RESUMEN
INTRODUCTION: With the introduction of minimally invasive cardiac surgery, more commonly cases of lung herniation are starting to appear. Acquired lung hernias are classified as postoperative, traumatic, pathologic, and spontaneous. Up to 83% of lung hernias are intercostal. Herein, we describe patients presenting with intercostal lung hernias following minimally invasive cardiac surgery at a single center in Medellín, Colombia. METHODS: We conducted a retrospective search of all patients presenting with intercostal lung hernias secondary to minimally invasive cardiac surgery at our clinic in Medellín since the beginning of our program, from 2010 to 2022. Mini-sternotomies were excluded from our study. We reviewed the incision type and other possible factors leading to intercostal lung hernia development. We also describe the approach taken for these patients. RESULTS: From 2010 up until 2022, 803 adult patients underwent minimally invasive cardiac surgeries through a mini-thoracotomy. At the time of data retrieval, nine patients presented with intercostal lung hernias at the previous incision site. Five hernias (55%) were from right 2nd intercostal parasternal mini-thoracotomies for aortic valve surgeries. Four hernias (45%) were from right 4th intercostal lateral mini-thoracotomies for mitral valve surgeries. Our preferred repair technique is a video-assisted thoracoscopic mesh approach. CONCLUSION: Minimally invasive cardiac surgical approaches are becoming more routine. Proper wound closure is critical in preventing lung hernias. Additionally, timely diagnosis and opportune hernia surgery using video-assisted thoracoscopic mesh repair can prevent further complications.
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Procedimientos Quirúrgicos Cardíacos , Enfermedades Pulmonares , Procedimientos Quirúrgicos Mínimamente Invasivos , Humanos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Anciano , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/cirugía , Toracotomía/efectos adversos , Toracotomía/métodos , Herniorrafia/efectos adversos , Herniorrafia/métodos , Hernia/etiología , Adulto , Cirugía Torácica Asistida por Video/efectos adversos , Cirugía Torácica Asistida por Video/métodos , Complicaciones Posoperatorias/etiologíaRESUMEN
BACKGROUND: Thoracoscopic-guided thoracic paravertebral nerve block (TG-TPVB) and thoracoscopic-guided intercostal nerve block (TG-INB) are two postoperative analgesia technology for thoracic surgery. This study aims to compared the analgesic effect of TG-TPVB and TG-INB after uniportal video-asssited thoracic surgery (UniVATS). METHODS: Fifty-eight patients were randomly allocated to the TG-TPVB group and the TG-INB group. The surgical time of nerve block, the visual analog scale (VAS) scores, the consumption of sufentanil and the number of patient-controlled intravenous analgesic (PCIA) presses within 24 h after surgery, the incidence of adverse reactions were compared between the two groups. RESULTS: The VAS scores were significantly lower during rest and coughing at 2, 6, 12, and 24 h in the TG-TPVB group than in the TG-INB group (P < 0.05). The consumption of sufentanil and the number of PCIA presses within 24 h after surgery were significantly lower in the TG-TPVB group than in the TG-INB group (P < 0.001).The surgical time of nerve block was significantly shorter in the TG-TPVB group than in the TG-INB group (P < 0.001). The incidence of bleeding at the puncture point was lower in the TG-TPVB group than that in the TG-INB group (P < 0.05). CONCLUSION: TG-TPVB demonstrated superior acute pain relieve after uniVATS, shorter surgical time and non-inferior adverse effects than TG-INB.
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Nervios Intercostales , Bloqueo Nervioso , Dolor Postoperatorio , Cirugía Torácica Asistida por Video , Humanos , Femenino , Masculino , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Persona de Mediana Edad , Cirugía Torácica Asistida por Video/métodos , Cirugía Torácica Asistida por Video/efectos adversos , Estudios Prospectivos , Estudios de Seguimiento , Anciano , Pronóstico , Adulto , Toracoscopía/métodos , Toracoscopía/efectos adversos , Dimensión del DolorRESUMEN
BACKGROUND: Early postoperative mobilization is important for enhanced recovery but can be hindered by orthostatic intolerance. However, study on postoperative orthostatic intolerance in thoracoscopic lung resection is limited. Thus, this investigation aims to examine the prevalence and variables contributing to orthostatic intolerance on the first day following thoracoscopic lung cancer resection. METHODS: A prospective observational study was conducted from February 01 to May 05, 2023, at the First Affiliated Hospital of Chongqing Medical University. Typically, 215 subjects subjected to thoracoscopic lung resection were enrolled in this study. Their general information, disease, and treatment information were collected, and the occurrence of orthostatic intolerance was recorded. RESULTS: Typically, 64 patients (29.77%) demonstrated orthostatic intolerance during early mobilization, and 43.75% failed to walk. The prevalence of nausea, dizziness, and impaired vision was 60.94%, 92.19%, and 25.00%, respectively, and no patient experienced syncope. The factors shown to be independently linked with orthostatic intolerance were being female (OR = 2.98, 1.53 to 5.82) and high pain level during sitting (OR = 2.69, 1.79 to 4.04). Individuals with orthostatic intolerance had a longer postoperative hospital stay with a mean of 5.42 days against 4.25 days (p = 0.003). CONCLUSIONS: Orthostatic intolerance was prevalent following thoracoscopic lung cancer resection and affected patients' capability to mobilize and prolonged postoperative hospitalization. Being female and having high pain levels during sitting were identified as independent factors for orthostatic intolerance. This suggests that more emphasis should be given to risky patients, and for these groups, we may optimize pain management to adjust the risk of emerging orthostatic intolerance, facilitating early mobilization and early postoperative rehabilitation.
