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Huang H, Peng X, Zhang H, Li W, Wang C. A Retrospective Case-Control Study on the Chest Wall and Lung Characteristics in Patients with Primary Spontaneous Pneumothorax. Med Sci Monit 2019; 25:8482-8491. [PMID: 31708570 PMCID: PMC6865251 DOI: 10.12659/msm.917075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) is reported to be more common in young men who are thin and tall. This retrospective study aimed to analyze the clinical and chest wall characteristics associated with PSP. MATERIAL AND METHODS Between January 2008 to December 2017, the clinical and imaging data of 99 patients at first presentation with PSP were compared with 82 age-matched healthy controls. Computed tomography (CT) imaging was used to measure the anteroposterior and transverse diameters of the chest at four levels, including the aortic arch, tracheal bifurcation, right inferior pulmonary vein, and lower sternal edge. Chest deformity was calculated as the ratio of the transverse diameter of the hemithorax divided by anteroposterior diameter. Lung volume and average lung density of 32 cases with PSP were measured and compared with 10 patients without PSP. Intrapleural pressure of 43 cases PSP who were treated with a closed chest drain was measured and compared with 39 patients with mediastinal tumor who underwent thoracoscopic surgery. RESULTS Patients with PSP showed a normal age distribution with a median of 17-18 years. The patients with PSP had significantly reduced anteroposterior and transverse diameters of the chest when compared with controls at four levels on CT (p<0.01). The lung volumes in patients with PSP were significantly reduced when compared with the controls (p<0.05), as were the minimum intrapleural pressure and pressure difference (p<0.05). CONCLUSIONS The findings support that chest wall dimensions may be associated with lung development, which are contributing factors in PSP.
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Affiliation(s)
- Haibo Huang
- Department of Thoracic Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China (mainland)
| | - Xiaonu Peng
- Department of Thoracic Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China (mainland)
| | - Hongwei Zhang
- Department of Thoracic Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China (mainland)
| | - Wenjun Li
- Department of Thoracic Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China (mainland)
| | - Chaoyang Wang
- Department of Thoracic Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China (mainland)
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Steger V, Sostheim U, Leistner M, Walles T. Recurrence of Spontaneous Pneumothorax Is Not Associated with Allegedly Risk-Prone Lifestyle Conduct. Ann Thorac Cardiovasc Surg 2018; 24:25-31. [PMID: 29279462 DOI: 10.5761/atcs.oa.17-00130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Spontaneous pneumothorax (PNTX) is a common disease frequently operated at specialized thoracic surgery units. Videothoracoscopic surgery (VATS) has become the standard for treatment and recurrence prevention. While there is broad consensus regarding indications and techniques of PNTX surgery, postoperative risks and consecutive patient behavioral advice have not been sufficiently elucidated. METHODS Single-center cohort analysis of 641 patients operated for primary PNTX by VATS over 10 years. Putatively recurrence-prone lifestyle activities (smoking status, flying habits, and scuba diving) and actual occurrence of recurrences were correlated. RESULTS Follow-up rate was 46% (279/607 patients). Mean time interval between primary operation and follow-up was 61 (range: 5-177) months. In 10 patients (3.6%), a PNTX recurrence was observed. Regarding postoperative risk behavior reported at follow-up, 28% of patients were active smokers (15 ± 7 cigarettes/day), 59% traveled by plane repeatedly, and only two patients did scuba diving (0.7%). Low body-mass-index was associated with an increase in PNTX recurrence, whereas smoking, flying, and scuba diving could not be identified as risk factors. CONCLUSION In our study, none of the supposed "classic" lifestyle-associated risk factors for PNTX recurrence after VATS proved to be a significant threat. Postoperative patient behavior might not be constrained by overcautious medical advice.
