The Interest of Performing “On-Demand Chest X-rays” after Lung Resection by Minimally Invasive Surgery

2017 ◽  
Vol 65 (07) ◽  
pp. 572-580
Author(s):  
Michael Bubenheim ◽  
Alain Bernard ◽  
Jean Melki ◽  
Christophe Peillon ◽  
Jean-Marc Baste ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Lung Resection ◽  
Daily Routine ◽  
X Rays ◽  
On Demand ◽  
Length Of Hospitalization ◽  
Routine Chest

Background There is a lack of consensus in hospital centers regarding costly daily routine chest X-rays after lung resection by minimally invasive surgery. Indeed, there is no evidence that performing daily chest X-rays prevents postoperative complications. Our objective was to compare chest X-rays performed on demand when there was clinical suspicion of postoperative complications and chest X-rays performed systematically in daily routine practice. Methods This prospective single-center study compared 55 patients who had on-demand chest X-rays and patients in the literature who had daily routine chest X-rays. Our primary evaluation criterion was length of hospitalization. Results The length of hospitalization was 5.3 ± 3.3 days for patients who had on-demand X-rays, compared with 4 to 9.7 days for patients who had daily routine X-rays. Time to chest tube removal (4.34 days), overall complication rate (27.2%), reoperation rate (3.6%), and mortality rate (1.8%) were comparable to those in the literature. On average, our patients only had 1.22 ± 1.8 on-demand X-rays, compared with 3.3 X-rays if daily routine protocol had been applied. Patients with complications had more X-rays (3.4 ± 1.8) than patients without complications (0.4 ± 0.7). Conclusion On-demand chest X-rays do not seem to delay the diagnosis of postoperative complications or increase morbidity–mortality rates. Performing on-demand chest X-rays could not only simplify surgical practice but also have a positive impact on health care expenses. However, a broader randomized study is warranted to validate this work and ultimately lead to national consensus.

When is a patient high risk for resection? A changing paradigm with minimally invasive lung surgery.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20059-e20059
Author(s):  
Hiroko Nakahama ◽  
Kostantinos Poulikidis ◽  
James Lubawski ◽  
Wickii T. Vigneswaran
Keyword(s):  
Minimally Invasive Surgery ◽  
Lung Function ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Chest Tube ◽  
Lung Resection ◽  
Invasive Technique ◽  
Air Leak ◽  
Tube Removal ◽  
Predicted Values

e20059 Background: The predicted post-operative forced expiratory volume after 1 second (FEV1) and the diffusing capacity of the lung for carbon monoxide (DLCO) are predictors of postoperative complications and survival. Despite the benefits of minimally invasive surgery in patients with marginal lung function current practice guidelines advocates non-surgical approach for treatment from evidence derived from patients undergoing thoracotomy. It is necessary to define what should be minimum acceptable lung function for resection in the era of minimally invasive surgery. Methods: Single institution retrospective study of 61 patients with pre-operative predicted FEV1 and DLCO < 60% that underwent lung resection for pulmonary lung nodules suspected to be malignant between January 2017 to June 2018. Patient demographic and clinical data were collected and the 30-day or in-hospital morbidity and mortality were assessed. Results: 28 (46%) patients with pre-operative predicted FEV1 < 60% and 33 (54%) with DLCO < 60% were reviewed. 10 patients had both FEV1 and DLCO < 60%. There were 12 patients (28% in FEV1, 12% in DLCO group) who had < 40% of pre-operative predicted values. 15 (65%) of FEV1 group and 15 (45%) of DLCO group had anatomic lung resections with either a lobectomy or a segmentectomy. 24 (39%) of cases were done robotically and the remaining with VATS. 80% of patients had cancer in their final pathology. Patients were 68± 7 years old, 34 (56%) were male. Significant baseline clinical findings include high incidence of smoking (82% in FEV1, 97% in DLCO group), HTN (71% in FEV1, 81% in DLCO group), COPD (61% in FEV1, 48% in DLCO group), CAD (25% in FEV1, 30% in DLCO group), and a total of 2 patients suffered previous CVD. Most common complications included persistent air leak > 5 days (21% in FEV1 and DLCO group) and arrhythmia (14% in FEV1, 15% in DLCO group). Of those with an air leak, 50% in the FEV1 group and 29% in the DLCO group had predicted values < 40%. Three patients developed pneumothorax post chest tube removal necessitating chest tube replacement, all of whom had predicted values < 40%. One patient developed acute DVT and PE and another patient required mechanical ventilation for > 48 hours. There were no 30-day mortalities. Conclusions: Lung resection using minimally invasive technique had low rates of 30-day morbidity in patients with reduced pulmonary function. Majority of complications observed were minor. Minimally invasive lung resection is possible and may be extended to selected patients with pre-operative predicted DLCO or FEV1 < 40% suspected of malignancy.

