SUBXIPHOID UNIPORTAL VATS THYMECTOMY IN CASES OF MYASTHENIA GRAVIS:SINGLE CENTRE EXPERIENCE

Background: Thymectomy has been identified as Constructive and active strategy for patients with Myasthenia gravis and thymic masses which have been done classically by Open Sternotomy technique and nowadays new Minimally invasive approaches have also been introduced. In this paper , Subxiphoid Uniportal VATS(Video Assis Method : ted Thoracoscopic Surgery) Thymectomy through a single port technique by utilizing the Subxiphoid approach has been discussed. I have improvised my technique pertaining to the requirements and better recovery and better post operative outcome of the patient .This procedure is indicated for all anterior mediastinal masses and maybe extended to lung cancer.The patient was placed in supine position instead of classical lithotomy position .Carbon dioxide insufflation was not used which led to faster recovery after the surgery.After dissection and resection of thymus Bilateral pleural drain were placed which was removed usually on Post Operative day 4 or 5 and patients were discharged afterwards. Several benefits of this Results: approach were observed and documented including reduced postoperative pain, Early extubation, better post operative outcome, and better dissection . In the near future ,the Subxiphoid approach has the potential to become Conclusion: GOLD STANDARD for Thymectomy and various other conditions

Implementation of an ERAS program in patients undergoing thoracic surgery at a third-level university hospital: an ambispective cohort study

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.

Management of video?assisted thoracoscopic (VATs) bilateral cardiac sympathectomy in refractory ventricular storm: A case report

A 65?year?old male post?CABG surgery presented with history of ventricular storm refractory to antiarrhythmics and requiring multiple DC shocks. He got posted for VATs bilateral cardiac denervation for sympathetic remodulation. Patient was induced with high dose opioids and Etomidate and intubated with 37Fr left double lumen tube. A multidisciplinary approach was planned to tackle peri?operative cardiac event along with the placement of invasive monitors. Events that might lead to sympathetic overactivation because of laryngoscopy, pain, capnothorax, and surgical handling were kept in mind and avoided with optimum depth of anesthesia, analgesia, and pharmacological sympatholysis. There was no major cardiac event intraoperatively as well as in postoperative period.

Cohort study on 20 years' experience of bilateral video-assisted thoracic sympathectomy (VATS) for treatment of hyperhidrosis in 2431 patients

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.

Upper left lung cancer with congenital complete left pericardial defect: A case report / 中国胸心血管外科临床杂志

@#A 54-year-old asymptomatic man underwent a video-assisted thoracoscopic left pneumonectomy for squamous-cell carcinoma. During the surgery, a complete left pericardial defect was unexpectedly discovered, but no special intervention was made. The preoperative chest CT was reciewed, which showed the heart extended unusually to the left, but the left pericardial defect was not evident. The operation time was 204 min and the patient was discharged from hospital upon recovery 9 days after the surgery. The pathological result indicated moderately differentiated squamous-cell carcinoma (T2N1M0, stage ⅡB), and metastasis was found in the parabronchial lymph nodes (3/5). The patient did not receive chemotherapy after the surgery, and there was no signs of recurrence 6 months after the surgery. Complete pericardial defects usually do not endanger the lives of patients, and if the patient is asymptomatic, pneumonectomy is feasible.

Safety and feasibility of no chest tube after thoracoscopic pneumonectomy: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To discuss the safety and feasibility of no chest tube (NCT) after thoracoscopic pneumonectomy. Methods    The online databases including PubMed, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to October 2020 to collect the research on NCT after thoracoscopic pneumonectomy. Two reviewers independently screened the literature, extracted the data, and evaluated the quality of the included studies. The RevMan 5.3 software was used for meta-analysis. Results    A total of 17 studies were included. There were 12 cohort studies and 5 randomized controlled trials including 1 572 patients with 779 patients in the NCT group and 793 patients in the chest tube placement (CTP) group. Meta–analysis results showed that the length of postoperative hospital stay in the NCT group was shorter than that in the CTP group (SMD=–1.23, 95%CI –1.59 to –0.87, P<0.000 01). Patients in the NCT group experienced slighter pain than those in the CTP group at postoperative day (POD)1 (SMD=–0.97, 95%CI –1.42 to –0.53, P<0.000 1), and POD2 (SMD=–1.10, 95%CI –2.00 to –0.20, P=0.02), while no statistical difference was found between the two groups in the visual analogue scale of POD3 (SMD=–0.92, 95%CI –1.91 to 0.07, P=0.07). There was no statistical difference in the 30-day complication rate (RR=0.93, 95%CI 0.61 to 1.44, P=0.76), the rate of postoperative chest drainage (RR=1.51, 95%CI 0.68 to 3.37, P=0.31) or the rate of thoracocentesis (RR=2.81, 95%CI 0.91 to 8.64, P=0.07) between the two groups. No death occurred in the perioperative period in both groups. Conclusion    It is feasible and safe to omit the chest tube after thoracoscopic pneumonectomy for patients who meet the criteria.