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Affiliation(s)
- Volker Steger
- Department of Thoracic, Cardiac and Vascular Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Ulrike Sostheim
- Department of Thoracic Surgery, Schillerhoehe Hospital, Schillerhoehe, Germany
| | - Marcus Leistner
- Department of Thoracic, Cardiac and Vascular Surgery, Goettingen University Hospital, Goettingen, Germany
| | - Thorsten Walles
- Department of Thoracic Surgery, Schillerhoehe Hospital, Schillerhoehe, Germany.,Department of Cardiothoracic Surgery, Magdeburg University Hospital, Magdeburg, Germany
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Spontaneous ventilation anaesthesia: total intravenous anaesthesia with local anaesthesia or thoracic epidural anaesthesia for thoracoscopic bullectomy. Eur J Cardiothorac Surg 2016; 50:927-932. [DOI: 10.1093/ejcts/ezw209] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 05/18/2016] [Indexed: 11/14/2022] Open
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Guo Z, Yin W, Zhang X, Xu X, Liu H, Shao W, Liu J, Chen H, He J. Primary spontaneous pneumothorax: simultaneous treatment by bilateral non-intubated videothoracoscopy. Interact Cardiovasc Thorac Surg 2016; 23:196-201. [PMID: 27165732 DOI: 10.1093/icvts/ivw123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/09/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Through a retrospective study, we assessed the feasibility and safety of simultaneous bilateral thoracoscopic wedge resection of blebs or bullae for the treatment of primary spontaneous pneumothorax (PSP) under thoracic epidural anaesthesia with spontaneous ventilation. METHODS This retrospective analysis involved a cohort of 37 consecutive patients undergoing simultaneous bilateral thoracoscopic bullectomy under spontaneous ventilation thoracic epidural anaesthesia (n = 15) or intubated general anaesthesia (n = 22) between July 2011 and September 2015. The perioperative data, short-term outcomes and recurrence rates of the two groups were compared. RESULTS The two groups had comparable preoperative demographic profiles. There were no conversions to thoracotomy or intubated single-lung ventilation. The peak end-tidal carbon dioxide in the non-intubated group was significantly higher than that in the intubated group (mean: 48 vs 34 mmHg, P < 0.001). Both groups had comparable surgical duration, blood loss and lowest intraoperative pulse oxygen saturation level. Postoperatively, the two groups had comparable chest tube duration, volume of fluid administration, length of hospital stay and complication rates. No mortality occurred. The total anaesthesia cost in non-intubated group was significantly lower (mean: CNY 4584 vs 5649, P = 0.016). The mean follow-up was 23.6 ± 12.9 months in the non-intubated group and 21.1 ± 13.4 months in the intubated group. Two recurrent pneumothoraxes in 2 patients were observed after surgical procedures for PSP. One recurrence developed in the non-intubated group (7%) and one in the intubated group (5%). CONCLUSIONS Simultaneous bilateral non-intubated thoracoscopic bullectomy is not only well tolerated and technically feasible but also a safe alternative for selected patients with simultaneous bilateral PSP or with high risk of contralateral recurrence.
