Application of Three-dimensional Computed Tomography Bronchography and Angiography Combined with Perfusion Area Identification Technique in Uniport Thoracoscopic Complex Segmentectomy / 中国肺癌杂志

BACKGROUND@#With the extensive application of segmental lung resection in the treatment of early-stage lung cancer, how to complete segmentectomy more accurately and minimally invasively has become a research hotspot. The aim of this study is to explore the application of three-dimensional computed tomography bronchography and angiography (3D-CTBA) combined with perfusion area recognition technique in single-hole thoracoscopic complex segmentectomy.@*METHODS@#From January 2021 to January 2022, the clinical data of 112 consecutive patients undergoing single-port thoracoscopic complex segmentectomy in the Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University were retrospectively analyzed. The three-dimensional reconstruction combined with perfusion area identification technique was used to perform the operation and the clinical data were analyzed.@*RESULTS@#The average operation time was (141.1±35.4) min; the initial time of intersegmental plane display was (12.5±1.7) s; the maintenance time of intersegmental plane was (114.3±10.9) s; the intersegmental plane was clearly displayed (100%); the amount of bleeding was [10 (10, 20)] mL; the total postoperative drainage volume was (380.5±139.7) mL; the postoperative extubation time was (3.9±1.2) d; and the postoperative hospitalization time was (5.2±1.6) d. Postoperative complications occurred in 8 cases.@*CONCLUSIONS@#The advantages of 3D-CTBA combined with perfusion area recognition technique are fast, accurate and safe in identifying intersegmental boundary in single-port thoracoscopic complex segmentectomy, which could provide guidances for accuratding resection of tumors, shortening operation time and reducing surgical complications.

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.

Single-versus Two-port Video-assisted Thoracic Surgery in Thymoma: A Propensity-matched Study / 中国肺癌杂志

BACKGROUND@#In recent years, with the advancement of minimally invasive techniques, thoracoscopic thymoma resection has experienced a development process from three-port video-assisted thoracic surgery (VATS) to two-port (TP) and single-port (SP) variants. However, the feasibility and safety of SP-VATS have not been generally recognized. This study intends to explore the safety and feasibility of SP-VATS in thymoma resection, in order to provide a reference for clinical surgicalselection.@*METHODS@#The clinical data of 197 patients who underwent thoracoscopic thymoma resection in Beijing Tongren Hospital from January 2018 to September 2021 were retrospectively analyzed. The patients were divided into SP-VATS group (n=42) and TP-VATS group (n=155). After matching propensity scores, there is no statistically significant difference in preoperative baseline data between SP-VATS group and TP-VATS group. Among them, there were 17 males and 25 females with an average age of 28-72 (48.00±9.43) years in the SP-VATS group, and 20 males and 22 females with an average age of 30-75 (50.38±9.83) years in TP-VATS group. The clinical effects of the two groups were compared.@*RESULTS@#The operation was successfully completed in both groups, and there was no conversion to thoracotomy or increased surgical incisions. Compared with the TP-VATS group, the chest drainage time and hospital stay in the SP-VATS group were shorter [(2.95±0.76) d vs (3.33±0.85) d; (4.57±0.83) d vs (5.07±1.13) d], and the visual pain score at 24 h and 72 h after surgery were lower [(3.64±0.85) points vs (4.05±0.66) points; (2.33±0.75) points vs (3.07±0.68) points] (P<0.05). There was no statistically significant difference between the two groups in operation time [(130.00±26.23) min vs (135.24±27.03) min], intraoperative blood loss [(69.52±22.73) mL vs (82.38±49.23) mL] (P>0.05).@*CONCLUSIONS@#SP-VATS in thymoma is a safe, feasible, and less invasive procedure, with less postoperative pain and faster recovery than multi-port VATS.

