scholarly journals VIDEO-ASSISTED RESECTIONS FOR PULMONARY TUBERCULOSIS WITH THE PRESENCE OF PLEURAL CAVITY OBLITERATION

2021 ◽  
Vol 29 (2) ◽  
pp. 53-57
Author(s):  
M. S. Opanasenko ◽  
◽  
V. I. Lysenko ◽  
O. V. Tereshkovych ◽  
B. N. Konik ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Pulmonary Tuberculosis ◽  
Pleural Cavity ◽  
Intraoperative Complications ◽  
Lung Resection ◽  
Parietal Pleura ◽  
Tuberculosis Patients ◽  
Video Assisted ◽  
Regular Open ◽  
Cavity Obliteration

Pulmonary tuberculosis surgery is characterized by a number of aspects associated with adhesions in the pleural cavity, fibrosis of the lung root, destruction of the parenchyma, which contribute to the development of intra- and postoperative complications such as residual pleural cavity and reactivation of tuberculosis in operated lung due to compensatory tissue distortion. Aim: to improve video-assisted lung resection (VATS) in tuberculosis patients with the presence of pleural cavity obliteration. Materials and methods. The developed method of VATS for tuberculosis patients with pleural cavity obliteration is based on separate intubation of right and left main bronchi for mechanical ventilation of one lung, placement of thoracic port, performing revision of pleural cavity using video-assisted thoracoscopy, performing mini-thoracotomy and resection of lung with separate treatment of anatomical structures in required volume by means of disposable stapler or regular open thoracotomy instruments, pleural cavity draining and layered wound closure. Computed tomography of chest is performed during the operation in order to assess the extent and severity of pleural adhesions and to locate safe position of thoracic ports. Hydraulic needle preparation of parietal pleura is performed in severe adhesions area. Hemorrhage is treated using hemostatic plate Surgicel Fibrillar made of restored cellulose. Phrenicotripsy, pleural cavity drainage and, finally, artificial pneumoperitoneum are performed. The proposed method of video-assisted lung resection was used in 41 patients, 25 patients underwent video-assisted resection according to the prototype method. Results. The proposed method reduced duration of the surgical intervention by 52.7 minutes; the frequency of intraoperative complications by 14.4%; the incidence of postoperative complications by 14.2; the duration of patient�s stay at the hospital by 5.8 days and increased of overall treatment efficiency by 14.5%. The proposed method of VATS for patients with pulmonary tuberculosis and pleural cavity obliteration is safe, effective, simple to implement and can be performed at thoracic surgery departments of various pulmonary hospitals of city and regional level. Key words: pulmo

scholarly journals Comparison of postoperative complications between segmentectomy and lobectomy by video-assisted thoracic surgery: a multicenter study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Benoît Bédat ◽  
Etienne Abdelnour-Berchtold ◽  
Thomas Perneger ◽  
Marc-Joseph Licker ◽  
Alexandra Stefani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Thoracic Surgery ◽  
Benign Lesion ◽  
Lung Resection ◽  
Primary Lung Cancer ◽  
Forced Expiratory Volume ◽  
University Hospitals ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted

Abstract Background Compared to lobectomy by video-assisted thoracic surgery (VATS), segmentectomy by VATS has a potential higher risk of postoperative atelectasis and air leakage. We compared postoperative complications between these two procedures, and analyzed their risk factors. Methods We reviewed the records of all patients who underwent anatomical pulmonary resections by VATS from January 2014 to March 2018 in two Swiss university hospitals. All complications were reported. A logistic regression model was used to compare the risks of complications for the two interventions. Adjustment for patient characteristics was performed using a propensity score, and by including risk factors separately. Results Among 690 patients reviewed, the major indication for lung resection was primary lung cancer (86.4%) followed by metastasis resection (5.8%), benign lesion (3.9%), infection (3.2%) and emphysema (0.7%). Postoperatively, there were 80 instances (33.3%) of complications in 240 segmentectomies, and 171 instances (38.0%) of complications in 450 lobectomies (P = 0.73). After adjustment for the patient’s propensity to be treated by segmentectomy rather than lobectomy, the risks of a complication remained comparable for the two techniques (odds ratio for segmentectomy 0.91 (0.61–1.30), p = 0.59). Length of hospital stay and drainage duration were shorter after segmentectomy. On multivariate analysis, an American Society of Anesthesiologists score above 2 and a forced expiratory volume in one second below 80% of predicted value were significantly associated with the occurrence of complications. Conclusions The rate of complications and their grade were similar between segmentectomy and lobectomy by VATS.

