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BACKGROUND: The erector spinae plane block (ESPB) is a valuable alternative for pain management after video-assisted thoracoscopy surgery (VATS). The incidence of postoperative chronic neuropathic pain (CNP) is high while the quality of life (QoL) after VATS remains unknown. We hypothesised that patients with ESPB would have a low incidence of acute and CNP and would report a good QoL up to three months after VATS. METHODS: We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively. RESULTS: We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively. CONCLUSIONS: We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively.
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Bloqueo Nervioso , Neuralgia , Dolor Postoperatorio , Calidad de Vida , Humanos , Dolor Postoperatorio/epidemiología , Proyectos Piloto , Estudios Prospectivos , Cirugía Torácica Asistida por Video/efectos adversosRESUMEN
Abstract Objective To analyze the effects of an ERAS program on complication rates, readmission, and length of stay in patients undergoing pulmonary resection in a tertiary university hospital. Methods Ambispective cohort study with a prospective arm of 50 patients undergoing thoracic surgery within an ERAS program (ERAS group) versus a retrospective arm of 50 patients undergoing surgery before the protocol was implemented (Standard group). The primary outcome was the number of patients with 30-day surgical complications. Secondary outcomes included ERAS adherence, non-surgical complications, mortality, readmission, reintervention rate, pain, and hospital length of stay. We performed a multivariate logistic analysis to study the correlation between outcomes and ERAS adherence. Results In the univariate analysis, we found no difference between the two groups in terms of surgical complications (Standard 18 [36%] vs. ERAS 12 [24%], p = 0.19). In the ERAS group, only the readmission rate was significantly lower (Standard 15 [30%] vs. ERAS 6 [12%], p = 0.03). In the multivariate analysis, ERAS adherence was the only factor associated with a reduction in surgical complications (OR [95% CI] = 0.02 [0.00, 0.59], p = 0.03) and length of stay (HR [95% CI] = 18.5 [4.39, 78.4], p < 0.001). Conclusions The ERAS program significantly reduced the readmission rate at our hospital. Adherence to the ERAS protocol reduced surgical complications and length of stay.
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Humanos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Cirugía Torácica , Estudios Prospectivos , Estudios Retrospectivos , Estudios de Cohortes , Hospitales , Tiempo de InternaciónRESUMEN
OBJECTIVE: To analyze the effects of an ERAS program on complication rates, readmission, and length of stay in patients undergoing pulmonary resection in a tertiary university hospital. METHODS: Ambispective cohort study with a prospective arm of 50 patients undergoing thoracic surgery within an ERAS program (ERAS group) versus a retrospective arm of 50 patients undergoing surgery before the protocol was implemented (Standard group). The primary outcome was the number of patients with 30-day surgical complications. Secondary outcomes included ERAS adherence, non-surgical complications, mortality, readmission, reintervention rate, pain, and hospital length of stay. We performed a multivariate logistic analysis to study the correlation between outcomes and ERAS adherence. RESULTS: In the univariate analysis, we found no difference between the two groups in terms of surgical complications (Standard 18 [36%] vs. ERAS 12 [24%], p=0.19). In the ERAS group, only the readmission rate was significantly lower (Standard 15 [30%] vs. ERAS 6 [12%], p=0.03). In the multivariate analysis, ERAS adherence was the only factor associated with a reduction in surgical complications (OR [95% CI]=0.02 [0.00, 0.59], p=0.03) and length of stay (HR [95% CI]=18.5 [4.39, 78.4], p<0.001). CONCLUSIONS: The ERAS program significantly reduced the readmission rate at our hospital. Adherence to the ERAS protocol reduced surgical complications and length of stay.
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Complicaciones Posoperatorias , Cirugía Torácica , Humanos , Estudios de Cohortes , Estudios Retrospectivos , Estudios Prospectivos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Hospitales , Tiempo de InternaciónRESUMEN
Background Ectopic deciduosis is a benign presence of endometrial tissue outside of the uterus during pregnancy that rarely presents with pleuropulmonary manifestations and recurrent pneumothorax. Case Description We report a 35-year-old woman at 15 weeks' gestation with a history of recurrent intrapartum right pneumothorax found to have pleural, pulmonary, and diaphragmatic lesions and a middle lobe air leak. Wedge resection of the middle lobe and mechanical pleurodesis was performed. Histopathological analysis was progesterone receptor and PAX8 positive consistent with ectopic deciduosis. Conclusion Ectopic deciduosis is a rare cause of recurrent pneumothorax in pregnancy and should be considered when evaluating these patients.
