Non-intubated video-assisted thoracic surgery with high-flow oxygen therapy shorten hospital stay

Abstract Background Non-intubated video-assisted thoracic surgery is a therapeutic option for intractable secondary spontaneous pneumothorax in patients who are poor candidates for surgery with endotracheal intubation under general anesthesia. However, intraoperative respiratory management in this surgery is often challenging because of hypoxia caused by surgical pneumothorax. Case presentation A 75-year-old man with idiopathic pulmonary fibrosis who had been on home oxygen therapy underwent non-intubated uniportal video-assisted thoracic surgery for intractable spontaneous pneumothorax. During the operation, oxygen was administered using a high-flow nasal cannula at a high flow rate. An air-locking port for single-incision surgery was used to minimize the inflow of air into the pleural cavity. The intrapleural air was continuously suctioned through the chest tube. The air-leak point was easily identified and closed using ligation. Oxygenation was satisfactory throughout the operation. Conclusions Non-intubated uniportal video-assisted thoracic surgery for secondary spontaneous pneumothorax with an air-locking port, continuous pleural suction, and high-flow nasal cannula may achieve satisfactory intraoperative oxygenation in patients with respiratory dysfunction. The intrapleural space can be feasible for surgical manipulation without surgical pneumothorax in non-intubated video-assisted thoracic surgery even when supplied with oxygen at a high flow rate using a high-flow nasal cannula.

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Recovery Pattern in Different Surgical Approaches on Thoracic Enhanced Recovery based Fourteen-Step Protocol in Patients Undergoing Cardio-thoracic Surgery at University Hospital of Nepal

Kathmandu University Medical Journal ◽

10.3126/kumj.v18i2.33260 ◽

2020 ◽

Vol 18 (2) ◽

pp. 78-82

Author(s):

R.M. Karmacharya ◽

R. Shakya ◽

A.K. Singh ◽

S. Baidya ◽

S. Dahal ◽

...

Keyword(s):

Thoracic Surgery ◽

Hospital Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

University Hospital ◽

Early Recovery ◽

Video Assisted Thoracic Surgery ◽

Icu Stay ◽

Video Assisted ◽

Surgery Group

Background Cardio-thoracic surgery involves open and minimally invasive techniques. Enhanced recovery after surgery is used for early recovery from surgery. Enhanced recovery after surgery decreases hospital stay duration. Patients undergoing Enhanced recovery after surgery after video assisted thoracic surgery use less pain killers and have less hospital cost. There has not been any study on outcomes on patient who follow physiotherapy protocol designed in our setting. Objective To find the physiotherapy outcomes in patients undergoing thoracic enhanced recovery after surgery (T-ERAS) based 14 step protocol locally designed at Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH). Method This is a retrospective cross sectional observational study. All the cases who underwent cardiothoracic surgery were classified based on the approach of chest surgery performed into groups Sternotomy, Thoracotomy and Video Assisted Thoracic Surgery (VATS) groups. Patients were advised for Thoracic Enhanced recovery after surgery based on the protocol that has been devised at Dhulikhel Hospital. The recovery of patients based on activities they could perform was noted and analyzed. Result Both ICU stay and hospital stay in number of days were highest in thoracotomy (6.04 days) group while that was lowest in video assisted thoracic surgery group (1.67 days). There is a similar recovery until step 5, i.e. 2 days and rapid progression in further steps in video assisted thoracic surgery group while it is much slower in both sternotomy and thoracotomy groups. Conclusion Postoperative mobilization and physiotherapy enhance early healing and decrease hospital stay. Mean hospital stay and ICU stay were shorter for video assisted thoracic surgery cases compared to Thoracotomy and Sternotomy groups and the mean days to achieve different steps varied within the protocol between groups compared.

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Video-Assisted Thoracic Surgery Lobectomy versus Lobectomy by Thoracotomy for Lung Cancer: Pilot Study

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e31828d5f15 ◽

2013 ◽

Vol 8 (1) ◽

pp. 6-11 ◽

Cited By ~ 3

Author(s):

Michael Papiashvilli ◽

Lior Sasson ◽

Sharbel Azzam ◽

Henri Hayat ◽

Letizia Schreiber ◽

...