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)

Biopsia pulmonar en la enfermedad pulmonar difusa por minitoracotomía o cirugía torácica videoasistida / Lung Biopsy in Diffuse Lung Disease by Minithoracotomy or Video-Assisted Thoracic Surgery

RESUMEN Introducción: La enfermedad pulmonar intersticial difusa constituye un grupo heterogéneo de lesiones con varias características comunes entre las cuales resaltan la inflamación y cicatrización del órgano. Por lo general, se requiere la obtención de tejido parenquimatoso para el diagnóstico definitivo. Objetivos: Describir los resultados obtenidos, según el método de minitoracotomía o cirugía torácica videoasistida, para obtener las muestras hísticas para estudio histopatológico. Métodos: Se realizó un estudio observacional, longitudinal y prospectivo de 52 pacientes consecutivos, con diagnóstico de enfermedad pulmonar intersticial difusa, a quienes se les practicó la toma de muestras tisulares obtenidas mediante cirugía torácica videoasistida o minitoracotomía en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras" entre el 2001 y el 2018. Se estudió la edad y el sexo de los pacientes, la técnica quirúrgica empleada y las complicaciones y mortalidad. Los resultados se exponen en tablas, en números absolutos y relativos. Resultados: Predominó el sexo femenino (59,6 por ciento). La técnica quirúrgica más utilizada fue la minitoracotomía (75,0 por ciento) en pacientes entre 41-50 años, con 15 enfermos. La afección más frecuente fue la fibrosis pulmonar con un 78,8 por ciento. En dos enfermos intervenidos mediante cirugía torácica videoasistida no fue posible obtener tejido para biopsia (15,4 por ciento). Hubo dos complicaciones en pacientes operados mediante minitoracotomía. Conclusiones: La cirugía torácica videoasistida permite una amplia exploración de la superficie pulmonar, pero la biopsia abierta puede tener la misma efectividad para la obtención de muestras hísticas pulmonares, con un mínimo por ciento de complicaciones y bajo índice de mortalidad(AU)

ABSTRACT Introduction: Diffuse interstitial lung disease makes up a heterogeneous group of lesions with several common characteristics, among which inflammation and scarring of the organ stand out. Generally, obtaining parenchymal tissue is required for definitive diagnosis. Objectives: To describe the outcomes of using the method of minithoracotomy or video-assisted thoracic surgery to obtain tissue samples for histopathological study. Methods: An observational, longitudinal and prospective study was carried out with 52 consecutive patients with a diagnosis of diffuse interstitial lung disease. Tissue samples obtained by video-assisted thoracic surgery or mini-thoracotomy were taken at Hermanos Ameijeiras Clinical-Surgical Hospital, between 2001 and 2018. The age and sex of the patients, the surgical technique used, and complications and mortality were studied. The results are presented in tables, in absolute and relative numbers. Results: The female sex predominated (59.6 percent). The most widely used surgical technique was minithoracotomy (75.0 percent) in patients between 41-50 years (15 patients). The most frequent condition was pulmonary fibrosis, accounting for 78.8 percent. In two patients who underwent video-assisted thoracic surgery, it was not possible to obtain any tissue for biopsy (15.4 percent). There were two complications in patients operated on by minithoracotomy. Conclusions: Video-assisted thoracic surgery allows wide exploration of the lung surface, but open biopsy can be just as effective in obtaining lung tissue samples, with a minimum percentage of complications and a low mortality rate(AU)

Teratomas del mediastino / Mediastinum Teratomas

RESUMEN Introducción: Los teratomas se definen como tumores de tejidos extraños al órgano o sitio anatómico en el cual se originan. Los teratomas mediastinales no son frecuentes, representan alrededor del 5 por ciento al 10 por ciento de todos los tumores mediastinales. Objetivo: Describir los resultados del tratamiento quirúrgico de pacientes con diagnóstico de teratomas mediastinales. Métodos: Se estudiaron 12 pacientes tratados entre enero de 2001 y diciembre de 2018. Las variables evaluadas fueron sexo, edad, tipo histológico: maduro o inmaduro, vía de acceso quirúrgico, accidentes quirúrgicos y evolución postoperatoria. Resultados: Correspondieron 9 al sexo femenino y 3 al masculino. El promedio de edad fue de 33,3 años (17-60 años). Hubo predominio absoluto del tipo maduro (11). La esternotomía media fue el acceso más frecuente. La toracotomía se realizó cuando el tumor, voluminoso, ocupaba la mayor parte de un hemitórax. Los accidentes quirúrgicos fueron un desgarro pulmonar y una apertura del pericardio. De dos pacientes tratados mediante cirugía torácica videoasistida, uno fue convertido por sangrado venoso molesto. Al año de seguimiento todos estaban vivos, sin evidencias de recidiva. Conclusiones: Contrariamente a lo esperado, hay predominio del sexo femenino, mientras que la edad y el tipo histológico coinciden con la literatura. La esternotomía, aún hoy, es comúnmente aceptada, a pesar del auge de la cirugía torácica videoasistida. La resección total produce resultados excelentes para los teratomas benignos(AU)

