scholarly journals The Safety and Feasibility of Laryngeal Mask Airway (LMA) Management in Non-intubated Subxiphoid-subcostal Thoracoscopic Thymectomy: Preliminary Results

Author(s):  
Peng Cao ◽  
Shan Hu ◽  
Qiaoqiao Xu ◽  
Kangle Kong ◽  
Peng Han ◽  
...  

Abstract Intubated general anesthesia and single-lung ventilation are considered mandatory for conventional thoracoscopic surgery. Non-intubated thoracoscopic thymectomy is technically challenging. The aim of this article was to present the initial results of non-intubated subxiphoid-subcostal thoracoscopic thymectomy (NI-STT) under LMA management for patients with thymic tumor or myasthenia gravis (MG) and to investigate the feasibility and safety of the procedure. A retrospective analysis of patients undergoing NI-STT for thymic tumor or MG at our department from January 2017 to January 2020 was performed. The clinical characteristics and perioperative outcomes of the patients were reviewed and analyzed. A total of 61 patients were received NI-STT in this analysis, of which 19 patients with MG undergone an extended thymectomy and the rest (n=42) undergone a partial thymectomy. The anesthetic induction duration, surgical duration and global operating room duration were 24.83±12.27 min, 118.75±32.49 min and 173.51±41.80 min, respectively. The lowest SpO2 and peak EtCO2 during operation were 96.15±2.93 mmHg and 41.79±7.53 mmHg, respectively. The mean duration of chest drainage and postoperative hospital stays were 1.87 days, and 2.91 days, respectively. Three cases had sore throat and irritable cough and two cases suffered nausea and vomiting occurred. one patient suffered from an atrial fibrillation, two patients experienced pneumonia, and one patient suffered wound infection, respectively. There were no phrenic nerve paralysis and mortality occurred in the study group. The postoperative pain was low on 1,3, 7, 14, 30, 90 and 180 postoperative days. NI-STT was a technically safe and feasible approach for treating thymic tumors or MG. It could be an alternative to intubated single-lung ventilation for thymectomy in selected patients.

Author(s):  
Michael C Giudici ◽  
Deborah L Paul ◽  
Caroline Sloane ◽  
Gisela Press ◽  
Ashley Petersen ◽  
...  

Introduction: Catheter ablation for atrial fibrillation (PVI) is being performed with increasing frequency. This time and labor-intensive procedure is under increasing scrutiny as we look for means to decrease costs of delivering care. Performing these procedures on therapeutic warfarin could shorten hospital stays, eliminate costly low-molecular weight heparin (LMW) use, and decrease procedural heparin administration which could reduce hemorrhage from access sites. Methods: Over a six-year period, 180 patients, 138 M/42 F, mean age 43 yr (18-77 yr), underwent PVI for persistent - 99 pts., and paroxysmal - 81 pts. atrial fibrillation. Mean INR was 2.2 (1.5 - 4.2). Procedures were performed with standard radiofrequency (RF) catheters - 132, Cryoablation - 27, and Ablation Frontiers RF - 21. Procedural time, fluoroscopy time, hospital stays, outcomes, and complications were tracked. Results: 127 of 180 pts. were discharged the day of procedure (OP) from the outpatient unit, 51 pts. stayed one night post-procedure (IP), 2 patients stayed 4 days, one for pulmonary treatment and one for CVA. Mean procedural length was 3.3 hours, mean fluoro time was 52 min. Mean time from hospital admit to discharge was 17.3 hr. Mean time from procedure end to discharge was 11.0 hr. 77% of pts. were free from AF on follow-up on no meds or “pill-in-the-pocket”. 6 complications occurred - 1 phrenic nerve paralysis (resolved), 2 CVAs (one was 72 hrs post PVI), 1 perforation/tamponade, 1 groin bleed requiring evacuation, 1 PV stenosis. There was no difference in outcome for patients discharged OP vs IP. Cost savings by continuing warfarin were LMW = $205/dose X 6 doses - $1230/pt. Cost savings by same day discharge = $1330/day. Conclusions: PVI can be safely performed as an outpatient procedure on therapeutic warfarin with good clinical outcomes. Significant cost savings can be realized from OP PVI from reduced staff, medication, and facilities utilization.


Author(s):  
Christopher B. Komanapalli ◽  
James I. Cohen ◽  
Mithran S. Sukumar

Objective The objective of this study was to demonstrate extended thymectomy via the transcervical route. Methods With the use of the Rultract retractor (Rultract, Cleveland, OH), videothoracoscopy and single-lung ventilation allowed complete thymectomy. Results This article demonstrates complete resection of all the thymus from the anterior and superior mediastinum. Conclusions In selected patients, the transcervical route can used to completely resect the thymus, avoiding the morbidity of sternotomy.


