RESUMEN

BACKGROUND: There is still a debate regarding the most appropriate pleural collector model to ensure a short hospital stay and minimum complications. OBJECTIVES: To study aimed to compare the time of air leak, time to drain removal, and length of hospital stay between a standard water-seal drainage system and a pleural collector system with a unidirectional flutter valve and rigid chamber. DESIGN AND SETTING: A randomized prospective clinical trial was conducted at a high-complexity hospital in São Paulo, Brazil. METHODS: Sixty-three patients who underwent open or video-assisted thoracoscopic lung wedge resection or lobectomy were randomized into two groups, according to the drainage system used: the control group (WS), which used a conventional water-seal pleural collector, and the study group (V), which used a flutter valve device (Sinapi® Model XL1000®). Variables related to the drainage system, time of air leak, time to drain removal, and time spent in hospital were compared between the groups. RESULTS: Most patients (63%) had lung cancer. No differences were observed between the groups in the time of air leak or time spent hospitalized. The time to drain removal was slightly shorter in the V group; however, the difference was not statistically significant. Seven patients presented with surgery-related complications: five and two in the WS and V groups, respectively. CONCLUSIONS: Air leak, time to drain removal, and time spent in the hospital were similar between the groups. The system used in the V group resulted in no adverse events and was safe. REGISTRATION: RBR-85qq6jc (https://ensaiosclinicos.gov.br/rg/RBR-85qq6jc).

Asunto(s)

Drenaje , Tiempo de Internación , Neumonectomía , Humanos , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Drenaje/instrumentación , Drenaje/métodos , Neumonectomía/instrumentación , Neumonectomía/efectos adversos , Neumonectomía/métodos , Anciano , Cirugía Torácica Asistida por Video/métodos , Cirugía Torácica Asistida por Video/instrumentación , Factores de Tiempo , Resultado del Tratamiento , Neoplasias Pulmonares/cirugía , Adulto , Diseño de Equipo , Complicaciones Posoperatorias/etiología

RESUMEN

OBJECTIVE: Since its first report, video-assisted thoracic surgery (VATS) lung lobectomy was carried out with the use of conventional surgical instruments, used in laparoscopy and open thoracotomy. These instruments are expensive, not standardized and there are a variety of models and manufacturers. The aim of this study was to determine the impact of the use of these instruments on the experimental pulmonary lobectomy. METHODS: We used a modified surgical simulator that uses a porcine heart-lung block filled with tomato sauce, and tested specific (Group 1) and regular (Group 2) instruments. Each group includes 15 experiments. RESULTS: The median total time, excluding the time spent to correct the lesions, was 45.08 and 45.81 minutes, respectively in Group 1 and Group 2. There was no statistical difference between the total times (p=0.58). The only statistically different was seen for partial times regarding the elapsed time to cut and suture of lung fissures (p=0.03 and 0.04, respectively). There were more direct lesions and indirect leaks in Group 2, but without statistical significance (p=1.000 and p=0.203, respectively). The mean time spent for the diagnosis and correction of these events was 1.77 minutes with a standard deviation of 1.18 for Group 1 and 2.72 ± 1.11 minutes for Group 2 (p=0.044). CONCLUSION: The use of minimally invasive instruments is not associated with time improvement spent with experimental video-assisted lung lobectomy and does not lead to a faster or safer surgery. The use of VATS instruments makes correction of adverse events faster when they occur.

Asunto(s)

Neumonectomía/instrumentación , Instrumentos Quirúrgicos , Cirugía Torácica Asistida por Video/instrumentación , Toracotomía/instrumentación , Humanos , Neumonectomía/métodos , Entrenamiento Simulado/métodos , Cirugía Torácica Asistida por Video/métodos , Toracotomía/métodos

RESUMEN

Anatomic segmentectomy is a form of sublobar resection that can be both diagnostic and therapeutic in the context of an indeterminate pulmonary nodule, suspected metastasis, or small peripheral cancer.  This video tutorial demonstrates our technique for an apicoposterior anatomical segmentectomy performed by video-assisted thoracoscopy, using two ports, for resection of an undiagnosed pulmonary nodule. The steps performed by the surgical team are shown, and we pay particular attention to the recognition of vascular anatomy. To perform this type of sublobar resection, it is necessary to understand both the normal anatomy and the different variants.  This tutorial will provide a thorough grounding in the anatomy of the apicoposterior segment as well as demonstrating the optimal approach for this type of resection.

