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Chuang JH, Hsu HH, Lin MW, Huang PM, Kuo SW, Chen KC, Chen JS. Evaluating postoperative recovery in uniportal versus needlescopic video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: a comparable study. Front Surg 2024; 11:1356989. [PMID: 38486793 PMCID: PMC10938593 DOI: 10.3389/fsurg.2024.1356989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024] Open
Abstract
Objectives Primary spontaneous pneumothorax (PSP) is a common disease in young and thin male. Operation has been regarded as definitive treatment for it. However, the operative methods for those patients are under dispute. This study aims to directly compare the outcomes of uniportal VATS vs. needlescopic VATS in the treatment of PSP, focusing on postoperative pain and safety outcomes. Methods From July 2013 to December 2017, the patients who underwent video-assisted thoracic surgery for pneumothorax in National Taiwan University Hospital were retrospectively collected. The preoperative condition, surgical results, and postoperative outcomes was analyzed. Results There were 60 patients undergoing needlescopic VATS and 91 undergoing uniportal VATS during the study period. There was no significant difference between the patients who underwent needlescopic VATS and those who underwent uniportal VATS in their demographic and clinical characteristics. The post-operative pain score was significantly lower in the uniportal VATS group compared to the needlescopic VATS group at day 1 (2.65 ± 1.59 vs. 1.74 ± 1.35, p = 0.001). Conclusion Uniportal VATS offers an effective, safe alternative for PSP treatment, with benefits including reduced post-operative pain. Our findings support the use of uniportal VATS, supplemented by a wound protector, as a viable option for PSP patients.
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Affiliation(s)
- Jen-Hao Chuang
- Department of Surgical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Ming Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shuenn-Wen Kuo
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ke-Cheng Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Chang J, Ratnaraj V, Fu V, Jiang M, Peri V, Nguyenhuy M, Antippa P. Pleural abrasion versus apical pleurectomy for primary spontaneous pneumothorax: a systematic review and Meta-analysis. J Cardiothorac Surg 2023; 18:105. [PMID: 37024894 PMCID: PMC10080866 DOI: 10.1186/s13019-023-02207-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/02/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Surgical approach is the most effective treatment for primary spontaneous pneumothorax. The two most widely adopted surgical methods are mechanical abrasion and apical pleurectomy, in addition to bullectomy. We performed a systematic review and meta-analysis to examine which technique is superior in treating primary spontaneous pneumothorax. METHODS PubMed, MEDLINE and EMBASE databases were searched for studies published between January 2000 to September 2022 comparing mechanical abrasion and apical pleurectomy for treatment of primary spontaneous pneumothorax. The primary outcome was pneumothorax recurrence. Secondary outcomes included post-operative chest tube duration, hospital length of stay, operative time and intra-operative of blood loss. RESULTS Eight studies were eligible for inclusion involving 1,613 patients. There was no difference in the rate of pneumothorax recurrence between pleural abrasion and pleurectomy (RR: 1.34; 95% CI: 0.94 to 1.92). However, pleural abrasion led to shorter hospital length of stay (MD: -0.25; 95% CI: -0.51 to 0.00), post-operative chest tube duration (MD: -0.30; 95% CI: -0.56 to -0.03), operative time (MD: -13.00; 95% CI -15.07 to 10.92) and less surgical blood loss (MD: -17.77; 95% CI: -24.36 to -11.18). CONCLUSION Pleural abrasion leads to less perioperative patient burden and shorter hospital length of stay without compromising the rate of pneumothorax recurrence when compared to pleurectomy. Thus, pleural abrasion is a reasonable first choice surgical procedure for management of primary spontaneous pneumothorax.
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Affiliation(s)
- Jaewon Chang
- St George Hospital, Kogarah, Sydney, NSW, 2217, Australia.
| | - Vignesh Ratnaraj
- The Royal Melbourne Hospital, Parkville, Melbourne, VIC, 3050, Australia
| | - Vincent Fu
- The University of Melbourne, Parkville, Melbourne, VIC, 3050, Australia
| | - Michael Jiang
- Austin Hospital, 3084, Heidelberg, Melbourne, VIC, Australia
| | - Varun Peri
- Austin Hospital, 3084, Heidelberg, Melbourne, VIC, Australia
| | | | - Phillip Antippa
- The Royal Melbourne Hospital, Parkville, Melbourne, VIC, 3050, Australia
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Tülüce K, Türüt H. Management of primary spontaneous pneumothorax: Our single-center, five-year experience. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2022; 30:75-82. [PMID: 35444856 PMCID: PMC8990153 DOI: 10.5606/tgkdc.dergisi.2022.21242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/23/2021] [Indexed: 04/08/2023]
Abstract
BACKGROUND In this study, we aimed to analyze the effects of admission time to the hospital and different variables on the treatment efficiency and to evaluate the recurrence during the clinical management process in patients with the diagnosis of primary spontaneous pneumothorax. METHODS A total of 149 patients with primary spontaneous pneumothorax (131 males, 18 females; mean age: 24.8±6.8 years; range, 17 to 35 years) treated in our clinic between January 2015 and December 2019 were retrospectively analyzed. Time from symptom onset to hospital admission (admission time) was classified as three periods: <24 h, between 24 and 72 h, and >72 h. Data including admission time, demographic and clinical characteristics, smoking history, body mass index, the use of pleurectomy or pleural abrasion during surgery were collected from the charts of the patients. RESULTS Admission time had no statistically significant effect on the length of hospital stay, recurrence, and the need for surgery. Male sex, smoking history, and lower body mass index had no significant effect on the recurrence. Recurrence and length of hospital stay did not significantly differ between the patients in whom pleurectomy or pleural abrasion added to the procedure during the operation. CONCLUSION A longer interval between symptom onset and hospital admission and lower body mass index have no adverse effect on treatment outcomes and the recurrence in patients with primary spontaneous pneumothorax. Despite the fact that surgical treatment significantly decreases the recurrence rate, pleurectomy and pleural abrasion techniques have no significant difference on the clinical influence and recurrence of these patients.
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Affiliation(s)
- Kerim Tülüce
- Department of Thoracic Surgery, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey
| | - Hasan Türüt
- Department of Thoracic Surgery, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey
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Tsuboshima K, Kurihara M, Seyama K. Current opinion and comparison of surgical procedures for the treatment of primary spontaneous pneumothorax. Expert Rev Respir Med 2021; 16:161-171. [PMID: 34821193 DOI: 10.1080/17476348.2022.2011218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Although three-port video-assisted thoracoscopic surgery (VATS) is the standard radical treatment for primary spontaneous pneumothorax (PSP), several issues need to be addressed as the postoperative recurrence rate remains relatively high. Although bullectomy is effective in preventing the postoperative recurrence of PSP, recurrent pneumothorax often occurs, requiring additional methods such as pleural covering with absorbable mesh sheets, surgical chemical pleurodesis, pleural abrasion, or pleurectomy. In addition, minimally invasive approaches that exceed three-port VATS are required according to the social demand. These approaches, such as uniportal VATS, reduced port surgery, and needlescopic surgery, have cosmetic merits, lower postoperative pain, and similar surgical results as three-port VATS. AREAS COVERED We focused on conventional and novel treatments for PSP in this article. EXPERT OPINION Effective methods that prevent postoperative recurrence and minimally invasive approaches will become popular in the near future.