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Affiliation(s)
- Zhihua Guo
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Weiqiang Yin
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Xin Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Xin Xu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Hui Liu
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenlong Shao
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jun Liu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Hanzhang Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jianxing He
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China National Clinical Research Center for Respiratory Disease, Guangzhou, China
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Soccorso G, Anbarasan R, Singh M, Lindley RM, Marven SS, Parikh DH. Management of large primary spontaneous pneumothorax in children: radiological guidance, surgical intervention and proposed guideline. Pediatr Surg Int 2015; 31:1139-44. [PMID: 26306420 DOI: 10.1007/s00383-015-3787-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Primary spontaneous pneumothorax (PSP) is managed in accordance with the adult British Thoracic Society (BTS) guidelines due to lack of paediatric evidence and consensus. We aim to highlight the differences and provide a best practice surgical management strategy for PSP based on experience of two major paediatric surgical centres. METHODS Retrospective review of PSP management and outcomes from two UK Tertiary Paediatric hospitals between 2004 and 2015. RESULTS Fifty children with 55 PSP (5 bilateral) were referred to our Thoracic Surgical Services after initial management: 53% of the needle aspirations failed. Nine children (20%) were associated with visible bullae on the initial chest X-ray. Forty-nine children were assessed with computed tomography scan (CT). Apical emphysematous-like changes (ELC) were identified in 37 children (75%). Ten children had also bullae in the asymptomatic contralateral lungs (20%). In two children (4%), CT demonstrated other lung lesions: a tumour of the left main bronchus in one child; a multi-cystic lesion of the right middle lobe in keeping with a congenital lung malformation in another child. Contralateral asymptomatic ELC were detected in 20% of the children: of those 40% developed pneumothorax within 6 months. Best surgical management was thoracoscopic staple bullectomy and pleurectomy with 11% risk of recurrence. Histology confirmed ELC in 100% of the apical lung wedge resections even in those apexes apparently normal at the time of thoracoscopy. CONCLUSION Our experience suggests that adult BTS guidelines are not applicable to children with large PSP. Needle aspiration is ineffective. We advocate early referral to a Paediatric Thoracic Service. We suggest early chest CT scan to identify ELC, for counselling regarding contralateral asymptomatic ELC and to rule out secondary pathological conditions causing pneumothorax. In rare instance if bulla is visible on presenting chest X-ray, thoracoscopy could be offered as primary option.
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Affiliation(s)
- Giampiero Soccorso
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Ravindar Anbarasan
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Michael Singh
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Richard M Lindley
- Paediatric Surgical Unit, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Sean S Marven
- Paediatric Surgical Unit, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Dakshesh H Parikh
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
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Baltayiannis N, Michail C, Lazaridis G, Anagnostopoulos D, Baka S, Mpoukovinas I, Karavasilis V, Lampaki S, Papaiwannou A, Karavergou A, Kioumis I, Pitsiou G, Katsikogiannis N, Tsakiridis K, Rapti A, Trakada G, Zissimopoulos A, Zarogoulidis K, Zarogoulidis P. Minimally invasive procedures. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:55. [PMID: 25861610 DOI: 10.3978/j.issn.2305-5839.2015.03.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/28/2015] [Indexed: 12/16/2022]
Abstract
Minimally invasive procedures, which include laparoscopic surgery, use state-of-the-art technology to reduce the damage to human tissue when performing surgery. Minimally invasive procedures require small "ports" from which the surgeon inserts thin tubes called trocars. Carbon dioxide gas may be used to inflate the area, creating a space between the internal organs and the skin. Then a miniature camera (usually a laparoscope or endoscope) is placed through one of the trocars so the surgical team can view the procedure as a magnified image on video monitors in the operating room. Specialized equipment is inserted through the trocars based on the type of surgery. There are some advanced minimally invasive surgical procedures that can be performed almost exclusively through a single point of entry-meaning only one small incision, like the "uniport" video-assisted thoracoscopic surgery (VATS). Not only do these procedures usually provide equivalent outcomes to traditional "open" surgery (which sometimes require a large incision), but minimally invasive procedures (using small incisions) may offer significant benefits as well: (I) faster recovery; (II) the patient remains for less days hospitalized; (III) less scarring and (IV) less pain. In our current mini review we will present the minimally invasive procedures for thoracic surgery.