Management of Pleural Empyema with Single-Port Video-Assisted Thoracoscopy

2012 ◽  
Vol 7 (5) ◽  
pp. 338-345 ◽  
Author(s):  
Alessandro Marra ◽  
Christoph Huenermann ◽  
Bernd Ross ◽  
Ludger Hillejan
Keyword(s):  
Chest Tube ◽  
Pleural Cavity ◽  
Single Port ◽  
Intraoperative Complications ◽  
Operation Time ◽  
Pleural Empyema ◽  
Metastatic Colon Cancer ◽  
Invasive Treatment ◽  
Female Ratio ◽  
Video Assisted

Objective The aim of this study was to evaluate the safety and efficacy of an original technique of single-port video-assisted thoracoscopy (S-VATS) for the minimally invasive treatment of pleural empyema in fibrinopurulent stage. Methods Single-port video-assisted thoracoscopy was performed under general anesthesia and single-lung ventilation using a 2-cm incision after ultrasound localization of the projected midpoint of the pleural effusion. Through the single access, a video scope and standard thoracoscopy instruments were simultaneously introduced to perform debridement and lavage of the pleural cavity. Postoperatively, patients underwent continuous or intermittent pleural irrigation through the chest tube until microbiological confirmation of sterility of the pleural fluid. Results Between November 2004 and December 2009, a total of 61 patients underwent S-VATS for pleural empyema in stage I(7%) or II (93%). Median age was 63.5 years (range, 22–94 years). Male-to-female ratio was 4.2. Surgery was performed 3 to 60 days after the onset of symptoms. Macroscopically complete debridement of the pleural cavity was achieved in most (98%) cases. Median operation time was 53 minutes (range, 29–90 minutes). No intraoperative complications occurred. In-hospital mortality and morbidity rates were 3% and 16%, respectively. Deaths were caused by diffuse metastatic colon cancer in one case and severe apoplectic insult in the other. Chest tube was removed after a median time of 12 days (range, 4–64 days). Four (6.5%) patients experienced a relapse of empyema; this was caused by complicated residual pleural space (two cases), persistent pleuropulmonary fistula (one case), or both (one case). Conclusions It seems that S-VATS is a safe and effective procedure for the treatment of pleural empyema in fibrinopurulent stage.

Ist die Adipositas ein Risikofaktor für postoperative Komplikationen nach Lungenlappenresektion?

2019 ◽  
Vol 7 (4) ◽  
pp. 200-201
Author(s):  
Thomas Lesser
Keyword(s):  
Postoperative Complications ◽  
Intraoperative Complications ◽  
Lung Resection ◽  
Postoperative Mortality ◽  
Obesity Paradox ◽  
P Value ◽  
Obese Patients ◽  
Short Term ◽  
Lung Lobectomy ◽  
The Impact

Background: The aim of the present study was to evaluate the impact of BMI on the short-term outcomes of patients undergoing lung lobectomy. Methods: This was a retrospective clinical cohort study conducted in a single institution to assess the short-term outcomes of obese patients undergoing lung resection. Intraoperative and postoperative parameters were compared between the two study subgroups: obese (BMI ≥30 kg/m2) and non-obese patients (BMI <30 kg/m2). Results: In total, 203 patients were enrolled in the study (70 obese and 133 non-obese patients). Both study subgroups were comparable with regards to demographics, clinical data and surgical approach (thoracoscopy vs. thoracotomy). The surgery time was significantly longer in obese patients (p = 0.048). There was no difference in the frequency of intraoperative complications between the study subgroups (p = 0.635). The postoperative hospital stay was similar in both study subgroups (p = 0.366). A 30-day postoperative morbidity was higher in a subgroup of non-obese patients (33.8% vs. 21.7%), but the difference was not significant (p = 0.249). In the subgroup of non-obese patients, a higher frequency of mild and severe postoperative complications was observed. However, the differences between the study subgroups were not statistically significant due to the borderline p-value (p = 0.053). The 30-day postoperative mortality was comparable between obese and non-obese patients (p = 0.167). Conclusions: Obesity does not increase the incidence and severity of intraoperative and postoperative complications after lung lobectomy. Slightly better outcomes in obese patients indicate that obesity paradox might be a reality in patients undergoing lung resection.

scholarly journals Frequency and nature of complications after lung resections for tuberculosis in HIV-infected patients

2018 ◽  
Vol 177 (5) ◽  
pp. 74-79
Author(s):  
D. V. Alkaz ◽  
T. S. Basek ◽  
Yu. I. Pashina ◽  
D. Sh. Dzhamshedov ◽  
A. M. Panteleev ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Pulmonary Tuberculosis ◽  
Comparison Group ◽  
Intraoperative Complications ◽  
Resistant Tuberculosis ◽  
Clinically Significant ◽  
Antituberculous Chemotherapy ◽  
Lung Resections ◽  
Hiv Negative