Keyword(s):

Postoperative Complications ◽

Thoracic Surgery ◽

Hospital Stay ◽

Propensity Scores ◽

Early Stage ◽

Small Cell Lung Carcinoma ◽

Safe Procedure ◽

Cell Lung Carcinoma ◽

Video Assisted Thoracic Surgery ◽

Video Assisted

Objective Video-assisted thoracic surgery lobectomy (VATS-L) has become accepted as a safe and effective procedure to treat early-stage non–small cell lung carcinoma (NSCLC). However, the advantages of VATS-L compared with lobectomy by thoracotomy (TL) remain controversial. The aim of this study was to compare the outcomes of patients who underwent VATS-L with those who underwent TL. Methods We studied 103 patients who underwent surgery for operable NSCLC between October 2009 and March 2012. All operations were performed by a single surgeon. The inclusion and exclusion criteria for VATS-L and TL were formulated before the study was initiated. Data on age, sex, preoperative comorbidities, intraoperative and postoperative complications, hospital stay, morbidity, mortality, and other characteristics were recorded preoperatively, in real time intra-operatively, and during hospitalization and were statistically compared. Comorbidities were scaled according to the Charlson Comorbidity Index, and propensity scores between the patients who underwent TL and VATS-L were compared. Results Sixty-three VATS-L operations and 40 TL operations were performed. There were no postoperative complications in 39 patients (61.9%) who underwent VATS-L compared with 25 patients (62.5%) who underwent TL. The patients who underwent TL were significantly younger than the patients who underwent VATS-L (mean ± SD, 64.7 ± 12.6 vs 70.9 ± 8.4; P = 0.003). Hospital stay was not found to be related to the type of surgery (mean ± SD, 8.43 ± 3.15 days vs 8.32 ± 4.13 days; P = 0.888). There were no significant differences when comparing postoperative complications. Conclusions Our initial data suggest that VATS-L is a safe procedure in patients with resectable IA/IB NSCLC and may be the preferred strategy for treatment of the older patient population.

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Nasal high-flow oxygen therapy during non-intubated thoracic surgery: does it offer a real advantage?

Video-Assisted Thoracic Surgery ◽

10.21037/vats.2019.03.03 ◽

2019 ◽

Vol 4 ◽

pp. 8-8 ◽

Cited By ~ 1

Author(s):

Carlos Gálvez ◽

José Navarro-Martínez ◽

Sergio Bolufer ◽

Julio Sesma ◽

Maria Galiana

Keyword(s):

Thoracic Surgery ◽

Oxygen Therapy ◽

High Flow ◽

High Flow Oxygen

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Comparison of VATS and limited axillary thoracotomy in the treatment of spontaneous pneumothorax: a cross-sectional study

Journal of the Pakistan Medical Association ◽

10.47391/jpma.821 ◽

2021 ◽

pp. 1-15

Author(s):

Hasan Oguz Kapicibasi

Keyword(s):

Thoracic Surgery ◽

Hospital Stay ◽

Spontaneous Pneumothorax ◽

Smoking Status ◽

University Teaching ◽

Recurrence Rates ◽

Video Assisted Thoracic Surgery ◽

Video Assisted ◽

Group A ◽

Group B

Objective: To compare the results of conventional mini axillary thoracotomy with video-assisted thoracic surgery in the treatment of spontaneous pneumothorax. Method: The retrospective study was conducted at at Izmit Seka State Hospital, Kocaeli, Turkey, and Çanakkale Onsekiz Mart University Teaching Hospital, Çanakkale, Turkey, and comprised data from November 2011 to May ??2019 of patients who underwent surgery for spontaneous pneumothorax either with video-assisted thoracic surgery, who were placed in Group A, ?or axillary thoracotomy, who wewre placed in Group B. Data gathered related to age, gender, operation side, smoking status, postoperative hospital stay, recurrence rates, and postoperative complications. Data was analysed using SPSS 25. Results: Of the 75 patients, 60(80%) were male and 15(20%) were female. The overall mean age was 29.37±11.60 years. Group A had 41(54.7%)patients, while Group B had 34(45.3%). Postoperative recurrence was not encountered in any patient in Group B, while 2(5.4%) patients in Group A had a recurrence (p>0.05) who both continued smoking. Hospital stay was significantly higher in Group B (p?<0.001).? Conclusion: Video-assisted thoracic surgery in the treatment of spontaneous pneumothorax was found to shorten hospital stay, and can be used more widely. Continuous...

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High Flow Oxygen Therapy and the Pressure to Feed Infants With Acute Respiratory Illness

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-19-00158 ◽

2020 ◽

Vol 5 (4) ◽

pp. 1006-1010

Author(s):