Asunto(s)

Hamartoma , Neoplasias Pulmonares , Pulmón , Metástasis de la Neoplasia/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Neumonectomía , Nódulo Pulmonar Solitario , Cirugía Torácica Asistida por Video , Diagnóstico Diferencial , Hamartoma/diagnóstico , Hamartoma/cirugía , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/cirugía , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Neumonectomía/instrumentación , Neumonectomía/métodos , Nódulo Pulmonar Solitario/diagnóstico , Nódulo Pulmonar Solitario/cirugía , Cirugía Torácica Asistida por Video/instrumentación , Cirugía Torácica Asistida por Video/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento

RESUMEN

ABSTRACT Objective: Since its first report, video-assisted thoracic surgery (VATS) lung lobectomy was carried out with the use of conventional surgical instruments, used in laparoscopy and open thoracotomy. These instruments are expensive, not standardized and there are a variety of models and manufacturers. The aim of this study was to determine the impact of the use of these instruments on the experimental pulmonary lobectomy. Methods: We used a modified surgical simulator that uses a porcine heart-lung block filled with tomato sauce, and tested specific (Group 1) and regular (Group 2) instruments. Each group includes 15 experiments. Results: The median total time, excluding the time spent to correct the lesions, was 45.08 and 45.81 minutes, respectively in Group 1 and Group 2. There was no statistical difference between the total times (p=0.58). The only statistically different was seen for partial times regarding the elapsed time to cut and suture of lung fissures (p=0.03 and 0.04, respectively). There were more direct lesions and indirect leaks in Group 2, but without statistical significance (p=1.000 and p=0.203, respectively). The mean time spent for the diagnosis and correction of these events was 1.77 minutes with a standard deviation of 1.18 for Group 1 and 2.72 ± 1.11 minutes for Group 2 (p=0.044). Conclusion: The use of minimally invasive instruments is not associated with time improvement spent with experimental video-assisted lung lobectomy and does not lead to a faster or safer surgery. The use of VATS instruments makes correction of adverse events faster when they occur.

---

RESUMO Objetivo: desde os primeiros registros, a lobectomia pulmonar por cirurgia torácica videoassistida (CTVA) foi feita usando instrumentos convencionais e de laparoscopia. Recentemente instrumentais específicos para CTVA surgiram. Esses instrumentais têm custo elevado, não são padronizados existindo uma variedade de modelos e fabricantes. Buscou-se determinar o impacto do uso desses instrumentais na realização da lobectomia pulmonar superior esquerda experimental. Métodos: foi usado simulador modificado com bloco de coração-pulmões preenchidos com molho de tomate para testar o uso de instrumental dedicado de CTVA e de cirurgia convencional (Grupo 1 e Grupo 2, respectivamente). Cada grupo inclui 15 experimentos. Resultados: a mediana do tempo total, excluído o tempo para corrigir vazamentos, foi de 45,8 e 45,81 minutos, respectivamente para o Grupo 1 e Grupo 2. Não houve diferença estatisticamente significante entre os tempos totais (p=0,58). Os únicos tempos parciais estatisticamente diferentes foram os para cortar e suturar a fissura pulmonar (p=0,03 e 0,04, respectivamente). Ocorreram mais lesões diretas e vazamentos indiretos no Grupo 2, mas sem significância estatística (p=1,000 e 0,203, respectivamente). A média de tempo gasto para diagnosticar e corrigir os eventos de lesão e vazamento foi de 1,77 minutos com desvio padrão de 1,18 para o Grupo 1 e 2,72±1,11 minutos para o Grupo 2 (p=0,044). Conclusão: o uso de instrumentos para CTVA não torna a cirurgia mais rápida, nem mais segura. O uso de instrumentos de CTVA permitiu uma correção mais rápida dos eventos adversos ocorridos.