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Affiliation(s)
- Kenji Tsuboshima
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Masatoshi Kurihara
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Kuniaki Seyama
- The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan.,Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
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SAYAN A, ÖZDEMIR T, MERT M, KÖYLÜOĞLU G. Primary spontaneous pneumothorax in adolescents: a single-center retrospective case series. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05162-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Iwazawa T, Kadota Y, Takeuchi Y, Yokouchi H, Shiono H, Hayakawa M, Sakamaki Y, Kurokawa E, Nishioka K, Shintani Y. Efficacy of pleural coverage with polyglycolic acid sheet after bullectomy for postoperative recurrence of spontaneous pneumothorax in young patients: a multi-institutional cohort study. Gen Thorac Cardiovasc Surg 2021; 69:1407-1413. [PMID: 34002337 DOI: 10.1007/s11748-021-01646-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Various surgical procedures have been performed to decrease the recurrence of primary spontaneous pneumothorax after video-assisted thoracic surgery. This study aimed to examine the efficiency of pleural coverage for the prevention of postoperative recurrence in relatively young patients. METHODS Between January 2008 and December 2012, a total of 357 cases of 345 patients (age 15-29 years) with primary spontaneous pneumothorax who underwent bullectomy at 13 institutions were enrolled in this multi-institutional retrospective cohort study. A concurrent bilateral operation was counted as two cases. Polyglycolic acid sheets were used in 238 cases, and oxidized regenerated cellulose sheets were used in 37 cases to cover the visceral pleura, with no pleural coverage in 82 cases. The average observation period was 4.2 ± 2.0 years. RESULTS Postoperative recurrence was observed in 50 cases (14.0%) after video-assisted thoracic surgery. Twenty-six cases (10.9%) in the polyglycolic acid group, eight (21.6%) in the oxidized regenerated cellulose group, and sixteen (19.5%) in the non-coverage group experienced postoperative recurrence. Kaplan-Meier analysis revealed that the rate of freedom from postoperative recurrence in the polyglycolic acid group was significantly higher than that in the non-coverage group. Multivariate analysis showed that age ≥ 20 years and coverage with polyglycolic acid sheets were associated with reduced risk factors for postoperative recurrence. CONCLUSION Pleural coverage with a polyglycolic acid sheet is suggested to be effective in preventing postoperative recurrence of pneumothorax compared with non-coverage in relatively young patients.
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Affiliation(s)
- Takashi Iwazawa
- Thoracic Surgery Study Group of Osaka University (TSSGO), Suita, Osaka, Japan. .,Department of Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibaharacho, Toyonaka, Osaka, 560-8565, Japan.
| | - Yoshihisa Kadota
- Thoracic Surgery Study Group of Osaka University (TSSGO), Suita, Osaka, Japan.,Department of Thoracic Surgery, Osaka Habikino Medical Center, Habikino, Osaka, Japan
| | - Yukiyasu Takeuchi
- Thoracic Surgery Study Group of Osaka University (TSSGO), Suita, Osaka, Japan.,Department of Thoracic Surgery, Osaka Toneyama Medical Center, Toyonaka, Osaka, Japan
| | - Hideoki Yokouchi
- Thoracic Surgery Study Group of Osaka University (TSSGO), Suita, Osaka, Japan.,Department of Thoracic Surgery, Suita Municipal Hospital, Suita, Osaka, Japan
| | - Hiroyuki Shiono
- Thoracic Surgery Study Group of Osaka University (TSSGO), Suita, Osaka, Japan.,Department of General Thoracic Surgery, Nara Hospital, Kinki University School of Medicine, Ikoma, Nara, Japan
| | - Masanobu Hayakawa
- Thoracic Surgery Study Group of Osaka University (TSSGO), Suita, Osaka, Japan.,Department of Thoracic Surgery, Higashiosaka City Medical Center, Higashi-ōsaka, Osaka, Japan
| | - Yasushi Sakamaki
- Thoracic Surgery Study Group of Osaka University (TSSGO), Suita, Osaka, Japan.,Department of Thoracic Surgery, Osaka Police Hospital, Osaka, Japan
| | - Eiji Kurokawa
- Thoracic Surgery Study Group of Osaka University (TSSGO), Suita, Osaka, Japan.,Department of Thoracic Surgery, Minoh Municipal Hospital, Minoh, Osaka, Japan
| | - Kiyonori Nishioka
- Thoracic Surgery Study Group of Osaka University (TSSGO), Suita, Osaka, Japan.,Department of Thoracic Surgery, Kinki Central Hospital of the Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
| | - Yasushi Shintani
- Thoracic Surgery Study Group of Osaka University (TSSGO), Suita, Osaka, Japan.,Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Recurrence of spontaneous pneumothorax six years after VATS pleurectomy: evidence for formation of neopleura. J Cardiothorac Surg 2020; 15:191. [PMID: 32723348 PMCID: PMC7389453 DOI: 10.1186/s13019-020-01233-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/20/2020] [Indexed: 12/03/2022] Open
Abstract
Background Primary Spontaneous Pneumothorax (PSP) is considered an absolute and definitive contraindication for scuba diving and professional flying, unless bilateral surgical pleurectomy is performed. Only then is there a sufficiently low risk of recurrence to allow a waiver for flying and/or diving. Case presentation A young fit male patient who suffered a PSP 6 years ago, and underwent an uncomplicated videoscopic surgical pleurectomy, presented with a complete collapse of the lung on the initial PSP side. Microscopic examination of biopsies showed a slightly inflamed tissue but otherwise normal mesothelial cells, compatible with newly formed pleura. Conclusions Even with pleurectomy, in this patient, residual mesothelial cells seem to have had the capacity to create a completely new pleura and pleural space. The most appropriate surgical technique for prevention of PSP may still be debated.
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8
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Abstract
Introduction: Pneumothorax is defined as the presence of air in the pleural space. Spontaneous pneumothorax, occurring without antecedent traumatic or iatrogenic cause, is classified as primary or secondary. There are substantial inconsistencies in international guidelines for the treatment of pneumothorax. Moreover, many geographical variations exist in daily clinical practice.Areas covered: In this article, we focus on novel treatment modalities for this significant health problem in young adults.Expert opinion: In part, these discrepancies have been caused by the lack of high-quality trials or evidence. Currently, the pathophysiological mechanisms underlying pneumothorax are better understood and have implications for clinical management. Studies have demonstrated that the judicious use of pleurodesis can decrease its rate of recurrence, both in surgical and nonsurgical patients.
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Affiliation(s)
- Ke-Cheng Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Pei-Hsing Chen
- Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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9
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VATS Partial Pleurectomy Versus VATS Pleural Abrasion: Significant Reduction in Pneumothorax Recurrence Rates After Pleurectomy. World J Surg 2018; 42:3256-3262. [PMID: 29717345 PMCID: PMC6132858 DOI: 10.1007/s00268-018-4640-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Introduction Surgical treatment of primary spontaneous pneumothorax (PSP) usually consists of bullectomy and any form of pleurodesis to reduce risk of disease recurrence. Whether pleurectomy is superior to pleural abrasion is still a matter of debate with recurrence rates especially high when performed with a video-assisted thoracoscopic (VATS) approach. Aim of this study was to compare the efficacy of the two methods in prevention of recurrence of pneumothorax in a minimally invasive setting. Materials and methods Between 01/2005 and 12/2015, 107 patients younger than 40 years with PSP underwent VATS bullectomy and either partial pleurectomy or pleural abrasion. Medical records of patients were reviewed retrospectively. Results Pleural abrasion was performed in 34/107 patients, 73/107 patients underwent partial pleurectomy. There were no statistically significant differences in age, sex, body mass index or smoking history at time of surgery. There was no significant difference in major postoperative complications (p = 0.3022). Nine (8.4%) patients had a recurrence of pneumothorax during follow-up. Incidence of recurrence in those undergoing pleural abrasion was significantly higher than those undergoing apical pleurectomy (8/34 vs. 1/73, p < 0.001). Surgical technique was the only factor associated with a recurrence of PSP after surgical intervention. Discussion In our analysis, a VATS partial pleurectomy proved to be effective for prevention of recurrent PSP. Recurrence rates were low despite a minimally invasive approach and significantly lower than in the pleural abrasion group. According to these findings, VATS pleurectomy might be considered as the primary choice for surgical pleurodesis in patients with PSP.
