and those that passed bias assessment were included in the analysis utilizing propensity score matching techniques. Meta-analysis was performed using random-effects and fixed-effects models. Risk of bias was assessed via the Newcastle-Ottawa Scale and the ROBINS-I tool. The study was registered in PROSPERO (CRD42020150923) prior to analysis. RESULTS: Overall, 1382 publications were identified but 19 studies were included encompassing 47,054 patients after matching. Minimally invasive techniques were found to be superior with respect to near-term mortality in early and advanced-stage lung cancer (risk ratio 0.45, 95% confidence interval [CI] 0.21-0.95, I2 = 0%) as well as for elderly patients (odds ratio 0.45, 95% CI 0.31-0.65, I2 = 30%), but did not demonstrate benefit for high-risk patients (odds ratio 0.74, 95% CI 0.06-8.73, I2 = 78%). However, no difference was found in long-term survival. CONCLUSIONS: We performed the first systematic review and meta-analysis to compare surgical approaches for lung cancer which indicated that minimally invasive techniques may be superior to thoracotomy in near-term mortality, but there is no difference in long-term outcomes.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Estadiamento de Neoplasias , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Pontuação de Propensão , Medição de Risco/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/estatística & dados numéricos , Toracotomia/efeitos adversos , Toracotomia/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento
5.
Cost Eff Resour Alloc ; 19(1): 55, 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454507

RESUMO

BACKGROUND: Lung cancer is highly prevalent in Chinese population. The association of operative approach with economic burden in these patients remains unknown. OBJECTIVES: This institution-level cohort study aimed to compare the cost-related clinical outcomes and health care costs among patients undergoing video-assisted thoracoscopic surgery (VATS) and open lobectomy, and to investigate the factors associated with the costs. METHODS: This retrospective cohort study included patients who underwent VATS or open lobectomy in a provincial referral cancer center in China in 2018. Propensity score matching (PSM) method was applied to balance the baseline characteristics in VATS lobectomy and open lobectomy group. Clinical effectiveness measures included post-operative blood transfusion, lung infection, and length of stay (LOS). Hospitalization costs were extracted from hospital information system to assess economic burden. Multivariable generalized linear model (GLM) with gamma probability distribution and log-link was used to analyze the factors associated with total costs. RESULTS: After PSM, 376 patients were selected in the analytic sample. Compared to open lobectomy group, the VATS lobectomy group had a lower blood transfusion rate (2.13% vs. 3.19%, P = 0.75), lower lung infection rate (21.28% vs. 39.89%, P < 0.001) and shorter post-operative LOS (9.4 ± 3.22 days vs. 10.86 ± 4.69 days, P < 0.001). Total hospitalization costs of VATS lobectomy group and open lobectomy were similar: Renminbi (RMB) 84398.03 ± 13616.13, RMB 81,964.92 ± 16748.11, respectively (P = 0.12). Total non-surgery costs were significantly lower in the VATS lobectomy group than in the open lobectomy group: RMB 41948.40 ± 7747.54 vs. RMB 45752.36 ± 10346.42 (P < 0.001). VATS approach, lung infection, longer post-operative length of stay, health insurance coverage, and lung cancer diagnosis were associated with higher total hospitalization costs (P < 0.05). CONCLUSIONS: VATS lobectomy has a lower lung infection rate, and shorter post-operative LOS than open lobectomy. Future studies are needed to investigate other aspects of clinical effectiveness and the economic burden from a societal perspective.