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Ambulación Precoz , Neoplasias Pulmonares , Intolerancia Ortostática , Neumonectomía , Complicaciones Posoperatorias , Humanos , Femenino , Masculino , Estudios Prospectivos , Persona de Mediana Edad , Neoplasias Pulmonares/cirugía , Intolerancia Ortostática/etiología , Intolerancia Ortostática/epidemiología , Neumonectomía/efectos adversos , Neumonectomía/métodos , Anciano , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Cirugía Torácica Asistida por Video/métodos , Cirugía Torácica Asistida por Video/efectos adversos , Prevalencia , Adulto , Tiempo de Internación/estadística & datos numéricosRESUMEN
BACKGROUND: Surgery for oesophageal squamous cell carcinoma involves dissecting lymph nodes along the recurrent laryngeal nerve. This is technically challenging and injury to the recurrent laryngeal nerve may lead to vocal cord palsy, which increases the risk of pulmonary complications. The aim of this study was to compare the efficacy and safety of robot-assisted oesophagectomy (RAO) versus video-assisted thoracoscopic oesophagectomy (VAO) for dissection of lymph nodes along the left RLN. METHODS: Patients with oesophageal squamous cell carcinoma who were scheduled for minimally invasive McKeown oesophagectomy were allocated randomly to RAO or VAO, stratified by centre. The primary endpoint was the success rate of left recurrent laryngeal nerve lymph node dissection. Success was defined as the removal of at least one lymph node without causing nerve damage lasting longer than 6 months. Secondary endpoints were perioperative and oncological outcomes. RESULTS: From June 2018 to March 2022, 212 patients from 3 centres in Asia were randomized, and 203 were included in the analysis (RAO group 103; VAO group 100). Successful left recurrent laryngeal nerve lymph node dissection was achieved in 88.3% of the RAO group and 69% of the VAO group (P < 0.001). The rate of removal of at least one lymph node according to pathology was 94.2% for the RAO and 86% for the VAO group (P = 0.051). At 1 week after surgery, the RAO group had a lower incidence of left recurrent laryngeal nerve palsy than the VAO group (20.4 versus 34%; P = 0.029); permanent recurrent laryngeal nerve palsy rates at 6 months were 5.8 and 20% respectively (P = 0.003). More mediastinal lymph nodes were dissected in the RAO group (median 16 (i.q.r. 12-22) versus 14 (10-20); P = 0.035). Postoperative complication rates were comparable between the two groups and there were no in-hospital deaths. CONCLUSION: In patients with oesophageal squamous cell carcinoma, RAO leads to more successful left recurrent laryngeal nerve lymph node dissection than VAO, including a lower rate of short- and long-term recurrent laryngeal nerve injury. Registration number: NCT03713749 (http://www.clinicaltrials.gov).
Oesophageal cancer often requires complex surgery. Recently, minimally invasive techniques like robot- and video-assisted surgery have emerged to improve outcomes. This study compared robot- and video-assisted surgery for oesophageal cancer, focusing on removing lymph nodes near a critical nerve. Patients with a specific oesophageal cancer type were assigned randomly to robot- or video-assisted surgery at three Asian hospitals. Robot-assisted surgery had a higher success rate in removing lymph nodes near the important nerve without permanent damage. It also had shorter operating times, more lymph nodes removed, and faster drain removal after surgery. In summary, for oesophageal cancer surgery, the robotic approach may provide better lymph node removal and less nerve injury than video-assisted techniques.
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Neoplasias Esofágicas , Esofagectomía , Escisión del Ganglio Linfático , Procedimientos Quirúrgicos Robotizados , Cirugía Torácica Asistida por Video , Humanos , Esofagectomía/métodos , Esofagectomía/efectos adversos , Masculino , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Femenino , Persona de Mediana Edad , Cirugía Torácica Asistida por Video/métodos , Cirugía Torácica Asistida por Video/efectos adversos , Neoplasias Esofágicas/cirugía , Escisión del Ganglio Linfático/métodos , Escisión del Ganglio Linfático/efectos adversos , Anciano , Carcinoma de Células Escamosas de Esófago/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Resultado del Tratamiento , Nervio Laríngeo Recurrente/cirugía , Traumatismos del Nervio Laríngeo Recurrente/etiología , AdultoRESUMEN
BACKGROUND: Primary hyperhidrosis is a condition caused by an excessive stimulation of sweat glands, leading to a decline in both quality of life and social wellbeing. Thoracic sympathectomy surgery provides a relief of the initial symptoms but poses a risk for developing compensatory hyperhidrosis (CH) in various degrees. OBJECTIVE: The aim of this study was to assess the occurrence and characteristics of CH post-thoracic sympathectomy. METHODS: A retrospective cohort study of patients who underwent video-assisted thoracic sympathectomy surgery at level T2-T3 between 2016 and 2022 was conducted. Patients' data were retrieved from medical records and through a telephone interview. RESULTS: A total of 50 patients (32 males and 18 females) were operated on with a mean ± standard deviation (SD) age of 25.9 ± 7.4 years at the time of surgery for palmoplantar hyperhidrosis. Initial symptoms started in childhood at a mean ± SD age of 11.4 ± 3.3 years. Postoperatively, 39 patients (78%) developed CH, more prevalent in males (64.1%) compared to females (35.8%). This CH mainly affected the back and abdomen (100%), followed by the groin and thighs (28.2%), and, to a lesser extent, the craniofacial area (15.3%). Onset of symptoms occurred within 1 week after surgery in 71.7% of cases, with 71.7% reporting mild to moderate symptoms. CH was significantly associated with higher age at the time of surgery, smoking status, and a longer time lapse in the surgery operation (P value < 0.05). CONCLUSIONS: Thoracic sympathectomy is an effective procedure with a high success rate. Despite a relatively higher occurrence of CH, most patients experience milder symptoms and express satisfaction, noting that their expectations were met following the surgery.