Clinical application of uniportal video-assisted thoracoscopic surgery anatomic basal segmentectomy / 中国胸心血管外科临床杂志

@#Objective    To investigate the efficacy of uniportal video-assisted thoracoscopic surgery (VATS) anatomic basal segmentectomy. Methods    The clinical data of 15 patients who underwent uniportal VATS anatomic basal segmentectomy between June 2020 and December 2020 were retrospectively reviewed. There were 4 males and 11 females with a median age of 53 (32-70) years. The incisions were placed in the fifth intercostal space across the mid-axillary line. All basal segmentectomies were performed through the interlobar fissure or inferior pulmonary ligament approach following the strategies of single-direction and stem-branch. Results    All patients underwent basal segmentectomy successfully with no conversion to multi-portal procedure or thoracotomy. The median operation time was 120 (90-160) min, median intraoperative blood loss was 20 (10-50) mL, median drainage time was 3 (2-5) d, and median postoperative hospital stay was 4 (4-10) d. The maximum diameter of the lesion in the resected basal segment was 1.2 (0.7-1.9) cm. The median resected lymph nodes were 7 (5-12). There was no evidence of nodal metastases. One patient suffered postoperative atelectasis and subsequent pneumonia. No perioperative death occurred. Conclusion    Uniportal VATS anatomic basal segmentectomy is feasible and safe. It can be performed in a simple manner following the strategy of single-direction.

Actualización y controversias en el tratamiento de las malformaciones congénitas de la vía aérea pulmonar / Update and disagreements in the treatment of congenital pulmonary airway malformations

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.

VATS Uniportal, masterclass Guatemala / VATS Uniportal, masterclass Guatemala

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)

Simultaneous thoracoscopic approach in a patient with long-standing persistent atrial fibrillation and primary lung cancer: the first described case

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.

A rare case of primary pulmonary Hodgkin’s lymphoma

A 46 years old male presented with fever, chest pain, dry cough, weight loss, and breathlessness over the preceding 3 months. CT scans of thorax revealed diffuse sclerosis with multiple ill-defined small erosion and pleural thickening of the right lung with bulky lymph node in a subcarinal region measuring approximately 13.5×11×27.5 mm and 20×5 mm soft tissue parenchymal lesion in a right apical zone. Examination of pleural fluid cytology was not diagnostic. Bronchoscopic fluid cytology was also not contributory. Hilar and pre aortic lymph node biopsies showed only reactive change. Video-assisted thoracoscopic surgery (VATS) with biopsy from all suspicious areas of lung and pleura was taken, which on evaluation confirmed the diagnosis of primary pulmonary Hodgkin’s lymphoma. We present here a rare case of primary pulmonary Hodgkin’s lymphoma with a review of the literature.

Video assisted thoracoscopic surgery in the management of acute fibrinopurulent empyema in paediatric patients

Background: Empyema is the presence of pus in the pleural space that usually follows an episode of pneumonia in pediatric age group. The aim of this study was to assess the efficacy of management of acute fibrinopurulent stage of empyema by early video assisted thoracoscopic surgery (VATS) in paediatric patients.Methods: The study was carried out at a tertiary care hospital in India. It was a prospective interventional observational study. The study included 40 children between age group 0-12 years attending the surgery in-patient department referred for further management of parapneumonic effusions who had clinical and radiological evidence of empyema and thoracocentesis confirmed purulent exudate in pleural cavity, were subjected to early VATS after thorough pre-operative workup.Results: The mean age was 7.22 years. Average operative time was 135.5 minutes. The mean duration of hospital stay was 7.5 days. Few complications were bleeding, superficial wound infection, bronchopleural fistula, pneumothorax, recurrence of empyema and incomplete expansion of lung.Conclusions: VATS facilitates the management of fibrinopurulent and organised pyogenic pleural empyema with less post-operative discomfort and complications and reduced hospital stay. However larger sample size study is required to come to a definitive conclusion.