6.
World J Surg Oncol ; 19(1): 33, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33516218

RESUMO

BACKGROUND: The role of surgical intervention as a treatment for pulmonary metastasis (PM) from hepatocellular carcinoma (HCC) has not been established. In this study, we investigated the clinical outcomes of pulmonary metastasectomy. Using propensity score matching (PSM) analysis, we compared the results according to the surgical approach: video-assisted thoracic surgery (VATS) versus the open method. METHODS: A total of 134 patients (115 men) underwent pulmonary metastasectomy for isolated PM of HCC between January 1998 and December 2010 at Seoul Asan Medical Center. Of these, 84 underwent VATS (VATS group) and 50 underwent thoracotomy or sternotomy (open group). PSM analysis between the groups was used to match them based on the baseline characteristics of the patients. RESULTS: During the median follow-up period of 33.4 months (range, 1.8-112.0), 113 patients (84.3%) experienced recurrence, and 100 patients (74.6%) died of disease progression. There were no overall survival rate, disease-free survival rate, and pulmonary-specific disease-free survival rate differences between the VATS and the open groups (p = 0.521, 0.702, and 0.668, respectively). Multivariate analysis revealed local recurrence of HCC, history of liver cirrhosis, and preoperative alpha-fetoprotein level as independent prognostic factors for overall survival (hazard ratio, 1.729/2.495/2.632, 95% confidence interval 1.142-2.619/1.571-3.963/1.554-4.456; p = 0.010/< 0.001/< 0.001, respectively). CONCLUSIONS: Metastasectomy can be considered a potential alternative for selected patients. VATS metastasectomy had outcomes comparable to those of open metastasectomy.


Assuntos
Carcinoma Hepatocelular , Neoplasias Colorretais , Neoplasias Hepáticas , Neoplasias Pulmonares , Metastasectomia , Carcinoma Hepatocelular/cirurgia , Humanos , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/cirurgia , Masculino , Recidiva Local de Neoplasia/cirurgia , Pneumonectomia , Prognóstico , Estudos Retrospectivos , Seul , Cirurgia Torácica Vídeoassistida , Toracotomia , Resultado do Tratamento
7.
BMC Surg ; 21(1): 88, 2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33596862

RESUMO

BACKGROUND: Neurofibroma of the esophagus, originated from the nerve sheath cells and fibroblasts of the esophageal submucosal plexus or the intestinal intermuscular plexus, is a very rare mesenchymal tumor. Most of the cases are treated by surgical methods. Due to the technical complexity of video-assisted thoracoscopic surgery (VATS), there are few reports in the literature of VATS for esophageal neurofibroma in recent years. CASE PRESENTATION: We report on two rare cases of esophageal neurofibroma, one of which is a 52-year-old male patient diagnosed with a 4.6 × 5.7 cm upper esophageal submucosal tumor in physical examination. He was admitted to our hospital and the tumor was enucleated by VATS combined with intraoperative endoscopy. There were no complications after operation, and the patients was discharged on the 16th postoperative day. The other patient was a 76-year-old man, with the main clinical manifestation of dysphagia for over 1 year, diagnosed with an 8.0 × 6.0 × 8.0 cm giant subepithelial mass in the lower esophagus. As the intraoperative exploration revealed the tumor connected tightly with the wall of the esophagus, this patient treated by transthoracic partial esophagectomy. The patient was discharged on the 14th postoperative day, and no signs of post-operative complication during the 53-month follow-up. The diagnosis of esophageal neurofibroma was based on these patients' postoperative pathological examination. In the latest follow-up, these two patients had no evidence of long-term postoperative complication and recurrence. CONCLUSION: This is the first reported case of 5 cm in diameter esophageal neurofibroma treated by VATS. This technique can be a commendable treatment option for esophageal neurofibroma, and the tumor diameter is not an absolute contraindication for thoracoscopy. To reduce the unnecessary damage, surgical method for complete tumor resection needs to be determined according to preoperative imaging and intraoperative conditions, partial esophagectomy can be performed via thoracotomy or thoracoscopy for removing neurofibroma when necessary.


Assuntos
Neoplasias Esofágicas , Neurofibroma , Idoso , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neurofibroma/diagnóstico , Neurofibroma/cirurgia , Cirurgia Torácica Vídeoassistida
8.
BMC Anesthesiol ; 20(1): 25, 2020 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992212

