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Migliore M, Fiore M, Filippini T, Tumino R, Sabbioni M, Spatola C, Polosa R, Vigneri P, Nardini M, Castorina S, Basile F, Ferrante M. Comparison of video-assisted pleurectomy/decortication surgery plus hyperthermic intrathoracic chemotherapy with VATS talc pleurodesis for the treatment of malignant pleural mesothelioma: A pilot study. Heliyon 2023; 9:e16685. [PMID: 37292347 PMCID: PMC10245266 DOI: 10.1016/j.heliyon.2023.e16685] [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: 12/29/2022] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
Hyperthermic intrathoracic chemotherapy (HITHOC) adjunct to surgery for Malignant Pleural Mesothelioma (MPM) has no definite role. The primary objective of this pilot-trial was to evaluate the feasibility for future large studies. The study design was a prospective randomized three-centric pilot trial. We recruited patients diagnosed with MPM and prospectively assigned them to two groups: Group A: Video Assisted Thoracic Surgery (VATS) talc pleurodesis or Group B: Video-assisted P/D plus HITHOC. From November-2011 to July-2017 24 males and 3 females, with a median age of 68-years were enrolled (recruitment rate 5 patients/year). Preoperative stage was I-II, and 18 had epithelioid type. 14 patients were in the Group A. Operative mortality was 0. Follow-up ranged 6-80 months. The median overall survival time started to diverge at 20 months, being 19 months (95% CI 12-25) in Group A and 28 months (95% CI 0-56) in Group B. Survival rate for the epithelioid type was 15 months (95% CI 0-34) in Group A and 45 months (95% CI 0-107) in the Group B. These findings suggest that video-assisted P/D plus HITHOC may improve survival time in MPM patients undergoing surgical treatment and support the need for a larger multicenter randomized clinical trial.
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Affiliation(s)
- Marcello Migliore
- Minimally Invasive Thoracic Surgery and New Technologies University Hospital of Catania, Department of General Surgery and Medical Specialties, University of Catania, Catania, Italy
- Thoracic Surgery and Lung Transplant, Lung Health Centre, Organ Transplant Center of Excellence (OTCoE), King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Maria Fiore
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP 7), Ragusa, Italy
| | | | | | - Riccardo Polosa
- General Medicine, Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy
| | - Paolo Vigneri
- Center of Oncology and Hematology, Department of Clinical & Experimental Medicine University of Catania, Catania, Italy
| | - Marco Nardini
- Department of Thoracic Surgery, St. James University Hospital, London, UK
| | - Sergio Castorina
- General and Thoracic Surgery, Morgagni Policlinic Hospital, Catania, Italy
| | - Francesco Basile
- General Surgery, University Hospital of Catania, Department of General Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Margherita Ferrante
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy
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Migliore M, Hirai K. Uniportal VATS: Comment on the consensus report from the uniportal VATS interest group (UVIG) of the European Society of Thoracic Surgeons. Eur J Cardiothorac Surg 2020; 57:612. [PMID: 31397477 DOI: 10.1093/ejcts/ezz221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/11/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marcello Migliore
- Thoracic Surgery, Department of Surgery and Medical Specialties, Policlinico University Hospital, University of Catania, Catania, Italy
| | - Kyoji Hirai
- Division of Thoracic Surgery, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan
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Abstract
Chest infection is a health care problem in many regions of the world, and pleural empyema is the most common type of surgical chest infection. In the past decennium, the introduction of nonintubated surgery and uniportal video-assisted thoracic surgery changed considerably surgical treatment of pleural empyema. Although the advantages seem evident, the need for randomized controlled trials is necessary to confirm the usefulness. Moreover, in the future, an education and training program for thoracic surgeons and anesthesiologists would allow increasing the number of awake surgical options in caring for patients with stages II to III empyema.
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Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of Surgery and Medical Specialities, University of Catania, Policlinic University Hospital, Catania, Italy.
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Comparison of Diagnostic Yield and Safety between Semirigid Pleuroscopic Cryobiopsy and Forceps Biopsy for Undiagnosed Pleural Effusion. Can Respir J 2019; 2019:5490896. [PMID: 31929846 PMCID: PMC6939421 DOI: 10.1155/2019/5490896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/18/2019] [Accepted: 11/28/2019] [Indexed: 01/09/2023] Open
Abstract
For undiagnosed pleural effusion, diagnostic yields and safety were similar between pleuroscopic cryobiopsy and forceps biopsy, but cryobiopsy obtained a larger pleural tissue sample than forceps biopsy.
