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Homma T, Saji H, Shimada Y, Tanabe K, Kojima K, Marushima H, Miyazawa T, Kimura H, Sakai H, Otsubo K, Hatakeyama T, Tsuchiya T. Early chest tube removal within 6 hours after thoracic surgery results in improved postoperative prognosis and no adverse effects. J Thorac Dis 2024; 16:3096-3106. [PMID: 38883671 PMCID: PMC11170371 DOI: 10.21037/jtd-23-1905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/07/2024] [Indexed: 06/18/2024]
Abstract
Background Advances in minimally invasive surgery and drainage systems have caused earlier chest-tube-removal. This retrospective study aimed to assess the safety of early chest tube removal using the institution's new criteria 6 hours after thoracic surgery. Methods Elective thoracic surgery patients from 2017 to 2023 were reviewed for meeting or not meeting the newer institutional requirement for early chest tube removal; (I) no air leak detected under the digital drainage device observation; (II) no fluid drainage of ≥100 mL/h; (III) no ≥3 combined risks [male, chronic obstructive pulmonary disease (COPD), body mass index (BMI) of <18.5 kg/m2, severe pleural adhesion, upper lobe lobectomy, or left upper division segmentectomy]. The incidence of adverse events, including chest tube replacement, subcutaneous tube placement, and postoperative thoracentesis, were investigated for 1 month postoperatively. Perioperative outcomes and factors involved in conventional chest tube removal were also assessed. Results Of the 942 patient charts reviewed, 244 (25.9%) met the criteria for chest tube removal within 6 hours postoperatively. This patient group did not experience adverse events. They also demonstrated shorter postoperative hospital stay (4 vs. 6 days, P<0.001), and lesser postoperative complications (7.4% vs. 25.6%, P<0.001) compared to those for whom early chest tube removal was not done. A correlation with thoracotomy, COPD, and steroid and/or immunosuppressant use was observed for patients in the conventional chest tube removal group. Conclusions Early chest tube removal after 6 postoperative hours was deemed safe for a selected group of patients who met the criteria for early chest tube removal. This study would support the potential expansion of our early removal criteria.
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Affiliation(s)
- Takahiro Homma
- Department of Thoracic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
- Division of Thoracic Surgery, Kurobe City Hospital, Toyama, Japan
| | - Hisashi Saji
- Department of Thoracic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshifumi Shimada
- Division of Thoracic Surgery, Kurobe City Hospital, Toyama, Japan
- Division of Thoracic Surgery, University of Toyama, Toyama, Japan
| | - Keitaro Tanabe
- Division of Thoracic Surgery, University of Toyama, Toyama, Japan
| | - Koji Kojima
- Department of Thoracic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hideki Marushima
- Department of Thoracic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoyuki Miyazawa
- Department of Thoracic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroyuki Kimura
- Department of Thoracic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroki Sakai
- Department of Thoracic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kanji Otsubo
- Department of Thoracic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takayuki Hatakeyama
- Department of Thoracic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoshi Tsuchiya
- Division of Thoracic Surgery, University of Toyama, Toyama, Japan
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Gajić D, Wojtyś M, Wójcik N, Maciąg B, Kiełbowski K, Wójcik J, Grodzki T. Examination of resistance of various methods of pulmonary vessel occlusion to hydrostatic pressure. Indian J Thorac Cardiovasc Surg 2023; 39:484-488. [PMID: 37609616 PMCID: PMC10441956 DOI: 10.1007/s12055-023-01505-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 08/24/2023] Open
Abstract
Objective The aim of this study was to compare pressure resistance of the most common methods of vessel occlusion during thoracic surgical procedures: ligations, clips, and vascular endostaplers. Methods Pulmonary vessels were obtained during routine thoracic surgeries. A ball-tipped cannula was inserted through an opening in the side wall and secured with a linen ligature from slipping out. Subsequently, saline was infused into the vessel. We recorded the pressure on which a leakage occurred. Results A total of 65 vessels, divided between 3 groups, were enrolled in the study. In the endostaplers group, median bursting pressures were 262.5 mmHg and 300 mmHg for arteries and veins, respectively. In the case of clips, it was over 750 mmHg in both types of the vessels. The same results were observed in the ligation group. Minimal bursting pressures in endostapler occlusion were 187.5 mmHg and 225 mmHg in arteries and veins, respectively. In the case of clips, it was 600 mmHg for arteries and 675 mmHg for veins. A total of 525 mmHg (arteries) and 750 mmHg (veins) were the minimal leaking values observed in vessels occluded with ligations. Comparative analysis showed statistically significant differences in endostapler-clips and endostapler-ligations pairs (p < 0.001). There were no differences between clips and ligations. Conclusions The examined methods are capable of occluding pulmonary vessels under physiological conditions. Furthermore, ligations and clips are resistant to pressures highly exceeding physiological values.