Author(s):  
Yaokai Wen ◽  
Hengrui Liang ◽  
Guanping Qiu ◽  
Zhichao Liu ◽  
Jun Liu ◽  
...  

Abstract It remains unclear whether non-intubated video-assisted thoracoscopic surgery (VATS) is comparable or advantageous compared with conventional intubated VATS. Thus, we systematically assessed the feasibility and safety of non-intubated VATS compared with intubated VATS perioperatively for the treatment of different thoracic diseases. An extensive search of literature databases was conducted. Perioperative outcomes were compared between 2 types of operations. The time trend of the overall results was evaluated through a cumulative meta-analysis. Subgroup analyses of different thoracic diseases and study types were examined. Twenty-seven studies including 2537 patients were included in the analysis. A total of 1283 patients underwent non-intubated VATS; intubated VATS was performed on the other 1254 patients. Overall, the non-intubated VATS group had fewer postoperative overall complications [odds ratios (OR) 0.505; P < 0.001]; shorter postoperative fasting times [standardized mean difference (SMD) −2.653; P < 0.001]; shorter hospital stays (SMD −0.581; P < 0.001); shorter operative times (SMD −0.174; P = 0.041); shorter anaesthesia times (SMD −0.710; P < 0.001) and a lower mortality rate (OR 0.123; P = 0.020). Non-intubated VATS may be a safe and feasible alternative to intubated VATS and provide a more rapid postoperative rehabilitation time than conventional intubated VATS.


Author(s):  
Yong Won Seong ◽  
Byung Su Yoo ◽  
Jin Tae Kim ◽  
In Kyu Park ◽  
Chang Hyun Kang ◽  
...  

Objective There have been only small numbers of reports for video-assisted thoracoscopic surgery (VATS) lobectomy in children because of its technically demanding aspects. This study was performed to evaluate the safety and the efficacy of the VATS lobectomy compared with the conventional lobectomy by thoracotomy and to investigate the risk factors of thoracotomy conversion. Methods From May 2005 to October 2010, a total of 37 pediatric patients underwent VATS lobectomy and 28 pediatric patients underwent conventional lobectomy. The VATS lobectomy group consisted of relatively older patients compared with the thoracotomy group. Clinical outcomes from the two groups were analyzed and compared. Results Of the 37 patients in the VATS group, 8 patients (23%) required thoracotomy conversion and 29 patients (77%) were successfully operated on thoracoscopically. There were no in-hospital mortalities in both groups. Annual thoracotomy conversion rate has decreased from 50% in 2005 to 9% in 2010. There were no significant differences in the outcome between the VATS group and the thoracotomy group. Morbidities in the VATS group included prolonged drainage longer than 7 days (two patients), prolonged air leakage (two patients), and bleeding (one patient). There was no difference in the incidence of morbidities between the two groups. Univariate analyses revealed failure of single-lung ventilation (P = 0.007) and history of pneumonia (P = 0.001) to be risk factors of thoracotomy conversion. Conclusions Video-assisted thoracoscopic surgery lobectomy in children is a safe and effective treatment modality, with results comparable with those of conventional lobectomy. In the univariate analysis, failure of single-lung ventilation and history of pneumonia were the two factors related to thoracotomy conversion.


2018 ◽  
Vol 28 (02) ◽  
pp. 163-170 ◽  
Author(s):  
Benno Ure ◽  
Jens Dingemann ◽  
Christoph Zoeller

AbstractVideo-assisted thoracoscopic surgery (VATS) has gained broad acceptance among pediatric surgeons. Today, VATS can be regarded as a routine approach for various conditions in neonates and infants. However, there is a lack of information concerning the complications of thoracoscopic pulmonary surgery in neonates and infants. We aimed to review the available data. A systematic review of the literature was performed using PubMed. All publications reporting on VATS for pulmonary procedures in neonates and infants up to the age of 1 year were included. Articles were reviewed in detail for occurrence of perioperative complications and their treatment. Nine case series were eligible for analysis. Entities treated included lung sequestration, congenital pulmonary airway malformation, congenital lobar emphysema, and bronchogenic cyst. Case series reported on a total number of 135 patients. Complications occurred in 14 patients (10.4%). The major complication was an accidental transection of the middle lobar bronchus that concluded in a later resection of a prior unaffected lung lobe. Other relevant complications reported were bleeding in four patients (3.0%) and persistent air leak in four cases (3.0%). Infectious complications were reported in four patients (3.0%). Additionally, iatrogenic phrenic nerve paralysis occurred in one patient. There were no deaths related to the VATS technique. In 11 cases (8.1%), conversion to thoracotomy had been necessary. General recommendations on the treatment of complications could not be derived due to small patient numbers and lack of details of the complications reported. Reports on major complications of pulmonary VATS in neonates and infants below 1 year of age are scarce. As severe complications such as accidental bronchus transection have been described, feasibility of neonatal/infant VATS cannot be unequivocally confirmed. No literature-based recommendation can be given on the treatment of complications.