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Thoracic endometriosis is an exceedingly rare condition characterized by the presence of endometriotic deposits on the diaphragm, lungs or pleural space. Patients may present with massive hemothorax, pneumothorax, hemoptysis or pulmonary nodules. It is a complex condition that often proves to be a diagnostic challenge, resulting in under-diagnosis, delays in treatment and significant morbidity in women of reproductive age. We report a case of endometriosis causing massive pleural effusion and ascites, with a left adnexal fibroid mass mimicking Meigs' syndrome in a nulliparous woman in her late 30s. The patient was successfully managed with hormonal therapy following fertility-sparing surgical treatment. This case highlights the diagnostic and therapeutic challenges associated with thoracic endometriosis because of its close resemblance to more sinister gynecological conditions. Hormonal therapy is the long-term treatment of choice in patients with thoracic endometriosis to reduce the risk of symptom recurrence and preserve fertility.
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Brazil is an emerging country with continental proportions, being one of the largest in the world. As big as its territory, are the complexities and singularities within it. Brazilian thoracic surgery reflects the picture of this unique giant, with all its virtues and problems. This peculiar framework of thoracic surgery in Brazil unfolds that the surgeons are usually well trained and can perform this specialty with technical and scientific excellence, making the country to play a true major role in Latin American thoracic surgery. Nevertheless, the chronic social imbalance present in every aspect of the Brazilian daily life hampers this ultra-specialized workforce to be equally and universally available for every citizen, in every corner of the country. Lung transplantation and minimally invasive approaches (including robotics) are performed by many surgeons with good results, comparable to those observed in high-income countries from North America, Europe and Asia. However, these procedures are still performed more often in centers of academic excellence, located at the main cities of the country, which also reflects an unequal access to these approaches within the Brazilian territory. The aim of this paper is to present a broad overview of the practice of general thoracic surgery in Brazil, as well as its main idiosyncrasies.
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Abstract BACKGROUND: Primary hyperhidrosis is a condition characterized by excessive sweating, inconsistent with the needs for thermoregulation. OBJECTIVE: To assess the effectiveness and the change in the quality of life of patients undergoing bilateral VATS (video-assisted thoracoscopic sympathectomy) for treatment of hyperhidrosis, in a large case series. DESIGN AND SETTING: Cohort study conducted in a tertiary hospital specializing in hyperhidrosis located in São Paulo, Brazil. METHODS: A total of 2,431 patients who underwent surgery consisting of bilateral video-assisted thoracoscopic sympathectomy between January 2000 and February 2017 were retrospectively assessed in an outpatient clinic specializing in hyperhidrosis. The patients underwent clinical and quality of life assessments on two occasions: firstly, prior to surgery, and subsequently, one month after the operation. The presence or absence of compensatory hyperhidrosis (CH) and general satisfaction after the first postoperative month were also evaluated. RESULTS: All the patients operated had poor or very poor quality of life before surgery. In the postoperative period, an improvement in the quality of life was observed in more than 90% of the patients. Only 10.7% of the patients did not present CH, and severe CH occurred in 22.1% of the patients in this sample. CONCLUSION: Bilateral VATS is a therapeutic method that decreases the degree of sweating more than 90% of patients with palmar and axillary hyperhidrosis. It improves the quality of life for more than 90% of the patients, at the expense of development of CH in approximately 90% of the patients, but not intensely.
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Humanos , Cirugía Torácica Asistida por Video/efectos adversos , Cirugía Torácica Asistida por Video/métodos , Hiperhidrosis/cirugía , Hiperhidrosis/etiología , Calidad de Vida , Simpatectomía/efectos adversos , Simpatectomía/métodos , Brasil , Estudios Retrospectivos , Estudios de Cohortes , Resultado del Tratamiento , Satisfacción del PacienteRESUMEN
Locally advanced lung cancer, defined by nodal involvement in upper mediastinal stations (N2) (stage IIIA-N2), includes a wide spectrum of patients with multiple therapeutic alternatives. Such heterogeneity is explained, at least in part, by tumor size and magnitude of mediastinal nodal involvement. In this setting, many variants can influence the prognosis, such as the specific nodal stations compromised, the burden of mediastinal disease, and the presence of skip metastasis. In the surgical field, the advent of minimally invasive techniques, including video-assisted thoracoscopic and robotic surgery, have revolutionized the management of early-stage lung cancer, but implementations of these approaches in the locally advanced setting have been erratic. This review attempts to highlight the most relevant scientific data of the surgical management of locally advanced lung cancer patients, analyzing not only the medical evidence but also the cost-effectiveness and accessibility.
