A real world cost-minimization analysis comparing the use of different endoscopic staplers in video-assisted thoracic surgery lobectomy procedures

2021 ◽  
Vol 10 (14) ◽  
pp. 1079-1088
Author(s):  
Wei Gu ◽  
Tao Wang ◽  
Wenting Wang ◽  
Guixian Tong ◽  
Shuqing Wu ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Minimization ◽  
Thoracoscopic Surgery ◽  
Selection Strategy ◽  
Base Case ◽  
Analysis Model ◽  
Vats Lobectomy ◽  
Cost Minimization Analysis ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Aim: China’s cost-containment measures increasingly focus solely on the prices of consumable medical supplies without taking a broader perspective on differences in features and overall costs. This study compared two types of endoscopic staplers in video-assisted thoracoscopic surgery (VATS) lobectomy. Materials & methods: Electronic medical records for video-assisted thoracoscopic surgery from 2016 to 2017 were collected from a hospital in Anhui province. Two cohorts were retroactively defined based on stapler type. Total costs were compared using a cost-minimization analysis model. Probabilistic sensitivity analysis was performed. Results: In the base case, the group using more expensive staplers achieved overall cost savings of about $300 per procedure. Sensitivity analysis confirmed this result in 86.5% of cases. Conclusion: A price-only supply selection strategy may have unintended cost consequences.

scholarly journals The evolution of intraoperative conversion in video assisted thoracoscopic lobectomy

2017 ◽  
Vol 99 (2) ◽  
pp. 129-133 ◽  
Author(s):  
A Vallance ◽  
P Tcherveniakov ◽  
C Bogdan ◽  
N Chaudhuri ◽  
R Milton ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Length Of Stay ◽  
Conversion Rate ◽  
Thoracoscopic Surgery ◽  
Lung Resection ◽  
Single Centre ◽  
Vats Lobectomy ◽  
Video Assisted ◽  
Intraoperative Conversion ◽  
Video Assisted Thoracoscopic Surgery

INTRODUCTION Unplanned conversion to thoracotomy remains a major concern in video assisted thoracoscopic surgery (VATS) lobectomy. This study aimed to investigate the development of a VATS lobectomy programme over a five-year period, with a focus on the causes and consequences of unplanned conversions. METHODS A single centre retrospective review was performed of patients who underwent complete anatomical lung resection initiated by VATS between January 2010 and April 2015. RESULTS In total, 1,270 patients underwent a lobectomy in the study period and 684 (53.9%) of these were commenced thoracoscopically. There were 75 cases (10.9%) with unplanned conversion. The proportion of lobectomies started as VATS was significantly higher in the second half of the study period (2010–2012: 277/713 [38.8%], 2013–2015: 407/557 [73.1%], p<0.001). The conversion rate dropped initially from 20.4% (11/54) in 2010 to 9.9% (15/151) in 2013 and then remained consistently under 10% until 2015. Conversions were most commonly secondary to vascular injury (26/75, 34.7%). Patients undergoing unplanned conversion had a longer length of stay than VATS completed patients (9 vs 6 days, p<0.001). There was a higher incidence of respiratory failure (10/75 [14.1%] vs 23/607 [3.8%], p<0.001) and 30-day mortality (7/75 [9.3%] vs 6/607 [1.0%], p=0.003) in patients with unplanned conversion than in those with completed VATS. CONCLUSIONS As our VATS lobectomy programme developed, the unplanned conversion rate dropped initially and then remained constant at approximately 10%. With increasing unit experience, it is both safe and technically possible to complete the majority of lobectomy procedures thoracoscopically.

scholarly journals Continuous surgical multi-level extrapleural block for video-assisted thoracoscopic surgery: a retrospective study assessing its efficacy as pain relief following lobectomy and wedge resection

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1783 ◽  
Author(s):  
Mark Larsson ◽  
Anders Öwall ◽  
Ulrik Sartipy ◽  
Anders Franco-Cereceda ◽  
Barbro Johansson ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Rating Scale ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Vats Lobectomy ◽  
Video Assisted ◽  
Analgesic Regimen ◽  
Multi Level ◽  
Pain At Rest ◽  
Video Assisted Thoracoscopic Surgery

