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Wang B, Yao L, Sheng J, Liu X, Jiang Y, Shen L, Xu F, Dai X. Is VATS suitable for lung diseases with hemoptysis? Experience from a hemoptysis treatment center in China. BMC Pulm Med 2023; 23:208. [PMID: 37316807 DOI: 10.1186/s12890-023-02506-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Surgery is crucial in the treatment of the potentially fatal pulmonary hemoptysis condition. Currently, most patients with hemoptysis are treated by traditional open surgery (OS). To illustrate the effectiveness of video-assisted thoracic surgery (VATS) for hemoptysis, we developed a retrospective study of surgical interventions for lung disease with hemoptysis. METHODS We collected and then analysed the data, including general information and post-operative outcomes, from 102 patients who underwent surgery for a variety of lung diseases with hemoptysis in our hospital between December 2018 and June 2022. RESULTS Sixty three cases underwent VATS and 39 cases underwent OS. 76.5% of patients were male (78/102). Comorbidities with diabetes and hypertension were 16.7% (17/102) and 15.7% (16/102) respectively. The diagnoses based on postoperative pathology included aspergilloma in 63 cases (61.8%), tuberculosis in 38 cases (37.4%) and bronchiectasis in 1 case (0.8%). 8 patients underwent wedge resection, 12 patients underwent segmentectomy, 73 patients underwent lobectomy and 9 patients underwent pneumonectomy. There were 23 cases of postoperative complications, of which 7 (30.4%) were in the VATS group, significantly fewer than 16 (69.6%) in the OS group (p = 0.001). The OS procedure was identified as the only independent risk factor for postoperative complications. The median (IQR) of postoperative drainage volume in the first 24 h was 400 (195-665) ml, which was 250 (130-500) ml of the VATS group, significantly less than the 550 (460-820) ml of the OS group (p < 0.05). The median (IQR) of pain scores 24 h after surgery was 5 (4-9). The median (IQR) of postoperative drainage tube removal time was 9.5 (6-17) days for all patients, and it was 7 (5-14) days for the VATS group, which was less than 15 (9-20) days for the OS group. CONCLUSION VATS for patients with lung disease presenting with hemoptysis is an effective and safe option that may be preferred when the hemoptysis is uncomplicated and the patient's vital signs are stable.
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Affiliation(s)
- Bing Wang
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China
| | - Li Yao
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China
| | - Jian Sheng
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China.
| | - Xiaoyu Liu
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China.
| | - Yuhui Jiang
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China
| | - Lei Shen
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China
| | - Feng Xu
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China
| | - Xiyong Dai
- Department of Surgery, Wuhan Pulmonary Hospital, Baofeng Road No.28, Wuhan, Hubei, China.
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Ultrasound-Guided Rhomboid Block versus Paravertebral Block in Postoperative Analgesia for Video-Assisted Thoracoscopic Surgery: A Prospective Randomized Controlled Clinical Trial. Pain Res Manag 2023; 2023:3924511. [PMID: 36911242 PMCID: PMC9995189 DOI: 10.1155/2023/3924511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023]
Abstract
Introduction The anesthetic efficacy of the ultrasound-guided rhomboid intercostal block (RIB) in alleviating postoperative pain has been well concerned. This study aims to compare the effectiveness between ultrasound-guided RIB and paravertebral block (PVB) in alleviating acute pain following video-assisted thoracic surgery. Methods It was a prospective, randomized, double-blinded clinical trial involving 132 patients with video-assisted thoracic surgery divided into three groups: the general anesthesia (GA) group, RIB group, and PVB group on T5 vertebra, using 0.4% ropivacaine at 3 mg/kg, registered in the Chinese Clinical Trial Registry (ChiCTR2100054057, "https://www.chictr.org.cn"). The visual analogue scale (VAS) scores at rest and cough during 48 h postoperatively and the postoperative consumption of pain rescue were the primary outcomes, and the QoR15 score 48 h postoperatively, the usage of opioids during and after operation, and nerve block-related complications were the secondary outcomes. Demographic characteristics, surgery characteristics, and primary outcomes between the groups were compared. Results A total of 120 eligible patients were recruited, including 40 in each group. Baseline and surgery characteristics between the groups were comparable (all p > 0.05). The PVB and RIB groups were better than the GA group in the primary and secondary outcomes (p < 0.05). The static VAS score, QoR15 score, and block-related complications within 48 hours after surgery were better in the RIB group than in the PVB group (p < 0.001). Conclusion Both PVB and RIB can provide adequate analgesia and accelerate the recovery of patients. Compared with PVB, RIB has a better analgesic effect, especially to avoid paravertebral pain caused by block, and the operation of RIB is more straightforward and the safety is higher.