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Affiliation(s)
- Nikolaos Baltayiannis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Chandrinos Michail
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - George Lazaridis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Dimitrios Anagnostopoulos
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Sofia Baka
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Ioannis Mpoukovinas
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Vasilis Karavasilis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Sofia Lampaki
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Antonis Papaiwannou
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Anastasia Karavergou
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Ioannis Kioumis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Georgia Pitsiou
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Nikolaos Katsikogiannis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Kosmas Tsakiridis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Aggeliki Rapti
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Georgia Trakada
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Athanasios Zissimopoulos
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Konstantinos Zarogoulidis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Paul Zarogoulidis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
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7
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Lazopoulos A, Barbetakis N, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Kioumis I, Pitsiou G, Papaiwannou A, Katsikogiannis N, Mpakas A, Tsakiridis K, Lampaki S, Karavergou A, Kipourou M, Lada M, Zarogoulidis K, Zarogoulidis P. Open thoracotomy for pneumothorax. J Thorac Dis 2015; 7:S50-5. [PMID: 25774309 DOI: 10.3978/j.issn.2072-1439.2015.01.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/08/2015] [Indexed: 11/14/2022]
Abstract
A thoracotomy is an incision into the pleural space of the chest. It is performed by surgeons (or emergency physicians under certain circumstances) to gain access to the thoracic organs, most commonly the heart, the lungs, or the esophagus, or for access to the thoracic aorta or the anterior spine. This surgical procedure is a major surgical maneuver it is the first step in many thoracic surgeries including lobectomy or pneumonectomy for lung cancer and as such requires general anesthesia with endotracheal tube insertion and mechanical ventilation, rigid bronchoscope can be also used if necessary. Thoracotomies are thought to be one of the most difficult surgical incisions to deal with post-operatively, because they are extremely painful and the pain can prevent the patient from breathing effectively, leading to atelectasis or pneumonia. In the current review we will present the steps of this procedure.
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Affiliation(s)
- Achilleas Lazopoulos
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Nikolaos Barbetakis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - George Lazaridis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Sofia Baka
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Ioannis Mpoukovinas
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Vasilis Karavasilis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Ioannis Kioumis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Georgia Pitsiou
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Antonis Papaiwannou
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Nikolaos Katsikogiannis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Andreas Mpakas
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Kosmas Tsakiridis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Sofia Lampaki
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Anastasia Karavergou
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Maria Kipourou
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Martha Lada
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
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Min X, Huang Y, Yang Y, Chen Y, Cui J, Wang C, Huang Y, Liu J, Wang J. Mechanical pleurodesis does not reduce recurrence of spontaneous pneumothorax: a randomized trial. Ann Thorac Surg 2014; 98:1790-6; discussion 1796. [PMID: 25236367 DOI: 10.1016/j.athoracsur.2014.06.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/29/2014] [Accepted: 06/02/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Mechanical pleurodesis is widely used to treat primary spontaneous pneumothorax to decrease postoperative recurrence after thoracoscopic bullectomy, but it is unclear whether it actually reduces primary spontaneous pneumothorax recurrence. We aimed to investigate the effectiveness of mechanical pleurodesis after thoracoscopic treatment of primary spontaneous pneumothorax. METHODS In our parallel-group, prospective, randomized, controlled trail at 2 hospitals in China, 289 patients were enrolled from January 2010 to January 2013. Patients were randomly assigned (1:1) to receive thoracoscopic wedge resection only (WR group) or thoracoscopic wedge resection and mechanical pleurodesis (WR+MP group). This trial is registered with ClinicalTrial.gov (NCT01463553). RESULTS Intraoperative bleeding and postoperative pleural drainage were significantly lower in the thoracoscopic WR only group. Postoperative recurrence rate did not significantly differ between groups (log-rank test p=0.791; Breslow test p=0.722). In the thoracoscopic WR only group, no recurrences were found when bullae were isolated or limited; recurrence was 7.5% with the presence of multiple bullae. Younger patients had an increased risk of recurrence (relative risk 3.015; 95% confidence interval 1.092 to 8.324). CONCLUSIONS Thoracoscopic mechanical pleurodesis did not significantly decrease primary spontaneous pneumothorax recurrence compared with simple wedge resection, but intraoperative bleeding and postoperative pleural drainage rates were higher. Younger age increases the risk of recurrence.