Background: Video-assisted thoracoscopic surgery (VATS) causes less postoperative pain than thoracotomy; however, adequate analgesia remains vital. As part of a multi-modal postoperative analgesia, a continuous surgeon-placed extrapleural block catheter is an option. The aim of this retrospective study was to evaluate the analgesic efficacy of a continuous extrapleural block as part of a multimodal analgesic regimen after VATS in general, and VATS lobectomy and wedge resection in particular. Methods: Case records for patients having undergone VATS surgery and been provided a multi-level continuous extrapleural block with an elastomeric pump infusing levobupivacaine 2.7 mg/ml at a rate of 5 ml/h during 2015 and 2016 were reviewed. Pain (Numeric Rating Scale) at rest and mobilisation as well as opioid requirement (daily, postoperative days 0-3, as well as accumulated) were analysed.    Results: In all, 454 records were reviewed: 150 wedge resections, 264 lobectomies and 40 miscellaneous cases. At rest, pain was mild median NRS rated 3-3-1-1 for postoperative day (POD) 0 to 3, during movement, pain was rated moderate during POD 0 and 1 and mild the remaining days (median NRS 4-4-3-3 for POD 0-3). The proportion of patients exhibiting mild pain at rest increased from 55% on POD 0 to 81 % on POD 3. The percentage of patients experiencing severe pain at rest decreased from 15% to 6%. Median oxycodone consumption was 10 mg per day for POD 1-3. Pain after VATS wedge resection was significantly lower at POD 1 and 3 compared to pain after VATS lobectomy. Conclusion: We found a continuous surgeon-placed extrapleural catheter block to be a valuable and seemingly safe addition to our multimodal procedure specific analgesia after VATS. Whether the efficacy of the block can be improved by increasing local anaesthetic and/or adding adjuncts warrants further investigation.

Comparison of Postoperative Pain and Recovery between Single-Port and Two-Port Thoracoscopic Lobectomy for Lung Cancer

2018 ◽  
Vol 67 (02) ◽  
pp. 142-146 ◽  
Author(s):  
Zhengcheng Liu ◽  
Rusong Yang ◽  
Feng Shao
Keyword(s):  
Postoperative Pain ◽  
Single Port ◽  
Thoracoscopic Surgery ◽  
Mediastinal Lymph Node ◽  
Perioperative Outcomes ◽  
Vats Lobectomy ◽  
Video Assisted ◽  
Incision Size ◽  
Wound Pain ◽  
Video Assisted Thoracoscopic Surgery

Objective To investigate whether the single-port (SP) technique had more favorable postoperative outcomes than had the two-port (TP) technique. Methods One hundred sixty-six single-port video-assisted thoracoscopic surgery (SP-VATS) lobectomy and 162 two-port video-assisted thoracoscopic surgery (TP-VATS) lobectomy had been successfully completed between August 2015 and September 2016. A single incision of ∼3 cm was made in an intercostal space along the anterior axillary line. Perioperative outcomes and the safety between SP-VATS and TP-VATS lobectomy for NSCLC was compared. Results In the SP-VATS group, incision size was kept to a minimum, with a median of 3 cm; mediastinal lymph node dissection was performed in all patients with malignancy. Overall, median operative time was 89 minutes, and median chest tube duration was 3.1 days. The VAS on postoperative days 3, 7, and 14 was less in the SP-VATS group than that in the TP-VATS group. The VAS on days 1, 30, 60, 90, 180, and 360 did not differ significantly between the two groups. The number of days of use of analgesic agents after surgery was less in the SP-VATS group. The pathological symptoms of wound pain were significantly less in the SP-VATS group. Conclusions Compared with the multiport approach, SP VATS lobectomy might reduce postoperative pain and lead to faster recovery.

Video-Assisted Thoracoscopic Lobectomy in Children: Safety and Efficacy Compared with the Conventional Thoracotomy Approach

2012 ◽  
Vol 7 (6) ◽  
pp. 394-398 ◽  
Author(s):  
Yong Won Seong ◽  
Byung Su Yoo ◽  
Jin Tae Kim ◽  
In Kyu Park ◽  
Chang Hyun Kang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Patients ◽  
Thoracoscopic Surgery ◽  
Univariate Analysis ◽  
Lung Ventilation ◽  
Vats Lobectomy ◽  
Single Lung Ventilation ◽  
Video Assisted ◽  
History Of ◽  
Video Assisted Thoracoscopic Surgery

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.

Evaluating competency in video-assisted thoracoscopic surgery (VATS) lobectomy performance using a novel assessment tool and virtual reality simulation

2018 ◽  
Vol 33 (5) ◽  
pp. 1465-1473 ◽  
Author(s):  
Katrine Jensen ◽  
Henrik Jessen Hansen ◽  
René Horsleben Petersen ◽  
Kirsten Neckelmann ◽  
Henrik Vad ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Assessment Tool ◽  
Thoracoscopic Surgery ◽  
Virtual Reality Simulation ◽  
Vats Lobectomy ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery
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