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1.
Rev. habanera cienc. méd ; 20(3): e3235, tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1280437

ABSTRACT

Introducción: La cirugía torácica videoasistida por un solo puerto (Uniportal VATS) se ha convertido hoy en uno de los abordajes más utilizados para resecciones pulmonares en muchos centros de cirugía torácica del mundo, en Cuba su introducción es bastante reciente y todavía se encuentra en fase inicial. Objetivo: Comparar los resultados obtenidos por cirugía torácica abierta y Uniportal VATS en pacientes intervenidos en el Instituto Nacional de Oncología y Radiobiología de La Habana (INOR) durante enero de 2016 a abril de 2017. Material y Métodos: Estudio observacional descriptivo de corte longitudinal retrospectivo con 60 pacientes atendidos en el INOR durante enero de 2016 a abril de 2017 a los cuales se les realizó cirugía torácica. Resultados: Veinticuatro pacientes fueron operados por Uniportal VATS y 36 a través de la toracotomía, primaron las lesiones del lado derecho, el procedimiento más realizado fue lobectomía. Los estadíos predominantes fueron IA y IB, la mayoría de los procedimientos fue realizada en tres horas o menos, 8 casos se convirtieron, 13 sufrieron complicaciones. La estadía media de los pacientes tratados con Uniportal VATS fue menor que los que recibieron la toracotomía abierta. Conclusiones: El abordaje Uniportal se caracterizó por ser seguro, tener una gran versatilidad, pocas complicaciones y por mejorar la recuperación postquirúrgica del paciente y acelerar su reincorporación a las actividades de la vida cotidiana(AU)


Introduction: Single-port Video Assisted Thoracic Surgery (Uniportal VATS) has currently become one of the most commonly used approaches for lung resections in many Thoracic Surgery Centers around the world. In Cuba, its introduction is quite recent and it is still in its initial phase. Objective: To compare the results obtained by open thoracic surgery and Uniportal VATS in patients who underwent surgery in the National Institute of Oncology and Radiobiology of Havana (INOR) from January 2016 to April 2017. Material and Methods: An observational descriptive longitudinal retrospective study was conducted in 60 patients who underwent Thoracic Surgery in the INOR during 2016 - April 2017. Results: A total of 24 patients were operated through Uniportal VATS and 36 underwent thoracotomy. The lesions predominantly affected the right side and lobectomy was the most performed surgical procedure. Stages IA and IB predominated. Most of the procedures were carried out in 3 hours or less, 8 cases were converted and 13 suffered from complications. The average postoperative length of stay in hospital for patients who underwent Uniportal VATS was reduced compared to those who underwent open thoracotomy. Conclusions: Uniportal VATS is characterized by being a safe procedure with few complications and great versatility. It improves postoperative recovery of patients and accelerates their return to daily life activities(AU)


Subject(s)
Humans , Surgical Procedures, Operative , Thoracic Surgery , Thoracotomy , Thoracic Surgery, Video-Assisted , Epidemiology, Descriptive , Cross-Sectional Studies , Retrospective Studies
2.
Säo Paulo med. j ; 139(3): 293-300, May-June 2021. tab
Article in English | LILACS | ID: biblio-1252238

ABSTRACT

ABSTRACT Lung cancer is a type of neoplasia with one of the highest incidences worldwide and is the largest cause of mortality due to cancer in the world today. It is classified according to its histological and biological characteristics, which will determine its treatment and prognosis. Non-small cell lung cancer accounts for 85% of the cases, and these are the cases that surgeons mostly deal with. Small cell lung cancer accounts for the remaining 15%. Surgery is the main method for treating early stage lung cancer, and lobectomy is the preferred procedure for treating primary lung cancer, while sublobar resection is an alternative for patients with poor reserve or with very small tumors. Surgeons need to be trained to use the resources and techniques available for lung resection, including less invasive approaches such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), and need to be familiar with new oncological approaches, including curative, adjuvant or palliative treatments for patients with lung cancer.


Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung/surgery , Surgeons , Lung Neoplasms/surgery , Pneumonectomy , Thoracic Surgery, Video-Assisted
3.
Medicina (B.Aires) ; 81(3): 467-469, jun. 2021. graf
Article in English | LILACS | ID: biblio-1346487

ABSTRACT

Abstract Diaphragmatic hernia during pregnancy or puerperium are rare entities that, in the event of a complication, represent a life-threatening emergency for both mother and the unborn child. Resolution in many cases requires a combined access through the thoracic and abdominal cavity to manage the complica tions of necrosis and/or perforation of an abdominal viscera. To treat the thoracic cavity, thoracotomy is the most described approach. Even more, the minimally invasive access by video-assisted thoracic surgery (VATS) is not widely referenced in the literature despite its clear benefits of this technique in the recovery of patients, even in emergencies. We present the case of a postpartum right diaphragmatic hernia, complicated by necrosis of the colonic wall, treated by combined VATS approach and laparotomy in the emergency.


