ABSTRACT
Background: This study investigated the feasibility of video-assisted thoracic surgery (VATS) performed under two-lung ventilation (TLV) and single-lumen endotracheal tube (SLET) intubation in patients with spontaneous pneumothorax. Methods: From January 2016 to December 2019, 344 patients who underwent VATS with spontaneous pneumothorax, whether primary or secondary, were enrolled. The surgery was performed through TLV using SLET intubation or one-lung ventilation (OLV) using double-lumen endotracheal tube (DLET) intubation. Patient data were collected retrospectively from medical records and compared with an emphasis on the time required for anesthesia and surgery. Results: The average anesthesia time was 72.6±17.8 min for TLV and 89.9±24.3 min for OLV (P<0.001). The average operating time was 42.1±16.2 min for TLV and 54.7±23.8 min for OLV (P<0.001). The average time from the onset of anesthesia to incision was 23.6±7.0 min for TLV and 27.6±9.5 min for OLV (P<0.001). There was no case of conversion to OLV using DLET intubation during surgery with TLV using SLET intubation. Removal of the chest tube took 1.6±1.1 days for the TLV group and 2.3±3.6 days for the OLV group (P=0.017). Patients were discharged at 2.7±1.2 days after surgery for the TLV group and 3.2±2.3 days after surgery for the OLV group (P=0.009). Conclusions: TLV using SLET intubation could shorten the time required for anesthesia-related procedures and surgery. In addition, it can be a beneficial surgical and anesthetic option for pneumothorax.
ABSTRACT
Background: Delayed sternal closure (DSC) is a useful option for patients with intractable bleeding and hemodynamic instability due to prolonged cardiopulmonary bypass and a preoperative bleeding tendency. Vacuum-assisted closure (VAC) has been widely used for sternal wound problems, but only rarely for DSC, and its efficacy for mediastinal drainage immediately after cardiac surgery has not been well established. Therefore, we evaluated the usefulness of DSC using VAC in adult cardiac surgery. Methods: We analyzed 33 patients who underwent DSC using VAC from January 2017 to July 2022. After packing sterile gauze around the heart surface and great vessels, VAC was applied directly without sternal self-retaining retractors and mediastinal drain tubes. Results: Twenty-one patients (63.6%) underwent emergency surgery for conditions including type A acute aortic dissection (n=13), and 8 patients (24.2%) received postoperative extracorporeal membrane oxygenation support. Intractable bleeding (n=25) was the most common reason for an open sternum. The median duration of open sternum was 2 days (interquartile range [25th-75th pertentiles], 2-3.25 days) and 9 patients underwent VAC application more than once. The overall in-hospital mortality rate was 27.3%. Superficial wound problems occurred in 10 patients (30.3%), and there were no deep sternal wound infections. Conclusion: For patients with an open sternum, VAC alone, which is effective for mediastinal drainage and cardiac decompression, had an acceptable superficial wound infection rate and no deep sternal wound infections. In adult cardiac surgery, DSC using VAC may be useful in patients with intractable bleeding or unstable hemodynamics with myocardial edema.
ABSTRACT
BACKGROUND: Pure ground glass opacity (GGO) or part-solid GGO with small solid component (≤5 mm) are likely to be non-invasive or minimally invasive lung cancer. However, those lesions sometimes are diagnosed as invasive adenocarcinoma postoperatively. The aim of this study was to determine the predictors of invasive adenocarcinoma in clinical non- or minimally invasive lung cancer. METHODS: From January 2010 to December 2017, 203 patients were diagnosed as clinical adenocarcinoma in situ (AIS) or minimally invasive adenocarcinoma (MIA) identified on chest computed tomography (CT) and they underwent surgical resection. A retrospective study was performed to analyze the prediction of invasive adenocarcinoma in clinical non- or minimally invasive lung cancer. RESULTS: Of all clinical AIS or MIA patients, invasive adenocarcinoma was diagnosed in 55 patients (27.1%). In clinical AIS, invasive adenocarcinoma was diagnosed in 19 patients (17.9%) and 36 patients (37.1%) were diagnosed as invasive adenocarcinoma in clinical MIA (P=0.002). Tumor diameter and the presence of solid component were confirmed to be significant predictive factors for invasive adenocarcinoma in a multivariate analysis [hazard ratio (HR) 1.071, P=0.037; HR 2.573, P=0.005; respectively]. CONCLUSIONS: Large tumor size and the presence of solid component in clinical AIS or MIA are predictive factors for invasive adenocarcinoma. Therefore, early surgical intervention is recommended for those lesions.