RESUMO

BACKGROUND: Inadvertent intraoperative hypothermia increases the risk of adverse events, but its related risk factors have not been defined in video-assisted thoracoscopic surgery (VATS). This study aimed at analyzing the prevalence and factors related to inadvertent intraoperative hypothermia in adults undergoing elective VATS under general anesthesia. METHODS: This was a retrospective study using data from the Peking University People's Hospital from January through December, 2018. Data were collected on age, sex, height, weight, American Society of Anesthesiologists physical status, the duration of preparation and surgery, timing of surgery, surgery types, anesthesia types, intraoperative core temperature and the length of stay (LOS) in the hospital from the electronic database in our center. Patients were covered with a cotton blanket preoperatively and the surgical draping during the operation. A circulation-water warming mattress set to 38 °C were placed under the body of the patients. Inadvertent intraoperative hypothermia was identified as a core temperature monitored in nasopharynx < 36 °C. Multivariate logistic regression analysis was used to identify independent risk factors of hypothermia. RESULTS: We found that 72.7% (95% CI 70.5 to 75.0%) of 1467 adult patients who underwent VATS suffered hypothermia during surgery. The factors associated with inadvertent intraoperative hypothermia included age (OR = 1.23, 95% CI 1.11 to 1.36, p < 0.001), BMI (OR = 1.83, 95% CI 1.43 to 2.35, p < 0.001), the duration of preparation (OR = 1.01, 95% CI 1.00 to 1.02, p = 0.014), the duration of surgery (OR = 2.10, 95% CI 1.63 to 2.70, p < 0.001), timing of surgery (OR = 1.64, 95% CI 1.28 to 2.12, p < 0.001), ambient temperature in the operating room (OR = 0.67, 95% CI 0.53 to 0.85, p = 0.001) and general anesthesia combined with paravertebral block after induction of anesthesia (OR = 2.30, 95% CI 1.31 to 4.03, p = 0.004). The average LOS in the hospital in the hypothermia group and the normothemic group was 9 days and 8 days, respectively (p < 0.001). CONCLUSIONS: We highlight the high prevalence of inadvertent intraoperative hypothermia during elective VATS and identify key risk factors including age, duration of surgery more than 2 h, surgery in the morning and general anesthesia combined with paravertebral block (PVB) after intubation. We also find that hypothermia did prolong the LOS in the hospital.


Assuntos
Hipotermia/epidemiologia , Complicações Intraoperatórias/epidemiologia , Cirurgia Torácica Vídeoassistida , Fatores Etários , Idoso , Anestesia Geral/métodos , Pequim/epidemiologia , Temperatura Corporal , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
9.
AJR Am J Roentgenol ; 213(4): 778-781, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31166753

RESUMO

OBJECTIVE. Thoracoscopic surgical resection of small peripheral pulmonary nodules can be challenging, and often preoperative localization techniques are needed to avoid conversion to open thoracotomy. In this article, we show the feasibility and benefits of performing intraoperative percutaneous microcoil localization with C-arm cone-beam CT in a hybrid operating room immediately before video-assisted thoracoscopic surgery for wedge resection of a small pulmonary nodule. CONCLUSION. This technique can provide safe and accurate localization while minimizing patient discomfort and thus enhancing the patient's experience.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Neoplasias Pulmonares/diagnóstico por imagem , Salas Cirúrgicas , Nódulo Pulmonar Solitário/diagnóstico por imagem , Idoso , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Cuidados Pré-Operatórios , Nódulo Pulmonar Solitário/cirurgia , Cirurgia Torácica Vídeoassistida
10.
Surg Today ; 49(5): 369-377, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30511319

RESUMO

OBJECTIVES: Video-assisted thoracoscopic surgery (VATS) lobectomy is performed widely for patients with clinical stage I non-small cell lung cancer (NSCLC) because of its superior short-term outcomes to those of thoracotomy lobectomy. However, the long-term outcomes of VATS lobectomy vs. thoracotomy lobectomy remain controversial. METHODS: We reviewed the clinical data of 202 consecutive patients who underwent lobectomy for clinical stage IA NSCLC at our institution between January, 2008 and December, 2013. Stage IA NSCLC was confirmed pathologically in 162 of these patients, 60 of whom underwent VATS lobectomy and 102 of whom underwent thoracotomy lobectomy. We compared the perioperative clinical factors and outcomes of these two groups, using a propensity score-matched analysis. RESULTS: In an analysis of 58 matched cases, the VATS group showed less blood loss, a shorter duration of chest tube placement, a shorter postoperative hospital stay, and a lower peak C-reactive protein value, despite a longer operative time. The VATS group also had significantly longer survival than the thoracotomy group [5-year overall survival, 100% vs. 87%, respectively (p = 0.01); 5-year disease-free survival, 100% vs. 86% (p = 0.03)]. CONCLUSIONS: These findings suggest that VATS may have better long-term as well as short-term outcomes than thoracotomy for patients with early-stage NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Tempo de Internação , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Duração da Cirurgia , Pneumonectomia/mortalidade , Pontuação de Propensão , Taxa de Sobrevida , Cirurgia Torácica Vídeoassistida/mortalidade , Toracotomia/mortalidade , Fatores de Tempo , Resultado do Tratamento
11.
Surg Innov ; 25(2): 121-127, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29357784