Resumen Las hernias diafragmáticas durante el embarazo o puerperio son entidades raras que, en caso de complicación, representan una emergencia potencialmente mortal tanto para la madre como para el feto. La resolución en muchos casos requiere un acceso combinado a través de la cavidad torácica y abdominal para manejar las complicaciones de la necrosis o perforación de las vísceras abdominales. Para tratar la cavidad torácica, la toracotomía es la vía más descrita. Más aún, el acceso mínimamente invasivo mediante cirugía torácica video-asistida (VATS) no está ampliamente referenciado en la literatura a pesar de los claros beneficios de esta técnica en la recuperación de los pacientes, incluso en emergencias. Presentamos el caso de una hernia diafragmática derecha posparto, complicada por necrosis de la pared colónica, tratada combinado VATS y laparotomía en la urgencia.


Subject(s)
Humans , Female , Pregnancy , Child , Thoracic Surgery, Video-Assisted , Hernia, Diaphragmatic/surgery , Thoracotomy , Postpartum Period , Emergencies
4.
Medicina (B.Aires) ; 81(1): 54-61, mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1287241

ABSTRACT

Resumen La hiperhidrosis es un trastorno caracterizado por la producción excesiva de sudor por las glándulas sudoríparas ecrinas que influye negativamente en las actividades sociales, laborales y fundamentalmente en la calidad de vida. Se divide en primaria o secundaria. La primaria es una enfermedad benigna caracterizada por una excesiva sudoración con mayor frecuencia en palmas, plantas, axilas y cara. Su incidencia es del 1% de la población y su causa es desconocida. La mayoría de los tratamientos médicos no logran un buen control sintomático y frecuentemente son transitorios. La simpaticotomía torácica bilateral videoasistida se ha vuelto el tratamiento de elección en pacientes muy sintomáticos. En el período de 1998 a 2018 se realizaron 174 simpaticotomias bilaterales videoasistidas por hiperhidrosis primaria, de las cuales 102 cumplieron los criterios de inclusión. Se excluyeron a 72 pacientes. El 20.5% fueron hombres y el 79.5% mujeres con una edad media de 29.22 años. En cuanto a la localización fue palmoplantar axilar en un 50.9%, axilar en un 23.5%, palmoplantar en un 10.7%, palmar en un 7.8%, palmoaxilar 6.8% y facial 5.8%. Los pacientes con sudoración palmar presentaron 94.9% de mejoría, axilar 84.51%, plantar 46.25% y facial 84% respectivamente. El post operatorio arrojó una media de internación de 1.1 días. Como efecto no deseado, se presentó sudoración compensatoria en 53 casos y complicaciones postoperatorias en 18 casos. Concluimos que es una técnica segura, que resuelve de manera significativa la sudoración, mejorando la calidad de vida.


Abstract Hyperhidrosis is a disorder consisting of excessive sweating through the different body sweat glands, which produces a negative impact socially and in work-related activities in those that suffer this condition. There are primary and secondary forms. The primary form is a benign condition with excessive sweating mainly in palms, soles of feet, axillae and face. It affects a 1% of the population, and its cause is unknown. Most medical treatments are unsuccessful, and at best, transitory. In patients who are very troubled by the condition, videoassisted bilateral thoracic sympathicotomy has become the elective treatment. In the period ranging from 1998 to 2018, 174 procedures were undertaken for primary hyperhidrosis, of which 102 satisfied the inclusion criteria. 72 patients were excluded. A 20.5% were males, and 79.5% were females, with an average age of 29.22 years at surgery. As to localization of sweating, a 50.9% was palmar-plantar-axillary, 23.5% axillary, 10.7% palmarplantar, 7.8% palmar, 6.8% palmar-axillary, and a 5.8% facial. Those patients with palmar sweating showed a 94.9% improvement, those with axillary sweating a 88.51%, with plantar a 46.25% and those with facial sweating a 84% improvement. The average admission time was 1.1 days. As an undesired effect, compensatory sweating occurred in 53 cases and postoperative complications in 18 cases. We conclude this is a safe technique, that diminishes sweating significantly, improving patient's quality of life.


Subject(s)
Humans , Male , Female , Adult , Quality of Life , Hyperhidrosis/surgery , Sympathectomy , Treatment Outcome , Thoracic Surgery, Video-Assisted
5.
Rev. colomb. cir ; 36(2): 275-282, 20210000. tab
Article in Spanish | LILACS | ID: biblio-1223978

