scholarly journals Thoracotomy versus VATS: is there an optimal approach to treating pneumothorax?

2013 ◽  
Vol 95 (1) ◽  
pp. 61-64 ◽  
Author(s):  
V Joshi ◽  
B Kirmani ◽  
J Zacharias
Keyword(s):  
Learning Curve ◽  
Recurrence Rate ◽  
Surgical Intervention ◽  
Thoracoscopic Surgery ◽  
Postoperative Bleeding ◽  
British Thoracic Society ◽  
Significant Difference ◽  
Optimal Approach ◽  
Video Assisted Thoracoscopic Surgery ◽  
Group 1

Introduction The 2010 British Thoracic Society guidelines recommend that a weighted decision be made by clinicians with regard to surgical intervention for pneumothorax as the video assisted thoracoscopic surgery (VATS) approach is better tolerated by patients but carries a higher rate of recurrence (5% vs 1%). Methods Overall, 163 patients underwent surgical intervention for pneumothorax at our institution and data were collected prospectively for almost 7 years. Of these, 86 patients underwent VATS under a single surgeon with extensive VATS experience to compensate for the associated learning curve while 79 patients underwent an open procedure. Results There was no statistically significant difference in the recurrence rate between the open and the VATS group (1% vs 3.5%, p=1.0). The VATS group was superior to the open group in terms of reduced postoperative bleeding (7.5% vs 0%, p=0.01), reduced number of intensive care unit admissions (16% vs 0%, p<0.01) and a reduced adjusted length of stay (3 vs 5.5 days, p<0.01). Conclusions A comparable recurrence rate is attainable with a VATS approach once the learning curve is surpassed and a reduction in morbidity is an additional merit.

scholarly journals Study of diagnostic and therapeutic utility of video assisted thoracoscopic surgery

2018 ◽  
Vol 5 (8) ◽  
pp. 2751
Author(s):  
Nilesh P. Mangam ◽  
Aashish R. Chavan ◽  
Ritesh Bodade ◽  
Asmita Dhurve
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Thoracoscopic Surgery ◽  
Postoperative Bleeding ◽  
Intraoperative Complication ◽  
Video Assisted ◽  
Significant Difference ◽  
Prolonged Air Leak ◽  
Video Assisted Thoracoscopic Surgery ◽  
Therapeutic Utility

Background: Video-assisted thoracoscopic surgery (VATS) is rapidly becoming a popular method for diagnostic and therapeutic purposes. Many diseases of the chest can now be diagnosed by VATS due to ease of look and biopsy. Hence the present study was undertaken to determine diagnostic and therapeutic utility of VATS in different chest pathologies.Methods: In this prospective study, total 36 patients of different age group were subjected to VATS procedure, to measured operative time, intra and post- operative complications, post-operative pain and hospital stay. Then patient was followed up at 15 days, at 1 month, 3 month and at 6 months.Results: VATS was successfully carried out in 28 patients as the only procedure whereas 8 patients required conversion to thoracotomy. Average operative time for patients operated by VATS only was 94.9 minute and for patients operated by VATS converted to thoracotomy was 175.5 minute. Most common intraoperative complication was bleeding (16.66 %) followed by anaphylactic shock observed in only one patient. Most common postoperative complication was prolonged air leak (5.55%) followed by port site infection (2.77%) and postoperative bleeding (2.77%). At 24 hours postoperatively, average pain score observed in VATS group was 3.73 and in thoracotomy group was 6.28. The mean postoperative hospital stay for patients operated by VATS was 7.28 days and for patients operated by VATS converted to thoracotomy was 10.36 days. There was significant difference observed in diagnosis of various chest pathologies by radiological investigations and VATS.Conclusions: VATS should be offered as the first approach to various chest pathologies requiring surgical intervention and preferred over thoracotomy when feasible. 

scholarly journals Defining The Learning Curve of Single-Port Inflatable Mediastinoscopy With Simultaneous Laparoscopic-Assisted Surgery For Radical Esophagectomy