Asunto(s)

Humanos , Neumonectomía/instrumentación , Instrumentos Quirúrgicos , Toracotomía/instrumentación , Cirugía Torácica Asistida por Video/instrumentación , Neumonectomía/métodos , Toracotomía/métodos , Cirugía Torácica Asistida por Video/métodos , Entrenamiento Simulado/métodos

RESUMEN

Endoscopic lung volume reduction is a minimally invasive procedure performed to reduce the space occupied by the emphysemas' lobes. This procedure has been demonstrated to be beneficial for patients with advanced chronic obstructive pulmonary disease and severe hyperinflation. The use of endobronchial valves is increasing, as well as the number of reports of adverse events. The most common complications after the procedure are a pneumothorax, bleeding, infections, the need for valve removal, and valve expulsion. We have recently treated a patient who achieved immediate left upper lobe atelectasis but developed a pneumothorax on the 6th day and near-fatal kinking of the left lower lobe bronchus. This patient had asphyctic episodes probably due to a functional left pneumonectomy. We should consider this unusual complication in patients undergoing endoscopic lung volume reduction whose condition worsens after achieving complete lobar atelectasis.

Asunto(s)

Neumonectomía/efectos adversos , Neumonectomía/métodos , Neumotórax/etiología , Complicaciones Posoperatorias/etiología , Enfisema Pulmonar/cirugía , Anciano , Broncoscopía , Remoción de Dispositivos , Humanos , Masculino , Neumonectomía/instrumentación , Neumotórax/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada por Rayos X

RESUMEN

The aim of this pilot test was to test a new self-locking resorbable implant for hilum occlusion during a video-assisted thoracoscopic lung lobectomy in a surviving pig model. Once the thoracic cavity was assessed and structures identified, the right middle lobe and its respective hilum were exposed. The implant was introduced with a semiclosed loop through a working channel and positioned around the pulmonary lobe. Occlusion was performed with a conventional Crile forceps and a laparoscopic Kelly forceps. Lobe section was done with laparoscopic Metzenbaum scissors and tissue removal through the dorsal access. No signs of pneumothorax or bleeding were observed during a 60-day follow-up. Necropsy findings showed minimal pleuritis in caudal access and in the lobar stump. A granulomatous formation was found around a dense, amorphous material, which was identified as remains of a small part of the implant. Histopathological findings showed signs of a chronic healing process without other alterations. The resorbable implant LigaTie appears to exhibit similar handling and application characteristics during surgery as nonsurgical tie wraps. The resorbable implant avoids the uncontrolled substances not suitable for implants of conventional ties. The results of this pilot test suggested the resorbable implant's mechanical properties provided effective tissue support to complete the healing of the pulmonary hilum.

Asunto(s)

Neoplasias Pulmonares/cirugía , Pulmón/cirugía , Neumonectomía/métodos , Cirugía Torácica Asistida por Video/métodos , Animales , Diseño de Equipo , Masculino , Neumonectomía/instrumentación , Neumotórax , Hemorragia Posoperatoria , Prótesis e Implantes , Porcinos , Cirugía Torácica Asistida por Video/instrumentación