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10
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Surgical Treatment of Spontaneous Pneumothorax: Pleural Abrasion or Pleurectomy? Surg Laparosc Endosc Percutan Tech 2018; 29:58-63. [PMID: 30499890 DOI: 10.1097/sle.0000000000000595] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE A primary spontaneous pneumothorax is a condition that occurs predominantly in young and thin male individuals who do not have any history of underlying lung disease. Various techniques such as pleural abrasion and pleurectomy are used to reduce the recurrence rate, but there exists no consensus among surgeons on which surgical technique offers the lowest risk of recurrence.We aimed to compare the efficiency and recurrence risk of pleural abrasion and pleurectomy methods in patients with primary spontaneous pneumothorax undergoing a wedge resection for the bulleous part of the paranchyme. MATERIALS AND METHODS Statistically compared variables between the 2 groups were age, sex, symptoms, smoking status, number of previous pneumothorax episodes, surgical indication, bleb number, estimated blood loss, intraoperative complication, duration of the surgery, conversion to open surgery, postoperative drainage amount, chest tube removal time, length of hospital stay, morbidity, mortality, duration of narcotic analgesic usage, pain according to Visual Analog Scale evaluation, follow-up period, and postoperative recurrence. RESULTS The medical records of 88 patients undergoing surgery between 2013 and 2017 were reviewed retrospectively. The pleural abrasion group was superior to the pleurectomy group in terms of operation time, drainage volume, time to drain removal, hospital stay, and Visual Analog Scale pain score on postoperative day 0. Statistically, there was no difference between the pleural abrasion group and the pleurectomy group in the recurrence rates after operation (2.0% vs. 2.5%, respectively; P=0.89). CONCLUSIONS Thoracoscopic pleural abrasion is safer than apical pleurectomy and is associated with the same pneumothorax recurrence rate.
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11
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Ozawa Y, Sakai M, Ichimura H. Covering the staple line with polyglycolic acid sheet versus oxidized regenerated cellulose mesh after thoracoscopic bullectomy for primary spontaneous pneumothorax. Gen Thorac Cardiovasc Surg 2018; 66:419-424. [PMID: 29693221 DOI: 10.1007/s11748-018-0927-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/19/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of this study was to compare coverage with oxidized regenerated cellulose mesh and that with polyglycolic acid sheet to decrease the incidence of postoperative recurrent pneumothorax. METHODS From August 2010 to August 2014, a total of 112 patients with primary spontaneous pneumothorax undergoing thoracoscopic bullectomy were enrolled. We compared the clinicopathological characteristics between recurrent and non-recurrent cases and examined their association with the material used for visceral pleural coverage: polyglycolic acid sheet versus oxidized regenerated cellulose mesh. RESULTS 57 patients underwent thoracoscopic bullectomy plus coverage using oxidized regenerated cellulose mesh and 55 underwent thoracoscopic bullectomy plus coverage using polyglycolic acid sheet. The recurrence rate among all patients was 13.3%. No severe postoperative complications were observed in either group. There were no significant differences in the perioperative outcomes. However, the postoperative recurrence rate was significantly higher in the oxidized regenerated cellulose mesh group than in the polyglycolic acid sheet group (22.8 vs 3.6%). CONCLUSIONS Our results suggest that coverage with oxidized regerated cellulose mesh was not superior to coverage with polyglycolic acid sheet for postoperative recurrent pneumothorax.
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Affiliation(s)
- Yuichiro Ozawa
- Department of General Thoracic Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.
| | - Mitsuaki Sakai
- Department of General Thoracic Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan
| | - Hideo Ichimura
- Department of General Thoracic Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan
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Aguinagalde B, Aranda JL, Busca P, Martínez I, Royo I, Zabaleta J. SECT Clinical practice guideline on the management of patients with spontaneous pneumothorax. Cir Esp 2017; 96:3-11. [PMID: 29248330 DOI: 10.1016/j.ciresp.2017.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 09/13/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022]
Abstract
This clinical practice guideline (CPG) emerges as an initiative of the scientific committee of the Spanish Society of Thoracic Surgery. We formulated PICO (patient, intervention, comparison, and outcome) questions on various aspects of spontaneous pneumothorax. For the evaluation of the quality of evidence and preparation of recommendations we followed the guidelines of the Grading of recommendations, Assessment, Development and Evaluation (GRADE) working group.
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Affiliation(s)
- Borja Aguinagalde
- Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, España.
| | | | - Pablo Busca
- Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, España
| | - Ivan Martínez
- Hospital Universitario 12 de Octubre, Madrid, España
| | - Iñigo Royo
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Jon Zabaleta
- Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, España
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13
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Yang SM, Hsu HH, Chen JS. Recent advances in surgical management of early lung cancer. J Formos Med Assoc 2017; 116:917-923. [DOI: 10.1016/j.jfma.2017.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 12/15/2022] Open
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Yang SM, Wu WT, Liu YH, Ko HJ. Needlescopic-assisted uniportal video-assisted thoracoscopic pulmonary anatomical segmentectomy. J Vis Surg 2017; 3:138. [PMID: 29078698 DOI: 10.21037/jovs.2017.08.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/22/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pulmonary segmentectomy can be an oncologic equivalent of lobectomy for small non-small cell lung cancer. Uniportal video-assisted thoracoscopic surgery (VATS) has recently showed favorable surgical outcomes, but remains technical demanding, especially in a complex procedure like anatomic segmentectomy. This manuscript demonstrates the surgical techniques for uniportal VATS segmentectomies with the assistance of additional needlescopic instruments. METHODS Data of 22 consecutive patients who underwent 24 needlescopic-assisted uniportal VATS segmentectomies between December 2016 and June 2017 was analyzed. RESULTS There were 12 uni-segmentectomies, 10 bi-segmentectomies, and 2 tri-segmentectomies. The mean operation time was 178.3 minutes. The mean duration of chest tube drainage was 5.2 days, and the mean duration of hospital stay was 7.4 days. There were two episodes of major bleeding and one case that required conversion to lobectomy. CONCLUSIONS Under the assistance of additional needlescopic instruments, segmentectomy can be performed more easily and safely with uniportal VATS.
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Affiliation(s)
- Shun-Mao Yang
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Wen-Ting Wu
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Yu-Hsuan Liu
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Huan-Jang Ko
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan
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15
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Kasem E, Elhawary A. Pleurodesis: Which of which in management of recurrent primary spontaneous pneumothorax. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2015.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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16
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Zhang Z, Du L, Feng H, Liang C, Liu D. Pleural abrasion should not routinely preferred in treatment of primary spontaneous pneumothorax. J Thorac Dis 2017; 9:1119-1125. [PMID: 28523168 DOI: 10.21037/jtd.2017.03.124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of this study was to find out whether thoracoscopic bullectomy with pleural abrasion (BLPA) could lower the recurrence ratio in primary spontaneous pneumothorax (PSP) patients compared with bullectomy alone. METHODS All PSP patients who underwent video assisted thoracoscopy (VATS) bullectomy (120 bullectomy cases) or BLPA (225 BLPA cases) in our department between 2008.1 and 2013.12 were retrospectively reviewed. Clinical data, perioperative data, and follow-up information were collected. Propensity score analysis was used in balancing preoperative factors between groups. RESULTS Three hundred and forty five patients (283 men and 62 women) with an average age of 27 (27.32±11.41) years old underwent 120 bullectomy and 225 BLPA in this study. There was no mortality or significant complication in both groups. More postoperative drainage (1,170.66±904.02 vs. 528.38±491.49, P<0.01), longer chest tube removal days (6.59±4.29 vs. 4.76±2.67, P<0.01), and more medical cost (4,703.86±1,526.31 vs. 4,204.64±1,203.90, P<0.01) were observed in BLPA group. Significant difference (P=0.02) existed in recurrence rate between BLPA group (3/225, 1.3%) and bullectomy group (7/120, 5.8%). After propensity score match, 114 patients were included in both bullectomy and BLPA groups. More postoperative drainage (1,280.18±1,071.04 vs. 523.55±484.79, P<0.01), longer chest tube removal days (6.53±4.16 vs. 4.69±2.63, P<0.01), and more medical cost (4,700.69±1,591.56 vs. 4,211.45±1,207.7, P<0.01) were observed in BLPA group. There was no significant recurrence difference between BLPA group and bullectomy group (2.6% vs. 5.3%, P=0.30). CONCLUSIONS Compared with bullectomy, BLPA could provide similar recurrence for PSP patients, but at the price of longer operation days, longer chest tube removal days, and more medical cost, and should not be performed in PSP patients.