RESUMO

OBJECTIVES: The investigation was aimed to evaluate the safety and efficacy of glasses-free 3-dimensional (3D) video-assisted thoracoscopic surgery (VATS) versus 2D VATS for radical resection of non-small cell lung cancer (NSCLC). METHODS: We reviewed the clinical data of patients with pathologically proven NSCLC who underwent glasses-free 3D (the 3D group) and 2D VATS radical lobectomy (the 2D group) with systematic lymph node dissection. The outcomes of this study included operative characteristics and safety of 2D and 3D VATS, and duration of lymphadenectomy of right stations 2 and 4. RESULTS: A total of 190 patients were eligible for the study. The 2D group consisted of 108 patients while the 3D group included 82 patients. The 2 groups were comparable in demographic and baseline variables ( P > .05). The median number of resected lymph nodes was 19 in both groups ( P = .583). The median length of hospital stay was comparable between the 2 groups (2D, 7 days vs 3D, 8 days; P = .167). No operative mortality was reported in either group. Complications developed in 21 (19.4%) patients in the 2D group and 14 (17.1%) in the 3D group ( P = .710). A subgroup analysis of patients who underwent right station 2 and 4 lymphadenectomy showed that the mean time for right station 2 and 4 lymph node dissection was significantly shorter in the 3D group than in the 2D group (3D, 430.9 ± 237.2 vs 2D, 648.6 ± 364.1 seconds; P < .001). CONCLUSIONS: Glasses-free 3D VATS and 2D VATS are comparable in operative characteristics and safety profile for radical resection of NSCLC. Glasses-free 3D visualization facilitates more rapid right-sided mediastinal lymphadenectomy.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Cirurgia Torácica Vídeoassistida , Idoso , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Cirurgia Torácica Vídeoassistida/estatística & dados numéricos , Resultado do Tratamento
12.
Surg Endosc ; 31(4): 1772-1777, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27519592

RESUMO

BACKGROUND: Diaphragmatic plication is an approved surgical procedure for treatment of symptomatic diaphragmatic paralysis and eventration. We aim to define our minimally invasive technique of plication and objectively assess our surgical outcomes of the largest series reported in the literature so far, using pulmonary function tests. METHODS: Symptomatic patients whom were planned to undergo plication using video-assisted mini-thoracotomy between December 2009 and December 2015 were the cohort of this retrospective study. Single camera port and a utility incision (3-4 cm) were used for access. Data of patient demographics with preoperative and postoperative spirometric results were collected for statistical comparison. RESULTS: Procedure (30 left, 7 right) was completed in 37 (27 male, 10 female) patients. One patient was excluded because of insufficient objective postoperative comparison criteria due to previous permanent tracheostomy. Mean length of surgery was 48.8 ± 19.7 (range: 30-70) min. Postoperative overall morbidity was 8.3 %, with no mortality. The mean length of hospital stay was 3.1 ± 1.7 days. All patients except one (97.3 %) were asymptomatic on discharge and on follow-ups. Significant improvement in measurements of forced expiratory volume in 1st second was observed on postoperative measurements (P < 0.001), with a mean overall increase of 13 % in whole cohort. No recurrence was detected throughout a mean follow-up of 19 months. CONCLUSIONS: Diaphragmatic plication via video-assisted mini-thoracotomy is an effective and curative surgical procedure which can be performed successfully with low morbidity rates. As it combines the rapidity and economical benefits of open thoracotomy with the advantages of video thoracoscopic procedures such as fast recovery and short postoperative hospital stay, it can be preferred as a safe and effective alternative hybrid method compared to standard open or closed techniques, for symptomatic patients with non-functional hemidiaphragm.