ABSTRACT Introduction: Teratomas are defined as tumors of tissues foreign to the organ or anatomical site in which they originate. Mediastinal teratomas are rare, accounting for about 5-10 percent of all mediastinal tumors. Objective: To describe the outcomes of the surgical treatment of patients diagnosed with mediastinal teratomas. Methods: Twelve patients treated between January 2001 and December 2018 were studied. The variables evaluated were sex, age, histological type (mature or immature), surgical access route, surgical accidents, and postoperative evolution. Results: Nine patients corresponded to the female sex and three, to the male. The average age was 33.3 years (17-60 years). There was an absolute predominance of the mature type (11). Median sternotomy was the most frequent access. Thoracotomy was performed when the bulky tumor occupied most of a hemithorax. The surgical accidents were lung tear and opening of the pericardium. Of two patients treated by video-assisted thoracic surgery, one was converted for bothersome venous bleeding. At one year of follow-up, all were alive, with no evidence of recurrence. Conclusions: Contrary to expectations, there is predominance of the female sex, while age and histological type coincide with the literature. Sternotomy, even today, is commonly accepted, despite the rise of video-assisted thoracic surgery. Total resection produces excellent outcomes in benign teratomas(AU)

Papel actual de la videomediastinoscopía en el cáncer pulmonar / Current Role of Videomediastinoscopy in Lung Cancer

RESUMEN La exploración mediastinal comienza desde la época de Galeno. Su desarrollo se alcanzó en la segunda mitad del siglo XX, utilizada para el estudio de los ganglios y tumores mediastinales. En la actualidad su uso se ha ampliado no solo como diagnóstico, sino con fines terapéuticos, al lograr realizar resecciones pulmonares. El objetivo es realizar una revisión actualizada de la literatura, acerca del uso de la mediastinoscopia en el diagnóstico del cáncer pulmonar. Se realizó una revisión de la literatura médica donde se utilizaron las bases de datos Scopus, Medline y Cochrane bajo los criterios de sus revisores. Se emplearon las palabras claves en idioma español e inglés. El método de análisis y síntesis se usó para la interpretación de la bibliografía. Se revisaron 173 artículos, de los cuales, se escogieron 58, que cumplían con los criterios de selección, entre ellos, 6 meta análisis, 11 artículos de revisión y 41 artículos originales. La videomediastinoscopía constituye una herramienta válida para el diagnóstico, así como para el estadiamiento de enfermedades dentro y fuera de la cavidad torácica y mediastino. Por otra parte, permite el tratamiento de algunas enfermedades(AU)

ABSTRACT The mediastinal exploration begins from the time of Galen. Its development was reached in the second half of the 20th century, used for the study of lymph nodes and mediastinal tumors. At present its use has been expanded not only as a diagnosis, but also for therapeutic purposes, by achieving lung resections. The objective is to carry out an updated review of the literature on the use of mediastinoscopy in the diagnosis of lung cancer. A review of the medical literature was carried out where the Scopus, Medline and Cochrane databases were used under the criteria of their reviewers. The keywords in Spanish and English were used. The method of analysis and synthesis was used for the interpretation of the bibliography. 173 articles were reviewed, of which 58 were chosen, which met the selection criteria, including 6 meta-analyzes, 11 review articles, and 41 original articles. Videomediastinoscopy is a valid tool for diagnosis, as well as for the staging of diseases inside and outside the thoracic cavity and mediastinum. On the other hand, it allows the treatment of some diseases(AU)

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.

Thoracoscopic instruments do not interfere in the outcome of uncomplicated, experimental, video-assisted pulmonary lobectomy / Instrumentos toracoscópicos não interferem no desfecho da lobectomia pulmonar videoassistida experimental não complicada

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.