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Hiperhidrosis , Índice de Severidad de la Enfermedad , Sudoración , Simpatectomía , Cirugía Torácica Asistida por Video , Humanos , Femenino , Masculino , Hiperhidrosis/cirugía , Hiperhidrosis/diagnóstico , Hiperhidrosis/fisiopatología , Estudios Retrospectivos , Adulto , Simpatectomía/efectos adversos , Adulto Joven , Cirugía Torácica Asistida por Video/efectos adversos , Resultado del Tratamiento , Adolescente , Factores de Tiempo , Incidencia , Factores de RiesgoRESUMEN
PURPOSE: The purpose of this study was to compare 3 intraoperative modalities to determine the best and most convenient one for pain control for uniportal lung surgery. This study compared general anesthesia with serratus plane block, general anesthesia with epidural, and general anesthesia alone to examine postoperative pain scores in patients. METHODS: Eighty patients were enrolled and statistically analyzed. Three interventions were studied: general anesthesia with serratus plane block (group S), general anesthesia with thoracic epidural (group E), and general anesthesia only (group G). Outcome measures compared among the 3 groups included demographic characteristics; surgical types; anesthesia and operative time; postoperative pain scores; vital signs; morphine consumption at 0, 2, and 6 hours and day 1 and day 2 after surgery; incidence of opioid-related adverse events and chronic pain; hospital length of stay (LOS); and overall expenses. The numerical rating scale was used to assess the degree of pain on the first and second postoperative days. Postoperative morphine consumption, incidence of opioid-related side effects, hospital LOS, and overall hospital expenses were documented, as well as incidence of chronic postoperative pain. FINDINGS: There was no difference in the incidence of opioid-related adverse events and chronic pain, hospital LOS, and overall expenses among the 3 groups. After investigating factors that may influence hospital LOS and overall expenses, the multivariable analysis indicated that only longer operative time was associated with longer hospital stay and more hospital expenses. IMPLICATIONS: This prospective study found that general anesthesia alone offers an easy and efficient approach resulting in similar postoperative pain scores and morphine consumption compared with nerve block and epidural. Longer operative time was associated with longer hospital stay and more hospital expenses. CLINICALTRIALS: gov identifier: NCT03839160. (Clin Ther. 2024;XX:XXX-XXX) © 2024 Elsevier HS Journals, Inc.
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Analgésicos Opioides , Anestesia General , Dolor Postoperatorio , Cirugía Torácica Asistida por Video , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Anestesia Epidural/métodos , Anestesia General/métodos , Tiempo de Internación , Pulmón/cirugía , Pulmón/fisiopatología , Morfina/administración & dosificación , Morfina/uso terapéutico , Bloqueo Nervioso/métodos , Tempo Operativo , Manejo del Dolor/métodos , Dimensión del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Estudios Prospectivos , Cirugía Torácica Asistida por Video/métodos , Cirugía Torácica Asistida por Video/efectos adversosRESUMEN
BACKGROUND: Minimally invasive thoracic surgery is associated with substantial pain that can impair pulmonary function. Fascial plane blocks may offer a favorable alternative to opioids, but conventional local anesthetics provide a limited duration of analgesia. We therefore tested the primary hypothesis that a mixture of liposomal bupivacaine and plain bupivacaine improves the overall benefit of analgesia score (OBAS) during the first three postoperative days compared to bupivacaine alone. Secondarily, we tested the hypotheses that liposomal bupivacaine improves respiratory mechanics, and decreases opioid consumption. METHODS: Adults scheduled for robotically or video-assisted thoracic surgery with combined ultrasound-guided pectoralis II and serratus anterior plane block were randomized to bupivacaine or bupivacaine combined with liposomal bupivacaine. OBAS was measured on postoperative days 1-3 and was analyzed with a linear mixed regression model. Postoperative respiratory mechanics were estimated using a linear mixed model. Total opioid consumption was estimated with a simple linear regression model. RESULTS: We analyzed 189 patients, of whom 95 were randomized to the treatment group and 94 to the control group. There was no significant treatment effect on total OBAS during the initial three postoperative days, with an estimated geometric mean ratio of 0.93 (95% CI: 0.76, 1.14; p = 0.485). There was no observed treatment effect on respiratory mechanics, total opioid consumption, or pain scores. Average pain scores were low in both groups. CONCLUSIONS: Liposomal bupivacaine did not improve OBAS during the initial postoperative three days following minimally invasive thoracic procedures. Furthermore, there was no improvement in respiratory mechanics, no reduction in opioid consumption, and no decrease in pain scores. Thus, the data presented here does not support the use of liposomal bupivacaine over standard bupivacaine to enhance analgesia after minimally invasive thoracic surgery. SUMMARY STATEMENT: For minimally invasive thoracic procedures, addition of liposomal bupivacaine to plain bupivacaine for thoracic fascial plane blocks does not improve OBAS, reduce opioid requirements, improve postoperative respiratory mechanics, or decrease pain scores.