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Balta C. Uniportal-Single Incision Thoracoscopic Access for Pulmonary Hydatid Cysts. CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/1573398x15666190508090653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective:
Pulmonary hydatid cyst is caused by Echinococcus Species and has high
prevalence in low and middle income countries. Surgery remains the gold standard method for this
parasitic pulmonary disease. Here, we report 20 cases of pulmonary hydatid cysts that underwent
minimally invasive videothoracoscopic surgery.
Methodology:
All the patients who underwent minimally invasive complete thoracoscopic removal
of pulmonary hydatid cysts in our clinic, which were recorded in the hospital database had been
extracted. Clinical properties and complications of the surgeries were analyzed retrospectively.
Results:
Minimally invasive method was performed in all 20 cases. The mean duration of operation
was 95 minutes (min-max: 45-175), and the mean length of hospitalization was 3.55 days (min-max:
2-7). The complication rate was 15% (n=3) and there was no recurrence in 6 months of follow- up.
Conclusion:
Videothorascopic pulmonary hydatid cysts removal seems to be a safe and useful
method. This method is applied in all suitable patients with pulmonary hydatid cysts.
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Affiliation(s)
- Cenk Balta
- Department of Thoracic Surgery, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
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Migliore M. Uniportal video-assisted thoracic surgery: twentieth anniversary. J Thorac Dis 2019; 10:6442-6445. [PMID: 30746185 DOI: 10.21037/jtd.2018.12.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marcello Migliore
- Thoracic Surgery, Policlinico University Hospital, University of Catania, Catania, Italy
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7
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Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of Surgery and Medical Specialities, Policlinico University Hospital, University of Catania, Catania, Italy
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Saleh W, AlShammari A, Sarraj J, AlAshgar O, Ahmed MH, AlKattan K. Surgical treatment of pulmonary metastasis: report from a tertiary care center. Asian Cardiovasc Thorac Ann 2018; 26:296-301. [PMID: 29587522 DOI: 10.1177/0218492318767795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective This retrospective analysis aimed to determine the factors influencing prognosis in adult patients who presented to our thoracic surgery service with lung metastases and were eligible for pulmonary metastasectomy. Methods We retrospectively reviewed the data of 296 patients who underwent resection of 575 lung metastases from January 2000 to January 2016. Univariate and multivariate analyses were performed based on age, sex, histology of the primary tumor, disease-free interval, number and size of metastases. Results Sixty-eight (22.97%) patients developed lung metastases from bone sarcoma, 68 (22.97%) from soft-tissue sarcoma, 56 (18.9%) from head and neck cancers, 46 (15.5%) from colorectal cancer, and 58 (19.6%) from other epithelial tumors. The mean size of the lung nodules was 2.48 cm. Open surgical resection was performed in 217 (73.3%) patients. After a mean follow-up of 43 months, 120 (40.7%) patients had died or were lost to follow-up. Univariate analysis confirmed that patients with bone cancer, soft tissue sarcoma, or colorectal carcinoma had a worse prognosis ( p = 0.0003). Moreover, those with a disease-free interval >24 months had a better 5-year survival ( p = 0.0001). The number and size of metastases, age, and sex had no effect on prognosis. The actuarial survival after complete metastasectomy was 71.6% (95% confidence interval: 66-75) at 2 years and 59.3% (95% confidence interval: 56-64) at 5 years. Conclusions Pulmonary metastasectomy provides good long-term survival. The type of primary tumor and disease-free interval are independent prognostic factors for survival.