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Affiliation(s)
- Xianjun Min
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, P.R. China
| | - Yuqing Huang
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, P.R. China.
| | - Yingshun Yang
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, P.R. China
| | - Yingtai Chen
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, P.R. China
| | - Jian Cui
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, P.R. China
| | - Chong Wang
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, P.R. China
| | - Yueqin Huang
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, P.R. China
| | - Jun Liu
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, P.R. China; Department of Thoracic Surgery, Peking University People's Hospital, Beijing, P.R. China
| | - Jun Wang
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, P.R. China; Department of Thoracic Surgery, Peking University People's Hospital, Beijing, P.R. China
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9
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Pleural Abrasion for Mechanical Pleurodesis in Surgery for Primary Spontaneous Pneumothorax. Surg Laparosc Endosc Percutan Tech 2012; 22:62-4. [PMID: 22318062 DOI: 10.1097/sle.0b013e31823cc61e] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Funai K, Suzuki K, Shimizu K, Shiiya N. Ablation of weak emphysematous visceral pleura by an ultrasonically activated device for spontaneous pneumothorax. Interact Cardiovasc Thorac Surg 2011; 12:908-11. [PMID: 21388985 DOI: 10.1510/icvts.2010.264044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Staple bullectomy is widely performed for the thoracoscopic treatment of spontaneous pneumothorax. When weak emphysematous change was observed to extend to the whole pleura around the localized bulla, weak emphysematous pleura always remain around the stapler after bullectomy. Such cases along with weak pleural surfaces around staplers belong to the groups at high risk of postoperative recurrence. We performed thoracoscopic ablation using an ultrasonically activated device (USAD) for such lesions and studied the efficacy. From April 2002 to December 2006, a total of 85 surgeries for spontaneous pneumothorax were performed in this hospital, of which 34 cases underwent ablation with a USAD for a weak pleural surface. No complications due to ablation were observed. Recurrence was observed in four subjects, but the cause of recurrence was the regeneration of a bulla outside the range of the ablation and was unrelated to the ablation itself. Moreover, significant white pleural thickening was observed at the ablation sites, demonstrating a stiffening effect of the weak visceral pleura. Ablation using a USAD is a safe and easy operative method, and it is an appropriate operative system as a stiffening procedure for a visceral pleura.
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Affiliation(s)
- Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan.
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11
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Kim SW, Kim DS, Lim CY, Lee HJ, Lee G, Kong JH. Recurrence Analysis after Video-assisted Thoracic Surgery for the Treatment of Spontaneous Pneumothorax. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.6.710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sung-Wan Kim
- Department of Thoracic and Cardiovascular Surgery, CHA Gumi Medical Center, CHA University
| | - Duk-Sil Kim
- Department of Thoracic and Cardiovascular Surgery, CHA Gumi Medical Center, CHA University
| | - Chang-Young Lim
- Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University
| | - Hyeon-Jae Lee
- Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University
| | - Gun Lee
- Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University
| | - Joon-Hyuk Kong
- Department of Thoracic and Cardiovascular Surgery, Daegu Veterans Hospital
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12
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Stolz A, Harustiak T, Pafko P. Spontaneous pneumothorax management. Eur Surg 2008. [DOI: 10.1007/s10353-008-0416-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Amjadi K, Alvarez GG, Vanderhelst E, Velkeniers B, Lam M, Noppen M. The Prevalence of Blebs or Bullae Among Young Healthy Adults. Chest 2007; 132:1140-5. [PMID: 17890475 DOI: 10.1378/chest.07-0029] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND To determine the prevalence of blebs or bullae using thoracoscopy in young healthy adults, and to compare patient characteristics among those with and without blebs. METHODS Bilateral thoracoscopic evaluation of the lungs was performed in healthy individuals who were referred for thoracoscopic thoracic sympathectomy for essential hyperhidrosis. Participants were enrolled into a registry and followed for up to 9 years. RESULTS Analysis was performed on 250 consecutive cases. Blebs were observed in 15 of 250 individuals (6%; male, n = 6; female, n = 9; mean age, 25.3 years; range, 15 to 51 years). Individuals with blebs had a significantly lower body mass index (BMI) [mean +/- SD, 20.7 +/- 2.4 kg/m(2) vs 22.7 +/- 3.4 kg/m(2); p = 0.027] when compared to individuals without blebs, whereas all other parameters were similar. Blebs were most prevalent among slim individuals (BMI < 22 kg/m(2)) who smoked (odds ratio, 5.9; 95% confidence interval, 1.19 to 29.20). CONCLUSION Blebs were identified thoracoscopically in 6% of young healthy adults with no underlying lung disease. Low BMI in combination with smoking may have an important role in the development of pleural blebs in healthy young adults; however, these changes may not be responsible for future spontaneous pneumothoraces.