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Affiliation(s)
- Darko Gajić
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Małgorzata Wojtyś
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Norbert Wójcik
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Bogumił Maciąg
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Kajetan Kiełbowski
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Janusz Wójcik
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
| | - Tomasz Grodzki
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Alfreda Sokołowskiego 11, 70-891 Szczecin, Poland
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Homma T, Uehara H, Saji H. Factors affecting insulation failure in reusable surgical devices. Sci Rep 2023; 13:13719. [PMID: 37608091 PMCID: PMC10444886 DOI: 10.1038/s41598-023-41059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 08/21/2023] [Indexed: 08/24/2023] Open
Abstract
The purpose of this study was to investigate the associated factors of insulation failure (IF) in reusable endoscopic instruments. The insulation coating of reusable endoscopic instruments underwent routine visual checks, hand washing to remove visible stains, and mechanized sterilization. We recorded the cleaning number and usage period of all instruments. The instruments were tested for IF using a detector. IF was found in eight of 69 devices (11.6%). Examining by clinical specialty, we found IF in 4 of 28 gastrointestinal (14.3%), 3 of 20 gynecological (15.0%), 1 of 12 urological (8.3%), and none of the nine thoracic devices. The median distance from the tip to the damaged part was 5 cm (3-5 cm). In the IF and the intact groups, the period of use [7 years (6-8) versus 7 years (4-8), P = 0.90] and the number of cleanings [281 (261-323) versus 261 (179-320), P = 0.27] were not significantly different. The IF group included products of three different companies; however, six of the eight (75.0%) were from the same company. Cleaning methods and usage period have a lower impact on IF. The use of reusable forceps as a monopolar device was found to pose a higher risk, requiring regular assessments.
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Affiliation(s)
- Takahiro Homma
- Division of Thoracic Surgery, Kurobe City Hospital, Toyama, Japan.
- Division of Thoracic Surgery, University of Toyama, Toyama, Japan.
- Department of Chest Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Hirofumi Uehara
- Central Sterile Supply Department, Toyama University Hospital, Toyama, Japan
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Kawasaki, Kanagawa, 216-8511, Japan
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Gabryel P, Roszak M, Skrzypczak P, Gabryel A, Zielińska D, Sielewicz M, Campisi A, Kasprzyk M, Piwkowski C. Identification of Factors Related to the Quality of Lymphadenectomy for Lung Cancer: Secondary Analysis of Prospective Randomized Trial Data. J Clin Med 2023; 12:jcm12113780. [PMID: 37297976 DOI: 10.3390/jcm12113780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/19/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
The outcomes of non-small cell lung cancer surgery are influenced by the quality of lymphadenectomy. This study aimed to evaluate the impact of different energy devices on lymphadenectomy quality and identify additional influencing factors. This secondary analysis of the prospective randomized trial data (clinicaltrials.gov: NCT03125798) compared patients who underwent thoracoscopic lobectomy with the LigaSure device (study group, n = 96) and monopolar device (control group, n = 94). The primary endpoint was the lobe-specific mediastinal lymphadenectomy. Lobe-specific mediastinal lymphadenectomy criteria were met in 60.4% and 38.3% of patients in the study and control groups, respectively (p = 0.002). In addition, in the study group, the median number of mediastinal lymph node stations removed was higher (4 vs. 3, p = 0.017), and complete resection was more often achieved (91.7% vs. 80.9%, p = 0.030). Logistic regression analysis indicated that lymphadenectomy quality was positively associated with the use of the LigaSure device (OR, 2.729; 95% CI, 1.446 to 5.152; p = 0.002) and female sex (OR, 2.012; 95% CI, 1.058 to 3.829; p = 0.033), but negatively associated with a higher Charlson Comorbidity Index (OR, 0.781; 95% CI, 0.620 to 0.986; p = 0.037), left lower lobectomy (OR, 0.263; 95% CI, 0.096 to 0.726; p = 0.010) and middle lobectomy (OR, 0.136; 95% CI, 0.031 to 0.606, p = 0.009). This study found that using the LigaSure device can improve the quality of lymphadenectomy in lung cancer patients and also identified other factors that affect the quality of lymphadenectomy. These findings contribute to improving lung cancer surgical treatment outcomes and provide valuable insights for clinical practice.