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Analgésicos Opioides , Anestésicos Locales , Bupivacaína , Liposomas , Procedimientos Quirúrgicos Mínimamente Invasivos , Bloqueo Nervioso , Dolor Postoperatorio , Humanos , Bupivacaína/administración & dosificación , Anestésicos Locales/administración & dosificación , Masculino , Femenino , Bloqueo Nervioso/métodos , Persona de Mediana Edad , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Liposomas/administración & dosificación , Anciano , Analgésicos Opioides/administración & dosificación , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Ultrasonografía Intervencional , Dimensión del Dolor , Músculos Pectorales/efectos de los fármacos , Músculos Pectorales/inervación , Cirugía Torácica Asistida por Video/métodos , Cirugía Torácica Asistida por Video/efectos adversos , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Adulto , Mecánica Respiratoria/efectos de los fármacos , Procedimientos Quirúrgicos Torácicos/efectos adversos , Procedimientos Quirúrgicos Torácicos/métodosRESUMEN
BACKGROUND: The objective of the present study was to evaluate the effect of dexmedetomidine administration during video-assisted thoracoscopic surgery for lung cancer on perioperative inflammatory response and chronic post-surgical pain. METHODS: A cohort of 152 patients with lung cancer scheduled for elective video-assisted thoracoscopic surgery participated in this randomized controlled trial. Patients were randomly divided into 2 groups and administered an equivalent volume of dexmedetomidine (n = 63) or normal saline (n = 63). Dexmedetomidine was administered at a dose of 0.6 µg/kg 10 minutes before anesthesia induction and maintained at 0.5 µg/kg/h until 0.5 hours before surgery completed. Anesthesia and postoperative pain management protocols were standardized for both groups. The analysis included vital signs, numerical rating scales of pain, blood inflammatory and oxidative stress biomarkers, pain type and location, patient-controlled intravenous analgesia usage, consumption of general anesthetics and pain rescue medications, as well as complications. RESULTS: The administration of dexmedetomidine resulted in decreased levels of inflammatory cytokines (interleukin-1 beta, interleukin-6, alongside tumor necrosis factor-alpha) and oxidative stress biomarkers (reactive oxygen species alongside malondialdehyde) but elevated levels of interleukin-10 and superoxide dismutase. In addition, the dexmedetomidine group showed lower postoperative numerical rating scale scores, reduced consumption of anesthetics, faster chest-tube removal, fewer patient-controlled intravenous analgesia presses, and shorter postoperative hospital stays. CONCLUSION: The administration of dexmedetomidine effectively attenuated surgical inflammation, oxidative stress, and postoperative pain, thereby promoting patient recovery after lung cancer surgery without increasing the risk of adverse effects or complications.
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Dolor Crónico , Dexmedetomidina , Neoplasias Pulmonares , Dolor Postoperatorio , Cirugía Torácica Asistida por Video , Humanos , Dexmedetomidina/administración & dosificación , Dexmedetomidina/uso terapéutico , Cirugía Torácica Asistida por Video/efectos adversos , Cirugía Torácica Asistida por Video/métodos , Neoplasias Pulmonares/cirugía , Femenino , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Anciano , Dolor Crónico/etiología , Dolor Crónico/prevención & control , Dolor Crónico/diagnóstico , Dolor Crónico/tratamiento farmacológico , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/uso terapéutico , Inflamación/prevención & control , Inflamación/etiología , Estrés Oxidativo/efectos de los fármacos , Método Doble CiegoRESUMEN
PURPOSE: Post-operative pain after video-assisted thoracoscopic surgery is often treated using thoracic epidural analgesics or thoracic paravertebral analgesics. This article describes a case where a thoracic disc herniation is treated with a thoracoscopic microdiscectomy with post-operative thoracic epidural analgesics. The patient developed a bupivacaine pleural effusion which mimicked a hemothorax on computed tomography (CT). METHODS: The presence of bupivacaine in the pleural effusion was confirmed using a high performance liquid chromatography method. RESULTS: The patient underwent a re-exploration to relieve the pleural effusion. The patient showed a long-term recovery similar to what can be expected from an uncomplicated thoracoscopic microdiscectomy. CONCLUSION: A pleural effusion may occur when thoracic epidural analgesics are used in patents with a corridor between the pleural cavity and epidural space.