ABSTRACT

Introducción. El avance de la cirugía torácica abierta a cirugía torácica asistida por vídeo por tres puertos, y sus posteriores efectos en la recuperación de los pacientes, conllevó al desarrollo de la técnica por un solo puerto, que ha mostrado beneficios en el postoperatorio.El objetivo de este estudio fue comparar los resultados postquirúrgicos de los pacientes sometidos a pleurectomía parietal y decorticación pulmonar toracoscópica asistida por video monopuerto y los obtenidos por toracotomía convencional, en una clínica de cuarto nivel, entre 2016 y 2019. Métodos. Estudio descriptivo, en el que se incluyeron 79 pacientes llevados a pleurectomía parietal y decorticación pulmonar por toracoscopia asistida por vídeo monopuerto y 25 pacientes operados por toracotomía convencional. Se evaluaron variables sociodemográficas, clínicas y postoperatorias. Se utilizaron las pruebas de Chi2 o de Fisher y las pruebas t de Student y Mann Whitney. Resultados. La mediana de edad fue menor en el grupo de pacientes operados por toracotomía convencional (28 años, RIC: 26­48, p=0,0005). No hubo diferencia en los tiempos quirúrgicos. Se encontró menor intensidad del dolor y disminución en los días con tubo de tórax, uso de antibióticos, días de UCI y días de estancia hospitalaria en el grupo de pacientes operados por toracoscopia asistida por vídeo monopuerto (p<0,05). Discusión. Este estudio refuerza la tendencia de mejores resultados postquirúrgicos, menos días de uso del tubo de tórax, uso de antibióticos, necesidad de UCI y días de estancia hospitalaria general con la técnica asistida por vídeo monopuerto comparado con la toracotomía abierta convencional


Introduction. The advancement from open to video-assisted thoracic surgery through three ports, and its sub-sequent effects on the recovery of patients, led to the development of the single port technique, which has shown benefits in the postoperative period. The objective of this study was to compare the postsurgical results of patients undergoing parietal pleurectomy and video-assisted single-port thoracoscopic pulmonary decortication to those obtained by conventional thoracotomy, in a fourth level clinic, between 2016 and 2019.Methods. Descriptive study, in which 79 patients underwent parietal pleurectomy and pulmonary decortication by single-port video-assisted thoracoscopy and 25 patients operated by conventional thoracotomy were included. Sociodemographic, clinical and postoperative variables were evaluated. The Chi-square or Fisher tests, and the t Student and Mann Whitney t tests were used.Results. The median age was lower in the conventional thoracotomy group (28 years; IQR: 26-48; p= 0.0005). There were no differences in surgical times. Lower pain level, and a decreased in days with chest tube, antibiotic use, need for ICU and of hospital stay were reported in the single-port video-assisted thoracoscopy group compared to conventional thoracotomy technique (p < 0.05). Discussion. This study reinforces the trend of better postsurgical results, fewer days of chest tube use, use of antibiotics, need for ICU and days of general hospital stay with the single-port video-assisted technique compared to conventional open thoracotomy


Subject(s)
Humans , Thoracic Surgery , Evaluation of Results of Therapeutic Interventions , Pneumonectomy , Thoracotomy , Thoracic Surgery, Video-Assisted
6.
Rev. colomb. cir ; 36(1): 60-65, 20210000. tab, fig
Article in Spanish | LILACS | ID: biblio-1148510

ABSTRACT

El tratamiento quirúrgico del empiema ha evolucionado, desde la medicina hipocrática, a través de los años, teniendo como premisa el drenaje. Con los avances médicos, el abordaje mínimamente invasivo se ha convertido en el estándar, dejando de lado otras técnicas quirúrgicas. La toracostomía abierta, en pacientes seleccionados, puede llegar a ser la última y mejor opción para el control del foco infeccioso: es una opción quirúrgica para el tratamiento de los empiemas en pacientes mórbidos y en fase de organización, cuando otros tratamientos han fallado, con una aceptable morbilidad y mortalidad. Esta técnica debe estar en el arsenal terapéutico del cirujano. Presentamos una serie de 4 casos de pacientes con empiema en fase de organización, en los cuales el riesgo quirúrgico era muy alto, por lo que se optó por realizar una toracostomía abierta, con éxito


The surgical treatment of empyema has evolved from Hippocratic medicine over the years, with drainage as its premise. With medical advances, the minimally invasive approach has become the standard, leaving aside other surgical techniques. Open thoracostomy, in selected patients, may become the last and best option for the control of the infectious focus: it is a surgical option for the treatment of empyemas in morbid patients and in the organization phase when other treatments have failed, with an acceptable morbidity and mortality. This technique should be in the surgeon's therapeutic arsenal. We present a series of four cases of patients with empyema in the organization phase, in which the surgical risk was very high, so it was decided to perform an open thoracostomy, which turn out successful


Subject(s)
Humans , Thoracotomy , Thoracic Surgery , Empyema, Pleural , Thoracic Surgery, Video-Assisted
7.
Rev. colomb. cir ; 36(1): 155-160, 20210000. fig
Article in Spanish | LILACS | ID: biblio-1150543

ABSTRACT

Introducción. El objetivo de este artículo fue reportar el caso de un paciente con antecedente de enfisema bulloso bilateral que le ocasionó un neumotórax persistente de difícil tratamiento. Caso clínico. Se trata de un paciente de 50 años de edad con diagnóstico de neumotórax asociado con un enfisema bulloso bilateral, en quien estaba contraindicado el tratamiento quirúrgico. El cuadro clínico comenzó con dolor en el hemitórax derecho y disnea, que se fue intensificando hasta el punto de no tolerar el decúbito. En la radiografía de tórax se observó colapso del pulmón derecho con múltiples bulas en ambos pulmones, por lo que se practicó una pleurotomía mínima alta derecha. La evolución del paciente no fue favorable por persistir el neumotórax, lo cual llevó al uso de un tratamiento alternativo. Discusión. En los pacientes con neumotórax persistente por enfisema bulloso bilateral sin indicación quirúrgica, el talco es una alternativa menos invasiva para lograr una sínfisis pleural con buenos resultados, método cuya utilidad se demuestra