RESUMEN

A técnica de lobectomia pulmonar pode ser utilizada para tratamento de neoplasias pulmonares, torção do lobo pulmonar, laceração pulmonar e abscessos pulmonares e dentre as complicações pós-operatórias, destacam-se a deiscência do coto brônquico, escape aéreo prolongado e desenvolvimento de fístula broncopleural. Esses problemas geralmente são decorrentes da má oclusão do coto brônquico e na maioria das vezes o tratamento consiste na realização de um novo procedimento cirúrgico com reabertura da cavidade torácica. Com o presente trabalho, objetivou-se avaliar a eficácia do n-butil cianoacrilato e da braçadeira de náilon como métodos para oclusão do coto brônquico e manutenção da aerostasia, comparando-o com a técnica de sutura manual, em modelo experimental empregando árvores traqueobrônquicas de suínos, submetidas a crescentes níveis de pressão positiva intrabrôquica. Foram utilizadas 30 árvores traqueobrônquicas, onde oito brônquios lobares de cada peça foram selecionados para estudo, sendo quatro de 10 mm e quatro de 5 mm. Posteriormente, as árvores e respectivos brônquios foram distribuídos equitativamente em três grupos experimentais: Grupo Sutura (GS) – sutura manual com pontos isolados simples, utilizando náilon cirúrgico nº 2.0; Grupo Cianocrilato (GC) - n-butil cianoacrilato e Grupo Braçadeira (GB) – braçadeiras de náilon. Após a oclusão dos cotos brônquicos, as peças foram imersas em água e realizado o teste de hermeticidade empregando-se pressão positiva intrabronquial de 30 cm de H20 por cinco minutos, sendo em seguida, gradualmente aumentada até atingir a pressão de 100 cm de H2O. Nos grupos GS e GB foram observados vazamentos com percentual de 1,25% (1∕80), quando submetidos a uma pressão de 30 cm de H20 e 100 cm de H20, respectivamente. No grupo GC não foi constatado vazamento em nenhum dos cotos brônquicos. Não foram evidenciadas diferenças estatísticas significativas entre três os tratamentos. Conclui-se que tanto o n-butil cianoacrilato, como a braçadeira de náilon, igualmente à sutura manual, são métodos eficazes na execução e manutenção da aerostasia bronquial.

---

The pulmonary lobectomy technique can be used on the lung cancer, lung lobe torsion,pulmonary laceration and lung abscesses treatment and among the postoperative problems the bronchial stump dehiscence, prolonged air leak and development of bronchopleural fistula are highlighted. These problems are usually resulting from malocclusion of the bronchial stump and most of the times the treatment for those problems consists on a new surgical procedure to reopen the chest cavity. The ain of the present paper was to evaluate the efficiency of n-butyl cyanoacrylate and nylon brassard as methods for occlusion of the bronchial stump andthe aerostasia maintenance, comparing it with the manual suture technique on an experimental model using pig tracheobronchial trees, submitted to increasing levels of positive intrabrochial pressure. 30 pig tracheobronchial trees were used, where eight lobar bronchi from each piece were selected for studying, four of 10 mm and four of 5 mm. Thereafter, the trees and their bronchi were equally distributed into three experimental groups: Suture Group(SG) – manual suture with simple isolated stitches, using nº 2,0 surgical nylon; Cyanoacrylate Group (CG) - n-butyl Cyanoacrylate and Brassard Group (BG) – nylon brassards. After the bronchial stumps occlusion, the pieces were immersed in water and the “tire fitter test” was made placing the positive intrabrochial pressure at 30 cm of H2O for five minutes, and then gradually increased to a pressure at 100 cm of H2O. Leaks with a percentage of 1, 25% (1/80) were observed on groups SG and BG, when respectively submitted to a pressure at 30 cm ofH2O and 100 cm of H2O. There were no leaks in any bronchial stumps on group CG. There were no statistically significant differences among the three treatments. It was concluded that,both n-butyl Cyanoacrylate such as nylon brassard, as also the manual suture, are effective methods for implementation and maintenance of bronchial aerostasia.