Cardiac sympathetic denervation for conventional treatment refractory arrhythmias / Denervación simpática cardíaca en arritmias refractarias al tratamiento convencional

Abstract Objective: Cardiac sympathetic denervation (CSD) using video-assisted thoracoscopy is a therapeutic alternative for cardiac arrhythmias refractory to conventional treatment in patients with ventricular structural heart disease, mainly due to ischemia, and in patients with hereditary conditions associated with sudden death such as long QT syndrome. In general, it is performed in cases with recurrent episodes of ventricular tachycardia or electrical storm, in spite of conventional treatment. The objective of this study is to show the experience of this institution with DSCI in refractory patients to conventional management and the results derived from its application. Methods: This was an observational retrospective study. The records of patients with a history of ventricular arrhythmias treated in our center with pharmacological treatment, catheter ablation, or implantation of an implantable cardioverter-defibrillator (ICD), who underwent video-assisted CSD were analyzed and described. Results: A total of six patients were included in the study. Patients with structural heart disease were the most frequent, median age was 56 � 16 years; 67% were male. The procedure evolved without complications in any of the patients and an overall significant improvement was observed. A 24-month follow-up was conducted; two patients had recurrence episodes presenting as slow ventricular tachycardia without severe symptoms and a third patient presented an episode of ventricular fibrillation aborted by the ICD. Conclusion: Video-assisted CSD should be considered as a treatment option for patients with potentially dangerous arrhythmias that do not respond to conventional treatment, especially in recurrent ventricular tachycardia.

Resumen Objetivo: La denervación simpática cardiaca izquierda (DSCI) por toracoscopia se ha convertido en una alternativa terapéutica para el manejo de arritmias cardíacas refractarias al tratamiento convencional en pacientes con cardiopatía estructural, principalmente isquémicos, y enfermedades hereditarias asociadas con muerte súbita como el síndrome de QT largo. Generalmente se realiza en quienes manifiestan episodios recurrentes de arritmias ventriculares o incluso tormenta eléctrica a pesar del tratamiento convencional. El objetivo de este estudio es mostrar la experiencia de esta institución con la DSCI en pacientes refractarios al manejo convencional y los resultados derivados de su aplicación. Métodos: Se revisaron los registros de 6 pacientes con antecedente de arritmias ventriculares tratados previamente con medicamentos y en algunos casos con ablación con catéter y la mayoría con desfibrilador automático implantable, que fueron llevados DSCI por toracoscopia video-asistida (VATS). Resultados: La principal enfermedad de base fue la cardiopatía estructural, la indicación más prevalente fue tormenta arrítmica incontrolable, la edad promedio fue de 56 +- 16 años, el 67% de los individuos fueron hombres. Este procedimiento no mostró complicaciones en ninguno de los pacientes y se encontró mejoría sintomática en todos los casos. Se realizó seguimiento por 24 meses; dos pacientes tuvieron recurrencias por taquicardia ventricular lenta sin síntomas severos y uno por fibrilación ventricular. Conclusion: La DSCI por VATS debe considerarse como opción terapéutica para pacientes con arritmias de difícil manejo.

Simpatectomia torácica por videotoracoscopia: revisão da literatura / Video-assisted thoracic sympathectomy: literature review

RESUMO A simpatectomia toracoscópica mostrou-se eficaz no alívio da hiperidrose em diversos pacientes, com melhora da qualidade de vida. O conhecimento do quadro clínico de cada paciente, assim como, as possíveis complicações pós-operatórias, são fundamentais para a obtenção de bons resultados. Deste modo, foi realizada uma revisão na base de dados PubMed de artigos publicados entre 2005 e 2019 que apresentavam como temática principal a simpatectomia realizada por videotoracoscopia para o tratamento da hiperidrose, com o objetivo de avaliar o atual estado da arte referente à qualidade de vida pós-operatória, o tempo de cirurgia e as suas complicações. A partir desta análise, verificou-se a importância do nível de secção da cadeia ganglionar simpática em relação aos resultados. As complicações, apesar de ocorrerem, não reduziram o nível de satisfação e qualidade de vida pós-operatória dos pacientes.

ABSTRACT. Thoracic sympathectomy has been effective in relieving hyperhidrosis in several patients, with quality of life improvement. The knowledge of the clinical picture of each patient, as well as the possible postoperative complications, are fundamental to obtain good results. Thus, we performed a review of articles from the PubMed database published between 2005 and 2019 that presented, as the main topic, thoracoscopy sympathectomy for the treatment of hyperhidrosis, with the objective of evaluating the current state of art referring to postoperative quality of life, surgical time and its complications. From this analysis, we verified the importance of the level of sympathetic ganglion chain section in relation to results. The complication, although occurring, did not reduced the postoperative level of satisfaction or patients' quality of life.