Introduction. The aim of this report was to present the case of a patient with a history of bilateral bullous emphysema that causes a persistent pneumothorax that was difficult to treat. Clinical case. This is a 50-year-old patient diagnosed with pneumothorax associated with bilateral bullous emphysema, in whom surgical treatment being contraindicated. The clinical picture began with pain in the right hemithorax and dyspnea, which intensified to the point of not tolerating decubitus. In the chest X-ray, collapse of the right lung was observed with multiple bullae in both lungs, therefore a right upper minimum pleurotomy was performed. The patient's evolution was not favorable due to persisting pneumothorax, which led to the use of an alternative treatment. Discussion. In patients with persistent pneumothorax due to bilateral bullous emphysema without surgical indication, talc is a less invasive alternative to achieve a pleural symphysis with good results, a method whose utility is demonstrated


Subject(s)
Humans , Pneumothorax , Diagnostic Imaging , Thoracic Surgery, Video-Assisted , Lung Diseases
8.
Rev. Col. Bras. Cir ; 48: e20202872, 2021. tab, graf
Article in English | LILACS | ID: biblio-1250708

ABSTRACT

ABSTRACT Objective: in Latin America, especially Brazil, the use of a robotic platform for thoracic surgery is gradually increasing in recent years. However, despite tuberculosis and inflammatory pulmonary diseases are endemic in our country, there is a lack of studies describing the results of robotic surgical treatment of bronchiectasis. This study aims to evaluate the surgical outcomes of robotic surgery for inflammatory and infective diseases by determining the extent of resection, postoperative complications, operative time, and length of hospital stay. Methods: retrospective study from a database involving patients diagnosed with bronchiectasis and undergoing robotic thoracic surgery at three hospitals in Brazil between January of 2017 and January of 2020. Results: a total of 7 patients were included. The mean age was 47 + 18.3 years (range, 18-70 years). Most patients had non-cystic fibrosis bronchiectasis (n=5), followed by tuberculosis bronchiectasis (n=1) and lung abscess (n=1). The performed surgeries were lobectomy (n=3), anatomic segmentectomy (n=3), and bilobectomy (n=1). The median console time was 147 minutes (range 61-288 min.) and there was no need for conversion to open thoracotomy. There were no major complications. Postoperative complications occurred in one patient and it was a case of constipation with the need for an intestinal lavage. The median for chest tube time and hospital stay, in days, was 1 (range, 1-6 days) and 5 (range, 2-14 days) respectively. Conclusions: robotic thoracic surgery for inflammatory and infective diseases is a feasible and safe procedure, with a low risk of complications and morbidity.


RESUMO Objetivo: na América Latina, especialmente no Brasil, a adoção da plataforma robótica para cirurgia torácica está aumentando gradativamente nos últimos anos. No entanto, apesar da tuberculose e doenças pulmonares inflamatórias serem endêmicas em nosso país, faltam estudos que descrevam os resultados do tratamento cirúrgico robótico das bronquiectasias. Este estudo tem como objetivo avaliar os resultados cirúrgicos da cirurgia robótica para doenças inflamatórias e infecciosas, determinando a extensão da ressecção, complicações pós-operatórias, tempo operatório e tempo de internação hospitalar. Métodos: estudo retrospectivo a partir de um banco de dados envolvendo pacientes com diagnóstico de bronquiectasia e submetidos à cirurgia torácica robótica em três hospitais brasileiros entre janeiro de 2017 e janeiro de 2020. Resultados: foram incluídos 7 pacientes. A média de idade foi 47 + 18,3 anos (variação, 18-70 anos). A maioria dos pacientes apresentou bronquiectasia não fibrose cística (n=5), seguida de bronquiectasia tuberculosa (n=1) e abscesso pulmonar (n=1). As cirurgias realizadas foram lobectomia (n=3), segmentectomia anatômica (n=3) e bilobectomia (n=1). O tempo médio do console foi de 147 minutos (variação de 61-288 min.) e não houve necessidade de conversão para toracotomia. Complicação pós-operatória ocorreu em um paciente, tratando-se de obstipação com necessidade de lavagem intestinal. A mediana do tempo de drenagem torácica e internação hospitalar, em dias, foi de 1 (variação, 1-6 dias) e 5 (variação, 2-14 dias), respectivamente. Conclusões: a cirurgia torácica robótica para doenças inflamatórias e infecciosas é um procedimento viável e seguro, com baixo risco de complicações e morbidade.


