Computer-Mediated Power Stapling for Anatomical Lung Resection: Experience in 100 Consecutive Cases

2006 ◽  
Vol 1 (6) ◽  
pp. 328-331 ◽  
Author(s):  
Wickii T. Vigneswaran ◽  
Charles Gruner
Keyword(s):  
Length Of Stay ◽  
Chest Tube ◽  
Lung Resection ◽  
Hospital Length ◽  
Chest Tube Drainage ◽  
Hospital Length Of Stay ◽  
Tube Drainage ◽  
Computer Mediated ◽  
Linear Cutter ◽  
Lung Resections

Objectives Mechanical stapling is widely used for lung resection. Complications related to the stapling are few but not infrequent. This varies from complete disruption of the staples to incomplete sealing of vascular structures. A stapling platform that has a strong clamping force with precise and consistent staple formation suitable for thickness of tissue is likely to be an advance in existing devices and may reduce the complication rate. A new, computer-mediated power stapling is currently available for lung resections, with three types of digital loading units (DLU). Clinical data on its use are limited. We report our experience with this stapling platform (SurgASSIST) in our first 100 patients undergoing anatomic lung resection. Methods Fifty-four men and forty-six women (mean age, 64 ± 7 years) underwent anatomic lung resections, using a lateral, muscle-sparing mini-thoracotomy, during 2004 to 2005, with the SurgASSIST platform. Three types of DLUs were used for lung resection: a linear cutter, a right-angled vascular cutter, and a right-angled bronchial cutter. Observational data were collected prospectively on the operative procedure, type of staples used, duration of operation, chest tube drainage, and hospital length of stay. Results There were 83 lobectomies, 5 bilobectomies, 5 segmental resections, and 7 pneumonectomies. A total of 502 DLUs (mean, 5 per patient; 102 vascular, 91 bronchial, and 309 linear cutters) were used in this series. There were no major operative complications. The mean operating time was 136 ± 41 minutes. One bronchial dehiscence and one incomplete sealing of the pulmonary vein in the staple line were observed. In one patient, the linear cutter could not be opened in the automatic setting. There were 15% misreads by the computer on the DLU or their inserts. There was one hospital death unrelated to the stapling. Twenty additional complications included prolonged chest tube drainage (n = 8), reoperations (n = 2), atrial fibrillation (n = 5), hemothorax (n = 1), chylothorax (n = 1), C-dif colitis (n = 1), myocardial ischemia (n = 1), and incarcerated ventral hernia (n = 1). The median hospital length of stay was 5 days (range, 3 to 26 days) and the median length of chest tube drainage was 3 days (1 to 22 days). Conclusions Our experience shows that the computer-mediated power stapling of lung parenchyma and hilar structures during anatomic resection is safe and reproducible.

scholarly journals Role of chest tube drainage in physical function after thoracoscopic lung resection

2019 ◽  
Vol 11 (S15) ◽  
pp. S1947-S1950
Author(s):  
Pengfei Li ◽  
Shuangjiang Li ◽  
Guowei Che
Keyword(s):  
Physical Function ◽  
Chest Tube ◽  
Lung Resection ◽  
Chest Tube Drainage ◽  
Tube Drainage

Displacement Patterns of Blunt Rib Fractures and Their Relationship to Thoracic Coinjuries: Minimal Displacements Count

2016 ◽  
Vol 82 (3) ◽  
pp. 199-206 ◽  
Author(s):  
Nikolay Bugaev ◽  
Janis L. Breeze ◽  
Majid Alhazmi ◽  
Hassan S. Anbari ◽  
Sandra S. Arabian ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Chest Tube ◽  
Hospital Length ◽  
Rib Fractures ◽  
Axial Displacement ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
Chest Tube Placement ◽  
Displacement Patterns

Displacement patterns of rib fractures (RF) and their association with thoracic coinjuries and outcomes are unknown. This is a retrospective review of adult patients with blunt closed RF who underwent chest CT at a Level I trauma center (2007–2012). Displacement patterns of RF were compared among the three-dimensional planes using CT images. An analysis of receiver operating characteristic (ROC) curves was performed to identify displacements in each plane most strongly associated with chest coinjuries. Univariate analysis was used to find association of displaced RF with hospital course and outcome. There were 1127 RF (245 patients, most in ribs 3–9, 45 per cent displaced). Axial displacement was the most common, with odds ratios 7.20 and 2.13 compared with cranio-caudal, and impaction-separation (along rib axis) movement, respectively. Axial displacement thresholds performed well with hemothorax (2.8 mm, ROC = 0.74), pneumothorax (2.6 mm, ROC = 0.70), hemopneumothorax (3.1 mm, ROC = 0.77), flail chest (3.4 mm, ROC = 0.80), and chest tube placement (2.8 mm, ROC = 0.75). RF displacement was associated with increased days on mechanical ventilation and hospital length of stay. In conclusion, even minimal RF displacement is associated with increased risk of chest coinjuries and chest tube placement, and displacements correlated with increased days on mechanical ventilation and hospital length of stay. Future studies are required to investigate these associations, especially in relationship to the indications for rib plating.

scholarly journals Preoperative Physical Activity Predicts Surgical Outcomes Following Lung Cancer Resection

2021 ◽  
Vol 20 ◽  
pp. 153473542097585
Author(s):  
Andrea Billé ◽  
James Buxton ◽  
Alessandro Viviano ◽  
David Gammon ◽  
Lukacs Veres ◽  
...  
Keyword(s):  
Physical Activity ◽  
Length Of Stay ◽  
Lung Resection ◽  
Admission Rate ◽  
Postoperative Outcome ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Smoking History ◽  
Short Term ◽  
High Physical Activity