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3
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Liao J, Wang Y, Dai W, Wei X, Yu H, Yang P, Xie T, Li Q, Liu X, Shi Q. Profiling symptom burden and its influencing factors at discharge for patients undergoing lung cancer surgery: a cross-sectional analysis. J Cardiothorac Surg 2022; 17:229. [PMID: 36057613 PMCID: PMC9441056 DOI: 10.1186/s13019-022-01974-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Following lung cancer surgery, patients often experience severe symptoms which are not properly assessed at discharge. The aim of this study was to identify the clinical presentation at discharge and the influencing factors of postoperative symptoms in patients who have undergone lung cancer surgery. Methods This cross-sectional study analysed data from patients who participated in a prospective cohort study that enrolled patients who underwent lung cancer surgery at six tertiary hospitals in the People’s Republic of China, from November 2017 to January 2020. Patient symptoms at discharge were measured using the MD Anderson Symptom Inventory Lung Cancer module. The five core symptoms were defined according to ratings of moderate to severe symptoms (≥ 4 on a 0–10 scale). A multivariate linear regression model was used to identify the influencing factors of each symptom at discharge. Results Among the 366 participants, 51.9% were male and the mean (SD) age was 55.81 (10.43) years. At discharge, the core symptoms were cough (36.4%), pain (28.2%), disturbed sleep (26.3%), shortness of breath (25.8%), and fatigue (24.3%), and more than half of the participants (54.6%) had one to five of the core symptoms, with moderate to severe severity. A low annual income and the use of two chest tubes were significantly associated (P = 0.030 and 0.014, respectively) with higher mean scores of the core symptoms. Conclusion Though clinically eligible for discharge, more than half of the participants had severe symptoms at discharge after lung cancer surgery. Special attention should be given to patients who have two chest tubes after surgery and those who have a low annual income.
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Affiliation(s)
- Jia Liao
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Yaqin Wang
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Hongfan Yu
- State Key Laboratory of Biomedical Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China
| | - Pu Yang
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Tianpeng Xie
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China
| | - Xiaoqin Liu
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China.
| | - Qiuling Shi
- Center for Cancer Prevention Research, Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 55, Section 4, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China. .,School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China.
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Dong Y, Shen C, Wang Y, Zhou K, Li J, Chang S, Ma H, Che G. Safety and Feasibility of Video-Assisted Thoracoscopic Day Surgery and Inpatient Surgery in Patients With Non-small Cell Lung Cancer: A Single-Center Retrospective Cohort Study. Front Surg 2021; 8:779889. [PMID: 34869571 PMCID: PMC8635799 DOI: 10.3389/fsurg.2021.779889] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/15/2021] [Indexed: 02/05/2023] Open
Abstract
Background and Objective: This study was undertaken to evaluate how safe and viable the use of video-assisted thoracoscopic day surgery (VATDS) is for individuals diagnosed with early-stage non-small cell lung cancer (NSCLC). Methods: Data obtained from the selected patients with NSCLC who underwent video-assisted thoracoscopic surgery (VATS) in the same medical group were analyzed and a single-center, propensity-matched cohort study was performed. In total, 353 individuals were included after propensity score matching (PSM) with 136 individuals in the day surgery group (DSG) and 217 individuals in the inpatient surgery group (ISG). Results: The 24-h discharge rate in the DSG was 93.38% (127/136). With respect to the postoperative complications (PPCs), no difference between the two groups was found (DSG vs. ISG: 11.76 vs. 11.52%, p = 0.933). In the DSG, a shorter length of stay (LOS) after surgery (1.47 ± 1.09 vs. 2.72 ± 1.28 days, p < 0.001) and reduced drainage time (8.45 ± 3.35 vs. 24.11 ± 5.23 h, p < 0.001) were found, while the drainage volume per hour (mL/h) was not notably divergent between the relevant groups (p = 0.312). No difference was observed in the cost of equipment and materials between the two groups (p = 0.333). However, the average hospital cost and drug cost of the DSG were significantly lower than those of the ISG (p < 0.001). Conclusion: The study indicated that the implementation of VATDS showed no difference in PPCs, but resulted in shorter in-hospital stays, shorter drainage times, and lower hospital costs than inpatient surgery. These results indicate the safety and feasibility of VATDS for a group of highly selected patients with early-stage NSCLC.