Assuntos
Diafragma/cirurgia , Eventração Diafragmática/cirurgia , Paralisia Respiratória/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodos , Adulto , Idoso , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
13.
J Formos Med Assoc ; 116(12): 917-923, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28781098

RESUMO

The broad application of low-dose computed tomography screening has resulted in the detection of many more cases of early lung cancer than ever before in modern history. Recent advances in the management of early-stage non-small cell lung cancer have focused on making therapy less traumatic, enhancing recovery, and preserving lung function. In this review, we discuss several new modalities associated with minimally invasive surgery for lung cancer. Firstly, less lung parenchyma resection via sublobar resection has become an acceptable alternative to lobectomy in patients with tumors less than 2 cm in size or with poor cardiopulmonary reserve. Secondly, thoracoscopic surgery using a single-portal or needlescopic approach to decrease chest wall trauma is becoming common practice. Thirdly, less invasive anesthesia, using nonintubated techniques, is feasible and safe and is associated with fewer intubation- and ventilator-associated complications. Fourthly, preoperative or intraoperative image-guided localization is an effective modality for identifying small and deep nodules during thoracoscopic surgery.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Anestesia , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Detecção Precoce de Câncer , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X
14.
Folia Morphol (Warsz) ; 76(3): 388-393, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28026848

RESUMO

BACKGROUND: Identification and section of pulmonary veins are an essential part of anatomical pulmonary resections. Intraoperative misunderstandings of pulmonary venous anatomy can lead to serious complications such as bleeding and delayed lung infarction or necrosis. We evaluated principally the rate of pulmonary veno-us anatomical variations, and secondarily the reliability and clinical outcomes of a preoperative morphological analysis. MATERIALS AND METHODS: Between November 2012 and October 2013, we studied 100 consecutive patients with highly suspected or diagnosed stage I-II primitive lung cancer lesion. The surgical procedure initially retained was video-assisted thoracoscopic surgery (VATS) pulmonary resections and we studied preoperatively the proximal pulmonary venous anatomy using 64 channels multi- -detector computed tomography (CT)-scan angiography to describe the venous anatomical variations. RESULTS: There were 65 men and 35 women with a mean age of 63 years. A pulmonary venous anatomical variation was present in 36 (36%) patients, and right-sided anatomical variations were more frequent than on left-sided ones (25% vs. 11%). The most frequent variation encountered on the right side was the existence of three separate pulmonary veins (16%), and on the left side a single pulmonary vein (8%). Surgical conversion occurred in 21% and we didn't experience a pulmonary venous lesion (0%) or a post-operative lung infarction (0%). CONCLUSIONS: We described pulmonary venous anatomical variations and their frequency. Anatomical variations exist and preoperative assessment of pulmo-nary venous anatomy using CT scan is a useful tool in VATS lobectomy to avoid unnecessary extension of pulmonary resections or iatrogenic complications in lung cancer surgery.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Imageamento Tridimensional/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
15.
Heart Lung Circ ; 25(4): 392-7, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26546096

RESUMO

BACKGROUND: To evaluate the efficacy and long-term survival outcomes of complete video-assisted thoracoscopic surgery (C-VATS) for the resection of anatomic pulmonary segments and systematic lymphadenectomy in the treatment of elderly and high-risk patients with stage IB for non-small cell lung cancer (NSCLC). METHODS: 242 elderly patients (≥65 years), who were operated on by the same operational team, were divided into high-risk group and conventional risk group from August 2008 to December 2010. All patients were diagnosed in stage IB (pT status: >2 to ≤3) NSCLC by biopsy and examination of PET-CT before operation. The high-risk patients were identified with severe cardiopulmonary and other system dysfunctions as follow-up criteria. They were treated with VATS anatomic pulmonary segments and systematic lymphadenectomy. The conventional risk patients with adequate cardiopulmonary reserve were treated with VATS radical lobectomy and systematic lymphadenectomy. The clinical and pathological data were recorded. The total survival, tumour-free survival, recurrence time and character of patients were followed-up. Appropriate statistical analyses involved the χ(2) test and Kaplan-Meier estimates of total survival and tumour-free survival. RESULTS: A total of 242 patients underwent surgical resection during our study period: Anatomic pulmonary segments in 116 patients and lobectomy in 126. The operative time and blood loss of the VATS anatomic pulmonary segments group (78.0±35.0 min, 95.6±30.4 ml) were significantly less than those of the VATS radical resection group (108.0±25.0 min, 165.6±58.4 ml). Neither group experienced post-operative death. The overall and tumour-free survival rate of the VATS anatomic pulmonary segments group within five years were 62.07% and 29.31%, and those of the VATS radical resection group were 63.49% and 33.33%,%; there was no significant difference (P>0.5). The recurrence rates of the VATS anatomic pulmonary segment group and VATS radical resection group were 13.79% and 12.70%; there was no significant difference (P>0.5). CONCLUSIONS: Thorascopic segmentectomy under anaesthesia and systematic lymphadenectomy is safe and minimally invasive and effective to treat a selected group of patients with stage IB NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Excisão de Linfonodo/métodos , Cirurgia Torácica Vídeoassistida/métodos , Idoso , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Seguimentos , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fatores de Risco
16.
Chin J Cancer Res ; 27(2): 197-202, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25937782