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Affiliation(s)
- Waleed Saleh
- 2 Division of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah AlShammari
- 1 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,2 Division of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Jumana Sarraj
- 1 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Omniyah AlAshgar
- 2 Division of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohamed Hussein Ahmed
- 2 Division of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khaled AlKattan
- 1 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,2 Division of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Olland A, Reeb J, Sauleau E, Meyer N, Bernard-Schweitzer M, Falcoz C, Falcoz PE, Massard G. Video-assisted thoracoscopic lobectomy versus open thoracotomy conventional lobectomy for stage I non-small cell lung cancer. Hippokratia 2017. [DOI: 10.1002/14651858.cd012641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Anne Olland
- Nouvel Hôpital Civil, University Hospital Strasbourg; Thoracic Surgery and Lung Transplantation; 1 place de l'Hôpital - BP 426 Strasbourg France 67091
| | - Jeremie Reeb
- Nouvel Hôpital Civil, University Hospital Strasbourg; Thoracic Surgery and Lung Transplantation; 1 place de l'Hôpital - BP 426 Strasbourg France 67091
| | - Erik Sauleau
- Nouvel Hôpital Civil, University Hospital Strasbourg; Medical Information Department; Service de Santé Publique 1 place de l'Hôpital - BP 426 Strasbourg France 67091
| | - Nicolas Meyer
- Nouvel Hôpital Civil, University Hospital Strasbourg; Medical Information Department; Service de Santé Publique 1 place de l'Hôpital - BP 426 Strasbourg France 67091
| | - Marion Bernard-Schweitzer
- Bibliothèque de Médecine et Odontologie; Service Commun de la Documentation, Université de Strasbourg; 4 rue Kirschleger Strasbourg France 67000
| | - Celine Falcoz
- Lucie Berger; Middle School; 1 rue des Greniers Strasbourg France 67000
| | - Pierre Emmanuel Falcoz
- Nouvel Hôpital Civil, University Hospital Strasbourg; Thoracic Surgery and Lung Transplantation; 1 place de l'Hôpital - BP 426 Strasbourg France 67091
| | - Gilbert Massard
- Nouvel Hôpital Civil, University Hospital Strasbourg; Thoracic Surgery and Lung Transplantation; 1 place de l'Hôpital - BP 426 Strasbourg France 67091
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Migliore M. Video-assisted thoracic surgery techniques for lung cancer: which is better? Future Oncol 2017; 12:1-4. [PMID: 27885852 DOI: 10.2217/fon-2016-0465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Policlinico University Hospital, Catania, Italy
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Migliore M, Halezeroglu S, Molins L, Van Raemdonck D, Mueller MR, Rea F, Paul S. Uniportal video-assisted thoracic surgery or single-incision video-assisted thoracic surgery for lung resection: clarifying definitions. Future Oncol 2016; 12:5-7. [DOI: 10.2217/fon-2016-0370] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Semih Halezeroglu
- Department of Thoracic Surgery, Acibadem University, Istanbul, Turkey
| | - Laureano Molins
- Department of Thoracic Surgery, Barcelona University, Barcelona, Spain
| | | | - Michael R Mueller
- Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria
| | - Federico Rea
- Department of Thoracic Surgery, University of Padua, Padua, Italy
| | - Subroto Paul
- Thoracic Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA
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Migliore M. Initial History of Uniportal Video-Assisted Thoracoscopic Surgery. Ann Thorac Surg 2016; 101:412-3. [DOI: 10.1016/j.athoracsur.2015.07.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 07/10/2015] [Accepted: 07/15/2015] [Indexed: 10/22/2022]
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Migliore M, Calvo D, Criscione A, Borrata F. Uniportal video assisted thoracic surgery: summary of experience, mini-review and perspectives. J Thorac Dis 2015; 7:E378-80. [PMID: 26543631 DOI: 10.3978/j.issn.2072-1439.2015.07.35] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The uniportal-video assisted thoracic surgery (VATS) technique comprises operations which can be performed with skin incisions ranging from 2 to 8 cm and the manifest result of the introduction of the uniportal lobectomy had made possible to increase rapidly the number of published papers on this subject. Many of the large ensuing literature report incomplete historical information on uniportal VATS, and doubts exist about the indication of uniportal VATS for some thoracic oncologic pathologies. Known limitations have been overcome. On the other hand, the modern thoracic surgical team includes one surgeon, one assistant and a scrub nurse, and it is clear that the new generation of thoracic surgeons need to use the "less" used hand. The new technology which permitted the introduction of the uniportal VATS could influence the future need of thoracic surgeons worldwide.