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Anestesia Epidural , Bupivacaína , Discectomía , Hemotórax , Desplazamiento del Disco Intervertebral , Derrame Pleural , Humanos , Anestesia Epidural/efectos adversos , Anestesia Epidural/métodos , Discectomía/efectos adversos , Discectomía/métodos , Bupivacaína/efectos adversos , Desplazamiento del Disco Intervertebral/cirugía , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/cirugía , Hemotórax/etiología , Hemotórax/cirugía , Hemotórax/inducido químicamente , Hemotórax/diagnóstico , Hemotórax/diagnóstico por imagen , Cirugía Torácica Asistida por Video/métodos , Cirugía Torácica Asistida por Video/efectos adversos , Diagnóstico Diferencial , Anestésicos Locales/efectos adversos , Anestésicos Locales/administración & dosificación , Vértebras Torácicas/cirugía , Masculino , Dolor Postoperatorio/tratamiento farmacológico , Persona de Mediana Edad , FemeninoRESUMEN
Objectives: This study aimed to determine the effects of perioperative transcutaneous electrical acupoint stimulation (TEAS) on postoperative pain management in patients undergoing thoracic surgery. Methods: In the prospective, randomized, controlled study, a total of 84 patients undergoing video-assisted thoracoscopic surgery (VATS) were randomly allocated to the TEAS group (Group T) or control group (Group C). Patients in the Group T received TEAS at Neiguan (PC6) and Hegu (LI4) acupoints for 30 min before anesthesia induction and 30 min after thoracoscopic surgery. Patients in the Group C received the same placement of electrodes but without electrical stimulation. The numeric rating scale (NRS) pain score, remifentanil consumption, demand for rescue analgesics and incidence of postoperative nausea and vomiting (PONV), patient satisfaction, and the levels of plasma ß-endorphin (EP) and IL-6 were recorded. Results: Patients in the Group T had significantly lower NRS pain scores at 6 h, 12 h, 24 h, and 48 h after surgery than those in the Group C. Compared with Group C, patients in Group T had lower remifentanil consumption during operation, lower demand for rescue analgesics and lower rate of PONV within 24 h after surgery. Patients in Group T also had lower IL-6 content, higher ß-EP content and higher satisfaction degree than those in the Group C. Conclusions: Perioperative TEAS significantly decreased postoperative pain and rescued analgesia requirements and the incidence of PONV in patients undergoing thoracoscopic surgery, with a higher patient satisfaction. This trial is registered with ChiCTR2100051841.
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Puntos de Acupuntura , Dolor Postoperatorio , Estimulación Eléctrica Transcutánea del Nervio , Humanos , Masculino , Femenino , Persona de Mediana Edad , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Estimulación Eléctrica Transcutánea del Nervio/métodos , Adulto , Anciano , Dimensión del Dolor , Estudios Prospectivos , Cirugía Torácica Asistida por Video/efectos adversos , betaendorfina/sangreRESUMEN
Background: Atrial fibrillation (AF) has become the most common postoperative arrhythmia of thoracic surgery. This study aimed to investigate the risk factors and complications of perioperative atrial fibrillation (PoAF) in elderly patients who underwent video-assisted thoracoscopic surgery (VATS). Methods: Data were collected from patients who underwent VATS between January 2013 and December 2022 at Peking Union Medical College Hospital (PUMCH). Univariable analyses and multivariable logistic regression analyses were used to determine the factors correlated with PoAF. Receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the indicators to predict PoAF. Results: The study enrolled 2920 patients, with a PoAF incidence of 5.2% (95% CI 4.4%-6.0%). In the logistic regression analyses, male sex (OR=1.496, 95% CI 1.056-2.129, P=0.024), left atrial anteroposterior dimension (LAD) ≥40 mm (OR=2.154, 95% CI 1.235-3.578, P=0.004), hypertension (HTN) without regular treatment (OR=2.044, 95% CI 0.961-3.921, P=0.044), a history of hyperthyroidism (OR=4.443, 95% CI 0.947-15.306, P=0.030), surgery of the left upper lobe (compared to other lung lobes) (OR=1.625, 95% CI 1.139-2.297, P=0.007), postoperative high blood glucose (BG) (OR=2.482, 95% CI 0.912-5.688, P=0.048), and the time of chest tube removal (per day postoperatively) (OR=1.116, 95% CI 1.038-1.195, P=0.002) were found to be significantly associated with PoAF. The area under the ROC curve was 0.707 (95% CI 0.519-0.799). 86.9% patients were successfully converted to sinus rhythm. Compared with the non-PoAF group, the PoAF group had significantly greater risks of prolonged air leakage, postoperative acute coronary syndrome, longer ICU stays, and longer hospital stays. Conclusion: Male sex, LAD≥40 mm, HTN without regular treatment, a history of hyperthyroidism, surgery of the left upper lobe, postoperative BG, and the time of chest tube removal were associated with PoAF. These findings may help clinicians identify high-risk patients and take preventive measures to minimize the incidence and adverse prognosis of PoAF.