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Affiliation(s)
- Zhenrong Zhang
- Department of General Thoracic Surgery, China Japan Friendship Hospital, Beijing 100029, China
| | - Lanfang Du
- Department of Emergency, Peking University Third Hospital, Beijing 100191, China
| | - Hongxiang Feng
- Department of General Thoracic Surgery, China Japan Friendship Hospital, Beijing 100029, China
| | - Chaoyang Liang
- Department of General Thoracic Surgery, China Japan Friendship Hospital, Beijing 100029, China
| | - Deruo Liu
- Department of General Thoracic Surgery, China Japan Friendship Hospital, Beijing 100029, China
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Tsai TM, Lin MW, Li YJ, Chang CH, Liao HC, Liu CY, Hsu HH, Chen JS. The Size of Spontaneous Pneumothorax is a Predictor of Unsuccessful Catheter Drainage. Sci Rep 2017; 7:181. [PMID: 28298628 PMCID: PMC5428034 DOI: 10.1038/s41598-017-00284-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 02/20/2017] [Indexed: 11/09/2022] Open
Abstract
Small-bore thoracic catheter drainage is recommended for a first large or symptomatic episode of primary spontaneous pneumothorax (PSP). However, one-third of these patients require a second procedure because of treatment failure. We investigated the factors associated with unsuccessful pigtail catheter drainage in the management of PSP. In this retrospective study, using a prospectively collected database, we enrolled 253 consecutive patients with PSP who underwent pigtail catheter drainage as initial treatment, from December 2006 to June 2011. The chest radiograph was reviewed in each case and pneumothorax size was estimated according to Light’s index. Other demographic factors and laboratory data were collected via chart review. Pigtail catheter drainage was successful in 71.9% (182/253) of cases. Treatment failure rates were 42.9%, 25.9%, and 15.5% in patients with pneumothorax sizes of >62.6%, 38–62.6%, and <38%, respectively (tertiles). An alternative cut-off point of 92.5% lung collapse was defined using a classification and regression tree method. According to the multivariate analysis, a large-size pneumothorax (p = 0.009) was the only significant predictor of initial pigtail catheter drainage treatment failure in patients with PSP. Early surgical treatment could be considered for those patients with a large-sized pneumothorax.
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Affiliation(s)
- Tung-Ming Tsai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10002, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10002, Taiwan
| | - Yao-Jen Li
- Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, 10055, Taiwan.,Genomic Research Center, Academia Sinica, Taipei, 11529, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, 10002, Taiwan
| | - Hsien-Chi Liao
- Department of Traumatology, National Taiwan University Hospital, Taipei, 10002, Taiwan
| | - Chao-Yu Liu
- Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, 22060, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10002, Taiwan.
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10002, Taiwan. .,Department of Traumatology, National Taiwan University Hospital, Taipei, 10002, Taiwan.
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Marchi E, de Carvalho MVH, Ventureli TR, Fruchi AJ, Lazaro A, do Carmo DC, Barreto TYAS, Dias BVB, Acencio MMP, Teixeira LR, Light RW. Abrasion Plus Local Fibrin Sealant Instillation Produces Pleurodesis Similar to Pleurectomy in Rabbits. Chest 2016; 150:673-9. [PMID: 27217265 DOI: 10.1016/j.chest.2016.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/09/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Pleurodesis performed either by pleurectomy or pleural abrasion is recommended in the approach to primary spontaneous pneumothorax to avoid recurrence. However, the efficacy of parietal pleural abrasion in producing pleurodesis is questioned. This study aims to determine the efficacy of apical abrasion alone, abrasion plus fibrin sealant application, and pleurectomy in producing pleurodesis in rabbits. METHODS Rabbits were subjected to video-assisted thoracic surgery alone (control) or to video-assisted thoracic surgery with apical gauze abrasion, abrasion plus fibrin sealant instillation, or apical pleurectomy. Blood samples were collected preoperatively and 48 h and 28 days postoperatively to measure total leukocytes (white blood cell count), neutrophil counts, and serum interleukin (IL)-8 levels. After 28 days the animals were sacrificed for macroscopic evaluation of the degree of apical pleurodesis and microscopic evaluation of local pleural fibrosis and collagen deposition. RESULTS White blood cell and neutrophil counts were similar in all groups, whereas the serum IL-8 level peaked at 48 h in all groups and decreased after 28 days, except in the pleurectomy group. After 28 days the abrasion plus fibrin sealant and pleurectomy groups had significantly more pleural adhesions, pleural fibrosis, and collagen deposition than the abrasion alone group, mainly due to thick mature fibers. CONCLUSIONS Abrasion with local fibrin sealant instillation is as effective as pleurectomy in producing pleurodesis in rabbits. Apical pleurectomy elicits a more persistent elevation of serum IL-8 levels than apical abrasion alone or abrasion plus fibrin adhesive instillation.
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Affiliation(s)
- Evaldo Marchi
- Thoracic Surgery Division, Medical College of Jundiaí, Jundiaí, Brazil.
| | | | - Tiago R Ventureli
- Thoracic Surgery Division, Medical College of Jundiaí, Jundiaí, Brazil
| | - Andre J Fruchi
- Thoracic Surgery Division, Medical College of Jundiaí, Jundiaí, Brazil
| | - Ariane Lazaro
- Thoracic Surgery Division, Medical College of Jundiaí, Jundiaí, Brazil
| | | | | | - Bruno V B Dias
- Thoracic Surgery Division, Medical College of Jundiaí, Jundiaí, Brazil
| | - Milena M P Acencio
- Pleura Laboratory, Pulmonary Division, InCor, University of São Paulo Medical School, São Paulo, Brazil
| | - Lisete R Teixeira
- Pleura Laboratory, Pulmonary Division, InCor, University of São Paulo Medical School, São Paulo, Brazil
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Hong KP, Kim DK, Kang KH. Staple Line Coverage with a Polyglycolic Acid Patch and Fibrin Glue without Pleural Abrasion after Thoracoscopic Bullectomy for Primary Spontaneous Pneumothorax. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:85-91. [PMID: 27066431 PMCID: PMC4825908 DOI: 10.5090/kjtcs.2016.49.2.85] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 02/23/2016] [Accepted: 03/08/2016] [Indexed: 11/21/2022]
Abstract
Background This study was conducted to determine the efficacy of staple line coverage using a polyglycolic acid patch and fibrin glue without pleural abrasion to prevent recurrent postoperative pneumothorax. Methods A retrospective analysis was carried out of 116 operations performed between January 2011 and April 2013. During this period, staple lines were covered with a polyglycolic acid patch and fibrin glue in 58 cases (group A), while 58 cases underwent thoracoscopic bullectomy only (group B). Results The median follow-up period was 33 months (range, 22 to 55 months). The duration of chest tube drainage was shorter in group A (group A 2.7±1.2 day vs. group B 3.9±2.3 day, p=0.001). Prolonged postoperative air leakage occurred more frequently in group B than in group A (43% vs. 19%, p=0.005). The postoperative recurrence rate of pneumothorax was significantly lower in group A (8.6%) than in group B (24.1%) (p=0.043). The total cost of treatment during the follow-up period, including the cost for the treatment of postoperative recurrent pneumothorax, was not significantly different between the two groups (p=0.43). Conclusion Without pleural abrasion, staple line coverage with a medium-sized polyglycolic acid patch and fibrin glue after thoracoscopic bullectomy for primary spontaneous pneumothorax is a useful technique that can reduce the duration of postoperative pleural drainage and the postoperative recurrence rate of pneumothorax.