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Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of Surgery and Medicinal Specialties, University of Catania, Catania, Italy
| | - Damiano Calvo
- Section of Thoracic Surgery, Department of Surgery and Medicinal Specialties, University of Catania, Catania, Italy
| | - Alessandra Criscione
- Section of Thoracic Surgery, Department of Surgery and Medicinal Specialties, University of Catania, Catania, Italy
| | - Francesco Borrata
- Section of Thoracic Surgery, Department of Surgery and Medicinal Specialties, University of Catania, Catania, Italy
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Migliore M, Criscione A, Calvo D, Borrata F, Gangemi M, Attinà G. Preliminary experience with video-assisted thoracic surgery lobectomy for lung malignancies: general considerations moving toward standard practice. Future Oncol 2015; 11:43-6. [DOI: 10.2217/fon.15.305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
As part of the Second Catania Symposium on Thoracic Oncology, as we started the experience with video-assisted thoracic surgery (VATS) lobectomy for lung malignancies, we reviewed our data and argued some comments in a more general discussion. Operated patients with non-small-cell lung cancer were divided in two groups and compared: VATS (collected in a prospective database) and open (historical group). Out of 74 patients, 31 in group A and 44 in group B. The majority of patients in group A were stage I–II. Mean operative time was shorter in group A. Postoperative hospital stay was shorter in group A. There was no mortality. VATS is effective and safe to perform pulmonary lobectomy in our unit, and it represents our preferred approach for early-stage lung cancer.
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Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of General surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Alessandra Criscione
- Section of Thoracic Surgery, Department of General surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Damiano Calvo
- Section of Thoracic Surgery, Department of General surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Francesco Borrata
- Section of Thoracic Surgery, Department of General surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Mariapia Gangemi
- Section of Thoracic Surgery, Department of General surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Giorgio Attinà
- Section of Thoracic Surgery, Department of General surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
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Migliore M, Calvo D, Criscione A, Viola C, Privitera G, Spatola C, Parra HS, Palmucci S, Ciancio N, Caltabiano R, Di Maria G. Cytoreductive surgery and hyperthermic intrapleural chemotherapy for malignant pleural diseases: preliminary experience. Future Oncol 2015; 11:47-52. [PMID: 25662329 DOI: 10.2217/fon.14.256] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cytoreductive surgery and hyperthermic-intraoperative-intrapleural-chemotherapy (HITHOC) is a known approach for malignant pleural diseases (MPD). This study was started to clarify the role of cytoreductive surgery and HITHOC in MPD. Criteria of inclusion were early-stage disease in malignant pleural mesothelioma (MPM), young age, good condition and selected stage-M1a lung cancer. Six patients with MPM and two patients with lung cancer were enrolled. After surgical debulking, intrapleural cisplatin was administered for 60 min at 42.5°C. Wedge, rib resection and repaired diaphragm were added in three, one and one patient, respectively. Morbidity, toxicity and mortality was nil. Hospital stay was 8 days. Mean survival is 13.6 months. This experience confirms that cytoreductive surgery and HITHOC is a good option in the treatment of MPD. A randomized controlled trial is necessary.
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Affiliation(s)
- Marcello Migliore
- Academic Thoracic Surgery Unit, A.O.U. Policlinico-Vittorio Emanuele, Department of Surgery, University of Catania, Catania, Italy
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Pignataro G, Basile F, Migliore M. Mediterranean symposium in thoracic surgery: opening lectures. Future Oncol 2015; 11:5-9. [PMID: 25662320 DOI: 10.2217/fon.14.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Migliore M, Criscione A, Parfrey H. A hybrid single-trocar VATS technique for extracorporeal wedge biopsy of the lingula in patients with diffuse lung disease. Updates Surg 2012; 64:223-5. [PMID: 22644718 DOI: 10.1007/s13304-012-0160-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 05/16/2012] [Indexed: 11/29/2022]
Abstract
Lung biopsy is the last option to obtain lung tissue for a precise diagnosis in patients with interstitial lung disease (ILD). Several surgical techniques have been reported. The successful application of a hybrid approach is herein reported. The procedure utilizes a single-trocar video-assisted thoracoscopic surgery technique to localize and withdraw the tip of the lingula outside the chest to perform a biopsy in the diagnosis of ILDs. The advantages of this technique over other commonly used methods have also been discussed.