Subject(s)
Humans , Adult , Aged , Thoracic Surgery , Robotic Surgical Procedures , Lung Neoplasms/surgery , Pneumonectomy , Postoperative Complications/epidemiology , Brazil , Retrospective Studies , Treatment Outcome , Thoracic Surgery, Video-Assisted , Length of Stay , Middle Aged
9.
Rev. Col. Bras. Cir ; 48: e20202890, 2021. tab, graf
Article in English | LILACS | ID: biblio-1287893

ABSTRACT

ABSTRACT Objective: to report the preoperative localization of pulmonary nodules with the placement of a guidewire oriented by Computed Tomography. Methods: the nodules were marked using a needle in the shape of a hook or another in the shape of a Q, guided by tomography. The choice of the location for the marking was the shortest distance from the chest wall to the nodule. The marking procedure was performed under local anesthesia and a tomographic control was obtained immediately at the end. Patients were referred to the operating room. Surgical resection occurred less than two hours after the needle placement. Results: between February 2017 and October 2019, 22 patients aged 43 to 82 years (mean 62.1) were included. The nodules had diameters that varied from 4 to 30 mm and the distance between the nodules and the pleural surface varied from 2 to 43 mm. The location and resection of the nodules were successfully performed in all cases. The guidewire was displaced in five cases. Five patients presented pneumothorax, with the space between the visceral and parietal pleura varying from 2 to 19 mm. In nine patients, an intraparenchymal hematoma of 6 to 35 mm in length was observed without signs, symptoms, or hemodynamic and ventilatory repercussions. The histopathological study was conclusive in all patients. Conclusions: the localization of pulmonary nodules through guidewires proved to be safe, reliable, and feasible in this series of cases. There was no need for surgical intervention to treat complications.


RESUMO Objetivo: relatar a marcação pré-operatória de nódulos pulmonares com o posicionamento de um fio-guia orientado por Tomografia Computadorizada. Métodos: os nódulos foram marcados utilizando-se agulha em formato de anzol ou outra em formato de Q, orientada por tomografia. A escolha do local para a realização da marcação foi o de menor distância da parede torácica até à lesão. O procedimento de marcação foi realizado sob anestesia local e controle tomográfico foi obtido imediatamente ao término da marcação. Os pacientes foram encaminhados ao centro cirúrgico. A ressecção cirúrgica ocorreu em tempo inferior a duas horas após a marcação. Resultados: entre fevereiro de 2017 e outubro de 2019, 22 pacientes, com faixa etária entre 43 e 82 anos (média 62,1) foram incluídos. Os nódulos apresentavam diâmetros que variaram de 4 a 30mm e, a distância entre os nódulos e a superfície pleural variou de 2 a 43mm. A localização e a resseção dos nódulos foram realizadas com sucesso em todos os casos. Houve deslocamento do fio-guia em cinco casos. Cinco pacientes apresentaram pneumotóraces, com o espaço entre as pleuras visceral e parietal variando de 2 a 19mm. Em nove pacientes, foi observado hematoma intraparenquimatoso com 6 a 35mm de extensão sem sinais, sintomas ou repercussão hemodinâmica e ventilatória. O estudo histopatológico foi conclusivo em todos os pacientes. Conclusões: a marcação de nódulos pulmonares por meio de fios marcadores se mostrou segura, confiável e factível nesta série de casos. Não houve necessidade de intervenção para o tratamento de complicações associadas ao método.


Subject(s)
Humans , Adult , Aged , Aged, 80 and over , Solitary Pulmonary Nodule , Multiple Pulmonary Nodules , Lung Neoplasms/surgery , Lung Neoplasms/diagnostic imaging , Preoperative Care , Retrospective Studies , Thoracic Surgery, Video-Assisted , Lung , Middle Aged
10.
Rev. Col. Bras. Cir ; 48: e20202914, 2021. tab, graf
Article in English | LILACS | ID: biblio-1287891

ABSTRACT

ABSTRACT Objective: interstitial lung disease comprises a group of lung diseases with wide pathophysiological varieties. This paper aims to report the video thoracoscopic surgical biopsy in patients with interstitial lung disease through a single minimal chest incision, without orotracheal intubation, without chest drainage, and without the use of neuromuscular blockers. Methods: this study is a series of 14 cases evaluated retrospectively, descriptively, where patients underwent a pulmonary surgical biopsy from January 2019 to January 2020. The patients included in the study had diffuse interstitial lung disease without a defined etiological diagnosis. Results: none of the patients had transoperative complications, there was no need for chest drainage in the postoperative period, and the patients pain, assessed using the verbal scale, had a mode of 2 (minimum value of 1 and maximum of 4) in the post immediate surgery and 1 (minimum value of 1 and maximum of 3) at the time of hospital discharge. The length of hospital stay was up to 24 hours, with 12 patients being discharged on the same day of hospitalization. Conclusion: therefore, it is concluded in this series of cases that the performance of uniportal video-assisted thoracoscopic surgery procedures to perform lung biopsies, without orotracheal intubation, without chest drainage, and without the use of neuromuscular blockers, bring benefits to the patient without compromising his safety. Further larger studies are necessary to confirm the safety and efficiency of this method.