Cirugía torácica videoasistida uniportal en dos centros universitarios: experiencia inicial / Initial experience in uniportal video-assisted thoracoscopic surgery at two university campuses

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.

Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: Systematic review of matched case control studies / Шинэ санаа Шинэ нээлт

Introduction@#The introduction of minimally invasive surgery has revolutionized multiple disciplines of surgical practice. @*Objectives@#This meta-analysis of matched case control studies aimed to compare the perioperative outcomes of video-assisted thoracic surgery (VATS) with open thoracotomy for patients with early-stage non-small cell lung cancer (NSCLC).@*Methods@#We searched from PubMed and Embase electronic database and revealed seven relevant studies. Endpoints included perioperative mortality and morbidity, postoperative complications and duration of hospitalization. Two investigators (L.S and D.N) independently reviewed each retrieved article. The values of RR and 95% CI were estimated. We used the fixed and random-effects models to estimate the size of the treatment benefit.@*Results@#Results indicate that perioperative mortality was similar between VATS and open thoracotomy (RR-0.62(95%CI 0.39-0.98). However, patients who underwent VATS were found to have fewer overall complications (RR-0.68(95%CI 0.59-0.78), and patients who underwent VATS had a significantly shorter length of hospitalization compared with those who underwent open thoracotomy (MD= -2.98(95%CI-4.09:-1.87)).@*Conclusions@#The present meta-analysis demonstrated superior perioperative outcomes for patients who underwent VATS, including overall complication rates and duration of hospitalization. Therefore, our study suggests that VATS should be performed widely to treat patients with lung cancer in the future.

Uniportal versus three-port single-direction thoracoscopic lobectomy: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To explore the feasibility and short-term efficacy of uniportal and three-port single-direction video-assisted thoracoscopic surgery (S-VATS) anatomical lobectomy for lung cancer. Methods    Clinical data of 60 lung cancer patients, including 40 males and 20 females with an average age of 62.2±9.0 years, who received S-VATS anatomic lobectomy and systematic lymph nodes dissection by the same surgeon in our hospital between July 2016 and January 2019 were retrospectively analyzed. These patients were divided into a uniportal S-VATS group and a three-port S-VATS group according to surgical procedures, with 30 patients in each group. The clinical data of the two groups were compared. Results    There was no conversion to thoracotomy, surgical port addition, or mortality in this cohort, with tumor-negative surgical margin. There was no statistical difference in the operation time between the two groups (70.8±16.4 min vs. 73.7±14.3 min, P>0.05). Meanwhile, both groups showed similar intraoperative blood loss, stations and numbers of dissected lymph nodes, incidence of operation-related complications, duration and volume of chest tube drainage, as well as postoperative hospital stay (P>0.05). Besides, pain score of the patients in the uniportal S-VATS group was significantly lower than that of the three-port S-VATS group on postoperative 3-14 d (P<0.05). The mean duration of follow-up was 10 months, and all the patients were survived without tumor recurrence or metastasis. Conclusion    The transition from three-port S-VATS to uniportal S-VATS anatomical lobectomy for treatment of lung cancer is feasible. However, further studies are needed to elucidate the optimal resection sequence of pulmonary vessels.

Robotic and thoracoscopic segmentectomy in the treatment for non-small cell lung cancer: A propensity score-matched study / 中国胸心血管外科临床杂志

@#Objective    To investigate the safety and efficiency of robotic lung segmentectomy. Methods    The clinical data of 110 patients receiving robotic or thoracoscopic segmentectomy in our hospital between June 2015 and June 2019 were retrospectively analyzed. The patients were divided into a robotic group [n=50, 13 males and 37 females aged 53.0 (46.0, 60.0) years] and a thoracoscopic group [n=60, 21 males and 39 females aged 61.0 (53.0, 67.0) years]. A propensity score-matched analysis was adopted to compare the perioperative data between the two groups. Results    After the propensity score-matched analysis, 34 patients were included in each group. In comparison with the thoracoscopic group, patients in the robotic group had less blood loss [40.0 (20.0, 50.0) mL vs. 60.0 (40.0, 80.0) mL, P<0.001], more stations of lymph node dissection [7.0 (6.0, 8.0) vs. 4.0 (3.0, 6.0), P<0.001], larger number of lymph node dissection [15.0 (11.0, 21.0) vs. 10.0 (6.0, 14.0), P=0.002], and a higher total cost of hospitalization [97.0 (92.0, 103.0) thousand yuan vs. 54.0 (42.0, 59.0) thousand yuan, P<0.001]. Conclusion    In contrast with the thoracoscopic segmentectomy, robotic segmentectomy has a similar operative safety, but less blood loss and a thorough lymphadenectomy.