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Affiliation(s)
- Ki Pyo Hong
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital
| | - Do Kyun Kim
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital
| | - Kyung Hoon Kang
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital
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Spontaneous pneumothorax in children - management, results, and review of the literature. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 12:322-7. [PMID: 26855648 PMCID: PMC4735533 DOI: 10.5114/kitp.2015.56782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/15/2015] [Indexed: 12/02/2022]
Abstract
Introduction Primary spontaneous pneumothorax (PSP) occurs at a frequency of 7.4-18 cases per 100 000 population per year. The PSP typically occurs in young adults and is uncommon in children. The aim of this study was to review our institutional experience with PSP in children. Material and methods Twenty-two paediatric patients with confirmed PSP, treated from 2004 to 2014 at the Paediatric Surgery Clinic. There were 18 boys and 4 girls. The mean age was 16 years, 6 months ± 1 month (range 14-17). The mean body mass index (BMI) was 20.1 (ranging from 17 to 24). Results The recurrence rate of PSP was 48%. The mean interval of the recurrence was 5 months ± 1 month (range from 3 weeks to 2 years). Recurrent pneumothorax was evacuated by thoracostomy with success in four patients. The first video-assisted thoracoscopic surgery (VATS) procedure had a failure rate of 50%. After second VATS procedure, we did not observe recurrent PSP in two patients. One patient with recurrent PSP, after two VATS procedures, was treated with success, with an open mini axillary thoracotomy. The mean follow-up period was 4 years 3 months ± 1 month (range 6 months – 10 years). We have not noted any intraoperative complications. Conclusions Although our study is limited by the small number of patients, we conclude that most patients resolve their spontaneous pneumothorax and air leak with tube thoracostomy alone. For those patients in whom chest tube drainage is not effective, and for those with recurrent PSP, early VATS and bullectomy combined with pleural abrasion is the most efficient intervention.
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The effect of pleural abrasion on the treatment of primary spontaneous pneumothorax: a systematic review of randomized controlled trials. PLoS One 2015; 10:e0127857. [PMID: 26042737 PMCID: PMC4456155 DOI: 10.1371/journal.pone.0127857] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 04/21/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pleural abrasion has been widely used to control the recurrence of primary spontaneous pneumothorax (PSP). However, controversy still exists regarding the advantages and disadvantages of pleural abrasion compared with other interventions in preventing the recurrence of PSP. METHODS The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to December 15, 2014 to identify randomized controlled trials (RCTs) that compared the effects of pleural abrasion with those of other interventions in the treatment of PSP. The study outcomes included the PSP recurrence rate and the occurrence rate of adverse effects. RESULTS Mechanical pleural abrasion and apical pleurectomy after thoracoscopic stapled bullectomy exhibited similarly persistent postoperative air leak occurrence rates (p = 0.978) and 1-year PSP recurrence rates (p = 0.821), whereas pleural abrasion led to reduced residual chest pain and discomfort (p = 0.001) and a smaller rate of hemothorax (p = 0.036) than did apical pleurectomy. However, the addition of minocycline pleurodesis to pleural abrasion did not reduce the pneumothorax recurrence rate compared with apical pleurectomy (3.8% for both procedures) but was associated with fewer complications. There was no statistical difference in the pneumothorax recurrence rate between mechanical pleural abrasion and chemical pleurodesis with minocycline on either an intention-to-treat basis (4 of 42 versus 0 of 42, p = 0.12; Fisher exact test) or after exclusions (2 of 40 versus 0 of 42, p = 0.24; Fisher exact test). Pleural abrasion plus minocycline pleurodesis also did not reduce the pneumothorax recurrence rate compared with pleural abrasion alone (p = 0.055). Moreover, pleural abrasion plus minocycline pleurodesis was associated with more intense acute chest pain. The postoperative overall recurrence rate in patients who underwent staple line coverage with absorbable cellulose mesh and fibrin glue was similar to that with mechanical abrasion after thoracoscopic bullectomy (13.8% vs. 14.2%, respectively; p = 0.555), but staple line coverage resulted in less postoperative residual pain than mechanical abrasion (0.4% vs.3.2%; p<0.0001). Pleural abrasion after thoracoscopic wedge resection did not decrease the recurrence of pneumothorax compared with wedge resection alone (p = 0.791), but the intraoperative bleeding and postoperative pleural drainage rates were higher when pleural abrasion was performed. CONCLUSIONS In addition to resulting in the same pneumothorax recurrence rate, thoracoscopic pleural abrasion with or without minocycline pleurodesis is safer than apical pleurectomy in the treatment of PSP. However, minocycline pleurodesis with or without pleural abrasion is not any more effective than pleural abrasion alone. Moreover, additional mechanical abrasion is not safer than additional staple line coverage with absorbable cellulose mesh and fibrin glue after thoracoscopic bullectomy because of increased postoperative pain. Additionally, pleural abrasion after thoracoscopic wedge resection should not be recommended for routine application due to the greater incidence of adverse effects than wedge resection alone. However, further large-scale, well-designed RCTs are needed to confirm the best procedure.
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Sihoe ADL, Yu PSY, Yeung JWL. Primary pneumothorax: Should surgery be offered after the first episode? World J Respirol 2015; 5:47-57. [DOI: 10.5320/wjr.v5.i1.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 01/01/2015] [Accepted: 02/02/2015] [Indexed: 02/06/2023] Open
Abstract
Surgery is the recommended and most effective means of preventing the recurrence of primary spontaneous pneumothorax (PSP). However, the conventional belief amongst most clinicians is that surgery should not be routinely offered to patients with an uncomplicated first episode of PSP. The view that surgery should be reserved for recurrent episodes of ipsilateral PSP is based on an apprehension regarding traumatic thoracic surgery combined with a perception that recurrences after a single episode of PSP are unlikely. Modern advances in minimally invasive thoracic surgery have now dramatically reduced the morbidity of PSP surgery. Such surgery is now safe, effective and causes minimal indisposition for patients. On the other hand, modern clinical data suggests that recurrence rate of PSP is perhaps much higher than previously assumed, with more than half of patients experiencing a second episode within several years of the first. With such new appreciations of the current situation, it is appropriate to now consider offering surgery to patients even after the first episode of PSP.
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Divisi D, Di Leonardo G, Crisci R. Video-assisted thoracic surgery versus pleural drainage in the management of the first episode of primary spontaneous pneumothorax. Am J Surg 2015; 210:68-73. [PMID: 25769881 DOI: 10.1016/j.amjsurg.2014.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/10/2014] [Accepted: 10/06/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the study was to analyze the cost-effectiveness outcomes of video-assisted thoracic surgery (VATS) in the treatment of primary spontaneous pneumothorax (PSP), comparing the minimally invasive procedure with pleural drainage (PD). METHODS Between July 2006 and October 2012, we treated 122 patients with a first episode of PSP by VATS (61 patients) or pleural drainage (61 patients). We established the relationship between costs and quality-adjusted life (QAL) for both techniques. RESULTS The total cost per patient of minimally invasive procedure was more advantageous than that of chest tube (€2,422.96 vs €4,855.12). The QAL expectancy of VATS was longer than that of PD (57.00 vs 40.80 at 60 months). The QAL year of VATS (.32 at 1st year and .25 at 5th year) was better than that of PD. Incremental cost-effectiveness ratio of VATS versus PD was between €7,600.00 (1st year) and €10,045.00 (5th year), remaining well below the threshold of acceptability. CONCLUSION VATS as the first-line treatment for PSP allowed low morbidity, short hospitalization, and excellent quality of life.