2021 ◽  
Author(s):  
Jinpeng Shi ◽  
Xiaojian Li ◽  
Tianchi Wu ◽  
Xiangwen Wu ◽  
Xiaojin Wang ◽  
...  
Keyword(s):  
Learning Curve ◽  
Single Port ◽  
Thoracoscopic Surgery ◽  
Surgical Team ◽  
Radical Esophagectomy ◽  
Extensive Experience ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Laparoscopic Assisted ◽  
Group 1

Abstract Background Single-port inflatable mediastinoscopy with simultaneous laparoscopic-assisted surgery for radical esophagectomy is a promising surgical method with high technical requirements and needs team cooperation. Therefore, it is necessary to define a learning curve to guide personnel training and improve the safety of these surgical techniques.Method This study prospectively analyzed the data of 79 consecutive patients, who underwent the surgery in the Fifth Affiliated Hospital of Sun Yat-sen University from October 2016 to May 2018. All of these patients were treated by the same surgical team with extensive experience in thoracotomy, laparotomy, thoracoscopic surgery and laparoscopic surgery. The learning curve was analyzed by cumulative summation (CUSUM) analysis, with the assessment of operative time, estimated blood loss, and postoperative complications.Result By analyzing these data, The scatter diagram of every measure showing a declining situation. The learning curve decreased beginning at 25th operation. All patients were chronologically divided into two groups, the group 1(the first 25 patients) and the group 2 (the last 54 patients). The median estimated blood loss of group 2 was lower than group 1(200 vs 100ml, p<0.05). No other clinic or pathologic characteristics were observed as significantly different.Conclusion For a surgical team with extensive experience in thoracotomy, laparotomy, thoracoscopic surgery and laparoscopic surgery, 25 cases are needed before becoming proficient in this surgery.

scholarly journals Pleurodesis methods in the surgical treatment of primary spontaneous pneumothorax

2021 ◽  
pp. 77-81
Keyword(s):  
Surgical Treatment ◽  
Recurrence Rate ◽  
Spontaneous Pneumothorax ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Primary Spontaneous Pneumothorax ◽  
High Recurrence Rate ◽  
Parietal Pleura ◽  
Advantages And Disadvantages ◽  
Video Assisted Thoracoscopic Surgery

Pneumothorax is the collection of air in the pleural space. Pneumothorax can be spontaneous, traumatic or iatrogenic. Primary spontaneous pneumothorax mostly occurs in healthy individuals without an apparent cause, probably due to the rupture of subpleural emphysematous bullae located on the apex of the lung. It usually occurs in tall and healthy males younger than 40 years old. Primary spontaneous pneumothorax has a recurrence rate of 20-30% after the first attack, 50% after the second attack, and 80% after the third attack. Surgery is presented as a treatment option to reduce the high recurrence rate after the second attack. It has been reported that recurrence is between 10 and 20% in patients who undergo bullectomy or wedge resection with endoscopic steps alone. Therefore, various pleural pleurodesis methods are applied in addition to bulla resection in order to reduce the recurrence rate after surgery. In mechanical pleurodesis, adhesion between visceral and parietal pleura is achieved by mechanical abrasion of the parietal pleura or by total or partial removal of the parietal pleura. In chemical pleurodesis, the visceral pleura is adhered to the parietal pleura by creating irritation in the pleura with chemical agents. In cases where pleurodesis was added, the recurrence rate was reported to be between 1.7 and 2.8%. Whether the pleurectomy, pleural mechanical or chemical abrasion methods performed with video-assisted thoracoscopic surgery is superior for preventing recurrence is still a matter of debate. In this article, we aimed to discuss the advantages and disadvantages of pleurodesis methods in the surgical treatment of primary spontaneous pneumothorax in the light of the literature.

scholarly journals Trephine Craniotomy versus Burr Hole Drainage for Chronic Subdural Hematoma—An Institutional Analysis of 156 Patients

2020 ◽  
Vol 17 (02) ◽  
pp. 110-120
Author(s):  
Ramesh Chandra Vemula ◽  
B. C.M. Prasad ◽  
Venkat Koyalmantham ◽  
Kunal Kumar
Keyword(s):  
Ct Scan ◽  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Surgical Intervention ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
P Value ◽  
First Choice ◽  
Significant Difference ◽  
Preoperative Ct