Asunto(s)

Bronquios/lesiones , Apósitos Oclusivos , Enbucrilato/administración & dosificación , Neumonectomía/instrumentación , Técnicas de Sutura

Asunto(s)

Neumonectomía/instrumentación , Neumonectomía/métodos , Neumonectomía

Asunto(s)

Humanos , Neumonectomía/métodos , Enfisema Pulmonar , Cuidados Paliativos , Esternón/cirugía , Neumonectomía/instrumentación

RESUMEN

Se presenta la experiencia desde mayo de 1992 a abril de 1993 en cirugía videoasistida en patología torácica. Incluye el tratamiento quirúrgico del neumotórax espontáneo, el empiema pleural, la biopsia pulmonar, las resecciones segmentarias y los tumores de la pared torácica. El método aplicado fue la cirugía videoasistida con los principios que se delimitaron en la técnica toracoscópica. El equipo utilizado consiste en una óptica Wolff de 0º, una fuente de luz de xerion para la fibra óptica, una endocámara MC800 + -, un equipo aspirador e irrigador. De los 19 procedimientos realizados se ha obtenido óptimos resultados en 16, aceptables en 2 y fracaso terapéutico en 1. La Cirugía Toraco Videoasistida ha demostrado ser un procedimiento excelente, si bien tiene indicaciones que aún deben ajustarse. La experiencia nacional e internacional coinciden entre sí

Asunto(s)

Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Toracoscopía/métodos , Cirugía Torácica/métodos , Televisión/tendencias , Neumotórax/cirugía , Neumotórax/epidemiología , Toracoscopía/instrumentación , Cirugía Torácica/instrumentación , Cirugía Torácica/tendencias , Empiema Pleural/cirugía , Nódulo Pulmonar Solitario/cirugía , Neumonectomía/instrumentación , Neumonectomía/métodos

RESUMEN

Se presenta la experiencia desde mayo de 1992 a abril de 1993 en cirugía videoasistida en patología torácica. Incluye el tratamiento quirúrgico del neumotórax espontáneo, el empiema pleural, la biopsia pulmonar, las resecciones segmentarias y los tumores de la pared torácica. El método aplicado fue la cirugía videoasistida con los principios que se delimitaron en la técnica toracoscópica. El equipo utilizado consiste en una óptica Wolff de 0º, una fuente de luz de xerion para la fibra óptica, una endocámara MC800 + -, un equipo aspirador e irrigador. De los 19 procedimientos realizados se ha obtenido óptimos resultados en 16, aceptables en 2 y fracaso terapéutico en 1. La Cirugía Toraco Videoasistida ha demostrado ser un procedimiento excelente, si bien tiene indicaciones que aún deben ajustarse. La experiencia nacional e internacional coinciden entre sí

Asunto(s)

Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Cirugía Torácica/métodos , Neumotórax/cirugía , Televisión/tendencias , Toracoscopía , Cirugía Torácica/instrumentación , Cirugía Torácica/tendencias , Empiema Pleural/cirugía , Neumonectomía/instrumentación , Neumonectomía/métodos , Neumotórax/epidemiología , Nódulo Pulmonar Solitario/cirugía , Toracoscopía/instrumentación

RESUMEN

The ND:YAG surgical laser is a safe and effective method for resection of pulmonary nodules using VATS. It may be used as the primary resecting tool or as an adjunct to endoscopic stapling techniques to provide optimal pulmonary tissue preservation, and to avoid injury to the lung from inappropriate stapler applications. Thoracoscopic laser resection is particularly suited for deep lesions and for surface nodules where staplers are inadequate. Laser ablation of bullous disease using thoracoscopy offers a minimally invasive method of treating symptomatic patients with complications from dominant bullae.

Asunto(s)

Terapia por Láser/instrumentación , Enfermedades Pulmonares/cirugía , Neoplasias Pulmonares/cirugía , Toracoscopios , Grabación en Video/instrumentación , Biopsia/instrumentación , Humanos , Pulmón/patología , Enfermedades Pulmonares/patología , Neoplasias Pulmonares/patología , Neumonectomía/instrumentación , Enfisema Pulmonar/patología , Enfisema Pulmonar/cirugía , Nódulo Pulmonar Solitario/patología , Nódulo Pulmonar Solitario/cirugía , Engrapadoras Quirúrgicas