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Affiliation(s)
- Piotr Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Magdalena Roszak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Rokietnicka 7 Street, 60-806 Poznan, Poland
| | - Piotr Skrzypczak
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Anna Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Dominika Zielińska
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Magdalena Sielewicz
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Alessio Campisi
- Department of Thoracic Surgery, University and Hospital Trust-Ospedale Borgo Trento, Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Mariusz Kasprzyk
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
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Homma T, Saji H, Shimada Y, Tanabe K. Experiences of novel cotton device for uniportal video-assisted thoracoscopic surgery: CS Two-Way Handle TM. J Thorac Dis 2023; 15:2800-2805. [PMID: 37324061 PMCID: PMC10267937 DOI: 10.21037/jtd-22-1602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/31/2023] [Indexed: 06/17/2023]
Abstract
In Japan, cotton is commonly used in thoracic surgery for the gentle handling of organs as well as obtaining a good surgical field. While uniportal video-assisted thoracoscopic surgery is being recognized as a major surgical approach, use of cotton is not noted in this technique. Uniportal video-assisted thoracoscopic surgery needs curved instruments because they are effective in preventing the interference of instruments. Thus, we developed a novel curved cotton instrument, known as the "CS Two-Way HandleTM", for uniportal video-assisted thoracoscopic surgery. The CS Two-Way HandleTM can be used not only as a cotton bar but also as a suction aid. Moreover, surgical smoke can be suctioned with the insertion of cotton. This instrument was introduced in our institution in September 2019, along with some other prototypes. When anatomical lung resection using uniportal video-assisted thoracoscopic surgery was first introduced, there were some instances of conversion to conventional multiportal video-assisted thoracoscopic surgery. However, after the CS Two-Way HandleTM introduction, the procedure has become easy to perform and the need for conversion to conventional methods has reduced. The main uses of the CS Two-Way HandleTM are: (I) exposure of the surgical view, (II) lymph node dissection, (III) bleeding control, (IV) suction, and (V) evacuation of surgical smoke. We present our experiences using the CS Two-Way HandleTM in uniportal video-assisted thoracoscopic surgery.
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Affiliation(s)
- Takahiro Homma
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
- Division of Thoracic Surgery, Kurobe City Hospital, Toyama, Japan
- Division of Thoracic Surgery, University of Toyama, Toyama, Japan
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | | | - Keitaro Tanabe
- Division of Thoracic Surgery, University of Toyama, Toyama, Japan
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Comparison of the LigaSure™ bipolar vessel sealer to monopolar electrocoagulation for thoracoscopic lobectomy and lymphadenectomy: a prospective randomized controlled trial. Surg Endosc 2023:10.1007/s00464-023-09892-0. [PMID: 36792782 DOI: 10.1007/s00464-023-09892-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/15/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND High-energy devices allow better vessel sealing compared with monopolar electrocautery and could improve the outcomes of surgical operations. The objective of the study was to compare tissue dissection by the LigaSure™ device with that by monopolar electrocoagulation for thoracoscopic lobectomy and lymphadenectomy. METHODS This pragmatic, parallel group, prospective randomized controlled trial was funded by the Medtronic External Research Program (ISR-2016-10,756) and registered at www. CLINICALTRIALS gov (NCT03125798). The study included patients aged 18 years or older, who had undergone thoracoscopic lobectomy with lymphadenectomy at the Department of Thoracic Surgery of Poznan University of Medical Sciences between May 3, 2018, and November 4, 2021. Using simple randomization, the patients were assigned to undergo tissue dissection with either the LigaSure