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OBJECTIVE: We hypothesize that segmentectomy is associated with similar recurrence-free and overall survival when compared with lobectomy in the setting of patients with clinical T1cN0M0 non-small cell lung cancer (NSCLC; >2-3 cm), as defined by the American Joint Committee on Cancer 8th edition staging system. METHODS: We performed a single-institution retrospective study identifying patients undergoing segmentectomy (90) versus lobectomy (279) for T1c NSCLC from January 1, 2003, to December 31, 2016. Univariate, multivariable, and propensity score-weighted analyses were performed to analyze the following endpoints: freedom from recurrence, overall survival, and time to recurrence. RESULTS: Patients undergoing segmentectomy were older than patients undergoing lobectomy (71.5 vs 68.8, respectively, P = .02). There were no differences in incidence of major complications (12.4% vs 11.7%, P = .85), hospital length of stay (6.2 vs 7 days, P = .19), and mortality at 30 (1.1% vs 1.7%, P = 1) and 90 days (2.2% vs 2.3%, P = 1). In addition, there were no statistical differences in locoregional (12.2% vs 8.6%, P = .408), distant (11.1% vs 13.9%, P = .716), or overall recurrence (23.3% vs 22.5%, P = 1), as well as 5-year freedom from recurrence (68.6% vs 75.8%, P = .5) or 5-year survival (57.8% vs 61.0%, P = .9). Propensity score-matched analysis found no differences in overall survival (hazard ratio [HR], 1.034; P = .764), recurrence-free survival (HR, 1.168; P = .1391), or time to recurrence (HR, 1.053; P = .7462). CONCLUSIONS: In the setting of clinical T1cN0M0 NSCLC, anatomic segmentectomy was not associated with significant differences in recurrence-free or overall survival at 5 years. Further prospective randomized trials are needed to corroborate the expansion of the role of anatomic segmentectomy to all American Joint Committee on Cancer 8th Edition Stage 1A NSCLC.
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Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Neumonectomía/mortalidad , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
En las dos últimas décadas la evolución de la cirugía mínimamente invasiva del tórax ha transmutado de un abordaje de tres puertos, siguiendo dos puertos hasta llegar a puerto único, conocido también como VATS Uniportal, procurando un confort mucho mejor para el paciente y resultados quirúrgicos similares. Objetivos. Presentar la técnica quirúrgica de VATS Uniportal en un hospital nacional, efectuadas por un experto internacional en este campo. Pacientes y Métodos. Se presentan dos casos clínicos quirúrgicos: El de una paciente con Miastenia Gravis a quien se le realizó timectomía por abordaje sub-xifoideo y otra paciente, a quien se le completó una lobectomía inferior derecha por hallazgos de patología posterior a la resección de un nódulo pulmonar solitario, reportado como cáncer primario de pulmón. Conclusiones. La técnica de cirugía mínimamente invasiva, VATS Uniportal, ofrece grandes beneficios para el paciente, tanto estéticos como funcionales y su aprendizaje es posible con la transmisión de conocimientos y experiencias directa con la presencia del experto o indirectas a través de la información publicada. (AU)
In the last two decades, the evolution of minimally invasive chest surgery has transmuted from a three-port approach, following two ports until reaching a single port, also known as VATS Uniportal, seeking much better comfort for the patient and similar surgical results. Objective. Present the VATS Uniportal surgical technique in a national hospital, performed by an international expert in this field. Patients and Methods. Two surgical clinical cases are presented: that of a patient with Myasthenia Gravis who underwent thymectomy through the sub-xiphoid approach and another patient, who underwent a right lower lobectomy due to findings of pathology after the resection of a pulmonary nodule. solitary, reported as primary lung cancer. Conclusions. The minimally invasive surgery technique, VATS Uniportal, offers great benefits for the patient, both aesthetic and functional and its learning is possible with the transmission of knowledge and experiences directly with the presence of the expert or indirectly through published information. (AU)