2015 ◽  
Vol 68 (6) ◽  
pp. 219-224
Author(s):  
Aurél Ottlakán ◽  
Tibor Géczi ◽  
Balázs Pécsy ◽  
Bernadett Borda ◽  
Judit Lantos ◽  
...  

Absztrakt Célkitűzés: A myasthenia gravis (MG) kezelésében számos nyitott, illetve minimálisan invazív thymectomia ismert. A tanulmány ugyanazon intézeten belül a transsternalis (TS), illetve kétféle minimálisan invazív thymectomia (video-assisted thoracoscopic extended thymectomy – VATET; unilateral video-assisted thoracoscopic surgery – UL-VATS) eredményeit hasonlítja össze. Anyag és módszerek: Három különböző időintervallumban 71 betegnél történt thymectomia MG miatt (60 nő, 11 férfi): 23 transsternalis thymectomia (1995. január–2004. szeptember), 22 VATET (2004. szeptember – 2009. augusztus) és 26 UL-VATS thymectomia (2009. szeptember – 2011. december). Az eredmények értékelésénél a műtéti idő, MG-hez társuló neurológiai és a műtét utáni sebészi szövődmények, valamint az MG státuszában az egyéves utánkövetéskor észlelt neurológiai változások szerepeltek. Eredmények: Perioperatív mortalitás nem fordult elő. A műtéti idő 112, 211, 116 perc (p = 0,001), a kórházi napok száma: 8,9, 5,6 és 4 nap (p = 0,001) volt a TS-, VATET- és UL-VATS-csoportban. Az MG-hez kapcsolódó postoperativ neurológiai szövődmények 21,7%, 18,2% és 7,7% (p = 0,365) értékeket mutattak. A sebészi szövődmény 4,3%, 13,7%, 0% (p = 0,118) volt. Az MG tüneteinek javulása 91,3%, 94,7%, 87,5% (p = 0,712), míg komplett remisszió 13%, 10,5%, 11,5% (p = 0,917) volt a TS-, VATET- és UL-VATS-csoportokban. Következtetések: A műtéti idő, valamint a kórházban eltöltött napok száma UL-VATS esetében volt a legrövidebb. A kisebb sebészi beavatkozáshoz alacsonyabb sebészi, illetve MG-s neurológiai szövődmények társultak. Az MG-tünetek javulásában mindhárom módszernél kiváló eredményt értek el.


2019 ◽  
Vol 68 (05) ◽  
pp. 450-456 ◽  
Author(s):  
Zhengcheng Liu ◽  
Rusong Yang ◽  
Yang Sun

Abstract Objective To investigate whether laryngeal mask anesthesia had more favorable postoperative outcomes than double-lumen tube intubation anesthesia in uniportal thoracoscopic thymectomy. Methods Data were collected retrospectively from December 2013 to December 2017. A total of 96 patients with anterior mediastinum mass underwent nonintubated uniportal video-assisted thoracoscopic thymectomy with laryngeal mask, and 129 patients underwent intubated uniportal video-assisted thoracoscopic thymectomy. A single incision of ∼3 cm was made in an intercostal space along the anterior axillary line. Perioperative outcomes between nonintubated uniportal video-assisted thoracoscopic surgery (NU-VATS) and intubated uniportal video-assisted thoracoscopic surgery (IU-VATS) were compared. Results In both groups, incision size was kept to a minimum, with a median of 3 cm, and complete thymectomy was performed in all patients. Mean operative time was 61 minutes. The mean lowest SpO2 during operation was not significantly different. However, the mean peak end-tidal carbon dioxide in the NU-VATS group was higher than in the IU-VATS group. Mean chest tube duration in NU-VATS group was 1.9 days. Mean postoperative hospital stay was 2.5 days, with a range of 1 to 4 days. Time to oral fluid intake in the NU-VATS group was significantly less than in the IU-VATS group (p < 0.01). Several complications were significantly less in the NU-VATS group than in the IU-VATS group, including sore throat, nausea, irritable cough, and urinary retention. Conclusion Compared with intubated approach, nonintubated uniportal thoracoscopic thymectomy with laryngeal mask is feasible for anterior mediastinum lesion, and patients recovered faster with less complications.


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