Evidence and Recommendations Regarding Urologic Laparoscopic and Robotic-Assisted Surgery in times of COVID-19

2020 ◽  
Vol 80 (3) ◽  
pp. 1-6
Author(s):  
Eduardo Alberto González-Bonilla ◽  
Jesús Emmanuel Rosas-Nava ◽  
Juan Eduardo Sánchez-Núñez ◽  
Mario Iván Doria-Lozano ◽  
Víctor Enrique Corona-Montes ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Patient Care ◽  
Invasive Surgery ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery ◽  
Patient At Risk ◽  
Underlying Pathology

On March 11, 2020, coronavirus disease 2019 (COVID-19) was declared a pandemic and has created an impact like no other on health systems worldwide. A restructuring in the priority of patient care has currently taken place that is based on the patient’s underlying pathology.  Urology services are no exception, postponing all the elective surgeries that can be delayed without putting the patient at risk. A surgical protocol has been adopted during the pandemic that attempts to reduce the amount of time the operating room is in use, as well as the risk for postoperative complications, so that hospital stay can be reduced.   In such a setting, minimally invasive surgery, such as laparoscopic and robotic-assisted surgery, can play a beneficial role in treating oncologic pathologies that cannot be deferred. Based on the best evidence that has currently been published and the guidelines of international associations, this paper summarizes the recommendations regarding urologic laparoscopic and robotic-assisted surgery in times of COVID-19.

scholarly journals Effect of hemodialysis on short-term outcomes after colon cancer surgery

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262531
Author(s):  
Toshio Shiraishi ◽  
Tetsuro Tominaga ◽  
Takashi Nonaka ◽  
Shintaro Hashimoto ◽  
Kiyoaki Hamada ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Minimally Invasive Surgery ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Hemodialysis Patients ◽  
Cancer Surgery ◽  
Poor Performance Status ◽  
Short Term ◽  
Colon Cancer Surgery

Background Hemodialysis patients who undergo surgery have a high risk of postoperative complications. The aim of this study was to determine whether colon cancer surgery can be safely performed in hemodialysis patients. Methods This multicenter retrospective study included 1372 patients who underwent elective curative resection surgery for colon cancer between April 2016 and March 2020. Results Of the total patients, 19 (1.4%) underwent hemodialysis, of whom 19 (100%) had poor performance status and 18 had comorbidities (94.7%). Minimally invasive surgery was performed in 78.9% of hemodialysis patients. The postoperative complication rate was significantly higher in hemodialysis than non-hemodialysis patients (36.8% vs. 15.5%, p = 0.009). All postoperative complications in the hemodialysis patients were infectious type. Multivariate analysis revealed a significant association of hemodialysis with complications (odds ratio, 2.9362; 95%CI, 1.1384–7.5730; p = 0.026). Conclusion Despite recent advances in perioperative management and minimally invasive surgery, it is necessary to be aware that short-term complications can still occur, especially infectious complications in hemodialysis patients.

scholarly journals Robotic Surgery for Non-Small Cell Lung Cancer

2021 ◽  
Author(s):  
Andrew X. Li ◽  
Justin D. Blasberg
Keyword(s):  
Lung Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Invasive Surgery ◽  
Thoracoscopic Surgery ◽  
Lung Resection ◽  
Small Cell ◽  
Robotic Assisted