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Affiliation(s)
- Yingxian Dong
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Cheng Shen
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Yan Wang
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Kun Zhou
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Jue Li
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Shuai Chang
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Hongsheng Ma
- Day Surgery Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
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5
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Yang W, Zhang G, Pan S, Wang Z, Li J, Ren W, Shi H. Comparison of the perioperative efficacy between single-port and two-port video-assisted thoracoscopic surgery anatomical lung resection for non-small cell lung cancer: a systematic review and meta-analysis. J Thorac Dis 2019; 11:2763-2773. [PMID: 31463104 DOI: 10.21037/jtd.2019.07.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background With the development of novel surgical techniques and instruments over the recent years, more and more surgeons consider single-port video-assisted thoracoscopic surgery (VATS) as a feasible option. However, whether single-port thoracoscopic surgery has more potential advantages than two-port thoracoscopic surgery for non-small cell lung cancer remains unknown. We conducted this systematic review and meta-analysis to compare the perioperative efficacy between single-port and two-port VATS anatomical lung resection for non-small cell lung cancer (NSCLC). Methods Eleven studies were identified from the databases of The Cochrane Library, PubMed, Embase, Web of science, and China Biology Medicine disc (CBMdisc). Prospective studies and retrospective studies that evaluated the perioperative efficacy of single-port VATS compared with two-port VATS were analyzed. We used 95% confidence intervals (CIs) to calculate the odds ratio (OR), and the weight mean difference (WMD). Results A total of 11 studies (3 prospective studies and 8 retrospective studies), including 1,592 patients, were included. We found that the duration of the operation in single-port VATS anatomical lung resection for NSCLC was shorter (P=0.02). Also, the bleeding volume amount was lower (P=0.01), the length of postoperative drainage was shorter (P<0.00001), the amount of postoperative hospital stay was lower (P<0.0001), and the visual analogue score 24 and 72 h after operation time was lower (P<0.0001, P<0.00001). However, the number of lymph nodes retrieved (P=0.92) and the rates of complications (P=0.15) had no statistical differences between the two groups. Conclusions These studies show that single-port VATS anatomical lung resection has certain advantages in the treatment of NSCLC compared with two-port VATS. It may be an alternative option for surgeons.
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Affiliation(s)
- Wenlong Yang
- Department of Cardiothoracic Surgery, Clinical College of Yangzhou University, Yangzhou 225001, China.,Key Laboratory of Integrative Medicine in Geriatrics Control of Jiangsu Province, Yangzhou 225001, China.,Center of Translational Medicine, Yangzhou University, Yangzhou 225001, China
| | - Guozhong Zhang
- Department of Cardiothoracic Surgery, Clinical College of Yangzhou University, Yangzhou 225001, China.,Key Laboratory of Integrative Medicine in Geriatrics Control of Jiangsu Province, Yangzhou 225001, China.,Center of Translational Medicine, Yangzhou University, Yangzhou 225001, China
| | - Shu Pan
- Department of Cardiothoracic Surgery, Clinical College of Yangzhou University, Yangzhou 225001, China.,Key Laboratory of Integrative Medicine in Geriatrics Control of Jiangsu Province, Yangzhou 225001, China.,Center of Translational Medicine, Yangzhou University, Yangzhou 225001, China
| | - Zhihao Wang