RESUMO

OBJECTIVE: The objective of the current study was to evaluate the feasibility and safety of nonintubated uniportal video-assisted thoracoscopic surgery (VATS) for the management of primary spontaneous pneumothorax (PSP). METHODS: From November 2011 to June 2013, 32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidural anaesthesia and sedation without endotracheal intubation. An incision 2 cm in length was made at the 6(th) intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a soft incision protector. Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy. Data were collected within a minimum follow-up period of 10 months. RESULTS: The average time of surgery was 49.0 min (range, 33-65 min). No complications were recorded. The postoperative feeding time was 6 h. The mean postoperative chest tube drainage and hospital stay were 19.3 h and 41.6 h, respectively. The postoperative pain was mild for 30 patients (93.75%) and moderate for two patients (6.25%). No recurrences of pneumothorax were observed at follow-up. CONCLUSIONS: The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible, but may also be a safe and less invasive alternative for select patients in the management of PSP. This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases. Further work and development of instruments are needed to define the applications and advantages of this technique.

17.
Acta Radiol ; 55(6): 699-706, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24078457

RESUMO

BACKGROUND: Small peripheral lung nodules detected on computed tomography (CT) scans are often difficult to find during thoracoscopic resection, and the present localizing techniques are inefficient or impractical. PURPOSE: To evaluate a novel marking procedure for small peripheral pulmonary nodules using an embolization coil. MATERIAL AND METHODS: Patients with small peripheral pulmonary nodules underwent preoperative CT-guided nodule localization using an embolization coil and then resection by fluoroscopically-guided video-assisted thoracoscopic surgery (VATS; group A, n = 22), or, underwent conventional VATS without prior location procedures (group B, n = 16). Comparisons were made between group A and group B concerning operative time, hospitalization, postoperative drainage, and complications. Histopathological diagnoses were made immediately after resection of pulmonary nodules. RESULTS: All CT-guided embolization coil fixations were successful. No patient in group A and eight (50%) in group B required conversion to open thoracotomy (P < 0.0001). No severe complications occurred in either group. Compared with group B, group A had a significantly shorter mean operative time and hospitalization, and less postoperative drainage. CONCLUSION: Preoperative localization of small peripheral pulmonary nodules using CT-guided embolization coil insertion and subsequent fluoroscopically-guided VATS resection is safer and more effective than conventional VATS.


Assuntos
Marcadores Fiduciais , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Cuidados Pré-Operatórios/métodos , Radiografia Intervencionista/métodos , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/cirurgia , Projetos Piloto , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/cirurgia
18.
Surg Innov ; 21(5): 481-6, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24292264