The objectiveof this work was to study the frequency and nature of complications after lung resections for tuberculosis in HIV-infected patients.Material and methods. Retrospective and prospective analysis of complications after lung resections for tuberculosis in 80 HIV-infected and 117 HIV-negative patients was carried out. Developed complications are divided into nonspecific and specific complications, according to the modified Russian classification of postoperative complications on the basis of Accordion classification.Results. It was noted that among the operated HIV-infected patients, XDR-TB (extensive drug-resistant tuberculosis) and clinically significant concomitant diseases were more common. Differences in the frequency of intraoperative complications in groups have not been established. Postoperative complications were mostly disposable, the frequency of deaths in the main group did not differ from that in the comparison group.Conclusion.Surgical treatment of pulmonary tuberculosis in HIV-infected patients is reasonable and justified, in general for patients with pulmonary tuberculosis, with adequate antituberculous chemotherapy and antiretroviral therapy.

The Role of Video-Assisted Thoracoscopic Surgery in Therapeutic Lung Resection for Pulmonary Tuberculosis

2013 ◽  
Vol 95 (1) ◽  
pp. 257-263 ◽  
Author(s):  
Yi-Ting Yen ◽  
Ming-Ho Wu ◽  
Wu-Wei Lai ◽  
Jia-Ming Chang ◽  
I-Lin Hsu ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Thoracoscopic Surgery ◽  
Lung Resection ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Predicted versus observed respiratory parameters after lung resection in different postoperative periods in pulmonary tuberculosis patients

2019 ◽  
Author(s):  
Nina Denisova ◽  
Larisa Kiryukhina ◽  
Natalia Nefedova ◽  
Grigorii Kudriashov ◽  
Eugeniy Sokolovich ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Lung Resection ◽  
Tuberculosis Patients ◽  
Respiratory Parameters

scholarly journals The use of transdermal therapeutic systems for chemical pleurodesis in a patient with prolonged air leakage after lung resection for cancer

2021 ◽  
Vol 2 (4) ◽  
pp. 18-25
Author(s):  
D. A. Rozenko ◽  
N. D. Ushakova ◽  
S. N. Tikhonova ◽  
Yu. N. Lazutin ◽  
N. N. Popova ◽  
...  
Keyword(s):  
Pain Relief ◽  
Pleural Cavity ◽  
Lung Resection ◽  
The Body ◽  
Parietal Pleura ◽  
External Respiration ◽  
Air Leakage ◽  
Narcotic Drug ◽  
Chemical Pleurodesis ◽  
Sharp Drop

This clinical observation demonstrates a method of a motivated use of a transdermal therapeutic system (TTS) based on fentanyl for chemical pleurodesis in a patient with prolonged air leakage after lung resection for cancer. The most common complication after elective lung resections is an alveolar-pleural fistula or prolonged air leakage. This clinical phenomenon occurs as a result of communication between the alveoli of the lung parenchyma distal to the segmental bronchus and the pleural cavity. In most cases, air leakage through the drains is eliminated spontaneously, but the frequency of prolonged pneumostasis absence in the postoperative period can reach 25 %, which has a negative effect on the outcomes of surgical interventions due to the development of pneumonia and empyema. Long-term drainage of the pleural cavity does not always end with aerostasis and requires repeated invasive interventions. One of the ways to achieve the tightness of the lung tissue involves various methods of chemical pleurodesis, which is a surgical manipulation – the introduction of a sclerosing chemical substance into the pleural cavity by spraying medical talc through a trocar or a injecting tetracycline solution into the pleural drains. The chemical causes aseptic inflammation and adhesions between the visceral and parietal pleura, followed by obliteration of the pleural cavity. The sclerosant introduction is accompanied by severe pain that can provoke respiratory and/or hemodynamic deficits, up to apnea and life-threatening heart rhythm disturbances. Pain relief during chemical pleurodesis is obviously an important factor in the prevention of a number of complications in patients undergoing surgery for lung cancer. Bolus intravenous injections of narcotic analgesics lead to an analgesic effect, but a short-term one due to the absence of a depot in the body and a sharp drop in the drug concentration in the blood serum. Unfortunately, this method of introducing narcotic drugs can cause various complications in weakened and elderly cancer patients, such as respiratory depression and cardiac arrest. The TTS action is characterized with continuous dosing and the creation of a constant concentration of the narcotic drug over a certain period of time. This method provides a multilevel and systematic approach to pain relief, reduces toxicity and minimizes the inhibition of the central mechanisms of external respiration regulation without causing respiratory and cardiac disorders in patients who underwent lung resection.

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