RESUMO Objetivo: a doença pulmonar intersticial compreende um grupo de doenças pulmonares com grandes variedades fisiopatológicas. Este trabalho objetiva relatar a biópsia cirúrgica videotoracoscópica em pacientes com doença pulmonar intersticial por meio de incisão torácica mínima única, sem intubação orotraqueal, sem drenagem torácica e sem uso de bloqueadores neuromusculares. Métodos: este estudo é uma série de 14 casos avaliados de forma retrospectiva, descritiva, onde no qual os pacientes foram submetidos a biópsia cirúrgica pulmonar no período de janeiro de 2019 a janeiro de 2020. Os pacientes incluídos na pesquisa, apresentavam doença pulmonar intersticial difusa sem diagnóstico etiológico definido. Resultados: nenhum dos pacientes apresentou complicações transoperatórias, não houve necessidade de drenagem torácica no período pós-operatório e a dor dos pacientes, avaliada por meio da escala verbal, teve moda de 2 (valores mínimos de 1 e máximo de 4) no período de pós-operatório imediato e 1 (valores mínimos de 1 e máximos de 3) no momento da alta hospitalar. O tempo de permanência hospitalar foi de até 24 horas, sendo que 12 pacientes receberam alta no mesmo dia da internação. Conclusão: conclui-se, assim, que nesta série de casos, a realização de procedimentos de cirurgia toracoscópica videoassistida uniportais para realização de biópsias pulmonares, sem intubação orotraqueal, sem drenagem torácica e sem uso de bloqueadores neuromusculares trazem benefícios para o paciente sem comprometer sua segurança. Estudos maiores são necessários para comprovar tanto a segurança quanto à eficácia deste método.


Subject(s)
Humans , Lung Diseases, Interstitial , Thoracic Surgery, Video-Assisted , Biopsy , Drainage , Retrospective Studies , Intubation, Intratracheal
11.
Chinese Journal of Lung Cancer ; (12): 683-689, 2021.
Article in Chinese | WPRIM | ID: wpr-922246

ABSTRACT

BACKGROUND@#Computed tomography (CT) three-dimensional reconstruction technology is increasingly used in preoperative planning of patients with ground glass nodule (GGN), but how to accurately locate the nodule and ensure the safe resection edge is still a difficult problem for clinicians. The purpose of this study was to investigate the accuracy, convenience and safety of CT three-dimensional reconstruction combined with intraoperative natural collapse localization in total thoracoscopic segmental pneumonectomy.@*METHODS@#A total of 45 patients with radiographic findings of pulmonary GGN admitted from July 2019 to December 2019 were selected as the study group. All patients received thin-slice CT scan and underwent preoperative three-dimensional reconstruction. After anesthesia, the small thoracic operation opening and the airway of the patients were quickly opened, and the lung was rapidly and naturally collapsed by pressure difference. GGN were positioned according to the natural marker line, and marked with 3-0 prolene line. After specimen removal, the distance between the GGN and the suture mark, the distance between the GGN and the incision margin were measured, and the incision margin was routinely examined. The general clinical data, pathological data and postoperative complications were counted and compared with 45 consecutive patients who were located with hookwire positioning needle in the same period.@*RESULTS@#The average localization time of non-invasive GGN with natural lung collapse during operation was 6.9 min, and the localization accuracy was 90.6%. There were 2 cases of extensive pleural adhesion and 1 case of emphysema. Postoperative pathology was confirmed as lung adenocarcinoma, and the examination of incision margin was negative. No GGNs were scanned again after surgery, and the precise resection rate of lung segment was 100.0%.@*CONCLUSIONS@#CT three-dimensional reconstruction combined with GGN localization of natural lung collapse during operation can shorten the time of searching for GGN during operation and guarantee the safety of the incision margin. It is a more economical and convenient localization method and makes pulmonary segment resection more accurate.


Subject(s)
Humans , Imaging, Three-Dimensional , Lung/surgery , Lung Neoplasms/surgery , Pulmonary Atelectasis , Retrospective Studies , Solitary Pulmonary Nodule , Thoracic Surgery, Video-Assisted , Tomography, X-Ray Computed
12.
Chinese Journal of Lung Cancer ; (12): 690-697, 2021.
Article in Chinese | WPRIM | ID: wpr-922242