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Affiliation(s)
- Kayvan Amjadi
- University of Ottawa, Ottawa Hospital, (Civic Campus), Division of Respirology, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9.
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Cardillo G, Carleo F, Giunti R, Carbone L, Mariotta S, Salvadori L, Petrella L, Martelli M. Videothoracoscopic talc poudrage in primary spontaneous pneumothorax: A single-institution experience in 861 cases. J Thorac Cardiovasc Surg 2006; 131:322-8. [PMID: 16434260 DOI: 10.1016/j.jtcvs.2005.10.025] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Revised: 10/11/2005] [Accepted: 10/20/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We sought to evaluate the outcome of 861 patients treated with videothoracoscopic talc poudrage for primary spontaneous pneumothorax. METHODS From September 1995 through January 2004, a total of 861 patients (578 male, 283 female, mean age 28.6 years) underwent videothoracoscopy for recurrent and complicated primary spontaneous pneumothorax. Patients were treated with videothoracoscopic talc poudrage only (group A: Vanderschueren's stage I, 196 patients; stage II, 112 patients) or videothoracoscopic talc poudrage plus stapling of the blebs/bullae (group B: stage III, 391 patients; stage IV 162 patients). Follow-up included clinical interview and chest radiography (805 patients). In 26 patients (follow-up longer than 5 years), respiratory function was investigated to determine residual volume and diffusing lung capacity. RESULTS No operative deaths occurred. No patient had adult respiratory distress syndrome. Postoperative complications occurred in 29 patients (3.36%). The conversion rate to an open procedure was 0.46% (4/861). After a mean follow-up of 52.5 months, 14 patients had recurrences (1.73%). The recurrence rate was 2.41% (7/290) in group A and 1.359% (7/515) in group B (chi2 value: 1.207389; P:.27; odds ratio: 0.56; 95% confidence interval: 0.20-1.62). Results of respiratory function tests were within normal ranges (80% or more of predictive value) in all 26 patients. CONCLUSIONS Videothoracoscopic talc poudrage achieves a high success rate in the treatment of primary spontaneous pneumothorax with a very low morbidity rate. Recurrences show a statistically significant relationship (P:.037) with smoking habits.
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Affiliation(s)
- Giuseppe Cardillo
- Thoracic Surgery Unit, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo-Forlanini, Medicine University of Rome La Sapienza, Rome, Italy.
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Abstract
Spontaneous pneumothoraces can occur without obvious underlying lung disease (primary) or in patients with known underlying lung disease (secondary). Management guidelines for spontaneous pneumothorax have been published by major professional organizations, but awareness and application among clinicians seems poor. First episodes of primary spontaneous pneumothorax can be managed with observation if the pneumothorax is small. If the pneumothorax is large or if the patient is symptomatic, manual aspiration via a small catheter or insertion of a small-bore catheter coupled to a Heimlich valve or water-seal device, should be performed. In general, definitive measures to prevent recurrence are recommended after the first recurrence of the pneumothorax, and can be achieved by medical (e.g. talc) or surgical (video-assisted thoracic surgery) pleurodesis. Secondary pneumothoraces should be treated with chest tube drainage followed by pleurodesis after the first episode to minimize any risk of recurrence. Traumatic pneumothoraces may be occult (not seen on an initial CXR) or non-occult. The majority are treated by placement of a chest tube. Selected patients may be treated conservatively, with approximately 10% of these patients eventually requiring chest tube placement. Iatrogenic pneumothoraces have a myriad of causes with transthoracic lung needle biopsy being most common. Transthoracic needle biopsy-related pneumothoraces have CT findings that can predict their occurrence and the need for chest tube placement. Iatrogenic pneumothoraces, regardless of cause, may be managed by observation or small bore chest tube placement, depending upon patient stability and the size of the pneumothorax.