Abstract Introduction Some neurosurgeons believe that doing a trephine craniotomy (TC) decreases the chance of recurrence in chronic subdural hematoma (cSDH). But this is not supported by any evidence. Methods A retrospective analysis of patients who were operated for cSDH from 2014 to 2019 at our institute was done. Factors causing recurrence were studied. Results A total of 156 patients were operated in the given period, among which 88 underwent TC and 68 patients underwent burr hole drainage (BHD) for evacuation of cSDH. All patients underwent two trephines or two burr holes placed according to the maximum thickness of the hematoma. Rate of recurrence in trephine group was 12.5% and in burr-hole group was 11.76% and was not statistically significant. Significant factors for recurrence included nontraumatic cSDH, anticoagulant use, presence of membranes, preoperative computed tomography (CT) showing iso- or mixed-density subdural collection and SDH volume > 60 mL. There was selection bias for the procedure. Patients with subdural membranes were preferentially taken for TC as the percentage of subdural membrane found intraoperatively was significantly greater in trephine group (51.1%) than burr-hole group (17.6%) (p value < 0.001).When all the patients who showed membranes in CT scan were excluded, there was no statistical difference in the base line characteristics of both the groups. After excluding the patients with membranes in preoperative CT scan, there was no significant difference in recurrence rate between the two groups.In TC group with membranes, 8 out of 45 had recurrence, whereas in burr-hole group with membranes, 8 out of 12 had recurrence. This difference was statistically significant. (p value < 0.001). Conclusion Surgical intervention in both modalities improves patient outcome with an overall recurrence rate of 12.17%. In the absence of any identifiable membranes in preoperative CT scan, BHD is the preferred surgical intervention. We prefer TC as first choice for patients with membranes in CT scan.

Post-Operative Outcomes of Off-Pump Coronary Artery Bypass Surgery Patients after Topical Use of Tranexamic Acid

2017 ◽  
Vol 2 (2) ◽  
pp. 79-83
Author(s):  
Asraful Hoque ◽  
Asit Baran Adhikary ◽  
KAM Mahbub Hasan ◽  
Romena Rahman ◽  
Mauin Uddin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Tranexamic Acid ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Pericardial Cavity ◽  
Significant Difference ◽  
Opcab Surgery ◽  
Group 2 ◽  
Topical Tranexamic Acid ◽  
Group 1

Background: Postoperative mediastinal bleeding in patients undergoing cardiac surgery is still one of the most common complications. Objective: This study was intended to investigate the efficacy of topical tranexamic acid in reducing postoperative bleeding after OPCAB surgery. Methodology: This non-randomized, double blinded, clinical trial was conducted in the Department of Cardiac Surgery at National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh during January 2014 to December 2015 for a period of two (2) years. Patients’ undergone CABG after fulfilling the inclusion and exclusion criteria was recruited for this study. They were assigned in two groups 30 patients in tranexamic acid group (Group 1) and 30 patients in placebo group (Group 2). On completion of the grafting, before closure of the sternum tranexamic acid (2.5 g/25 mL) or placebo (25 mL of saline) diluted in 100 mL of warm saline (37° C) was instilled into the pericardial cavity including the mediastinal tissues and left for 5 minutes. Then it was cleared out by wall sucker and sternum was closed. Result: There was no significant difference in baseline demographic data, basic clinical characteristics and preoperative coagulation profile between the 2 groups (P>0.05). Total mediastinal bleeding in group 1 and group 2 patients were 421.67±70.32 vs 593.33±77.38 ml (p<0.001). In case of, whole blood transfusion in group 1 and group 2 patients were 0.87±0.0.73 units and 1.77±0.57 units respectively (p<0.001). No patient required reoperation for bleeding and there was no incidence of prolonged ventilation, MI, thromboembolism, DVT or CVA in any of the patients in either group. Conclusion: In conclusion the efficacy of topical tranexamic acid is helpful for reducing postoperative bleeding after OPCAB surgery. Journal of National Institute of Neurosciences Bangladesh, 2016;2(2): 79-83

scholarly journals Subxiphoid uniportal video assisted thoracoscopic surgery lobectomy, evolution of the technique and progress of learning curve