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Humanos , Femenino , Adulto , Anciano , Timectomía/métodos , Cirugía Torácica Asistida por Video/métodos , Neumonectomía/métodos , Toracoscopía/instrumentación , Miastenia Gravis/complicacionesRESUMEN
Congenital pulmonary airway malformations (CPAM) are rare and occur due to a failure in lung embryological development. They are classified according to their pathological characteristics and their anatomical origin. They can occur from the antenatal period to adulthood, can be associated with hydrops fetalis, respiratory distress, recurrent infections, or in an otherwise asymptomatic patient. In this article we carry out a scope review of the literature to answer frequent questions of the clinical teams in charge of patients with CPAM, such as the antenatal approach, the different types of surgeries and the management of asymptomatic patients. Although the indication for surgery is clear in symptomatic patients, little is known about its natural history of this condition, including the possibility of spontaneous resolution and the development of complications or neoplasm. So, the treatment of asymptomatic patients continues to be controversial. Therapeutic decisions must be made by multidisciplinary teams with the informed participation of parents and patients. In our opinion, considering the excellent results of minimally invasive surgery, its low incidence of complications, and practically zero mortality when performed by experienced groups, it seems reasonable to consider elective resection of a MCVAP in asymptomatic patients.
Las malformaciones congénitas de la vía aérea pulmonar (MCVAP) son infrecuentes y ocurren debido a una falla en el desarrollo embriológico pulmonar. Se clasifican de acuerdo con sus características patológicas y a su origen anatómico. Se pueden presentar desde el periodo antenatal hasta la adultez, asociarse a cuadros de hidrops fetal, distrés respiratorio, infecciones recurrentes, o como un hallazgo en pacientes asintomáticos. En este artículo realizamos una revisión bibliográfica exploratoria para responder dudas frecuentes de los equipos clínicos a cargo de pacientes con MCVAP, como el enfrentamiento antenatal, los distintos tipos de cirugía y su abordaje, y el manejo de pacientes asintomáticos. Si bien la indicación de cirugía es clara en pacientes sintomáticos, poco se conoce acerca de su historia natural, incluyendo la posibilidad de resolverse de forma espontánea, de complicarse o de evolucionar hacia el desarrollo de una neoplasia, por lo que el tratamiento de pacientes asintomáticos continúa siendo controversial. Las decisiones terapéuticas deben ser tomadas por equipos multidisciplinarios con la participación informada de los padres y de los pacientes. En nuestra opinión, considerando los excelentes resultados de la cirugía mínimamente invasiva, su baja incidencia de complicaciones y prácticamente nula mortalidad, al ser realizada por grupos con experiencia, nos parece razonable plantear la resección electiva de una MCVAP en un paciente asintomático.
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Humanos , Niño , Anomalías del Sistema Respiratorio/cirugía , Neumonectomía , Atención Prenatal , Imagen por Resonancia Magnética , Toracotomía , Radiografía Torácica , Malformación Adenomatoide Quística Congénita del Pulmón/cirugía , Anomalías del Sistema Respiratorio/clasificación , Anomalías del Sistema Respiratorio/embriología , Anomalías del Sistema Respiratorio/diagnóstico por imagen , Riesgo , Pulmón/anomalíasRESUMEN
Cardiac rhythm disorders are common in many patients with cancer. The management of synchronous long-standing persistent atrial fibrillation and pulmonary lesions remains a serious surgical dilemma due to the lack of clinical data and surgical guidelines. To the best of our knowledge, this is the first described case of simultaneous thoracoscopic pulmonary segmentectomy and left atrial posterior wall and pulmonary vein isolation combined with left atrial appendage resection in a patient with early-stage primary lung cancer and long-standing persistent atrial fibrillation.