Objectives: To assess whether preoperative levels of physical activity predict the incidence of post-operative complications following anatomical lung resection. Methods: Levels of physical activity (daily steps) were measured for 15 consecutive days using pedometers in 90 consecutive patients (prior to admission). Outcomes measured were cardiac and respiratory complications, length of stay, and 30-day re-admission rate. Results: A total of 78 patients’ datasets were analysed (12 patients were excluded due to non-compliance). Based on steps performed they were divided into quartiles; 1 (low physical activity) to 4 (high physical activity). There were no significant differences in age, smoking history, COPD, BMI, percentage predicted FEV1 and KCO and cardiovascular risk factors between the groups. There were significantly fewer total complications in quartiles 3 and 4 (high physical activity) compared to quartiles 1 and 2 (low physical activity) (8 vs 22; P = .01). There was a trend ( P > .05) towards shorter hospital length of stay in quartiles 3 and 4 (median values of 4 and 5 days, respectively) compared to quartiles 1 and 2 (6 days for both groups). Conclusions: Preoperative physical activity can help to predict postoperative outcome and can be used to stratify risk of postoperative complications and to monitor impact of preoperative interventions, ultimately improving short term outcomes.

Initial Suction Evacuation of Traumatic Hemothoraces: A Novel Approach to Decreasing Chest Tube Duration and Complications

2012 ◽  
Vol 78 (8) ◽  
pp. 883-887 ◽  
Author(s):  
Rajesh Ramanathan ◽  
Luke G. Wolfe ◽  
Therese M. Duane
Keyword(s):  
Length Of Stay ◽  
Chest Tube ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
Suction Catheter ◽  
Trauma Patients ◽  
Surgical Drainage ◽  
High Resource ◽  
Number Of Patients

Between 2 and 4.4 per cent of all patients with trauma chest tubes develop retained hemothoraces. Retained hemothoraces prolong chest tube duration and hospital length of stay, and increase infectious complications like empyema. Early surgical drainage of retained hemothoraces has been shown to decrease complications and reduce hospital length of stay. However, the high resource and expertise requirement may limit the widespread applicability of surgical drainage. We present the results of a relatively simple and novel intervention for traumatic hemothoraces undertaken by our faculty to shorten chest tube duration and prevent empyema formation. At our Level I trauma center, 10 trauma patients underwent initial suction evacuation of their traumatic hemothoraces using a sterile suction catheter before chest tube placement. Compared with propensity matched controls, patients that underwent initial suction evacuation experienced significantly shorter chest tube duration (4.2 ± 1.9 vs 5.8 ± 2.3 days, P = 0.04). Also, in this population, there was an 8.2 per cent decrease in the number of patients that developed empyema or required additional drainage. Our study suggests that initial suction evacuation of traumatic hemothoraces is an effective and relatively easy intervention that reduces the duration of chest tube therapy, empyema formation, and the need for additional surgical intervention.

scholarly journals Omitting chest tube drainage after thoracoscopic major lung resection

2013 ◽  
Vol 44 (2) ◽  
pp. 225-229 ◽  
Author(s):  
K. Ueda ◽  
M. Hayashi ◽  
T. Tanaka ◽  
K. Hamano
Keyword(s):  
Chest Tube ◽  
Lung Resection ◽  
Chest Tube Drainage ◽  
Tube Drainage

Clinico-bacteriological Profile and Outcome of Empyema Thoracis in Children at a Tertiary Care Hospital of Central Nepal

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Atanu Pan ◽  
Debarshi Jana
Keyword(s):  
Ct Scan ◽  
Broad Spectrum ◽  
Chest Tube ◽  
Chest Tube Drainage ◽  
Diagnostic Tools ◽  
High Morbidity ◽  
Care Hospital ◽  
Empyema Thoracis ◽  
First Line ◽  
Tube Drainage

Background: Empyema thoracis (ET) is a serious infection of the pleural space. Despite the availability of broad spectrum antibacterial, improved vaccination coverage and better diagnostic tools, Empyema Thoracis remains associated with high morbidity worldwide. Delay   in   early   diagnosis,   failure   to institute   appropriate   antimicrobial   therapy,   multidrug resistant   organisms,   malnutrition,   comorbidities,   poor health  seeking  behaviour  and  high treatment  cost  burden contribute  to  increased  morbidity  in  children. The available  treatment  options  include  intravenous broad-spectrum antibiotics  either  alone  or  in  combination  with surgical  procedure  (thoracocentesis,  chest  tube  drainage, fibrinolytic  therapy,  decortications  with  video  assistedthoracoscopic surgery (VATS) and open drainage. Methods: Fifty Children between 1 month to 16 years admitted in the Pediatrics Ward, PICU of College of Medical Sciences, Bharatpur,Nepal. Data analysis was done by SPSS 24.0. Results: Present study found that according to blood culture, 3(6.0%) patients had enterococcus, 40(80.0%) patients had no growth, 2(4.0%) patients had pseudomonas, 4(8.0%) patients had staphylococcus and 1(2.0%) patients had streptococcus. We found that 20(40.0%) patients had done CT scan thorax, 30(60.0%) patients had not done CT scan thorax and 32(64.0%) patients had Amoxiclav first line antibiotic and 18(36.0%) patients had Ceftriaxone first line antibiotic. Conclusions: Suitable antibiotics and prompt chest tube drainage is an effective method of treatment of childhood empyema, especially in resource-poor settings. Majority of the patients progress on this conservative management and have good recovery on follow up.  

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