ABSTRACT

BACKGROUND@#With the extensive development of minimally invasive surgery for pulmonary nodules, preoperative localization becomes more and more critical. There are some defects in traditional localization methods, so it is necessary to improve. The aim of this study was to compare and analyze the safety and effectiveness of two new methods, namely four-hook needle and memory alloy coil, in the localization of pulmonary nodules.@*METHODS@#A retrospective analysis of 152 patients was performed. 76 cases were in four-hook needle group, and 76 cases were in memory alloy coil group. Pulmonary nodules were located before operation, and then video-assisted wedge resection was performed. The average procedure time, localization complications and nodule resection time were counted.@*RESULTS@#The target pulmonary nodules were successfully removed in both groups. In four-hook needle group, 76 patients found localization devices, all the pulmonary nodules were successfully removed, and one case was transferred to open the chest for wedge resection of pulmonary nodules due to severe thoracic adhesion. All 76 patients in memory alloy coil group were successfully resected with pulmonary nodules, and one patient underwent compromising enlarged resection because no lesion was found after the specimen was removed during the operation. There was no significant difference in the incidence of pneumothorax and pulmonary hemorrhage, the success rate of localization and nodule wedge resection time between the two groups. The average time of localization in four-hook needle group was (13.66±3.11) min, lower than that of memory alloy coil group (15.51±3.65) min, and the difference was statistically significant (P=0.001). In memory alloy coil group, when the distance from the nodule to the pleura was ≥1.5 cm and <1.5 cm, the average localization time was (17.20±4.46) min and (14.91±3.15) min, respectively, and there was a statistical difference between the two distance (P=0.044).@*CONCLUSIONS@#Four-hook needle and memory alloy coil have good safety and effectiveness, and the localization time of four-hook needle is shorter. When using memory alloy coil, the effect of the method is better for pulmonary nodules with a distance less than 1.5 cm to pleura.


Subject(s)
Alloys , Humans , Lung Neoplasms/surgery , Multiple Pulmonary Nodules , Retrospective Studies , Thoracic Surgery, Video-Assisted , Tomography, X-Ray Computed
13.
Chinese Journal of Lung Cancer ; (12): 838-846, 2021.
Article in Chinese | WPRIM | ID: wpr-922152

ABSTRACT

BACKGROUND@#Postoperative complications are an important cause of death after lung resection. At present, the adoption of video assisted thoracoscopic surgery (VATS) for lung cancer in China is increasing every year, but the prediction model of postoperative complications of VATS for lung cancer is still lack of evidence based on large sample database. In this study, Thoracic Mortality and Morbidity (TM&M) classification system was used to comprehensively describe the postoperative complications of VATS major lung resection in our center, and the prediction model of complications was established and verified. The model can provide basis for the prevention and intervention of postoperative complications in such patients, and accelerate the recovery of patients.@*METHODS@#The clinical data of patients underwent VATS major lung resection in our center from January 2007 to December 2018 were collected retrospectively. Only patients with stage I-III lung cancer were included. The postoperative complications were registered strictly by TM&M classification system. The patients were divided into two groups according to the operation period: the early phase group (From 2007 to 2012) and the late phase group (From 2013 to 2018). The baseline data of the two groups were matched by propensity score matching. After matching, binary logistic regression analysis was used to establish the prediction model of complications, and bootstrap internal sampling was used for internal verification.@*RESULTS@#A total of 2,881 patients with lung cancer were included in the study, with an average age of (61.0±10.1) years, including 180 major complications (6.2%). Binary Logistic regression analysis of 1,268 matched patients showed: age (OR=1.04, 95%CI: 1.02-1.06, P<0.001), other period (OR=0.62, 95%CI: 0.49-0.79, P<0.001), pathological type (OR=1.73, 95%CI: 1.24-2.41, P=0.001), blood loss (OR=1.001, 95%CI: 1.000-1.003, P=0.03), dissected lymph nodes (OR=1.022, 95%CI: 1.00-1.04, P=0.005) were independent risk factors for postoperative complications. The ROC curve indicates that the model has good discrimination (C-index=0.699), and the C-index is 0.680 verified by bootstrap internal sampling for 1,000 times. The calibration curve shows a good calibration of the prediction model.@*CONCLUSIONS@#TM&M system can comprehensively and accurately report the postoperative complications of thoracoscopic lung cancer surgery. Age, operative period, pathological type, intraoperative bleeding and dissected lymph nodes were independent risk factors for postoperative complications of VATS major lung resection for lung cancer. The established complication prediction model has good discrimination and calibration.


Subject(s)
Aged , Humans , Lung , Lung Neoplasms/surgery , Middle Aged , Morbidity , Nomograms , Pneumonectomy , Postoperative Complications/etiology , Retrospective Studies , Thoracic Surgery, Video-Assisted
14.
Chinese Journal of Lung Cancer ; (12): 756-763, 2021.
Article in Chinese | WPRIM | ID: wpr-922143

ABSTRACT

BACKGROUND@#Segmentectomy has gradually become one of the standard surgical methods for small pulmonary nodules with early lung cancer on imaging. This study aimed to investigate the perioperative outcomes of patients who underwent uniport video-assisted thoracoscopic surgery (VATS) segmentectomy for identifying the intersegmental boundary line (IBL) by the near-infrared fluorescence imaging with intravenous indocyanine green (ICG) method or the modified inflation-deflation (MID) method and assess the feasibility and effectiveness of the ICG fluorescence (ICGF)-based method.@*METHODS@#We retrospectively analyzed the perioperative data in total 198 consecutive patients who underwent uniport VATS segmentectomy between February 2018 and August 2020. With the guidance of preoperative intelligent/interactive qualitative and quantitative analysis-three dimensional (IQQA-3D), the targeted segment structures could be precisely identified and dissected, and then the IBL was confirmed by ICGF-based method or MID method. Clinical effectiveness and postoperative complications of the two methods were evaluated.@*RESULTS@#An IBL was visible in 98% of patients by the ICGF-based group, even with the low-doses of ICG. The ICGF-based group was significantly associated with the shorter IBL clear presentation time [(23.59±4.47) s vs (1,026.80±318.34) s] (P0.05).@*CONCLUSIONS@#The ICGF-based method could highly accurately identify the IBL and make anatomical segmentectomy easier and faster, and therefore has the potential to be a feasible and effective technique to facilitate the quality of uniport VATS segmentectomy.