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Adenocarcinoma Mucinoso , Fibrilación Atrial , Ablación por Catéter , Neoplasias Pulmonares , Adenocarcinoma Mucinoso/complicaciones , Adenocarcinoma Mucinoso/diagnóstico por imagen , Adenocarcinoma Mucinoso/cirugía , Anciano , Apéndice Atrial/cirugía , Fibrilación Atrial/complicaciones , Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Femenino , Atrios Cardíacos/cirugía , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Venas Pulmonares/cirugía , Toracoscopía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Abstract Cardiac rhythm disorders are common in many patients with cancer. The management of synchronous long-standing persistent atrial fibrillation and pulmonary lesions remains a serious surgical dilemma due to the lack of clinical data and surgical guidelines. To the best of our knowledge, this is the first described case of simultaneous thoracoscopic pulmonary segmentectomy and left atrial posterior wall and pulmonary vein isolation combined with left atrial appendage resection in a patient with early-stage primary lung cancer and long-standing persistent atrial fibrillation.
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Humanos , Femenino , Anciano , Fibrilación Atrial/cirugía , Fibrilación Atrial/complicaciones , Ablación por Catéter/métodos , Adenocarcinoma Mucinoso/cirugía , Adenocarcinoma Mucinoso/complicaciones , Adenocarcinoma Mucinoso/diagnóstico por imagen , Neumonectomía/métodos , Venas Pulmonares/cirugía , Toracoscopía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Apéndice Atrial/cirugía , Atrios Cardíacos/cirugía , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico por imagenRESUMEN
A 36-year-old-woman, smoker, without other relevant medical history, presented with symptoms of dyspnea, right localized chest pain, and non-productive cough. On the emergency department, the chest X-ray was interpreted as a giant right pneumothorax and a chest drain was inserted. Thoracic computed tomography demonstrated a giant emphysematous bulla with 23 cm on her right upper lobe. We report the first uniportal video-assisted thoracic surgery bullectomy for a bulla greater than 20 cm, in a patient with vanishing lung syndrome.
Una mujer de 36 años de edad, fumadora, se presentó en la sala de emergencias por disnea, tos y dolor torácico derecho. La radiografía fue interpretada como neumotórax y se colocó un tubo de drenaje. La tomografía computarizada del tórax mostró una bulla enfisematosa gigante, de aproximadamente 23 cm. Reportamos el primer caso de bullectomía por uniportal VATS en una paciente con síndrome del pulmón evanescente que presentaba una bulla mayor de 20 cm.
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Neumotórax , Enfisema Pulmonar , Adulto , Vesícula/diagnóstico por imagen , Vesícula/cirugía , Femenino , Humanos , Pulmón , Neumotórax/diagnóstico por imagen , Neumotórax/etiología , Neumotórax/cirugía , Enfisema Pulmonar/diagnóstico por imagen , Enfisema Pulmonar/cirugía , Cirugía Torácica Asistida por VideoRESUMEN
Resumen Introducción: Uno de los mayores avances de las últimas décadas en la cirugía de tórax ha sido el desarrollo de la cirugía mínimamente invasiva. Objetivos: Describir la experiencia en videotoracoscopía (VATS) Uniportal de miembros del equipo de Cirugía de Tórax de la Universidad de Chile en 2 campos clínicos, (Clínica Las Condes y Hospital Clínico de la Universidad de Chile). Materiales y Método: Se estudiaron 105 pacientes sometidos a VATS uniportal entre enero de 2016 y enero de 2019. Los datos se analizaron de manera retrospectiva considerando variables demográficas (edad, sexo) y clínicas (diagnóstico, cirugía, estadía hospitalaria, días de pleurostomía, conversión y complicaciones). Resultados: De las 105 cirugías realizadas, 28 (26,6%) correspondieron a cirugías mayores complejas lobectomías y segmentectomías anatómicas. En 4 pacientes se agregó un 2° puerto, uno se convirtió a minitoracotomía y uno a toracotomía (5,7% conversión global). La estadía hospitalaria fue en promedio 3,07 ± 3,1 días y el promedio de mantención de pleurostomía de 2,67 ± 1,61 días. Siete pacientes (6,6%) presentaron complicaciones postoperatorias. Un paciente falleció por progresión de su enfermedad, no hubo mortalidad relacionada a la cirugía. Discusión: Las contraindicaciones de la VATS uniportal son las mismas que en la VATS multipuerto. En manos experimentadas, las complicaciones en cirugía por puerto único son bajas. Impresiona tener menos dolor postoperatorio, menor estadía hospitalaria y reintegración precoz a las actividades diarias comparado con la VATS tradicional. Conclusiones: Se presenta la primera serie de VATS uniportal publicada en Chile. Los resultados obtenidos son comparables a los observados en la literatura. Su implementación y desarrollo requiere de una curva de aprendizaje similar a cualquier nueva técnica quirúrgica.