RESUMO

BACKGROUND: The objectives of this study were to report the surgical techniques and clinical outcome of thoracoscopic half carina resection and thoracoscopic bronchial sleeve resection for central lung cancer. METHODS: Between January 2011 and November 2012, 675 patients with lung cancer underwent radical surgery by thoracoscopy, and 49 (7.3%) underwent bronchial sleeve resection. Among 49 patients, 20 (41%) received thoracoscopic bronchial sleeve lobectomy. Perioperative variables and postoperative outcomes of these cases were analyzed to evaluate the technical feasibility and safety of this operation. RESULTS: In one patient, right upper lung sleeve resection was combined with half-carinal resection and reconstruction. In another, right medial lung sleeve resection was combined with lower right dorsal segment resection. The average time of surgery was 239 ± 51 minutes (range = 142-330 minutes), and the average time of airway reconstruction was 44 ± 17 minutes (range = 22-75 minutes). The intraoperative blood loss averaged 207 ± 96 mL (range = 80-550 mL). The median postoperative hospital stay was 10 days (interquartile range = 8-12 days). Postoperatively, extubation was achieved in the recovery room without further need for mechanical ventilation. None of the patients developed anastomotic leak. Perioperative mortality was not observed. CONCLUSION: Thoracoscopic bronchial sleeve resection can be considered a feasible and safe operation for selected patients with central lung cancer. The complicated anastomosis technique of half carina resection was feasible.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pneumonectomia/instrumentação , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/instrumentação
19.
Chin J Cancer Res ; 26(4): 418-22, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25232214

RESUMO

OBJECTIVE: The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery (VATS) radical treatment for patients with stage IIIA lung cancer, with the primary endpoints being the safety and feasibility of this operation and the second endpoints being the survival and complications after the surgery. METHODS: A total of 51 patients with radiologically or mediastinoscopically confirmed stage IIIA lung cancer underwent VATS radical treatment, during which the standard pulmonary lobectomy and mediastinal lymph node dissection were performed after pre-operative assessment. The operative time, intraoperative blood loss/complications, postoperative recovery, postoperative complications, and lymph node dissection were recorded and analyzed. This study was regarded as successful if the surgical success rate reached 90% or higher. RESULTS: A total of 51 patients with non-small cell lung cancer (NSCLC) were enrolled in this study from March 2009 to February 2010. The median post-operative follow-up duration was 50.5 months. Of these 51 patients, 41 (80.4%) had N2 lymph node metastases. All patients underwent the thoracoscopic surgeries, among whom 50 (98%) received pulmonary lobectomy and mediastinal lymph node dissection completely under the thoracoscope, 6 had their incisions extended to about 6 cm due to larger tumor sizes, and 1 had his surgery performed using a 12 cm small incision for handling the adhesions between lymph nodes and blood vessels. No patient was converted to conventional open thoracotomy. No perioperative death was noted. One patient received a second surgery on the second post-operative day due to large drainage (>1,000 mL), and the postoperative recovery was satisfactory. Up to 45 patients (88.2%) did not suffer from any perioperative complication, and 6 (11.8%) experienced one or more complications. CONCLUSIONS: VATS radical treatment is a safe and feasible treatment for stage IIIA lung cancer.

20.
Chin J Cancer Res ; 26(4): 391-8, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25232210

RESUMO

BACKGROUND: Video-assisted thoracic surgery (VATS) has been shown to be a safe alternative to conventional thoracotomy for patients with non-small cell lung cancer (NSCLC). However, popularization of this relatively novel technique has been slow, partly due to concerns about its long-term outcomes. The present study aimed to evaluate the long-term survival outcomes of patients with NSCLC after VATS, and to determine the significant prognostic factors on overall survival. METHODS: Consecutive patients diagnosed with NSCLC referred to one institution for VATS were identified from a central database. Patients were treated by either complete-VATS or assisted-VATS, as described in previous studies. A number of baseline patient characteristics, clinicopathologic data and treatment-related factors were analyzed as potential prognostic factors on overall survival. RESULTS: Between January 2000 and December 2007, 1,139 patients with NSCLC who underwent VATS and fulfilled a set of predetermined inclusion criteria were included for analysis. The median age of the entire group was 60 years, with 791 male patients (69%). The median 5-year overall survival for Stage I, II, III and IV disease according to the recently updated TNM classification system were 72.2%, 47.5%, 29.8% and 28.6%, respectively. Female gender, TNM stage, pT status, and type of resection were found to be significant prognostic factors on multivariate analysis. CONCLUSIONS: VATS offers a viable alternative to conventional open thoracotomy for selected patients with clinically resectable NSCLC.

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