Videotoracoscopía con anestesia peridural en paciente despierto / Epidural anesthesia for videoassisted thoracic surgery in awake patient

Video-assisted thoracic surgery (VATS) is traditionally performed under general anesthesia and endotracheal intubation with a double lumen tube. In recent years, a growing trend towards these procedures being performed under loco regional anesthesia, particularly under epidural block with or without sedation in patients in spontaneous ventilation has appeared. It can be used to perform procedures that include pneumothorax management, wedge resection, lobectomy and surgical reduction of lung volume. The most attractive reason is to eliminate the side effects related to general anesthesia looking for a lower perioperative risks and shorter hospital stays, especially in elderly patients and those with compromised respiratory function. The thoracic epidural anesthesia has been effective allowing an adequate surgical approach, guaranteeing an idoneus level of analgesia, an optimal oxygenation, and facilitating an early postoperative recovery. We present a case of a patient undergoing to lung biopsy performed by VATS patient under epidural block and Ramsay scale sedation level III in spontaneous ventilation, who was discharged 48 hours after the surgical procedure.

La cirugía torácica asistida por vídeo se realiza tradicionalmente bajo anestesia general e intubación endotraqueal con tubo de doble luz. En los últimos años ha existido una corriente creciente hacia la realización de estos procedimientos en pacientes bajo anestesia locorregional, particularmente con bloqueo epidural con o sin sedación y en ventilación espontánea, para procedimientos que incluyen manejo de neumotórax, resección en cuña, lobectomía y cirugía de reducción de volumen pulmonar. La razón más atractiva es evitar los efectos secundarios relacionados con la anestesia general en búsqueda de menor riesgo perioperatorio y menor estancia hospitalaria, especialmente en pacientes mayores y en aquellos con función respiratoria comprometida. La anestesia epidural torácico (AET) ha sido efectiva para permitir un adecuado abordaje quirúrgico, garantizando un idóneo nivel de anestesia, una correcta oxigenación y facilitando la recuperación posoperatoria precoz]. Se presenta el caso clínico de una biopsia pulmonar realizada mediante toracoscopia en un paciente bajo AET con sedación escala Ramsay III y en ventilación espontánea, quien fue dado de alta a las 48 horas posterior a la cirugía.

Marcación de nódulos pulmonares con lipiodol bajo tomografía computada: experiencia local y correlación anatomopatológica / Marking of pulmonary nodules with lipiodol by computerized tomography: local experience and anatomopathological correlation

El objetivo de este estudio es la descripción de la novedosa y poco invasiva técnica de marcación de pequeños nódulos pulmonares con lipiodol, guiado con TAC para su posterior resección por cirugía videotoracoscópica con apoyo radioscópico. Se trata de un estudio retrospectivo que incluye 51 pacientes consecutivos en un tiempo comprendido entre junio del 2012 a septiembre del 2017, obteniendo el diagnóstico final mediante la correlación anatomopatológica, representando los procesos malignos el 81% y los benignos el 19%. Mediante esta técnica se lograron identificar y extraer con éxito el 100% de los nódulos marcados, demostrándose la efectividad y seguridad del procedimiento por las mínimas complicaciones relacionadas.

The purpose of this study is describing a novel and minimally invasive technique of CT-guided marking of small pulmonary nodules with lipiodol prior to resection by videothoracoscopic surgery with radioscopic support. This is a retrospective study that includes 51 consecutive patients between June 2012 and September 2017, with the final diagnosis confirmed by pathology. Malignant nodules represented 81% of the cases with the remaining 19% being benign nodules. Through this technique, 100% of the marked nodules were successfully identified and extracted with few procedure related complications and no adverse clinical outcome, demonstrating the effectiveness and safety of the procedure.