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Fibrilación Atrial , Cirugía Torácica Asistida por Video , Humanos , Masculino , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/cirugía , Fibrilación Atrial/epidemiología , Fibrilación Atrial/etiología , Fibrilación Atrial/fisiopatología , Factores de Riesgo , Femenino , Anciano , Estudios Retrospectivos , Cirugía Torácica Asistida por Video/efectos adversos , Incidencia , Resultado del Tratamiento , Medición de Riesgo , Persona de Mediana Edad , Factores de Tiempo , Factores de Edad , Neumonectomía/efectos adversos , Beijing/epidemiología , Anciano de 80 o más AñosRESUMEN
BACKGROUND: This study aimed to explore the efficacy of hookwire for computed tomography (CT)-guided pulmonary nodule (PN) localization before video-assisted thoracoscopic surgery (VATS) resection and determine the risk factors for localization-related complications. METHODS: We enrolled 193 patients who underwent preoperative CT-guided PN hookwire localization. The patients were categorized into groups A (103 patients had no complications) and B (90 patients had complications) according to CT and VATS. Uni- and multivariate logistic regression analyses were used to identify risk factors for localization-related complications. A numerical rating scale was used to evaluate hookwire localization-induced pain. RESULTS: We successfully performed localization in 173 (89.6%) patients. Pneumothorax was the main complication in 82 patients (42.5%). Patient gender, age, body mass index, tumor diameter, consolidation tumor ratio, pathologic diagnosis, position adjustment during location, lesion location, waiting time for surgery, and pleural adhesions were not significantly different between the two groups. The number of nodules, number of punctures, scapular rest position, and depth of insertion within the lung parenchyma were significant factors for successful localization. Multivariate regression analysis further validated the number of nodules, scapular rest position, and depth of insertion within the lung parenchyma as risk factors for hookwire-localization-related complications. Hookwire localization-induced pain is mainly mild or moderate pre- and postoperatively, and some patients still experience pain 7 days postoperatively. CONCLUSIONS: Hookwire preoperative PN localization has a high success rate, but some complications remain. Thus, clinicians should be vigilant and look forward to further improvement.
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Neoplasias Pulmonares , Nódulo Pulmonar Solitario , Cirugía Torácica Asistida por Video , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Persona de Mediana Edad , Factores de Riesgo , Tomografía Computarizada por Rayos X/métodos , Cirugía Torácica Asistida por Video/métodos , Cirugía Torácica Asistida por Video/efectos adversos , Anciano , Neoplasias Pulmonares/cirugía , Nódulo Pulmonar Solitario/cirugía , Nódulo Pulmonar Solitario/diagnóstico por imagen , Adulto , Nódulos Pulmonares Múltiples/cirugía , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Estudios Retrospectivos , Complicaciones Posoperatorias/etiología , Cuidados Preoperatorios/métodosRESUMEN
INTRODUCTION: Lung-protective ventilation strategies (LPVS) for one-lung ventilation (OLV) in paediatric patients pose greater challenges than in adults. Optimising LPVS for paediatric OLV to mitigate postoperative pulmonary complications (PPCs) has emerged as a current research focal point. However, there remains a divergence of opinions concerning the individualised setting and application of positive end-expiratory pressure (PEEP). Lung dynamic compliance (Cdyn) can serve as a reflection of the lung's physiological state in children during OLV and is a readily obtainable parameter. This study protocol is formulated to assess the effectiveness of Cdyn-guided PEEP titration on PPCs during paediatric OLV. METHODS AND ANALYSIS: This study constitutes a single-centre, prospective, double-blind, randomised controlled trial. The trial aims to recruit 60 paediatric patients scheduled for video-assisted thoracoscopic surgery. These eligible patients will be randomly assigned to either the Cdyn-guided PEEP group or the conventional PEEP group during general anaesthesia for OLV. The primary outcome will involve assessing the incidence of PPCs at 7 days after surgery. Secondary outcomes will encompass the evaluation of the modified lung ultrasound score following surgery, as well as monitoring the oxygenation index, driving pressure and Cdyn during mechanical ventilation. Data collection will be performed by investigators who are kept blinded to the interventions. ETHICS AND DISSEMINATION: The Clinical Trial Ethics Committee at Shenzhen Children's Hospital has conferred ethical approvals for this trial (approval number: 2022076). Results from this trial will be disseminated in peer-reviewed journals and presented at professional symposiums. TRAIL REGISTRATION NUMBER: NCT05386901.
Asunto(s)
Respiración con Presión Positiva , Complicaciones Posoperatorias , Cirugía Torácica Asistida por Video , Humanos , Respiración con Presión Positiva/métodos , Cirugía Torácica Asistida por Video/efectos adversos , Cirugía Torácica Asistida por Video/métodos , Método Doble Ciego , Estudios Prospectivos , Niño , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Rendimiento Pulmonar , Ventilación Unipulmonar/métodos , Ventilación Unipulmonar/efectos adversos , Femenino , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto , Preescolar , Enfermedades Pulmonares/prevención & control , Enfermedades Pulmonares/etiologíaRESUMEN
BACKGROUND: Diabetes is considered a general surgical risk factor, but with few data from enhanced recovery (ERAS) otherwise known to improve outcome. Therefore, this study aimed to investigate postoperative outcomes of patients with diabetes who underwent video-assisted thoracoscopic surgery (VATS) lobectomy in an established ERAS setting. METHODS: We retrospectively analysed outcome data (hospital stay (LOS), readmissions, and mortality) from a prospective database with consecutive unselected ERAS VATS lobectomies from 2012 to 2022. Complete follow-up was secured by the registration system in East Denmark. RESULTS: We included 3164 patients of which 323 had diabetes, including 186 treated with insulin and antidiabetic medicine, 35 with insulin only and 102 with antidiabetic medicine only. The median LOS was 3 days, stable over the study period. There were no differences in terms of LOS, postoperative complications, readmissions or 30 days alive and out of hospital. Patients with diabetes had significantly higher 30- and 90-day mortality rates compared to those without diabetes (p < .001), but also had higher preoperative comorbidity. Preoperative HbA1c levels did not correlate with postoperative outcomes. CONCLUSION: In an ERAS setting, diabetes may not increase the risk for prolonged LOS, complications, and readmissions after VATS lobectomy, however with higher 30- and 90-day mortality probably related to more preoperative comorbidities.