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Affiliation(s)
- Marcello Migliore
- Department of Surgery, Policlinic Hospital, University of Catania, Catania, Italy.
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Migliore M. Efficacy and safety of single-trocar technique for minimally invasive surgery of the chest in the treatment of noncomplex pleural disease. J Thorac Cardiovasc Surg 2004; 126:1618-23. [PMID: 14666042 DOI: 10.1016/s0022-5223(03)00592-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the efficacy and the safety of a single-trocar technique for minimally invasive surgery of the chest in the management of multiple noncomplex thoracic diseases, a prospective study was performed and the results are presented. METHODS Between October 1998 and December 2001, 100 patients underwent video-assisted thoracic surgery through a single trocar. The patients were divided into 4 groups as follows: (1) benign, (2) malignant, (3) pleural effusion, and (4) empyema. The following data were analyzed: age, sex, forced vital capacity, forced expiratory volume in 1 second, percentage of the predicted forced expiratory volume in 1 second, type of anesthesia, anesthesia time, surgery time, intraoperative complications, morbidity, chest tube removal, hospital stay, and follow-up. RESULTS The patient population consisted of 64 men and 36 women with a mean age of 62 years (range 31-92 years). General anesthesia was used in 53 patients (25 double-lumen and 28 single-lumen tube) and local anesthesia and sedation in 47 patients. Talc pleurodesis was performed in 55 patients. Mean operative time was 65 +/- 37 minutes, 48 +/- 18 minutes for simple and 67 +/- 37 minutes (P =.004) for complex pleural effusion. Mean anesthesia time was 102 +/- 85 minutes. Chest tubes were removed after 5 +/- 2 days. Mean overall hospital stay was 6 +/- 3 days, 5 +/- 2 days for benign diseases, 7 +/- 3 days for malignant diseases, and 8 +/- 3 for empyema. Morbidity was present in 19 patients. Two patients had intraoperative bleeding; 1 required a mini-thoracotomy to control it. There was no hospital mortality. Three patients had wound infection, and no patient with malignant diseases had port site metastasis. CONCLUSION Video-assisted thoracic surgery through a single trocar is simple, effective, and beneficial for all patients in the diagnosis and treatment of noncomplex diseases of the chest. Furthermore, with this newest type of technologically advanced instrumentation it is possible to carry out simple intrathoracic procedures without using additional ports.
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Affiliation(s)
- Marcello Migliore
- Section of General Thoracic Surgery, Department of Surgery, University of Catania, Italy.
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Migliore M, Deodato G. A single-trocar technique for minimally-invasive surgery of the chest. Surg Endosc 2001; 15:899-901. [PMID: 11443464 DOI: 10.1007/s004640090033] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2000] [Accepted: 12/07/2000] [Indexed: 11/24/2022]
Abstract
BACKGROUND In thoracic surgery, the classic thoracoscope is used to perform simple maneuvers in the chest. We have devised a minimally invasive technique that requires only a single trocar. This technique is used in our department to diagnose and treat a wide range of thoracic pathologies. METHODS Between October 1998 and August 1999, 37 patients underwent surgery prospectively for a thoracic disease through a single trocar. There were 19 men and 18 women with a mean age of 60 years (range, 40-85). The trocar was flexible or soft and had a diameter of 15-20 mm. A 2-cm skin incision was made in the planned intercostal space. The chest drain was always inserted under video control. RESULTS The mean operative time was 53 +/- 5 min. One patient developed intraoperative bleeding that required intubation and a 5-cm mini-thoracotomy. In one patient with stage II empyema, it was necessary to insert another trocar. Chest tubes were removed after 77.7 +/- 7 h. Hospital stay was 4 +/- 1 days (range, 2-14). Histologic examination revealed malignant disease in 26 cases and benign disease in 11. Two patients (5.4%) developed wound infections. None of the patients had port site metastasis. There were no hospital deaths. CONCLUSION Because of its simplicity, we recommend the use of this mini-invasive technique in place of the classic thoracoscope or video-mediastinoscope.
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Affiliation(s)
- M Migliore
- Department of Surgery, Section of General Thoracic Surgery, University of Catania, Ospedale Tomaselli, Via Passo Gravina 187, 95124 Catania, Italy
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