- Department of Cardiothoracic Surgery, Clinical College of Yangzhou University, Yangzhou 225001, China.,Key Laboratory of Integrative Medicine in Geriatrics Control of Jiangsu Province, Yangzhou 225001, China.,Center of Translational Medicine, Yangzhou University, Yangzhou 225001, China
| | - Jianfeng Li
- Department of Cardiothoracic Surgery, Clinical College of Yangzhou University, Yangzhou 225001, China.,Key Laboratory of Integrative Medicine in Geriatrics Control of Jiangsu Province, Yangzhou 225001, China.,Center of Translational Medicine, Yangzhou University, Yangzhou 225001, China
| | - Weidong Ren
- Department of Cardiothoracic Surgery, Clinical College of Yangzhou University, Yangzhou 225001, China.,Key Laboratory of Integrative Medicine in Geriatrics Control of Jiangsu Province, Yangzhou 225001, China.,Center of Translational Medicine, Yangzhou University, Yangzhou 225001, China
| | - Hongcan Shi
- Department of Cardiothoracic Surgery, Clinical College of Yangzhou University, Yangzhou 225001, China.,Key Laboratory of Integrative Medicine in Geriatrics Control of Jiangsu Province, Yangzhou 225001, China.,Center of Translational Medicine, Yangzhou University, Yangzhou 225001, China
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Ng CS, MacDonald JK, Gilbert S, Khan AZ, Kim YT, Louie BE, Blair Marshall M, Santos RS, Scarci M, Shargal Y, Fernando HC. Optimal Approach to Lobectomy for Non-Small Cell Lung Cancer: Systemic Review and Meta-Analysis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:90-116. [DOI: 10.1177/1556984519837027] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective Video-assisted thoracic surgery (VATS) lobectomy was introduced over 25 years ago. More recently, the technique has been modified from a multiport video-assisted thoracic surgery (mVATS) to uniportal (uVATS) and robotic (rVATS), with proponents for each approach. Additionally most lobectomies are still performed using an open approach. We sought to provide evidence-based recommendations to help define the optimal surgical approach to lobectomy for early stage non-small cell lung cancer. Methods Systematic review and meta-analysis of articles searched without limits from January 2000 to January 2018 comparing open, mVATS, uVATS, and rVATS using sources Medline, Embase, and Cochrane Library were considered for inclusion. Articles were individually scrutinized by ISMICS consensus conference members, and evidence-based statements were created and consensus processes were used to determine the ensuing recommendations. The ACC/AHA Clinical Practice Guideline Recommendation Classification system was used to assess the overall quality of evidence and the strength of recommendations. Results and recommendations One hundred and forty-five studies met the predefined inclusion criteria and were included in the meta-analysis. Comparisons were analyzed between VATS and open, and between different VATS approaches looking at oncological outcomes (survival, recurrence, lymph node evaluation), safety (adverse events), function (pain, quality of life, pulmonary function), and cost-effectiveness. Fifteen statements addressing these areas achieved consensus. The highest level of evidence suggested that mVATS is preferable to open lobectomy with lower adverse events (36% versus 42%; 88,460 patients) and less pain (IIa recommendation). Our meta-analysis suggested that overall survival was better (IIb) with mVATS compared with open (71.5% versus 66.7% 5-years; 16,200 patients). Different VATS approaches were similar for most outcomes, although uVATS may be associated with less pain and analgesic requirements (IIb). Conclusions This meta-analysis supports the role of VATS lobectomy for non-small cell lung cancer. Apart from potentially less pain and analgesic requirement with uVATS, different minimally invasive surgical approaches appear to have similar outcomes.