Objective: To describe the initial results with uniportal Video-Thoracoscopic Surgery (VATS) performed in two campuses by members of the Section of Thoracic Surgery of the University of Chile ("Clínica Las Condes" and University of Chile Clinical Hospital). Materials and Method: Between January 2016 and January 2019, a total of 105 patients underwent uniportal VATS. Clinical data was collected retrospectively from digital records including demographic (age, sex) and clinical variables (diagnosis, surgery, duration of the chest tube, length of stay, conversion rate and postoperative complications). Results: Uniportal VATS was performed on 105 patients during the study period. Twenty-eight cases (26.6%) corresponded to lobectomy or anatomic segmentectomy. In 4 cases a 2nd port was required, 1 patient had to be converted to mini-thoracotomy and 1 to thoracotomy (5.8% global conversion). Overall, the median length of stay was 3.07 ± 3.1 days and the median duration of chest tube drainage was 2.67 ± 1.61 days. Seven patients (6.6%) presented complications. One patient died due to progression of his disease, there were no deaths related to the procedures. Discussion: Uniportal VATS has similar indications than multiportal VATS. On experienced hands, uniportal VATS has a low morbidity rate. Uniportal VATS appears to produce less post-operative pain, with shorter hospital stay and a faster return to normal life compared to standard VATS. Conclusion: We present the first uniportal VATS series in Chile. Results were similar to published series. Implementation and development of uniportal VATS requires a learning curve similar to any new surgical procedure.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Cirugía Torácica Asistida por Video/efectos adversos , Cirugía Torácica Asistida por Video/métodos , Chile , Estudios Retrospectivos , Procedimientos Quirúrgicos Mínimamente Invasivos , Procedimientos Quirúrgicos Torácicos/métodos , Cirugía Torácica Asistida por Video/instrumentaciónRESUMEN
Tracheal resection followed by reconstruction is one of the most difficult procedures in thoracic surgery. Intrathoracic tracheal injuries were usually treated by sternotomy, thoracotomy, or a combination of these techniques. In the last decade, minimally invasive surgical techniques have become an innovative trend in the treatment of thoracic tracheal conditions. Recent authors have proven the feasibility and safety of tracheal operations using video-assisted thoracoscopic surgery (VATS). This video tutorial demonstrates our technique for intrathoracic tracheal resection performed by VATS, using 2 ports, for the resection of postintubation stenosis. We show the steps performed by the surgical team and pay special attention to the maneuvers needed to operate with greater safety and achieve a tension-free reconstruction. This tutorial provides a method for treating this type of tracheal injury. It is of special interest for surgeons who specialize in the airway.
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Procedimientos de Cirugía Plástica/métodos , Cirugía Torácica Asistida por Video/métodos , Toracotomía/métodos , Estenosis Traqueal/cirugía , Adulto , Femenino , Humanos , Resultado del TratamientoRESUMEN
Mediastinal ectopic parathyroid glands are uncommon. Traditionally, median sternotomies were performed to treat this type of lesion, resulting in a long, painful postoperative period and poor aesthetic results. With the advent of video-assisted thoracoscopic surgery, procedures were performed more frequently by this route with the same surgical and oncological results as those achieved with conventional surgery. The introduction of more sophisticated imaging studies, such as computed tomography, computed tomography-technetium-99m sestamibi scintigraphy, and single-photon emission computed tomography, facilitated identification of the exact location of the lesion. Video-assisted thoracoscopy became a safe approach and the treatment of choice for resection.