Subject(s)
Feasibility Studies , Humans , Indocyanine Green , Ion Transport , Lung Neoplasms/surgery , Pneumonectomy , Postoperative Complications , Retrospective Studies , Thoracic Surgery, Video-Assisted
15.
Article in Chinese | WPRIM | ID: wpr-878710

ABSTRACT

Video-assisted thoracoscopic surgery(VATS)has become the main method of lobectomy.Multimodal analgesia is one of the core contents of enhanced recovery after surgery(ERAS)management in VATS lobectomy,which aims to control perioperative pain,reduce stress response,and achieve rapid recovery after surgery.In recent years,multimodal analgesia has developed rapidly,emphasizing the comprehensive implementation of a variety of analgesic methods and the synergistic application of analgesics with different mechanisms.This article reviews the new progress in the implementation of multimodal analgesia in VATS lobectomy and addresses the current problems and challenges,aiming to help develop more effective and practical analgesic strategies of ERAS.


Subject(s)
Analgesia , Analgesics/therapeutic use , Enhanced Recovery After Surgery , Humans , Pain , Thoracic Surgery, Video-Assisted
16.
Article in Chinese | WPRIM | ID: wpr-887894

ABSTRACT

Objective To investigate the application value of indocyanine green(ICG)in the localization of small pulmonary nodules in video-assisted thoracoscopic surgery(VATS). Methods We retrospectively analyzed the clinical data of 45 patients with small nodules(diameter<1 cm)who received preoperative localization with ICG and underwent VATS wedge resection from October 2020 to February 2021.The data for analysis included patients age,nodule diameter,distance from the parietal pleura,nodule density,success rate of localization,time of localization,incidence of complications,and pathological findings. Results The success rate of localization was 100%.The average nodule size was 6.3 mm,and the nodules were(10±11)mm from the parietal pleura.After localization of 59 nodules,13(22.0%)cases were found to have mild pneumothorax,and 4(6.7%)cases were found to have mild hemorrhage.The success rate of operation was 100%,and 43(72.9%)cases were confirmed adenocarcinoma by postoperative pathology. Conclusion ICG has a high success rate and good safety in the localization of small pulmonary nodules in VATS.


Subject(s)
Humans , Indocyanine Green , Lung Neoplasms/surgery , Retrospective Studies , Solitary Pulmonary Nodule/surgery , Thoracic Surgery, Video-Assisted , Tomography, X-Ray Computed
17.
Article in Chinese | WPRIM | ID: wpr-880418

ABSTRACT

The magnetic anchoring lung nodule positioning device is composed of a target magnet, an anchor magnet, a coaxial puncture needle and a puncture navigation template, through these, a new type of accurate positioning technology for small pulmonary nodules is derived. The device inserts the target magnet into the both sides nearby the lung nodule under the guidance of CT. Helped by the mutual attraction of the two target magnets, they can be fixed in the lung tissue, avoiding the movement in the lung, and accurately positioning the target lung nodule before surgery. In thoracoscopic surgery, the anchor magnet and the target magnet attract each other to achieve the purpose of positioning the target nodule. The device uses the characteristics of non-contact suction of magnetic materials biomedical engineering technology, eliminating the previous procedure of direct interaction with the positioning marks, finally achieves the target of precise positioning of lung nodules and rapid surgical removal.


Subject(s)
Humans , Lung , Lung Neoplasms , Magnetic Phenomena , Magnets , Solitary Pulmonary Nodule , Thoracic Surgery, Video-Assisted , Tomography, X-Ray Computed
18.
Rev. cuba. cir ; 59(4): e1009, oct.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1149845

ABSTRACT

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)


Subject(s)
Humans , Female , Adult , Middle Aged , Thoracotomy/methods , Lung Diseases, Interstitial/pathology , Thoracic Surgery, Video-Assisted/methods , Prospective Studies , Longitudinal Studies , Observational Studies as Topic
19.
Rev. cuba. cir ; 59(3): e975, jul.-set. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144432

ABSTRACT

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)


Subject(s)
Humans , Male , Female , Adult , Teratoma/diagnosis , Thoracotomy/methods , Thoracic Surgery, Video-Assisted/methods , Sternotomy/methods , Retrospective Studies
20.
Rev. cir. (Impr.) ; 72(3): 195-202, jun. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1115542

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Thoracic Surgery, Video-Assisted/adverse effects , Thoracic Surgery, Video-Assisted/methods , Chile , Retrospective Studies , Minimally Invasive Surgical Procedures , Thoracic Surgical Procedures/methods , Thoracic Surgery, Video-Assisted/instrumentation
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