Jennifer Raminick ◽

Hema Desai

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Oxygen Therapy ◽

Respiratory Illness ◽

High Flow ◽

Oral Feeding ◽

Respiratory Support ◽

Acute Respiratory Illness ◽

High Flow Oxygen

Purpose Infants hospitalized for an acute respiratory illness often require the use of noninvasive respiratory support during the initial stage to improve their breathing. High flow oxygen therapy (HFOT) is becoming a more popular means of noninvasive respiratory support, often used to treat respiratory syncytial virus/bronchiolitis. These infants present with tachypnea and coughing, resulting in difficulties in coordinating sucking and swallowing. However, they are often allowed to feed orally despite having high respiratory rate, increased work of breathing and on HFOT, placing them at risk for aspiration. Feeding therapists who work with these infants have raised concerns that HFOT creates an additional risk factor for swallowing dysfunction, especially with infants who have compromised airways or other comorbidities. There is emerging literature concluding changes in pharyngeal pressures with HFOT, as well as aspiration in preterm neonates who are on nasal continuous positive airway pressure. However, there is no existing research exploring the effect of HFOT on swallowing in infants with acute respiratory illness. This discussion will present findings from literature on HFOT, oral feeding in the acutely ill infant population, and present clinical practice guidelines for safe feeding during critical care admission for acute respiratory illness. Conclusion Guidelines for safety of oral feeds for infants with acute respiratory illness on HFOT do not exist. However, providers and parents continue to want to provide oral feeds despite clinical signs of respiratory distress and coughing. To address this challenge, we initiated a process change to use clinical bedside evaluation and a “cross-systems approach” to provide recommendations for safer oral feeds while on HFOT as the infant is recovering from illness. Use of standardized feeding evaluation and protocol have improved consistency of practice within our department. However, further research is still necessary to develop clinical practice guidelines for safe oral feeding for infants on HFOT.

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Primary hyperparathyroidism caused by mediastinum located ectopic parathyroid adenoma resected by video-assisted thoracic surgery

Endocrine Abstracts ◽

10.1530/endoabs.35.p291 ◽

2014 ◽

Author(s):

Narin Nasiroglu Imga ◽

Ozgur Karakurt ◽

Bercem Aycicek Dogan ◽

Zeynep Karabulut ◽

Yasemin Tutuncu ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Thoracic Surgery ◽

Parathyroid Adenoma ◽

Video Assisted Thoracic Surgery ◽

Video Assisted ◽

Ectopic Parathyroid Adenoma ◽

Ectopic Parathyroid

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Az első száz minimálisan invazív tüdőlebeny-eltávolítás eredményei osztályunk beteganyagában

Magyar Sebészet (Hungarian Journal of Surgery) ◽

10.1556/1046.73.2020.2.2 ◽

2020 ◽

Vol 73 (2) ◽

pp. 57-60

Author(s):

Károly Kovács ◽

Csaba Oláh ◽

László Füstös ◽

Zoltán Fülep ◽

Gábor Cserni ◽

...

Keyword(s):

Thoracic Surgery ◽

Video Assisted Thoracic Surgery ◽

Video Assisted

Absztrakt: Bevezetés: Közleményünkben ismertetjük a 2013–2019 közötti időszakban osztályunkon minimálisan invazív módszerrel (video-assisted thoracic surgery – VATS) elvégzett tüdőlobectomiák során szerzett tapasztalatainkat, eredményeinket. Betegek és módszer: 2013. november 1. és 2019. június 30. közötti időszakban osztályunkon 112 VATS lobectomiát végeztünk. A műtéteket izolált intubációval altatott betegeken elülső behatolás technikával végeztük. 98 betegnél malignus, 9 betegnél benignus elváltozás miatt történtek a műtétek. 10 esetben a műtét utáni szövettani diagnózis metasztázis volt. 78 férfi és 34 nőbetegen végeztük a műtéteket. A betegek átlagéletkora 60,5 (42–63) év volt. Az eltávolított lebenyek megoszlása a következő volt: bal felső: 5, bal alsó: 36, Jobb felső: 15, középső: 11, jobb alsó: 44, pulmonectomia: 1. Eredmények: Műtéti halálozás nem volt. Konverzióra 3 alkalommal kényszerültünk. Az átlagos műtéti idő 150 (70–215) perc volt. Reoperációt 2 betegnél végeztünk, vérzés, légáteresztés miatt. A 112 műtét során 88 betegnél primer tüdőrák, 9 betegnél jóindulatú elváltozás/gyulladás miatt történt a műtét. 10 esetben más szerv tumora miatti metasztázis miatt végeztük a beavatkozásokat. A primer tüdőrák miatt végzett műtétek stádium szerinti megoszlása a szövettani eredmények alapján a következő volt: I.a: 57, I.b: 22, II.a: 6, II.b: 3. A szövettani típus szerinti megoszlás: adenocarcinoma: 52, laphámrák: 23, kissejtes carcinoma: 2, nagysejtes carcinoma: 5, carcinoid: 6 volt. Következtetés: Osztályunkon a szükséges tanuló időszak után a VATS lobectomia megfelelő indikáció szerint rutin műtéti eljárássá vált. Jelenleg mellkasi műtéteink 65%-a, a lobectomiák több mint 50%-a VATS technikával történik. Eredményeink az országos és az irodalmi adatoknak megfelelnek.

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