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Affiliation(s)
| | | | | | | | - Young T. Kim
- Seoul National University Hospital, Chongro-Ku, South Korea
| | - Brian E. Louie
- Swedish Cancer Institute and Medical Center, Seattle, WA, USA
| | | | | | | | - Yaron Shargal
- St Joseph’s Healthcare, MacMaster University, Hamilton, ON, Canada
| | - Hiran C. Fernando
- Inova Fairfax Medical Campus, Virginia Commonwealth University, Falls Church, Richmond, VA, USA
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Factors Associated With New Persistent Opioid Usage After Lung Resection. Ann Thorac Surg 2018; 107:363-368. [PMID: 30316852 DOI: 10.1016/j.athoracsur.2018.08.057] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/24/2018] [Accepted: 08/22/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Opioid dependence, misuse, and abuse in the United States continue to rise. Prior studies indicate an important risk factor for persistent opioid use includes elective surgical procedures, though the probability following thoracic procedures remains unknown. We analyzed the incidence and factors associated with new persistent opioid use after lung resection. METHODS We evaluated data from opioid-naïve cancer patients undergoing lung resection between 2010 and 2014 using insurance claims from the Truven Health MarketScan Databases. New persistent opioid usage was defined as continued opioid prescription fills between 90 and 180 days following surgery. Variables with a p value less than 0.10 by univariate analysis were included in a multivariable logistic regression performed for risk adjustment. Multivariable results were each reported with odds ratio (OR) and confidence interval (CI). RESULTS A total of 3,026 patients (44.8% men, 55.2% women) were identified as opioid-naïve undergoing lung resection. Mean age was 64 ± 11 years and mean postoperative length of stay was 5.2 ± 3.3 days. A total of 6.5% underwent neoadjuvant therapy, while 21.7% underwent adjuvant therapy. Among opioid-naïve patients, 14% continued to fill opioid prescriptions following lung resection. Multivariable analysis showed that age less than or equal to 64 years (OR, 1.28; 95% CI, 1.03 to 1.59; p = 0.028), male sex (OR, 1.40; 95% CI, 1.13 to 1.73; p = 0.002), postoperative length of stay (OR, 1.32; 95% CI, 1.05 to 1.65; p = 0.016), thoracotomy (OR, 1.58; 95% CI, 1.24 to 2.02; p < 0.001), and adjuvant therapy (OR, 2.19; 95% CI, 1.75 to 2.75; p < 0.001) were independent risk factors for persistent opioid usage. CONCLUSIONS The greatest risk factors for persistent opioid use (14%) following lung resection were adjuvant therapy and thoracotomy. Future studies should focus on reducing excess prescribing, perioperative patient education, and safe opioid disposal.
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Raveglia F, Cioffi U, De Simone M, Rizzi A, Leporati A, Tinelli C, Chiarelli M, Baisi A. Advantages of wound retractor device versus rigid trocar at camera port in video-assisted thoracic surgery-a single institution experience. J Vis Surg 2018; 4:66. [PMID: 29780712 DOI: 10.21037/jovs.2018.03.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/11/2018] [Indexed: 11/06/2022]
Abstract
Background rigid trocars are widely adopted in video-assisted thoracic surgery (VATS), despite some disadvantages: (I) cannula strong pressure on intercostal nerve stimulating postoperative pain; (II) limited movement of thoracoscopic devices on their fulcrum when extreme acute angles with the chest wall are needed. Wound retractor (WR) device, designed for laparoscopic surgery, it is also used in VATS, but to protect mini-thoracotomy. We compared the use of extra-small WR versus rigid trocar at camera port that is the most painful thoracostomy. The aim was to determine if WR is associated with less postoperative pain and better scope maneuverability. Methods This is a single institution prospective study recorded and approved by ethics committee at our hospital. From October 2016 to June 2017, we enrolled 40 patients (statistical power 88%), randomized into two different groups. Group A (20 patients) underwent VATS lung resection using WR at camera port, group B (20 patients) using rigid trocar. Intra-operative data collected were maximum acute angle obtained between the camera and chest wall and chest wall thickness. Pain was measured by numerical analog scales (NAS) at 6, 12, 24, 48 and 72 hours after surgery. We also measured total morphine consumption at 72 h administered by patient controlled analgesia (PCA) system. Results No statistical significance was found in the demographic traits of the two groups (P=1). Statistically significant differences were found in favor of group A for both pain control, morphine consumption (P<0.001) and camera maneuverability (described as maximum acute angle obtained/chest wall thickness) (P<0.001). Conclusions patients who had WR showed less postoperative pain. Moreover, WR presented other advantages: camera protection by small bleeding from chest wall, adaptability with every chest wall thickness, absence of skin injury around the port. We suggest its use instead of rigid trocar.
