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Source Control
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
A 56-year-old male is on amoxicillin/clavulanic acid IV for a community-acquired pneumonia with empyema. He has a chest drain which is still producing pus. No samples have been sent to the microbiology laboratory. He is clinically improving, and the house officer asks you how long to continue antibiotic therapy. You advise to send drain samples for culture, continue antibiotics for at least 3 weeks post-drainage and then review. Oral stepdown depends on culture results or response to intravenous therapy. Complication of pneumonia, trauma or, less commonly, as a complication of thoracic surgical procedures.In the early stages, empyema is liquid and drainage via placement of a chest tube allows removal of pus and expansion of the lung.Percutaneous catheters have a failure rate of up to 20% when collections are extensive or multiloculated.If tube thoracostomy fails (e.g. in a later stage of the empyema when a thick fibrous peel has formed), video-assisted thoracic surgery (VATS) can be performed, allowing for decortication of empyema.
Outpatient thoracic surgery
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Laureano Molins, Juan J. Fibla, Jorge HernÁNdez
Although the role of ambulatory thoracic surgery has increased over the past two decades, it has not reached the level of use seen in other surgical specialties. Therefore, there is significant scope for extending its use routinely for selected thoracic surgical procedures.
Medical and open surgical management of chylous disorders
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
Ying Huang, Audra A. Duncan, Gustavo S. Oderich, Peter Gloviczki
The incidence of post-operative chylothorax was 0.42% among 11,315 patients undergoing general thoracic surgical procedures at the Mayo Clinic6; it was 1.4% in 2838 patients operated on by Dr. Cerfolio after pulmonary resection and complete thoracic mediastinal lymph node dissection.7 In patients with primary lung cancer, chylothorax developed in 2.3% (37/1580) of patients after lobectomy or greater resection with simultaneous systematic mediastinal lymph node dissection. Several studies focused on post-esophagectomy chylothorax, with a quoted incidence of less than 4.0%. The reported incidence of chyle leak after neck dissection varies from 0.6% to 6.2%.
Surgical management of spine injuries in severe polytrauma patients: a retrospective study
Published in British Journal of Neurosurgery, 2020
C. Joubert, P.-J. Cungi, P. Esnault, A. Sellier, H. de Lesquen, J.-P. Avaro, J. Bordes, A. Dagain
Long constructs including two or three levels above and below the level injured, accounted for 48.5% of the thoracic surgical procedures (n = 16/33) and 42.9% of the lumbar surgical procedures (n = 12/28). Long constructs were systematically performed in junctional injuries (one involving the cervico–thoracic junction and 11 involving the thoraco–lumbar junction) and contiguous injuries (n = 10, all at the thoracic levels). In six cases, long constructs were employed to achieve better reduction by one-stage posterior approach. Short constructs were preferentially employed in injuries located at the upper thoracic levels (n = 2, T3 and T5) or the middle lumbar levels (n = 10, L2–L4, Figure 4), or in very unstable patients in damage control procedures regardless of neurological status (n = 21).
Interventional pulmonary medicine
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2020
Bronchoscopic technologies are increasingly being used to complement minimally-invasive thoracic surgical procedures. For patients with small pulmonary nodules without nodal metastasis, sub-lobar anatomic resection is gaining favor, particularly in patients with poor cardiopulmonary reserve. These nodules are difficult to identify intra-operatively with minimally invasive techniques, particularly if they are small, have non-solid radio-density and are deep to the visceral pleura. Bronchoscopy with electromagnetic navigation can accurately localize small lesions through trans-bronchial injection of blue dyes or using near-infrared fluorescence with indocyanine green contrast (ICG).19 Peritumoral ICG injection has shown promise for sentinel lymph node mapping and simple transbronchial ICG injection may help delineate surgical margins for sublobar resection.20,21 The integration of bronchoscopy and advanced imaging technology is already occurring with the development of hybrid operating theaters, including at the University of Toronto.
Minimally invasive surgical approaches for lung cancer
Published in Expert Review of Respiratory Medicine, 2019
Hideki Ujiie, Alexander Gregor, Kazuhiro Yasufuku
Modern thoracic surgical procedures incorporate various advanced technologies including VATS, RATS, and image-guided surgery. These capabilities allow surgeons to perform even more advanced procedures with less invasiveness. The development of image-guided surgery has greatly facilitated the adoption and ease of MIS approaches in the lung. This is particularly relevant in the context of growing numbers of patients presenting with small peripheral nodules, identified on screening CT, that are extremely challenging to localize intraoperatively. If performing a sublobar resection, nodule localization becomes especially important. Platforms employing three-dimensional imaging and/or fluorescence guidance are being evaluated for integration with surgical navigation systems to address this challenge. To realize this potential fully, hybrid operating rooms are likely to be necessary. These procedural areas are designed to allow routine intraoperative imaging whose results can be fed back directly to the surgeon. At our own institution, we constructed a guided therapeutics operating room (GTx OR) for evaluating new technologies related to surgical guidance. This has been described previously elsewhere [73], but in brief key features include dedicated engineering support staff, increased space to accommodate larger teams and devices, and integration of relevant devices within the OR design to facilitate clinical workflow. Devices include a dual-energy CT scanner, a robotic cone-beam CT (CBCT) C-arm, endobronchial ultrasound systems, and NIR fluorescence endoscopes.