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Affiliation(s)
- Duilio Divisi
- Department of Thoracic Surgery, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, Teramo, Italy.
| | - Gabriella Di Leonardo
- Department of Thoracic Surgery, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, Teramo, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, Teramo, Italy
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Staple Line Coverage After Bullectomy for Primary Spontaneous Pneumothorax: A Randomized Trial. Ann Thorac Surg 2014; 98:2005-11. [DOI: 10.1016/j.athoracsur.2014.06.047] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 06/03/2014] [Accepted: 06/11/2014] [Indexed: 11/24/2022]
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How CH, Tsai TM, Kuo SW, Huang PM, Hsu HH, Lee JM, Chen JS, Lai HS. Chemical pleurodesis for prolonged postoperative air leak in primary spontaneous pneumothorax. J Formos Med Assoc 2014; 113:284-90. [DOI: 10.1016/j.jfma.2012.12.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 12/24/2012] [Accepted: 12/27/2012] [Indexed: 10/27/2022] Open
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Tsou KC, Huang PM, Hsu HH, Chen KC, Kuo SW, Lee JM, Chang YC, Chen JS, Lai HS. Role of computed tomographic scanning prior to thoracoscopic surgery for primary spontaneous pneumothorax. J Formos Med Assoc 2014; 113:606-11. [PMID: 24709294 DOI: 10.1016/j.jfma.2014.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/03/2014] [Accepted: 02/27/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/PURPOSE The role computed tomography (CT) performed prior to thoracoscopic surgery for primary spontaneous pneumothorax (PSP) remains unclear. METHODS We retrospectively reviewed medical records of all patients who underwent thoracoscopic surgery for PSP during 2008-2012. Patients were stratified into two groups: CT group (patients who received preoperative CT scanning) and control group (patients who did not receive preoperative scanning). Short-term postoperative results and long-term pneumothorax recurrence rates were compared. RESULTS A total of 298 patients were studied. Preoperative CT scanning was performed in 140 of them. The duration of operation, incidence of bullae formation, number of excised specimens, rate of complications, and postoperative hospital stay were similar between the two groups. After a mean follow-up of 20 months, the recurrence rates were 8.6% (12/140) in the CT group and 5.7% (9/158) in the control group (p = 0.371). In the CT group, five patients had unexpected pulmonary findings and three of them (60%) developed pneumothorax recurrence, the rate of which was significantly higher than that in patients without unexpected pulmonary findings (9/135, 6.7%, p = 0.004). Unexpected pulmonary lesions were more commonly noted in females (4/19, 21.1%) than in males (1/121, 0.8%; p < 0.001). CONCLUSION Preoperative CT scanning was not associated with better results after thoracoscopic surgery for PSP and is, therefore, not justified as a routine examination prior to the operation. In female patients, however, preoperative CT scanning might be needed because these patients tended to have a higher incidence of unexpected pulmonary lesions, which were associated with a higher rate of recurrence.
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Affiliation(s)
- Kuan-Chuan Tsou
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Ming Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ke-Cheng Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shuenn-Wen Kuo
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jang-Ming Lee
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Hong-Shiee Lai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Thoracoscopic Water Pleurectomy for the Treatment of Recurrent Spontaneous Pneumothorax. Ann Thorac Surg 2014; 97:1088-90. [DOI: 10.1016/j.athoracsur.2013.07.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 07/02/2013] [Accepted: 07/22/2013] [Indexed: 11/21/2022]
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Hamaji M, Tanaka T, Tachi H, Ohsumi A. Thoracoscopic 360 degree apical pleurodesis with turned-over parietal pleura. Eur J Cardiothorac Surg 2013; 46:327-8. [PMID: 23918769 DOI: 10.1093/ejcts/ezt409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Apical pleurodesis procedures, in addition to the resection of bullae or blebs, proved to lower the recurrence rate in spontaneous pneumothoraces. Here, we describe our thoracoscopic technique of making a 360° apical pleurodesis. After resecting responsible bullae or blebs thoracoscopically, we dissect the parietal pleura off the chest wall up, turn it over on the mediastinal side, clip it on the mediastinal pleura and place the lung apex against the rough surface to promote extensive apical pleurodesis. The technique has been performed for 18 patients so far and no late recurrence of pneumothorax has been noted.
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Affiliation(s)
| | - Toru Tanaka
- Department of Thoracic Surgery, Kansai Electric Power Hospital, Osaka, Japan
| | - Hidekazu Tachi
- Department of Thoracic Surgery, Kansai Electric Power Hospital, Osaka, Japan
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
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Efficacy of polyglycolic acid sheet after thoracoscopic bullectomy for spontaneous pneumothorax. Ann Thorac Surg 2013; 95:1919-23. [PMID: 23623546 DOI: 10.1016/j.athoracsur.2013.03.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/02/2013] [Accepted: 03/07/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Various procedures have been performed to decrease the incidence of recurrent postoperative pneumothorax after thoracoscopic bullectomy. The purpose of this study was to determine the efficacy of a polyglycolic acid (PGA) sheet and pleural abrasion for prevention of recurrent postoperative pneumothorax. METHODS From January 2009 to August 2011, 257 patients underwent thoracoscopic bullectomy for primary spontaneous pneumothorax. In group A, 128 patients underwent pleural abrasion. These patients were compared with 129 patients (group B) who underwent a procedure to cover stable lines with an absorbable PGA sheet in addition to pleural abrasion. RESULTS There was no difference in preoperative demographics, although the age of patients in group A was statistically higher than that of patients in group B (23.67 ± 6.54 versus 21.69 ± 5.65; p = 0.010). In group A, prolonged postoperative air leaks (≥ 3 days) occurred more frequently (7.8% versus 2.3%; p = 0.045). A Kaplan-Meier curve showed that recurrence-free rates were higher in group B (p = 0.047). CONCLUSIONS Coverage with PGA sheet and pleural abrasion after thoracoscopic bullectomy is effective for preventing prolonged postoperative air leaks and reducing postoperative recurrence rates.
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Oda M, Matsumoto I, Takizawa M, Waseda R, Suzuki M, Ishiyama Y, Abe T, Ishikawa N, Watanabe G. Needlescopic video-assisted wedge resection combined with the subcostal trans-diaphragmatic approach for undetermined peripheral pulmonary nodules. Surg Endosc 2013; 27:3671-7. [PMID: 23572223 DOI: 10.1007/s00464-013-2943-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 03/17/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Reduced mortality from lung cancer by computed tomography (CT) screening facilitates the use of video-assisted thoracic surgery (VATS) lung wedge resection to obtain a definite diagnosis and to treat tiny nodules. The authors evaluated their initial experience using novel needlescopic VATS wedge resection combined with the subcostal trans-diaphragmatic (SCTD) approach for managing undetermined peripheral pulmonary nodules. METHODS Between 2009 and 2012, 35 patients who had 36 operations underwent needlescopic VATS wedge pulmonary resection with the SCTD approach. Preoperative percutaneous CT-guided marking of the nodule was performed. Two 3-mm miniports were placed in the thorax for the thoracoscopic camera and minigrasper. Just anterior to the 10th rib, a 2-cm subcostal incision was made, and a 12- or 15-mm port was placed trans-diaphragmatically into the chest cavity. Wedge resection of the lung was performed with endostaplers introduced through a subcostal port. RESULTS The median tumor size was 1.1 cm. Localization of the tumor was widely distributed. The mean operation time was 51 min, and the mean blood loss was 4.2 mL. No patients required conversion to thoracotomy, and one patient required conversion to conventional VATS. Additional thoracic ports were placed in five patients, and the needlescopic incision was extended to 15 mm in one patient. The median duration of chest drainage was 1 day. Additional analgesia was not required for 22 patients and was used for less than 1 day for three patients, less than 2 days for seven patients, and less than 3 days for seven patients. The pathologic diagnosis of the nodules was malignant for 28 patients and benign for 8 patients. On postoperative day 7 or at admission, 34 patients were free of postoperative neuralgia. CONCLUSIONS Needlescopic VATS wedge pulmonary resection combined with the SCTD approach is both safe and feasible and offers the specific advantages of minimal invasiveness and good cosmetic outcomes.