Laparoscopic Surgery in Pediatric Age Group – Our 10 Years Experience from a Tertiary Care Centre

Background: To study the role of Laparoscopic surgery in Pediatric age group. Settings: Department of General and Minimal Access Surgery, Government Medical College Srinagar. Methods: Three hundred and sixty four pediatric patients referred to our tertiary care center in the pediatric age group were operated upon laparoscopically for various conditions from January 2009 to January 2019. Results: A total of 364 non-infantile pediatric cases were operated upon laparoscopically which included 107 Non-palpable UDT, 71 Appendectomies, 67 Diagnostic laparoscopies, 31 Cholecystectomies, 5 VATS procedures, 8 Varicocelectomies, 2 Advance urological procedures, 55 Herniotomies, 3 umbilical hernia laparoscopic anatomical repairs, 7 Hepatic Hydatid cyst surgeries, 5 Laparoscopic assisted Soaves procedures, 1 each of Laparoscopic Pyeloplasty, Morgagni hernia repair and Ladd’s procedure for Malrotation of Gut. There were 5 conversions to open procedure and 8 cases were completed by laparoscopic assisted methods. The complication rate including minor complications was approximately 4%. Conclusion: Laparoscopy including Videoassisted Thoracoscopic Surgeries (VATS) in pediatric age group is safe, feasible and rapidly gaining popularity even for advanced and reconstructive procedures. However the threshold for better judgement should be low for decreasing avoidable morbidity in small children.

Analgesia en cirugía torácica videoasistida / Analgesia in video-assisted thoracic surgery

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).

Recuperación mejorada después de cirugía torácica: ERAS / Enhanced recovery after thoracic surgery

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.

Retrospective Study of Surgical Treatment of Thoracic Empyema in Adults

Background: Pleural space infection is common and causessignificant morbidity and mortality up to 10%. The propermanagement of empyema remains controversial, and patientsare often seen by a physician after their purulent process hasalready reached the fibrinopurulent or chronic stage. Thesepatients are often subjected to multiple procedures and longhospitalization before the empyema is successfully treated.Most cases are treated initially using antibiotics with or withoutrepeated thoracentesis or chest tube insertion. Surgicalapproaches, such as video-assisted thoracic surgery (VATS) oropen thoracotomy and decortications, are usually reserved forpatients with deteriorated clinical condition following failedconservative treatment, which in turn increase the mortalityrate.Aims and Objective: The aim of our retrospective study is toevaluate our experience with thoracic empyema over a 36-month period with special attention to procedures used,success rate of each procedure and outcome.Materials & Methods: A retrospective chart analysis onpatients in whom thoracic empyema was diagnosed fromMarch 2016 to March 2018 at Civil hospital, BJ Medicalcollege, Ahmedabad, India. was performed. The definition ofempyema was selected as any pleural fluid that was grosslypurulent, and/or had a positive Gram stain or culture andempyema were classified by etiology and culture results.Charts were reviewed for patients age, symptoms, underlyingdisease, etiology of empyema, culture results, diagnosticmodalities, duration of hospitalization, therapeutic intervention,date of procedures, complications, mortality and long-termoutcome.Results and Conclusion: Empyema thoracis is a cause ofhigh mortality in man and its occurrence is increasing in bothchildren and adults. Two guidelines documents on themanagement of empyema in adults have been published bythe ACCP and the BTS. Although they differ in their approachto management, they agree on that the pleural space shouldbe drained in all patients with exudative PPE with pleural fluidpH < 7.2 and in those who have frank pus in the pleural space.Patients who do not improve should be referred to the surgeonfor further management. A large randomized multi-centre trialhas shown no survival advantage with the use of intrapleuralstreptokinase in patients with pleural infection and the use ofstreptokinase has not prevented surgery in the group ofpatients studied. However, streptokinase enhances infectedpleural fluid drainage and may still be used in patients whohave large collection of infected pleural collection causingventilatory impairment.