RESUMEN

Entre enero de 1981 y diciembre de 1991 (diez años), 262 pacientes fueron sometidos a cirugía torácica en el Servicio número uno, en el Hospital Central Miguel Pérez Carreño de Caracas, (IVSS), bajo la supervisión de uno de nosotros (JRLO). Las suturas automáticas fueron utilizadas en todos los pacientes. Representando las neoplasias malignas el 5,73 por ciento . La mortalidad operatoria fue nula. Uno de nuestros enfermos sometido a resección atípica por neumotorax espontáneo idiopático benigno recurrente falleció a las cuatro semanas de intervenido por Neumonía como consecuencia de paro cardio-respiratorio que presentó en la sala de recuperación, a las doce horas de la intervención. Con rango de edad entre los 14 y 84 años con media de 58. Masculinos el 70,23 por ciento , femeninos el 29,77 por ciento restante. El porcentaje de complicaciones fue de 3,44 por ciento (nueve casos). La fístula bronco-pleural en el 1,15 por ciento (tres casos). La incidencia de fístulas post-neumonectomías fue del 1,33 por ciento a los tres meses de la cirugía y un 2,5 por ciento del total. El agrapado de uno o más elementos anatómicos del hilio pulmonar lo realizamosen todas las neumonectomías (nueve). El rol que representan las suturas automáticas en la cirugía pulmonar es analizado, haciendo especial referencia a las fuga aéreas persistentes y fístulas broncopleurales

Asunto(s)

Adolescente , Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Procedimientos Quirúrgicos Pulmonares/instrumentación , Procedimientos Quirúrgicos Pulmonares/métodos , Neumonectomía/instrumentación , Neumonectomía/métodos , Técnicas de Sutura

RESUMEN

Técnicas de los diferentes tipos de resección pulmonar, con detalle de cada una, así como instrumental, posiciones y métodos de anestesia. Detallada explicación de la anatomía quirúrgica del pulmón, hilio pulmonar, bronquios, arterias y venas pulmonares

Asunto(s)

Neumonectomía/métodos , Pulmón/anatomía & histología , Toracoplastia/métodos , Anestesia General/efectos adversos , Anestesia General/instrumentación , Anestesia General/métodos , Arteria Pulmonar/anatomía & histología , Bronquiectasia/cirugía , Quiste Broncogénico/cirugía , Complicaciones Intraoperatorias/cirugía , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/terapia , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Cuidados Intraoperatorios/métodos , Cuidados Intraoperatorios/normas , Cuidados Preoperatorios/métodos , Cuidados Preoperatorios/normas , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/normas , Neoplasias Pulmonares/cirugía , Neumonectomía/clasificación , Neumonectomía/instrumentación , Pulmón/irrigación sanguínea , Toracoplastia/instrumentación , Toracoplastia/normas , Tuberculosis Pulmonar/cirugía , Venas Pulmonares/anatomía & histología

RESUMEN

Técnicas de los diferentes tipos de resección pulmonar, con detalle de cada una, así como instrumental, posiciones y métodos de anestesia. Detallada explicación de la anatomía quirúrgica del pulmón, hilio pulmonar, bronquios, arterias y venas pulmonares

Asunto(s)

Pulmón/anatomía & histología , Neumonectomía/métodos , Toracoplastia/métodos , Pulmón/irrigación sanguínea , Neumonectomía/clasificación , Neumonectomía/instrumentación , Neoplasias Pulmonares/cirugía , Bronquiectasia/cirugía , Tuberculosis Pulmonar/cirugía , Quiste Broncogénico/cirugía , Toracoplastia/instrumentación , Toracoplastia/normas , Arteria Pulmonar/anatomía & histología , Complicaciones Intraoperatorias/cirugía , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/terapia , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Cuidados Intraoperatorios/métodos , Cuidados Intraoperatorios/normas , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/normas , Cuidados Preoperatorios/métodos , Cuidados Preoperatorios/normas , Anestesia General/efectos adversos , Anestesia General/instrumentación , Anestesia General/métodos , Venas Pulmonares/anatomía & histología