Asunto(s)
Recuperación Mejorada Después de la Cirugía , Tiempo de Internación , Neoplasias Pulmonares , Readmisión del Paciente , Neumonectomía , Complicaciones Posoperatorias , Cirugía Torácica Asistida por Video , Humanos , Masculino , Cirugía Torácica Asistida por Video/métodos , Cirugía Torácica Asistida por Video/efectos adversos , Femenino , Anciano , Neumonectomía/métodos , Neumonectomía/efectos adversos , Estudios Retrospectivos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Tiempo de Internación/estadística & datos numéricos , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Neoplasias Pulmonares/cirugía , Diabetes Mellitus/epidemiología , Resultado del Tratamiento , Dinamarca/epidemiología , Hipoglucemiantes/uso terapéutico , Factores de Riesgo , Anciano de 80 o más AñosRESUMEN
OBJECTIVES: Thoracoscopic segmentectomy is the recommended treatment option for small peripheral pulmonary nodules. To assess the ability of preoperative three-dimensional (3D) reconstruction computed tomography (CT) to shorten the operative time and improve perioperative outcomes in thoracoscopic segmentectomy compared with standard chest CT, we conducted this randomized controlled trial. METHODS: The DRIVATS study was a multicentre, randomized controlled trial conducted in 3 hospitals between July 2019 and November 2023. Patients with small peripheral pulmonary nodules not reaching segment borders were randomized in a 1:1 ratio to receive either 3D reconstruction CT or standard chest CT before thoracoscopic segmentectomy. The primary end-point was operative time. The secondary end-points included incidence of postoperative complications, intraoperative blood loss and operative accident event. RESULTS: A total of 191 patients were enrolled in this study: 95 in the 3D reconstruction CT group and 96 in the standard chest CT group. All patients underwent thoracoscopic segmentectomy except for 1 patient in the standard chest CT group who received a wedge resection. There is no significant difference in operative time between the 3D reconstruction CT group (median, 100 min [interquartile range (IQR), 85-120]) and the standard chest CT group (median, 100 min [IQR, 81-140]) (P = 0.82). Only 1 intraoperative complication occurred in the standard chest CT group. No significant difference was observed in the incidence of postoperative complications between the 2 groups (P = 0.52). Other perioperative outcomes were also similar. CONCLUSIONS: In patients with small peripheral pulmonary nodules not reaching segment borders, the use of 3D reconstruction CT in thoracoscopic segmentectomy was feasible, but it did not result in significant differences in operative time or perioperative outcomes compared to standard chest CT.
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Imagenología Tridimensional , Neoplasias Pulmonares , Tempo Operativo , Neumonectomía , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Persona de Mediana Edad , Imagenología Tridimensional/métodos , Tomografía Computarizada por Rayos X/métodos , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/diagnóstico por imagen , Neumonectomía/métodos , Neumonectomía/efectos adversos , Anciano , Cirugía Torácica Asistida por Video/métodos , Cirugía Torácica Asistida por Video/efectos adversos , Complicaciones Posoperatorias/epidemiologíaRESUMEN
Surgical resection remains the optimal therapeutic option for early-stage operable NSCLC. Despite significant advances in recent years related to anesthetic and surgical techniques, cardiopulmonary complications remain major causes for postoperative morbimortality. In this paper we present a case of a patient who developed complete AV block followed by asystole after lung resection surgery. The patient underwent surgery via right VATS and the procedure was uneventful. On the first post-operative day patient developed a third-degree atrioventricular block followed by 6 seconds asystole. Pharmacological treatment was instituted and implementation of a permanent pacemaker occurred on the third post-operative day, without complications. The remaining postoperative course was uneventful and the patient was discharged home on the sixth post-operative day. It is the objective of the authors to report and highlight this rare and potencial fatal complication of lung resection.