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Affiliation(s)
- Federico Raveglia
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy
| | - Ugo Cioffi
- Department of Surgery, Università degli Studi di Milano, Milano, Italy
| | - Matilde De Simone
- Department of Surgery, Università degli Studi di Milano, Milano, Italy
| | - Alessandro Rizzi
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy
| | - Andrea Leporati
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy
| | - Carmine Tinelli
- Biometry and Medical Statistics, Policlinico San Matteo di Pavia, Pavia, Italy
| | - Marco Chiarelli
- Department of Surgery, Università degli Studi di Milano, Milano, Italy
| | - Alessandro Baisi
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milano, Italy
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Koryllos A, Stoelben E. Video assisted thoracic surgery vs. thoracotomy regarding postoperative chronic pain. J Thorac Dis 2017; 9:3498-3500. [PMID: 29268325 DOI: 10.21037/jtd.2017.08.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Aris Koryllos
- Lungclinic, Hospital of Cologne, Chair of Thoracic Surgery, Private University Witten/Herdecke, Cologne 51109, Germany
| | - Erich Stoelben
- Lungclinic, Hospital of Cologne, Chair of Thoracic Surgery, Private University Witten/Herdecke, Cologne 51109, Germany
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Dolci G, Campisi A, Giunta D, Congiu S, Daddi N, Murana G, Dell'Amore A. Video-assisted thoracoscopic surgery lobectomy using "the caudal approach": results and evolution. J Vis Surg 2017; 3:187. [PMID: 29399511 PMCID: PMC5765269 DOI: 10.21037/jovs.2017.11.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/20/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) has become a common surgical approach in the diagnosis and treatment of lung and mediastinal diseases. In this study, we reported our current experience of thoracoscopic surgery using a new caudal position technique for anatomical lung resections and compared it with the standard anterior VATS technique. METHODS From January 2016 to October 2017, 92 consecutive patients with lung cancer underwent VATS lobectomy. Among these, 34 patients were treated by conventional anterior three portal VATS lobectomy, and 58 patients were treated using the caudal three port VATS lobectomy. The mean operative time, conversion rate, hospital stay, post-operative drainage, reoperation, post operative pain were compared between each group. RESULTS No differences between the two groups are showed in terms of surgical time, post-operative drainage, incidence of prolonged air leaks and post-operative pain. CONCLUSIONS The caudal approach to major pulmonary resection of thoracoscopic lobectomy results in a reliable and comfortable procedure for the surgeon. Once demonstrated the reliability of the VATS lobectomy with three accesses using the caudal position, we are starting to standardize biportal and uniportal VATS with the surgeon in the caudal position.
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Affiliation(s)
- Giampiero Dolci
- Department of CardioThoracic and Vascular Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
| | - Alessio Campisi
- Department of CardioThoracic and Vascular Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
| | - Domenica Giunta
- Department of CardioThoracic and Vascular Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
| | - Stefano Congiu
- Department of CardioThoracic and Vascular Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
| | - Niccolò Daddi
- Department of CardioThoracic and Vascular Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
| | - Giacomo Murana
- Department of CardioThoracic and Vascular Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
| | - Andrea Dell'Amore
- Department of CardioThoracic and Vascular Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
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Zhang R, Schwabe K, Krüger M, Haverich A, Krauss JK, Alam M. Electro-physiological evidence of intercostal nerve injury after thoracotomy: an experimental study in a sheep model. J Thorac Dis 2017; 9:2461-2465. [PMID: 28932551 DOI: 10.21037/jtd.2017.07.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although intercostal nerve injury is one of the major causes for post-thoracotomy pain, the exact mechanisms are still unclear. We sought to evaluate the electro-physiological changes of intercostal nerve injury after thoracotomy in a sheep model. METHODS Adult sheep underwent thoracotomy in the sixth intercostal space by employing diathermy to superior border of the seventh rib. In two sheep, ribs were then spread using retractor spreading for a distance of 7 cm for 30 minutes. In the third sheep, thoracotomy was followed by harvesting intercostal muscles including the neurovascular bundle adjacent to inferior edge of the sixth rib. Thereafter, ribs were spread in the same way, but with the muscle flap dangled between the blades for intercostal nerve protection (dangling muscle flap technique). The nerve conduction velocity of the intercostal nerve was recorded before and after incision of intercostal muscles, immediately and 30 minutes after retractor placement and 30 minutes after removal of the retractor. RESULTS In the sheep undergoing conventional thoracotomy, the physiological conductivity of intercostal nerve was completely blocked immediately after retractor placement using the same stimulation intensity or even the supra-threshold intensity. The conduction block persisted for 30 minutes during the retractor placement and further 30 minutes after removal of the retractor. In contrast, intercostal nerve conduction was not impaired throughout the experiment with the dangling muscle flap technique. CONCLUSIONS Our experiment provides electro-physiological evidence for intercostal nerve injury after thoracotomy. The injury is primarily attributed to mechanical compression caused by the rib retractor.