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Affiliation(s)
- Makoto Oda
- Department of General and Cardiothoracic Surgery, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan,
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Dearden AS, Sammon PM, Matthew EF. In patients undergoing video-assisted thoracic surgery for pleurodesis in primary spontaneous pneumothorax, how long should chest drains remain in place prior to safe removal and subsequent discharge from hospital? Interact Cardiovasc Thorac Surg 2013; 16:686-91. [PMID: 23403769 DOI: 10.1093/icvts/ivt030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was how long chest drains should be left in place following video-assisted thoracic surgery (VATS) pleurodesis for primary spontaneous pneumothorax. Altogether, a total of 730 papers were found using the reported search, of which eight represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We report that the main determining factor for the length of hospital stay following VATS pleurodesis is chest-drain duration. Providing no postoperative complications occur, and chest X-ray appearances of lung inflation are satisfactory, there is no documented contraindication to removing chest drains as early as 2 days postoperatively, with discharge the following day. Furthermore, leaving chest drains on water seal after a brief period of suction has been shown to benefit in reducing postoperative chest-drain duration and subsequent hospital stay. There is a paucity of literature directly addressing early vs late chest-drain removal protocols in this patient group. Hence, we conclude that, in clinical practice, the decision of when to remove chest drains postoperatively should remain guided empirically towards the individual patient.
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Affiliation(s)
- Alexander S Dearden
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
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Chen KC, Cheng YJ, Hung MH, Tseng YD, Chen JS. Nonintubated thoracoscopic lung resection: a 3-year experience with 285 cases in a single institution. J Thorac Dis 2012; 4:347-51. [PMID: 22934136 DOI: 10.3978/j.issn.2072-1439.2012.08.07] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 08/10/2012] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Tracheal intubation with one-lung ventilation is considered mandatory for thoracoscopic surgery. This study reported the experience of thoracoscopic lung resection without endotracheal intubation in a single institution. METHODS From August 2009 through July 2012, 285 consecutive patients were treated by nonintubated thoracoscopic surgery using epidural anesthesia, intrathoracic vagal blockade, and sedation for lobectomy, segmentectomy, or wedge resection in a tertiary medical center. The feasibility and safety of this technique were evaluated. RESULTS The final diagnosis for surgery were primary lung cancer in 159 patients (55.8%), metastatic lung cancer in 17 (6.0%), benign lung tumor in 104 (36.5%), and pneumothorax in 5 (1.8%). The operative methods consisted of conventional (83.2%) and needlescopic (16.8%) thoracoscopic surgery. The operative procedures included lobectomy in 137 patients (48.1%), wedge resection in 132 (46.3%), and segmentectomy in 16 (5.6%). Collapse of the operative lung and inhibition of coughing were satisfactory in most of the patients. Fourteen (4.9%) patients required conversion to tracheal intubation because of significant mediastinal movement [5], persistent hypoxemia [2], dense pleural adhesions [2], ineffective epidural anesthesia [2], bleeding [2], and tachypnea [1]. One patient (0.4%) was converted to thoracotomy because of bleeding. No mortality was noted in our patients. CONCLUSIONS Nonintubated thoracoscopic lung resection is technically feasible and safe in selected patients. It can be a valid alternative in managing patients with pulmonary lesions.
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Tseng YD, Cheng YJ, Hung MH, Chen KC, Chen JS. Nonintubated Needlescopic Video-Assisted Thoracic Surgery for Management of Peripheral Lung Nodules. Ann Thorac Surg 2012; 93:1049-54. [PMID: 22386086 DOI: 10.1016/j.athoracsur.2012.01.062] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 01/16/2012] [Accepted: 01/18/2012] [Indexed: 10/28/2022]
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Thoracoscopic pleurodesis for primary spontaneous pneumothorax with high recurrence risk: a prospective randomized trial. Ann Surg 2012; 255:440-5. [PMID: 22323011 DOI: 10.1097/sla.0b013e31824723f4] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the efficacy and safety between apical pleurectomy and pleural abrasion with minocycline in primary spontaneous pneumothorax (PSP) with high recurrence risk. BACKGROUND The optimal thoracoscopic pleurodesis procedure for PSP with high recurrence risk remains controversial. METHODS Between January 2006 and May 2009, a total of 369 patients with spontaneous pneumothorax were treated by video-assisted thoracoscopic surgery. After stapled bullectomy, 160 patients with no identifiable bleb or multiple blebs (≥3) were randomly chosen to undergo apical pleurectomy (pleurectomy group, 80 patients) or pleural abrasion with minocycline (abrasion/minocycline group, 80 patients). RESULTS Patients in the pleurectomy group had a longer operation duration (mean, 81.4 minutes vs 55.8 minutes, P < 0.001), a greater amount of operation bleeding (mean, 29.4 mL vs 13.2 mL, P = 0.025), and a greater amount of postoperative chest drainage (mean, 287.4 mL vs 195.8 mL, P = 0.040). Patients in the abrasion/minocycline group had a higher intensity of chest pain and required more frequent meperidine injections. Hemothorax occurred in 3 pleurectomy patients (3.8%). The short-term results showed that the 2 groups had comparable durations of postoperative chest drainage, durations of postoperative hospital stay, and complication rates. After a mean follow-up of 26.1 months, recurrent ipsilateral pneumothorax occurred in 3 patients (3.8%) in the pleurectomy group and 3 patients (3.8%) in the abrasion/minocycline group. Postoperative long-term residual chest pain and pulmonary function were comparable in both groups. CONCLUSIONS : Pleural abrasion with minocycline pleurodesis is as effective as apical pleurectomy and either technique is appropriate for treating PSP patients with high recurrence risk. This trial was registered at http://www.clinicaltrials.gov (ID: NCT00270751).
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Sepehripour AH, Nasir A, Shah R. Does mechanical pleurodesis result in better outcomes than chemical pleurodesis for recurrent primary spontaneous pneumothorax? Interact Cardiovasc Thorac Surg 2011; 14:307-11. [PMID: 22184464 DOI: 10.1093/icvts/ivr094] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A best-evidence topic was written according to a structured protocol. The question addressed was whether mechanical pleurodesis results in better outcomes in comparison with chemical pleurodesis in patients undergoing surgery for recurrent primary spontaneous pneumothorax. A total of 542 papers were found using the reported searches, of which 6 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The studies found compared the outcomes of mechanical and chemical pleurodesis and also focused on the outcomes of the different methods of mechanical pleurodesis: pleural abrasion and pleurectomy. Reported measures were operative mortality, mean operation time, post-operative bleeding, persistent air leaks, chest drain duration, pain levels, pneumonia, respiratory failure, wound infection, pulmonary function, re-exploration for bleeding and air leak, hospital stay, recurrence and re-operation for recurrence. One large cohort study compared the outcomes of mechanical and chemical talc pleurodesis and reported a significant reduction in recurrence with talc pleurodesis in comparison with pleurectomy (1.79 vs. 9.15%, P = 0.00018). Another large cohort study, analysing pleural abrasion, pleurectomy and talc pleurodesis, both in isolation and in combination with apical bullectomy, reported the highest rate of recurrence in bullectomy plus abrasion patients (1.4%) followed by bullectomy plus talc pleurodesis patients (0.4%). No recurrence was seen with other techniques. The reported freedom from surgery at 10-year follow-up was 98.9% with talc pleurodesis, 97.5% with pleurectomy and 96.4% with pleural abrasion, however, with no statistical significance. A prospective randomized study, a retrospective case series review and two smaller cohort studies compared the outcomes of pleural abrasion and pleurectomy as different techniques of mechanical pleurodesis and reported statistically significant shorter operation times, lower rates of post-operative bleeding, re-exploration and pain observed with pleural abrasion and lower rates of recurrence with pleurectomy. Three studies reported the outcomes of apical bullectomy or wedge resection with recurrence rates ranging from 0.4 to 6.2%. We conclude that there is a very similar outcome profile in the comparison of mechanical and chemical pleurodesis, with modest evidence suggesting lower rates of recurrence with chemical talc pleurodesis.
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Affiliation(s)
- Amir H Sepehripour
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester, UK.
