Video-assisted thoracoscopic suturing of apical bullae. An alternative to staple resection in the management of primary spontaneous pneumothorax

Negative Outcomes following Video-Assisted Thoracic Surgery

The author reviewed his personal experience with 776 video-assisted thoracoscopic procedures on 526 patients over a 34-month period, with particular attention to perioperative complications and procedure failures. There was one death (mortality rate 0.2%). Nonfatal complications comprised persistent air leaks (13), bleeding (4), wound infection (2), intercostal neuralgia (5), cerebrovascular accident (1), reexpansion pulmonary edema (1), deep vein thrombosis (1), prolonged ventilatory support (1), and port site recurrence (1), giving rise to an overall nonfatal complication rate of 5.5%. Procedure failures consisted of 4 incidences of recurrence of pneumothorax (out of 213 cases or 1.9%); 2 recurrences of malignant pleural effusion (out of 39 cases or 5.1%); 2 recurrences following resections for stage I lung cancer (out of 32 cases or 6.3%). Proportionally more complications and procedure failures were seen in the first 17 months compared to the following 17 months, in spite of the fact that more technically advanced procedures were performed in the latter period. Careful patient selection and attention to details are essential in optimizing surgical results.

Low-cost biportal endoscopic surgery for primary spontaneous pneumothorax

BACKGROUND

Like many other countries, including the United States, China faces the problem of rising health care costs, which have become a heavy burden on the state and individuals. Endoscopic surgery offers many benefits. However, the need for more expensive endoscopic consumables brings further high medical costs. Therefore, the development of video-assisted thoracic surgery with no disposable consumables will help to control medical cost escalation.

METHODS

Between October 2011 and September 2014, a series of 66 patients with primary spontaneous pneumothorax underwent hand ligation of blebs under biportal video-assisted thoracoscopic surgery or bullectomy with stapler during triportal video-assisted thoracoscopic surgery. After treatment of blebs, pleural abrasion was performed with an electrocautery cleaning pad.

RESULTS

Compared with the group treated by bullectomy with stapler, we found a significant reduction in postoperative costs in the group with bleb ligation. There was no difference in operating time, chest tube drainage, and postoperative stay between the two groups. The follow-up period varied from 1 to 35 months and six cases of recurrence were noted.

CONCLUSIONS

The technique that we described appears to offer better economic results than bullectomy with a stapler under three-port video-assisted thoracoscopic surgery for treating primary spontaneous. The clinical outcomes are similar.

Preventing recurrence of spontaneous pneumothorax after thoracoscopic surgery: a review of recent results

Spontaneous pneumothorax (SP) is now commonly treated with thoracoscopic surgery, which is associated with less pain and a shorter hospital stay than thoracotomy; however, in its initial stages, thoracoscopic stapled bullectomy resulted in an unexpectedly high incidence of postoperative SP recurrence. Thus, new thoracoscopic procedures, designed to be performed in addition to stapled bullectomy, were developed, which resulted in a gradual decline in the postoperative recurrence rate. We review the recent literature on SP recurrence after thoracoscopic surgery with these other surgical procedures. Pleurectomy and pleural abrasion have been performed for a long time with low recurrence rates; however, they cause the lung to adhere to the parietal pleura, often resulting in complications such as postoperative bleeding. Other surgical procedures that may be recommended to minimize the risk of recurrence are reinforcement of the staple lines using fleece-coated glue or an absorbable sheet. These procedures are now considered to be the thoracoscopic treatment of choice for SP.

Video assisted thoracoscopic surgery (VATS) in Asia--its impact and implications

BACKGROUND

Within a short period of time, video assisted thoracoscopic surgery (VATS) has revolutionised the practice of thoracic surgery. Most of the existing literature, however, is concentrated on the technical aspects.

AIMS

We examined the impact of VATS on our practice and its implications.

METHODS

We reviewed our thoracic case load two years before and two years after the introduction of VATS in our hospital.

RESULTS

We have witnessed a rapid and progressive increase in our thoracic case load since the introduction of VATS. With increased experience, proportionally more cases were performed using VATS compared to conventional surgical access. The increased case load covered a wide range of thoracic diseases with the majority for spontaneous pneumothorax and pleural diseases.

CONCLUSIONS

The higher case load is due to increased referrals which at least partly reflect earlier acceptance by both the patients and their physicians for surgical intervention. The changing indications for surgery and the high cost associated with VATS, however, could place extra demand on the healthcare, especially for some countries in Asia. Cost containment is therefore a high priority here. More research is greatly needed in this area.

Complications and failures of video-assisted thoracic surgery: experience from two centers in Asia

BACKGROUND

There have been few specific reports on negative outcomes after video-assisted thoracic surgery. We report our combined experience from two centers in Asia.

METHODS

From September 1992 to April 1995, 1,337 patients were operated on with the video-assisted thoracic surgical approach. All the patients were prospectively studied.

RESULTS

There was one death (mortality rate, 0.07%) and 56 nonfatal complications: persistent air leaks (21), bleeding (6), wound infection (13), empyema (2), cerebrovascular accident (1), reexpansion pulmonary edema (2), deep vein thrombosis (1), prolonged ventilatory support (4), intercostal neuralgia (5), and port-site recurrence (1), giving rise to an overall nonfatal complication rate of 4.26%. Procedure failures consisted of 7 recurrences of spontaneous pneumothorax (of 407 cases or 1.7%); 2 recurrences of malignant pleural effusion (of 39 cases or 5.1%), and 2 local recurrences after resections for stage I lung cancers (of 41 cases or 4.9%).

CONCLUSIONS

We conclude that video-assisted thoracic surgery is safe and effective for a wide range of procedures. A learning curve is present, and careful patient selection and attention to details are essential in optimizing surgical results.