Pulmonary resection has been a cornerstone in the management of patients with non-small cell lung cancer (NSCLC) for decades. In recent years, the popularity of minimally-invasive techniques as the primary method to manage NSCLC has grown significantly. With smaller incisions and a lower incidence of peri-operative complications, minimally-invasive lung resection, accomplished through keyhole incisions with miniaturized cameras and similarly small instruments that work through surgical ports, has been shown to retain equivalent oncologic outcomes to the traditional gold standard open thoracotomy. This technique allows for the safe performance of anatomic lung resection with complete lymphadenectomy and has been a part of thoracic surgery practice for three decades. Robotic-assisted thoracoscopic surgery (RATS) represents another major advancement for lung resection, broadening the opportunity for patients to undergo minimally invasive surgery for NSCLC, and therefore allowing a greater percentage of the lung cancer population to benefit from many of the advantages previously demonstrated from video assisted thoracoscopic surgery (VATS) techniques. RATS surgery is also associated with several technical advantages to the surgeon. For a surgeon who performs open procedures and is looking to adopt a minimally invasive approach, RATS ergonomics are a natural transition compared to VATS, particularly given the multiple degrees of freedom associated with robotic articulating instruments. As a result, this platform has been adopted as a primary approach in numerous institutions across the United States. In this chapter, we will explore the advantages and disadvantages of robotic-assisted surgery for NSCLC and discuss the implications for increased adoption of minimally invasive surgery in the future of lung cancer treatment.

PS01.222: HAS A MEDIASTINOSCOPE-ASSISTED ESOPHAGECTOMY CONTRIBUTE TO CURABILITY AND MINIMAL INVASIVE SURGERY?

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 113-113
Author(s):  
Yasuto Uchikado ◽  
Itaru Omoto ◽  
Ken Sasaki ◽  
Hiroshi Okumura ◽  
Yoshiaki Kita ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Chest Wall ◽  
Invasive Surgery ◽  
Operation Time ◽  
Pulmonary Complications ◽  
Preoperative Treatment ◽  
Synchronous Cancer ◽  
Tumor Depth

Abstract Background In a mediastinoscope-assisted esophagectomy, it is unknown whether it contributes to minimally invasive surgery or curability. We examined the outcome of treatment of a mediastinoscope-assisted esophagectomy performed in our hospital. Methods From June 2014 to October 2017, 31 patients underwent a mediastinoscope-assisted esophagectomy. The examined items were clinicopathological factors, preoperative complications, preoperative treatment, bleeding volume, operation time, postoperative complications, and recurrence. Results There were 29 males, 2 females, and the average age 66 years. As preoperative treatment, 12 nontreatment, 4 chemotherapies, and 15 chemoradiotherapy (CRT) were performed. Preoperative complications were found in 27 cases, among which 13 cases were respiratory complications. The percentage of double cancers was also high, 8 cases with synchronous cancer, and 6 cases with metachronous cancer. Gastric cancer accounted for half in synchronous cancer, and in metachronous lung cancer was 4 cases. The reconstructed organs were 29 cases of stomach tube and 2 cases of colon. The reconstruction route was 17 cases in front of the chest wall and the chest wall anterior route was selected for the case of preoperative CRT significantly. The average bleeding volume was 316 ml, and the average operation time was 560 minutes. Pathological tumor depth T0/1a/1b/2/3 were each 2/11/6/7/4 cases. In the postoperative complications, 12 cases of temporary recurrent nephropathy, 5 cases of anastomotic suture failure, 3 cases of pulmonary complications. There were 6 cases (19.3%) of recurrence. Postoperative recurrence was associated with significant pathological tumor depth. Conclusion A mediastinoscope-assisted esophagectomy decreased postoperative pulmonary complications and there were not many recurrences after surgery. It seemed to contribute to minimally invasive surgery and curability. Disclosure All authors have declared no conflicts of interest.

Minimally invasive surgery and its impact on 30-day postoperative complications, unplanned readmissions and mortality

2017 ◽  
Vol 104 (10) ◽  
pp. 1372-1381 ◽  
Author(s):  
A. Sood ◽  
C. P. Meyer ◽  
F. Abdollah ◽  
J. D. Sammon ◽  
M. Sun ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Invasive Surgery
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