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Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax using a single-incision laparoscopic surgery port: a feasible and safe procedure. Surg Endosc 2010; 25:2044-7. [PMID: 21136111 DOI: 10.1007/s00464-010-1470-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Accepted: 11/02/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recent authors have pioneered the use of single-incision laparoscopic surgery (SILS) for umbilical cholecystectomy. The SILS approach has the potential of reducing the trauma of the surgical access and postoperative pain. Video-assisted thoracic surgery (VATS) greatly reduces patient postoperative pain compared with traditional thoracotomy incisions. The current trend is to use fewer working ports to reduce even more postoperative pain, chest wall paresthesia, and hospital stay. No reports have described using a SILS port in VATS. METHODS From September 2009 to March 2010, 13 patients had surgery for primary spontaneous pneumothorax. The patients underwent single-lung ventilation. A 2.5-cm-long incision was made at the sixth intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a single flexible port. A 5-mm 0° videothoracoscope, a roticulating grasper, and an endoGIA stapler were introduced through port channels. Apical lung blebs were stapled, and pleurodesis by pleural abrasion with Marlex mesh was performed. RESULTS The study enrolled nine men (69.2%) and four women with a median age of 26.3 years. No complications were recorded. The postoperative pain was mild for 10 patients (76.9%) and moderate for 3 patients. Mild chest wall paresthesia (numbness) was observed in three patients (23.07%). The postoperative hospital stay was 2.15 days. CONCLUSIONS Although the SILS port is for laparoscopic use, it allowed an adequate lineup of the instruments along the intercostal space and adequate instrument maneuverability for stapling and resecting of apical lung bullae or blebs. The procedure was accomplished successfully for 92.3% of the patients. This is the first report on the use of a SILS port in VATS. Further work and development of a proper thoracic single port are needed to define the uses and advantages of this uniportal technique.
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Muramatsu T, Nishii T, Takeshita S, Ishimoto S, Morooka H, Shiono M. Preventing recurrence of spontaneous pneumothorax after thoracoscopic surgery: a review of recent results. Surg Today 2010; 40:696-9. [PMID: 20676850 DOI: 10.1007/s00595-009-4208-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 11/05/2009] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Takashi Muramatsu
- Division of Respiratory Surgery, Department of Surgery, Nihon University School of Medicine, 30-1 Oyaguchikamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
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Chiang HH, Lee JY, Chou SH, Wang JY, Chang YT. Simultaneous occurrence of ipsilateral primary spontaneous hemopneumothorax and contralateral pneumothorax in an adolescent. J Pediatr Surg 2009; 44:1821-3. [PMID: 19735832 DOI: 10.1016/j.jpedsurg.2009.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Revised: 04/24/2009] [Accepted: 04/26/2009] [Indexed: 10/20/2022]
Abstract
Primary spontaneous hemopneumothorax is a rare disorder but can be life-threatening secondary to massive bleeding. The authors encountered an uncommon case of left primary spontaneous hemopneumothorax and simultaneous right pneumothorax. After initial bilateral tube thoracostomies, successful 1-stage bilateral video-assisted thoracic surgery (VATS) was performed before the condition deteriorated or complications occurred. Active oozing from a ruptured vascularized bulla was identified at the apex of the left upper lobe. One-stage bilateral VATS appears to be a reasonable method of surgical intervention, but in patients under life-threatening clinical conditions, it may still be difficult to use this strategy, and a staged operation may be considered.
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Affiliation(s)
- Hung-Hsing Chiang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
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Kim H, Kim HK, Choi YH, Lim SH. Thoracoscopic bleb resection using two-lung ventilation anesthesia with low tidal volume for primary spontaneous pneumothorax. Ann Thorac Surg 2009; 87:880-5. [PMID: 19231412 DOI: 10.1016/j.athoracsur.2008.12.071] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 12/22/2008] [Accepted: 12/22/2008] [Indexed: 01/08/2023]
Abstract
BACKGROUND We performed thoracoscopic surgery for pneumothorax using two-lung ventilation with low tidal volume and evaluated the feasibility and safety of this procedure. METHODS Forty-six patients (mean age, 23.6 +/- 10.47 years) each with a primary spontaneous pneumothorax underwent wedge resection with chemical and mechanical pleurodesis. Two-lung ventilation anesthesia was performed with a single-lumen endotracheal tube, and the tidal volume was reduced to 4 mL/kg; the respiratory rate was increased to 24 cycles/min. Airway pressure, end-tidal CO(2), and the results of blood gas analysis were obtained right after endotracheal intubation and during the operation, and were compared. RESULTS The tidal volume was 496.2 +/- 94.33 mL at anesthesia induction, which decreased to 243.9 +/- 34.43 mL during the two-lung ventilation. In 5 patients, the tidal volume was additionally decreased by 32.5 +/- 12.58 mL (p = 0.014) to obtain an optimal working field. The differences between the airway pressure, pH, partial pressure of carbon dioxide, and partial pressure of oxygen were significant between the two measurement times. However, all of the values of the arterial blood gas analysis were within normal range. The oxygen saturation (99.9% +/- 0.69% versus 99.8 +/- 0.72%; p = 0.160) and end-tidal CO(2) (33.2 +/- 3.74 mm Hg versus 34.1 +/- 4.19 mm Hg; p = 0.157) were not significantly different. The time from intubation before the incision was 17.1 +/- 4.18 minutes, the operation time was 31.9 +/- 14.48 minutes, and the total anesthesia time was 65.8 +/- 15.02 minutes. CONCLUSIONS Thoracoscopic surgery for primary spontaneous pneumothorax using two-lung ventilation with low tidal volume was technically feasible.
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Affiliation(s)
- Heezoo Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Chen JS, Hsu HH, Kuo SW, Huang PM, Lee JM, Lee YC. Management of recurrent primary spontaneous pneumothorax after thoracoscopic surgery: should observation, drainage, redo thoracoscopy, or thoracotomy be used? Surg Endosc 2009; 23:2438-44. [DOI: 10.1007/s00464-009-0404-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 01/14/2009] [Accepted: 02/11/2009] [Indexed: 10/21/2022]
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Residual apical space following surgery for pneumothorax increases the risk of recurrence. Eur J Cardiothorac Surg 2008; 34:169-73. [DOI: 10.1016/j.ejcts.2008.03.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 03/25/2008] [Accepted: 03/31/2008] [Indexed: 11/17/2022] Open
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Chung WJ, Jo WM, Lee SH, Son HS, Kim KT. Effects of additional pleurodesis with dextrose and talc-dextrose solution after video assisted thoracoscopic procedures for primary spontaneous pneumothorax. J Korean Med Sci 2008; 23:284-7. [PMID: 18437013 PMCID: PMC2526449 DOI: 10.3346/jkms.2008.23.2.284] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Recurrence after thoracoscopic surgery for primary spontaneous pneumothorax is a lingering problem, and many intraoperative methods to induce pleural symphysis have been introduced. We analyzed the effects of chemical pleurodesis during thoracoscopic procedures. Between August 2003 and July 2005, 141 patients among indicated surgical treatment for primary spontaneous pneumothorax in two hospitals of our institution allowed this prospective study. The patients were randomly assigned to 3 groups: thoracoscopic procedure only (group A, n=50), thoracoscopic procedure and pleurodesis with dextrose solution (group B, n=49), and thoracoscopic procedure and pleurodesis with talc-dextrose mixed solution (group C, n=42). There was no significant difference in demographic data among the three groups. The two groups that underwent intraoperative pleurodesis had significantly longer postoperative hospital stays (A/B/C: 2.50+/-1.85/4.49+/-2.10/6.00+/-2.58 days; p=0.001) and a higher incidence of postoperative fever (A/B/C: 10.0/22.45/52.38%; chi(2)= 21.598, p=0.00). No significant differences were found for recurrence rates or the number of postoperative days until chest tube removal. Therefore, the results of our study indicate that intraoperative chemical pleurodesis gives no additional advantage to surgery alone in deterring recurrence for patients with primary spontaneous pneumothorax. Thus, the use of such scarifying agents in the operating room must be reconsidered.
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Affiliation(s)
- Won Jae Chung
- Department of Thoracic and Cardiovascular Surgery, Ansan Hospital, Korea University, 516 Gojan-1-dong, Ansan, Korea
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