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Affiliation(s)
- Michael H Baumann
- Division of Pulmonary and Critical Care Medicine, University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA.
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Czerny M, Salat A, Fleck T, Hofmann W, Zimpfer D, Eckersberger F, Klepetko W, Wolner E, Mueller MR. Lung wedge resection improves outcome in stage I primary spontaneous pneumothorax. Ann Thorac Surg 2004; 77:1802-5. [PMID: 15111189 DOI: 10.1016/j.athoracsur.2003.10.057] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND To evaluate the role of apical lung wedge resection in patients with recurrent primary spontaneous pneumothorax with no endoscopic abnormalities at surgery as compared with simple apical pleurectomy. METHODS We performed a retrospective analysis on 126 consecutive video-assisted thoracoscopic surgery (VATS) procedures in 113 patients treated for stage I recurrent PSP between January 1994 and December 2001. Two surgical strategies were applied: simple apical pleurectomy (57 procedures, 45.2%: group A) and apical pleurectomy together with an apical lung wedge resection (69 procedures, 54.8%: group B). RESULTS Mean duration of chest tubes was 1.4 days (range, 1 to 7), mean hospital stay was 2.4 days. Three patients (2.4%) required redo VATS, 2 in group A (3.5%) for persistent air leak and 1 (1.4%) in group B for apical hematothorax. Mean follow-up was 38.7 months. Overall recurrence rate was 3.2%. Four patients in group A (7%) experienced recurrent ipsilateral pneumothoraces 4 to 73 weeks (mean, 30.2) after surgery. No recurrences were observed in group B (p = 0.009). CONCLUSIONS In this selected group of patients without endoscopical abnormalities, VATS offers low recurrence rates. However, these data suggest that apical pleurectomy should be accompanied by apical lung wedge resection even for this favorable category of patients.
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Affiliation(s)
- Martin Czerny
- Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria
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17
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Affiliation(s)
- M Henry
- Department of Respiratory Medicine, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK.
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18
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Affiliation(s)
- M Henry
- Department of Respiratory Medicine, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK.
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Lang-Lazdunski L, Chapuis O, Bonnet PM, Pons F, Jancovici R. Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax: long-term results. Ann Thorac Surg 2003; 75:960-5. [PMID: 12645724 DOI: 10.1016/s0003-4975(02)04544-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The goal of this study was to evaluate the long-term efficiency of videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax. METHODS From July 1991 to December 1997, 182 patients with primary spontaneous pneumothorax were treated by a single technique at our institution. Seven patients had single-stage bilateral procedures and 11 other patients had staged bilateral procedures. Indications for operation were first episode with prolonged air leak, incomplete lung reexpansion, or job restrictions (n = 59), first ipsilateral recurrence (n = 57), second or third ipsilateral recurrence (n = 34), contralateral recurrence (n = 25), synchronous bilateral pneumothorax (n = 3), hemopneumothorax (n = 3), and tension pneumothorax (n = 1). All patient data were reviewed retrospectively, and 167 patients were available for late follow-up (92%). RESULTS Mean operative time was 57 +/- 19 minutes. Conversion to thoracotomy was required in 1 patient (0.6%). Mean duration of pleural drainage was 5.8 +/- 1.2 days (range, 4 to 26 days), and mean postoperative stay was 7.7 +/- 1.6 days (range, 6 to 31 days). Postoperative complications occurred in 50 patients (27.4%), the most frequent being prolonged air leak (14.8%), and in-hospital mortality was 0%. After a mean follow-up of 93 +/- 22 months (range, 57 to 134 months; median, 84 months), five ipsilateral recurrences were noted (3%). Three recurrences occurred within 12 months of videothoracoscopy and required reoperation. Two patients had partial pneumothorax recurrence at 39 and 58 months, and were treated conservatively with chest tube insertion and tale slurry. After 1 year, 10.7% of patients complained of chronic chest pain or discomfort, although none was taking pain medication after 3 months. Most patients (89.8%) were satisfied or very satisfied of their operation. All patients had returned to sport activities within 2 years. CONCLUSIONS Videothoracoscopic bullectomy and pleural abrasion is a reliable and safe method to treat primary spontaneous pneumothorax. Long-term recurrences occur with an acceptable rate that compares with results after limited thoracotomy. Chronic chest pain or discomfort is unpredictable and may represent a problem in a few patients.