2018 ◽  
Vol 2 ◽  
pp. 88-88 ◽  
Author(s):  
Amr Abdellateef ◽  
Chenlu Yang ◽  
Jian Chen ◽  
Jichen Qu ◽  
Jing Huang ◽  
...  
Keyword(s):  
Learning Curve ◽  
Thoracoscopic Surgery ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Efficacy of Perioperative Administration of Intravenous Parecoxib on Postoperative Morphine Consumption after Video-Assisted Thoracoscopic Surgery

2021 ◽  
Vol 104 (11) ◽  
pp. 1836-1842
Keyword(s):  
Postoperative Pain ◽  
Pain Score ◽  
Rating Scale ◽  
Thoracoscopic Surgery ◽  
Morphine Consumption ◽  
High Dose ◽  
Video Assisted ◽  
Significant Difference ◽  
Postoperative Morphine ◽  
Video Assisted Thoracoscopic Surgery

Background: Morphine is commonly used to relief pain after video-assisted thoracoscopic surgery (VATS), however high dose morphine is usually related with many complications. Parecoxib is a potent cyclo-oxygenase inhibitor for parenteral administration that has a role in acute pain management addition to opioid protocol. Objective: To investigate the potential benefits of intravenous parecoxib for relieving postoperative pain after VATS. Materials and Methods: The present study was a randomized controlled trial that assigned 22 patients undergoing VATS into two groups to received either parecoxib 40 mg as P group with 11 patients, or placebo using 2 mL of Normal Saline Solution as C group with 11 patients with an intravenous administration at 30 minutes prior to surgery and then 12 hours later. In the postoperative period, all patients received intravenous patient-controlled analgesia (PCA) with morphine. The primary outcome was the total morphine consumption for 24 hours postoperatively. The secondary outcomes were pain score at 2, 6, 12, and 24 hours postoperatively, using a numeric rating scale (NRS, 0 to 10) and the incidence of side effects. Results: The total morphine consumption was significantly lower in P group (26.64±4.41 mg) than C group (39.82±3.87 mg) at 24 hours postoperatively (p<0.001). The NRS pain score at rest and on coughing at 24 hours postoperatively between P group compared with C group were 1.09±1.04 versus 4.45±0.69 (p<0.001) and 2.91±0.83 versus 5.36±0.81 (p<0.001), respectively. The incidences of nausea and vomiting were found in both groups at 2, 6, and 12 hours, postoperatively, but there was no statistically significant difference between both groups (p>0.05). Other adverse events such as sedation, pruritus, dyspepsia, headache, hypotension, and respiratory depression were not found. Conclusion: Perioperative administration of parecoxib was safe and effectively decrease postoperative morphine consumption and pain score at rest and on coughing within 24 hours postoperatively after VATS. Keywords: Intravenous parecoxib; Video-assisted thoracoscopic surgery; Acute postoperative pain

Requirement of interventional treatment in a patient being conservatively managed for persistent pneumothorax over a prolonged period

2021 ◽  
Vol 14 (7) ◽  
pp. e243556
Author(s):  
Sophia Brenac
Keyword(s):  
Patient Involvement ◽  
Surgical Intervention ◽  
Thoracoscopic Surgery ◽  
Interventional Treatment ◽  
Decision Making Process ◽  
Good Recovery ◽  
Talc Pleurodesis ◽  
Cystic Changes ◽  
Video Assisted Thoracoscopic Surgery

An 85-year-old ex-smoker being managed conservatively over 2 years for a small right apical pneumothorax presented to the respiratory clinic with suddenly worsening shortness of breath and chest pain. A chest radiograph demonstrated sudden deterioration in the size of his pneumothorax. Previous CT scans had found emphysematous cystic changes within the lungs, and his new presentation warranted definitive surgical intervention with a right bullectomy and talc pleurodesis through a video-assisted thoracoscopic surgery procedure. The patient made a good recovery and was discharged from clinic a year later. This case demonstrates the importance of follow-up in patients with unresolved pneumothoraces due to the potential for sudden deterioration, and highlights the significance of respecting patient involvement and autonomy in the decision-making process.

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