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Bloqueo Atrioventricular , Paro Cardíaco , Neoplasias Pulmonares , Neumonectomía , Humanos , Bloqueo Atrioventricular/etiología , Bloqueo Atrioventricular/diagnóstico , Paro Cardíaco/etiología , Neoplasias Pulmonares/cirugía , Neumonectomía/efectos adversos , Masculino , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Marcapaso Artificial/efectos adversos , Anciano , Cirugía Torácica Asistida por Video/efectos adversos , Persona de Mediana Edad , Complicaciones Posoperatorias/etiologíaRESUMEN
INTRODUCTION: Myasthenia gravis (MG) is an autoimmune, neurologic disease that causes a wide range of symptoms. While the transsternal, transcervical and thoracotomy approaches are accepted as effective, there is still debate regarding the VATS approach. MATERIALS AND METHODS: We analyzed our center's surgical experience with thymectomy for myasthenia gravis, comparing the results of patients operated on using VATS and more invasive approaches, over a period of 10 years. A search of the department's surgical database for myasthenia gravis cases between January 2010 and January 2021, revealed a total of 40 cases. Twenty-four patients were included in the final analysis and were distributed into two groups: the VATS procedure group (group A) and the open procedure group (group B). The latter included sternotomy, thoracotomy, transcervical and hemiclamshell approaches. Only radical thymectomies were included. The established outcomes were clinical improvement defined as asymptomatic remission, reduction, or discontinuation of the medication necessary to achieve optimal symptom control. RESULTS: The median follow-up time was 27 months (ranging from 4 to 75 months). Videothoracoscopy radical thymectomy was performed on 12 patients. Complete remission with no medication was achieved in 1 case (8.3%), while 2 patients (16.7%) became asymptomatic with reduced medication. An improvement (reduced symptoms or decreased medication) was observed in 8 cases (66.6%). No change in clinical outcome was noted in 1 patient (8.3%). None of the patients reported worsening symptoms. Open thymectomy was performed on 12 patients. Complete remission with no medication was achieved in 1 case (8.3%), while 2 patients (16.7%) became asymptomatic with reduced medication. An improvement was noted in 6 cases (50%). No change in clinical outcome was observed in 3 patients (25%) whereas 2 of them (16.7%) experienced slightly better symptom control but with a significant increase in medication. One patient (8.3%) described the clinical results as without any significant change. None of the patients reported worsening symptoms. CONCLUSION: The videotoracoscopic approach in the treatment of myasthenia gravis is non-inferior compared to the open approach and effective in a long-term follow-up, offering all the additional benefits of less invasive surgery.
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Miastenia Gravis , Cirugía Torácica Asistida por Video , Timectomía , Humanos , Miastenia Gravis/cirugía , Timectomía/métodos , Cirugía Torácica Asistida por Video/métodos , Cirugía Torácica Asistida por Video/efectos adversos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Resultado del Tratamiento , Anciano , Toracotomía/métodos , Toracotomía/efectos adversos , Adulto JovenRESUMEN
BACKGROUND: The objective of this study is to identify and evaluate the risk factors associated with the development of postoperative pulmonary complications (PPCs) in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia. METHODS: The retrospective study consecutively included elderly patients (≥ 70 years old) who underwent thoracoscopic lobectomy at Xuanwu Hospital of Capital Medical University from January 1, 2018 to August 31, 2023. The demographic characteristics, the preoperative, intraoperative and postoperative parameters were collected and analyzed using multivariate logistic regression to identify the prediction of risk factors for PPCs. RESULTS: 322 patients were included for analysis, and 115 patients (35.7%) developed PPCs. Multifactorial regression analysis showed that ASA ≥ III (P = 0.006, 95% CI: 1.230 â¼ 3.532), duration of one-lung ventilation (P = 0.033, 95% CI: 1.069 â¼ 4.867), smoking (P = 0.027, 95% CI: 1.072 â¼ 3.194) and COPD (P = 0.015, 95% CI: 1.332 â¼ 13.716) are independent risk factors for PPCs after thoracoscopic lobectomy in elderly patients. CONCLUSION: Risk factors for PPCs are ASA ≥ III, duration of one-lung ventilation, smoking and COPD in elderly patients over 70 years old undergoing thoracoscopic lobectomy. It is necessary to pay special attention to these patients to help optimize the allocation of resources and enhance preventive efforts.
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Anestesia General , Neumonectomía , Complicaciones Posoperatorias , Cirugía Torácica Asistida por Video , Humanos , Estudios Retrospectivos , Anciano , Cirugía Torácica Asistida por Video/efectos adversos , Cirugía Torácica Asistida por Video/métodos , Factores de Riesgo , Femenino , Masculino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Anestesia General/efectos adversos , Neumonectomía/efectos adversos , Neumonectomía/métodos , Anciano de 80 o más Años , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/etiologíaAsunto(s)
Nervios Intercostales , Bloqueo Nervioso , Dolor Postoperatorio , Músculos Paraespinales , Cirugía Torácica Asistida por Video , Humanos , Bloqueo Nervioso/métodos , Cirugía Torácica Asistida por Video/efectos adversos , Cirugía Torácica Asistida por Video/métodos , Nervios Intercostales/efectos de los fármacos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Músculos Paraespinales/inervación , Cirujanos , Anestesistas , Ultrasonografía Intervencional , Anestésicos Locales/administración & dosificaciónRESUMEN
BACKGROUND: The role of mechanical power on pulmonary outcomes after thoracic surgery with one-lung ventilation was unclear. We investigated the association between mechanical power and postoperative pulmonary complications in patients undergoing thoracoscopic lung resection surgery. METHODS: In this single-center, prospective observational study, 622 patients scheduled for thoracoscopic lung resection surgery were included. Volume control mode with lung protective ventilation strategies were implemented in all participants. The primary endpoint was a composite of postoperative pulmonary complications during hospital stay. Multivariable logistic regression models were used to evaluate the association between mechanical power and outcomes. RESULTS: The incidence of pulmonary complications after surgery during hospital stay was 24.6% (150 of 609 patients). The multivariable analysis showed that there was no link between mechanical power and postoperative pulmonary complications. CONCLUSIONS: In patients undergoing thoracoscopic lung resection with standardized lung-protective ventilation, no association was found between mechanical power and postoperative pulmonary complications. TRIAL REGISTRATION: Trial registration number: ChiCTR2200058528, date of registration: April 10, 2022.