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Hatz RA, Kaps MF, Meimarakis G, Loehe F, Müller C, Fürst H. Long-term results after video-assisted thoracoscopic surgery for first-time and recurrent spontaneous pneumothorax. Ann Thorac Surg 2000; 70:253-7. [PMID: 10921718 DOI: 10.1016/s0003-4975(00)01411-9] [Citation(s) in RCA: 142] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Few investigators have reported on results after video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax (SP) with follow-up periods longer than 24 months. The aim of this study was to evaluate VATS for first-time and recurrent SP and to follow patients long-term. METHODS One hundred nine patients were followed long-term after treatment of SP by VATS. Ninety-five patients had primary SP and 14 had secondary SP. Sixty-two patients had a first episode and 47 had a recurrence. In 72 patients leaks or ruptured blebs were identified and excised without subsequent pleurodesis. In 37 patients showing no ruptured bullae or leaks only pleurodesis was applied. RESULTS Median follow-up was 53.2 months. Postoperative complications were rare. Three patients (2.7%) had a prolonged air leak. The long-term recurrence rate was 4.6%. Only those patients who had not received pleurodesis at the time of first treatment by VATS experienced recurrence. CONCLUSIONS Immediate postoperative results show VATS to be a safe and reliable method in first-time and recurrent SP to obtain quick reexpansion of the lung. Long-term recurrence rates are acceptable and compare with results after open thoracotomy. Pleurodesis should be included in each procedure for adequate recurrence prevention.
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Affiliation(s)
- R A Hatz
- Department of Surgery and General Thoracic Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Germany.
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Affiliation(s)
- S A Sahn
- Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston 29425, USA.
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23
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Abstract
Minimally invasive techniques for treatment of pneumothorax should yield the standard of results set with open procedures: the operative morbidity should remain less than 15%, and the recurrence rate less than 1%. In the era before video-assisted thoracic surgery, two minimally invasive variants were used. Chemical pleurodesis resulted in an unsatisfactory recurrence rate of at least 15%. In contrast, pleurectomy and apical stapling performed through a transaxillary minithoracotomy compared favorably with larger thoracotomy approaches, and allowed a reduced hospital stay. Evaluation of video-assisted thoracic surgical operations for spontaneous pneumothorax is hampered by a lack of controlled studies. The general impression is that morbidity did not decline significantly; the main determinant of complications is the patient's underlying health status. However, published recurrence rates range from 5% to 10%, in spite of a shorter follow-up time span. Optimized results are achieved when classic principles combining apical wedge resection and pleurodesis are applied. Reduction of hospital stay is not only a result of the new technology, but also changing drainage and discharge policies. Reduction of cost is debatable, because many studies do not consider the cost of video equipment. The main advantage when compared with open thoracotomy is reduction of postoperative pain. The only two available controlled studies conclude that there is no obvious advantage of video-assisted thoracic surgery when compared with conventional limited-access surgery. The future role of video-assisted thoracic surgery in this disease remains to be determined by a large-scale prospective evaluation.
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Affiliation(s)
- G Massard
- Department of Thoracic Surgery, Hôpitaux Universitaires de Strasbourg, France.
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