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Hiperparatiroidismo Primario/cirugía , Paratiroidectomía/métodos , Cirugía Torácica Asistida por Video/métodos , Anciano , Femenino , Humanos , Hiperparatiroidismo Primario/diagnóstico , Glándulas Paratiroides/diagnóstico por imagen , Glándulas Paratiroides/cirugía , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
Resumen: En los últimos años, la cirugía torácica videoasistida (VATS) se ha realizado con más frecuencia. Aunque la VATS reduce el dolor postoperatorio debido a sus incisiones más pequeñas, el control del dolor después de ésta sigue siendo un desafío. Hasta la fecha, no existen recomendaciones internacionales específicas para este procedimiento, en donde se ha demostrado que el dolor en las primeras 24 horas no difiere mucho del provocado por una toracotomía, dado que los drenajes son un común denominador entre ambos procedimientos y son causa principal de molestia importante entre los pacientes; razón por la cual deben implementarse medidas analgésicas que prevengan este tipo de dolor. Otra consideración importante es la persistencia del dolor, que puede ocasionar síndrome postoracotomía, que se asocia con una disminución significativa de la calidad de vida y a un aumento en la necesidad de medicamentos a largo plazo contra el dolor. El bloqueo eficaz de los aferentes neurales en el postoperatorio reduce el dolor agudo postoracotomía y, por lo tanto, puede entorpecer el desarrollo de dolor crónico. Por lo tanto, se ha sugerido un manejo multimodal efectivo enfocado al procedimiento específico para prevenir el dolor descontrolado en el postoperatorio inmediato; pero sobre todo, para limitar la persistencia de éste a largo plazo. Se debe procurar la utilizacion de técnicas regionales con anestésico local, como el bloqueo del plano erector spinae, el bloqueo paravertebral, el bloqueo serrato y el BRILMA (bloqueo de las ramas intercostales de la línea media axilar), de acuerdo a las necesidades de cada paciente, para lograr un buen alivio del dolor con la mínima administración sistémica de opiáceos, ya que esto mejorará la satisfacción del paciente y su recuperación al reducir los efectos secundarios relacionados con los opioides facilitando la movilización, la fisioterapia efectiva y el alta temprana (para ver el artículo completo visite http://www.painoutmexico.com).
Abstract: In recent years, video-assisted thoracic surgery (VATS) has been performed more frequently. Although VATS reduces postoperative pain due to its smaller incisions, pain control after this remains a challenge. Actually there are no specific international recommendations for this procedure where it has been shown that pain in the first 24 hrs does not differ much from that caused by thoracotomy, due to drains are a common denominator between both procedures and are a major cause of significant discomfort among patients, which is why they should have analgesic measures to prevent this type of pain. Another important consideration is the persistence of pain, which can cause post-thoracotomy syndrome that is associated with a significant decrease in quality of life and an increase in the need for long-term pain medication. Effective blockade of neural afferents in the postoperative period reduces acute post-thoracotomy pain and, therefore, may hinder the development of chronic pain. Therefore, effective multimodal management focused on the specific procedure has been suggested to prevent uncontrolled pain in the immediate postoperative period, but above all to limit its persistence in the long term. The use of regional techniques with local anesthetic, such as the blockade of the erector spinae plane, paravertebral block, serratus block and BRILMA (Intercostal branches of the mid-axillary line block), should be sought, according to the needs of each patient, to achieve good pain relief with minimal systemic administration of opioids, as this will improve patient satisfaction and recovery by reducing side effects related to facilitating mobilization, effective physiotherapy and early discharge (visit http://www.painoutmexico.com to see the full article and recommendations diagram).
RESUMEN
Resumen El concepto de Recuperación Mejorada Después de Cirugía, Enhanced recovery after Surgery (ERAS), engloba una serie de protocolos para el manejo perioperatorio optimizado en diversas patologías quirúrgicas. Los objetivos de estos protocolos son: mejorar los resultados quirúrgicos, disminuir las complicaciones, reducir los días de hospitalización, disminuir los costos asociados a la intervención y, finalmente, favorecer una rehabilitación más rápida. Para una correcta aplicación de estos protocolos, se requiere la interacción y el trabajo de un equipo multidisciplinario. En este artículo, se realizará una puesta al día de las intervenciones más importantes de los procesos perioperatorios de la cirugía torácica.
The concept of ERAS includes a series of optimized perioperative management protocols in various surgical pathologies. The objectives of these protocols are: improve surgical results, reduce complications, reduce length of in-hospital stay, reduce the associated health care costs and finally, favor a more rapid rehabilitation. For the correct application of these protocols, the interaction and work of a multidisciplinary team is required. In this article, an update will be made of the most important interventions in the perioperative processes of thoracic surgery.