Caracterización de nódulos pulmonares resecados. Experiencia de manejo por un programa multidisciplinario / Features of excised pulmonary nodules in 100 patients

Background: Pulmonary nodules are common, and surgery is the only alternative that allows a diagnostic and therapeutic management in a single procedure. Aim: To report the epidemiological, radiological, surgical and pathological features of excised pulmonary nodules. Material and Methods: Review of medical records of patients in whom a pulmonary nodule was excised between 2014 and 2018. Those with incomplete data or without a pathological study were excluded from analysis. Results: We retrieved 108 records and 8 had to be excluded, therefore 100 patients aged 34 to 82 years (57% females) were analyzed. Sixty percent had a history of smoking. Mean nodule size was 16 mm and the solid type was the most common (65%). Forty five percent of nodules had irregular margins and 55% were in the superior lobes. All patients operated by video-assisted thoracoscopic surgery and 40% underwent a lobectomy. Malignant lesions were observed in 87% of biopsies and a pulmonary adenocarcinoma was found in pathology in 40%. Conclusions: A multidisciplinary approach of pulmonary nodules, using adapted international guidelines, accomplishes an appropriate management, decreasing unnecessary surgical interventions.

Transient Horner's syndrome after single shot paravertebral block / Síndrome de Horner transitória após bloqueio paravertebral em injeção única

Abstract Background Thoracic paravertebral block can provide analgesia for unilateral chest surgery and is associated with a low complication rate. Horner syndrome also referred to as oculosympathetic paresis, is a classic neurologic constellation of ipsilateral blepharoptosis, pupillary miosis, and facial anhidrosis resulting from disruption of the sympathetic pathway supplying the head, eye, and neck. Case report We present a patient with an ipsilateral transient Horner syndrome after ultrasound guided single shot of 15 mL 0.25% levobupivacaine for thoracic paravertebral block at T5-6 level. Conclusions It should be kept in mind that even a successful ultrasound guided single shot thoracic paravertebral block can be complicated with Horner syndrome due to unpredictable distribution of the local anesthetic.

Resumo Justificativa O bloqueio paravertebral torácico pode proporcionar analgesia para cirurgia torácica unilateral e está associado a um baixo índice de complicações. A síndrome de Horner (também denominada paralisia oculossimpática) é uma constelação neurológica clássica de blefaroptose ipsilateral, miose pupilar e anidrose facial devido a distúrbio da via simpática que fornece inervação para a cabeça, os olhos e o pescoço. Relato de caso Apresentamos o caso de um paciente com síndrome de Horner transitória ipsilateral após a administração de injeção única de 15 mL de levobupivacaína a 0,25% para bloqueio paravertebral torácico ao nível de T5-6 guiado por ultrassom. Conclusões Devemos considerar que mesmo um bloqueio paravertebral torácico bem-sucedido com a administração de injeção única e guiado por ultrassom pode ser complicado com a síndrome de Horner devido à distribuição imprevisível do anestésico local.

Simpatectomía torácica, solución para hiperhidrosis / Toracic Sympathectomy, solution for hyperhidrosis

PREFACE: Videothoracoscopic sympathectomy (VTS) is the gold standard treatment for the upper extremity hyperhidrosis (HH) because it is safe and has good results. OBJECTIVE: To evaluate retrospectively the long term results of VTS for the treatment of HH on 50 operated patients in the Maule Region from the year 2003 to september of 2015. METHODS: For axillary HH a T2 to T4 VTS was performed, and T3 VTS for palmar HH. All the patients were operated bilaterally through 2 axillary ports. The operatory sucess was evaluated through the persistence or not of sweating of the palm and armpit. Also, all the complications associated were registered. RESULTS: The procedure was successful in 96% of the patients, who reached anhidrosis in the palms and armpits. The most common complication was compensatory sweating, minimal to mild in 28% of the patients aproximately, severe only in one case; intense post operatory pain in 3 cases and sympathyc reinervation in 2 cases. There was no Infection, Horner syndrome, inthercostal arthery injury or mortality reported. CONCLUSION: The billateral VTS is an effective and safe procedure to obtain anhidrosis in patients with upper extremity hyperhidrosys.

