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Management of vascular complications during nonvascular operations
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Kush Sharma, M. Ashraf Mansour
VATS was introduced in the early 1990s and has gained increasing popularity secondary to the treatment of benign or malignant lung cancers. The most feared vascular injury during VATS lobectomy is to the pulmonary artery, most commonly seen during left upper lobectomy, and may be one of the main deterrents for widespread acceptance.18 Injury to pulmonary artery branches/veins has been widely described in the literature, however descending aortic injury is a rare complication within the realm of vascular injuries.19
The Surgical Management of Tuberculosis and Its Complications
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Digital examination through the interspace will identify a safe target that can be incised to provide a large biopsy. The procedure can be enhanced by using the video mediastinoscope (as used for cervical mediastinoscopy). The use of the diathermy should be reserved for hemostasis after a representative biopsy has been secured; one should avoid the temptation to biopsy vascular nodes using the diathermy ventilation, and this is mandatory if more complex procedures are contemplated involving several access ports. Although VATS can be used to access mediastinal lymph nodes that lie in a suitable location, these are usually accessible with greater ease and less equipment using one of the previous techniques. VATS is of value when biopsy of the pleura (Figure 17.5) or lung is needed.
Thoracic and Chest Disease
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Empyema management has also moved to the less invasive route. Empyema exists in three stages, where each stage gets progressively more scars and is more difficult to evacuate. Without appropriate debridement of the infectious material and release of the lung, respiratory status will fail and sepsis will progress. Open thoracotomy with decortication has been the mainstay, but minimally invasive procedures have since been taken seriously in the last 15 years. Video-assisted thoracoscopic surgery (VATS) has gained popularity in its use for the decortication of stage 2 and 3 empyema. Tong et al. (2010) looked retrospectively over a 10-year period at their institution on VATS versus open decortication for benign disease. To date, they have one of the largest numbers of patients included in a study. Three hundred twenty-six VATS and 94 open decortication patients were identified, with an 11.4% conversion to open rate on the VATS patients. The VATS group was found to have shorter operative time, hospital length of stay (LOS), fewer complications, and lower mortality.
Advantages and feasibility of intercostal nerve block in uniportal video-assisted thoracoscopic surgery (VATS)
Published in Postgraduate Medicine, 2023
Thoracoscopic surgery, which is a minimally invasive procedure, has become a mainstream treatment option for thoracic diseases in recent years [1]. Early uniportal video-assisted thoracic surgery (VATS) was primarily used for a range of intrathoracic lesions, such as sympathetic resection, pleural dissection, and lung and mediastinal biopsy [2]. With rapid technological advancements over the past two decades, uniportal VATS has become increasingly successful in performing more complex procedures, including lobectomy, segmentectomy, sleeve resection, and pulmonary artery reconstruction [3,4]. Compared with traditional VATS, uniportal VATS is advantageous as it is associated with reduced trauma, lesser postoperative pain, faster recovery, and higher patient satisfaction [5]. Although there was no significant difference in the long-term pain effect between uniportal and traditional three-port VATS, postoperative pain in patients who underwent uniportal VATS was lower than that in patients who underwent traditional three-port VATS in the short-term [6]. However, uniportal VATS can cause chronic postoperative thoracotomy pain and intercostal neuralgia [7,8], and postoperative pain management remains a challenge.
Surgical Treatment of Ectopic Mediastinal Parathyroid Tumors: A 23-Year Clinical Data Study in a Single Center
Published in Journal of Investigative Surgery, 2022
Lei Liu, Jia-qi Zhang, Gui-ge Wang, Ke Zhao, Chao Guo, Cheng Huang, Shan-qing Li, Ye-ye Chen
Although most EMPT can be removed through a neck incision, the thoracic approach is a safer choice because the neck approach provides insufficient exposure and manipulation space. According to literature, the thoracotomy approach is associated with serious complications, including damage to the phrenic nerve and recurrent laryngeal nerve, innominate vein rupture, wound infection, mediastinal infection, and death.1 With the successful implementation of the first VATS approach surgery in 199426 and the first robotic-assisted surgery in 200427 for EMPT, the thoracic approach has increasingly become minimally invasive. In this study, 12 patients underwent thoracotomy and VATS approaches, respectively. Through Mann-Whitney U test, we found that VATS approach had a shorter operation time (P = 0.039) and less intraoperative bleeding (P < 0.001). The above findings are consistent with those of Du et al.28 In addition, this study found that VATS approach surgery has not only a better short-term prognosis after surgery but also a satisfactory long-term prognosis. We suggest that the specific surgical approach can be determined by tumor's location and surgeon's experience. If possible, the VATS surgical approach should be the first choice.
Comparison of surgical gloves: perforation, satisfaction and manual dexterity
Published in International Journal of Occupational Safety and Ergonomics, 2022
Tulay Basak, Gul Sahin, Ayla Demirtas
An observational, prospective study was performed during April–May 2018. Scrub nurses used specified gloves during nine selected surgeries: (a) total hip prosthesis or total knee prosthesis; (b) lumbar laminectomy; (c) vitrectomy; (d) transurethral resection of the prostate or ureterorenoscopy; (e) ileus surgery; (f) caesarean section; (g) graft-flap surgeries; (h) video-assisted thoracoscopic surgery (VATS); (i) appendectomy surgery. We determined the cases by taking the frequencies of procedures into consideration in our hospital. A homogeneous number for the surgeries is aimed at mostly operative clinics in our hospital. scrub nurses wore antiallergenic surgical (powder and latex free). Also use powder and latex free gloves during three operations, double latex and powdered gloves during three operations and single latex and powdered gloves during three operations. Within the scope of the study, each type of glove was used in each of nine operations. All gloves were worn 105 times by 35 nurses. Thus, the effectiveness of all types of gloves was examined 315 times in total (Figure 1). If the gloves were visibly perforated during surgery, they were immediately replaced with new gloves of the same type and size. The number of punctured gloves was recorded. Among the scrub nurses, 60% were women and 40% were men.