device (study group) or monopolar electrocautery (control group). Participants and care givers, except operating surgeons, were blinded to group assignment. The primary outcome was postoperative chest drainage volume. Secondary outcomes were change of the esophageal temperature during subcarinal lymphadenectomy and C-reactive protein level 72 h after surgery. RESULTS Study outcomes were analyzed in 107 patients in each group. We found no differences between the study and control groups in terms of chest drainage volume (550 vs. 600 mL, respectively; p = 0.315), changes in esophageal temperature (- 0.1 °C vs. - 0.1 °C, respectively; p = 0.784), and C-reactive protein levels (72.8 vs. 70.8 mg/L, respectively; p = 0.503). The mean numbers of lymph nodes removed were 12.9 (SD: 3.1; 95% CI, 12.4 to 13.5) in the study group and 11.6 (SD: 3.2; 95% CI, 11.0 to 12.2) in the control group (p < 0.001). CONCLUSIONS The use of the LigaSure device did not allow to decrease the chest drainage volume, local thermal spread, and systemic inflammatory response. The number of lymph nodes removed was higher in patients operated with the LigaSure device, which indicated better quality of lymphadenectomy.
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Piemontese A, Cohen L, Wright GWJ, Robledinos-Antón N, Jamous N, Tommaselli GA, Galvain T. Adopting a portfolio of ultrasonic and advanced bipolar electrosurgery devices from a single manufacturer compared to currently used ultrasonic and advanced bipolar devices: a probabilistic budget impact analysis from a Spanish hospital perspective. J Med Econ 2023; 26:179-188. [PMID: 36646702 DOI: 10.1080/13696998.2023.2169496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIMS Advanced energy devices are commonly used in electrosurgery, including ultrasonic and advanced bipolar (ABP) devices. Smoke evacuation and reusable dispersive electrodes are also utilized during electrosurgery to improve staff and patient safety. This study assessed the budget impact of adopting a portfolio of Ethicon energy devices compared to devices from other manufacturers from a Spanish hospital perspective. METHODS The main analysis compared the Ethicon advanced energy device portfolio (ultrasonic and ABP devices) to Non-Ethicon advanced energy devices. It was assumed that 4,000 procedures using one advanced energy device each were performed annually, and the cost impact of operating room time, length of stay, and transfusions were considered. A probabilistic budget impact analysis with 10,000 iterations was conducted for generalizability to other hospitals in Spain and Europe. Secondary analysis assessed whether cost savings from the Ethicon advanced energy device portfolio could offset costs of adopting smoke evacuation and reusable dispersive electrodes (Full Ethicon energy portfolio). RESULTS In the main analysis, the annual budget impact of introducing the Ethicon advanced energy device portfolio was cost saving in 79.8% of probabilistic iterations (mean: -€945,214; 95% credible interval [CrI]: -€3,242,710; €1,285,942) with a mean budget impact per procedure of -€236 (95% CrI: -€811; €321). In the secondary analysis, adding smoke evacuation and reusable dispersive electrodes was still cost saving in 75.3% of iterations compared to Non-Ethicon advanced energy devices (mean: -€778,208; 95% CrI: -€3,075,086; €1,464,728) with a mean budget impact per procedure of -€97 (95% CrI: -€384; €183). Savings resulted from differences in operating room time, length of hospital stay, and volume of disposable electrodes. CONCLUSIONS Adopting Ethicon advanced energy devices demonstrated economic benefits compared to non-Ethicon devices. Introducing the advanced portfolio may improve surgical care quality and the full portfolio was cost saving while improving OR safety for staff and patients.
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Affiliation(s)
- Alessandra Piemontese
- EMEA Health Economics & Market Access, Johnson & Johnson Medical Devices Companies, Diegem, Belgium
| | | | | | | | - Nadine Jamous
- EMEA Health Economics & Market Access, Johnson & Johnson Medical Devices Companies, Diegem, Belgium
| | | | - Thibaut Galvain
- Global Health Economics, Johnson and Johnson Medtech, New Brunswick, NJ, USA
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