Cirugía videoasistida en traumatismo de tórax / Video assisted thoracic surgery in thoracic trauma

El objetivo es discutir el manejo del hemotórax traumático con cirugía videoasistida (VATS) y una revisión de sus principales indicaciones. Se presenta el caso de un paciente con hemotórax por traumatismo penetrante. Inicialmente manejado con pleurostomía, evoluciona con persistencia del sangrado, por lo que se explora. Como hallazgo se encuentra una lesión de arteria torácica interna que se controla con clips de VATS. El paciente evoluciona estable, sin dolor, por lo que se da de alta al tercer día. El manejo quirúrgico preferido del traumatismo de tórax clásicamente ha sido la toracotomía, pero los abordajes mínimamente invasivos han ganado espacio gracias a su menor morbilidad asociada. Algunos de sus beneficios son el menor dolor en el posoperatorio, menor sangrado y menor tiempo operatorio. Algunas indicaciones validadas son el hemotórax retenido y la persistencia del sangrado, siempre que el paciente se encuentre hemodinámicamente estable y no haya sospecha de lesión cardíaca o de grandes vasos. Se concluye que la VATS es una técnica apropiada en casos seleccionados de hemotórax traumático, pero el abordaje de elección sigue siendo la toracotomía tradicional.

The objective is to discuss the use of video assisted thoracic surgery (VATS) in thoracic trauma and to review the most common indications. A young male with a hemothorax due to penetrating trauma is seen at the emergency department. Initial management with a pleural tube revealed persistence of bleeding so surgical exploration was performed. A lesion of the internal thoracic artery was found and controlled with VATS using laparoscopic clips. The patient had an uneventful postoperative course and was discharged home on the third day posterior to surgery. Usually, surgical management of thoracic trauma has been thoracotomy, but minimally invasive procedures have gained terrain in this area thanks to their lower morbility. Some benefits of these are less postoperative pain, less bleeding, and shorter surgical time. Its validated indications include retained hemothorax and persistent bleeding, but only if the patient is hemodinamically stable and cardiac or large vessel lesions are not suspected. As a conclussion, VATS is an appropriate technique for selected cases of traumatic hemothorax, but thoracotomy still remains as the prefered surgical approach.

Anatomic pulmonary resection via video-assisted thoracic surgery: analysis of 117 cases at a referral center in Brazil / Ressecções pulmonares anatômicas por cirurgia torácica videoassistida: experiência de 117 casos em um centro de referência no Brasil

ABSTRACT Objective: To describe our experience with video-assisted thoracic surgery (VATS) for anatomic pulmonary resection at a referral center for thoracic surgery in Brazil. Methods: All patients who underwent anatomic pulmonary resection by VATS between 2010 and 2015 were included. Clinical and pathological data, as well as postoperative complications, were analyzed. Results: A total of 117 pulmonary resections by VATS were performed, of which 98 were lobectomies and 19 were anatomic segmentectomies. The mean age of the patients was 63.6 years (range, 15-86 years). Females predominated (n = 69; 59%). The mean time to chest tube removal was 2.47 days, and the mean length of ICU stay was 1.88 days. The mean length of hospital stay was 4.48 days. Bleeding ≥ 400 mL occurred in 15 patients. Conversion to thoracotomy was required in 4 patients. Conclusions: Our results are similar to those published in major international studies, indicating that VATS is an important strategy for pulmonary resection. They also show that VATS can be safely performed with adequate training. This technique should be used more often for the treatment of lung diseases in Brazil.

RESUMO Objetivo: Relatar a experiência com cirurgia torácica videoassistida (CTVA) para ressecções pulmonares anatômicas em um centro nacional de referência de cirurgia torácica no Brasil. Métodos: Foram incluídos todos os pacientes tratados com ressecções pulmonares anatômicas por CTVA entre 2010 e 2015 e analisados dados clínicos e patológicos, assim como complicações pós-operatórias. Resultados: Foram realizadas 117 ressecções pulmonares por CTVA, sendo 98 lobectomias e 19 segmentectomias anatômicas. A média de idade foi de 63,6 anos (variação, 15-86 anos), sendo a maioria mulheres (n = 69; 59%). A média de tempo de permanência com dreno foi de 2,47 dias e a de estada em UTI foi de 1,88 dias. A média de tempo de internação foi de 4,48 dias. Sangramento ≥ 400 ml ocorreu em 15 pacientes. Houve conversão para toracotomia em 4 pacientes. Conclusões: Nossos resultados vão ao encontro de publicações em grandes séries internacionais, corroborando que a CTVA é uma importante via de execução de ressecções pulmonares e que pode ser realizada com segurança quando há treinamento adequado, devendo ser mais utilizada no Brasil para o tratamento das doenças pulmonares.