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Affiliation(s)
- Ruoyu Zhang
- Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Schillerhoehe Hospital, Gerlingen, Germany
| | - Kerstin Schwabe
- Section of Neurosurgery, Department of Surgery, Hannover Medical School, Hannover, Germany.,Center for Systems Neuroscience (ZSN) Hannover, Hannover, Germany
| | - Marcus Krüger
- Section of Thoracic, Cardiac, Transplant and Vascular Surgery, Department of Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Section of Thoracic, Cardiac, Transplant and Vascular Surgery, Department of Surgery, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Section of Neurosurgery, Department of Surgery, Hannover Medical School, Hannover, Germany.,Center for Systems Neuroscience (ZSN) Hannover, Hannover, Germany
| | - Mesbah Alam
- Section of Neurosurgery, Department of Surgery, Hannover Medical School, Hannover, Germany
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Koryllos A, Stoelben E. Scientific prove of better quality of life and postoperative pain by minimal invasive thoracic surgery. J Thorac Dis 2017; 8:E1746-E1747. [PMID: 28149630 DOI: 10.21037/jtd.2016.12.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Aris Koryllos
- Lungclinic, Thoracic Surgery, Hospital of Cologne, Private University Witten/Herdecke, 51109 Cologne, Germany
| | - Erich Stoelben
- Lungclinic, Thoracic Surgery, Hospital of Cologne, Private University Witten/Herdecke, 51109 Cologne, Germany
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Chang JM, Kam KH, Yen YT, Huang WL, Chen W, Tseng YL, Wu MH, Lai WW, Gonzalez-Rivas D. From biportal to uniportal video-assisted thoracoscopic anatomical lung resection: A single-institute experience. Medicine (Baltimore) 2016; 95:e5097. [PMID: 27749589 PMCID: PMC5059092 DOI: 10.1097/md.0000000000005097] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Our study sought to review our experience from biportal to uniportal video-assisted thoracoscopic surgery (VATS) major lung resection. Lessons we learned from the evolution regarding technical aspects were also discussed.We retrospectively reviewed patients who underwent VATS lobectomy or segmentectomies in Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan, during January 2012 and December 2014. Patient clinical profiles, surgical indications and procedures, postoperative course, and oncological parameters were analyzed and compared between the biportal and uniportal groups.A total of 121 patients were enrolled in this study with median follow-up of 19.5 ± 11.6 months for all patients and 22.5 ± 11.5 months for primary lung cancer patients. Operation time (146.1 ± 31.9-158.7 ± 40.5 minutes; P = 0.077), chest drainage time (3.8 ± 3.3-4.4 ± 2.4 days; P = 0.309), conversion to thoracotomy rate (2.2%-2.6%; P = 0.889), and complication rate (15.6%-19.7%; P = 0.564) were equal between the groups, whereas blood loss (96.7 ± 193.2-263.6 ± 367; P = 0.006) was lower in the uniportal group. For lung cancer cases, there were no statistical differences in the histology, cancer staging, mediastinal lymph node dissection stations, numbers of dissected N1, N2, and overall lymph nodes between uniportal and biportal groups.Our preliminary data showed that uniportal VATS anatomical lung resection is as feasible, equally safe, and of comparative oncological clearance efficacy to biportal VATS.
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Affiliation(s)
- Jia-Ming Chang
- Division of Thoracic Surgery, Department of Surgery, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
- Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
- Graduate Institute of Medical Sciences, College of Health Science, Chang Jung Christian University, Tainan, Taiwan
| | - Kam-Hong Kam
- Division of Thoracic Surgery, Department of Surgery, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Yi-Ting Yen
- Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wei Chen
- Division of Pulmonary and Critical Care Medicine, Chia-Yi Christian Hospital, and Department of Respiratory Therapy, China Medical University
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ming-Ho Wu
- Division of Thoracic Surgery, Department of Surgery, Tainan Municipal Hospital, Tainan, Taiwan
| | - Wu-Wei Lai
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
- Correspondence: Wu-Wei Lai, Associate Professor, No.138, Sheng Li Road, Tainan, Taiwan 704, ROC (e-mail: )
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Coruna University Hospital and Minimally Invasive Thoracic Surgery Unit, Coruna, Spain
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