China
Africa
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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
Lung Cancer Screening Using Low-Dose Computed Tomography
Published in Ayman El-Baz, Jasjit S. Suri, Lung Imaging and CADx, 2019
Alison Wenholz, Ikenna Okereke
Minimally invasive thoracic surgery is beneficial to patients because it decreases postoperative pain for the patient. Performing the surgery thoracoscopically or with robotic assistance minimizes surgical incisions and reduces trauma to tissues. This results in shorter hospital stays, reduced blood loss, decreased pain, and less scarring. Since the late 1990s, video-assisted thoracic surgery (VATS) has been utilized, particularly for early-stage lung cancers. One study analyzed the perioperative parameters in patients who underwent lobectomy by either an open approach or a VATS approach, and the consensus was that VATS major lung resection is favorable and results in shorter hospital stay and reduced overall costs [22]. According to a retrospective, multi-institutional database analyses of nearly 4,000 patients who underwent either open lobectomy or VATS lobectomy, VATS lobectomy was significantly superior to an open approach in hospital costs, length of stay, and risk of adverse events [22]. The only disadvantage of VATS procedure is a longer operating time, but recently most centers that have active minimally invasive programs have experienced similar operative times as the surgeon experience level has increased. Minimally invasive thoracic surgery is the optimal choice for patients undergoing a lobectomy if technically possible.
Right-sided pulmonary resections
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Evarts Graham performed the first successful pneumonectomy for lung cancer in 1933.1 Pulmonary resection was also applied to patients with tuberculosis before effective drugs were developed. Lobectomy became the standard procedure as a radical resection for lung cancer in the 1950s. Cahan described procedures of mediastinal and hilar lymph node dissection for pneumonectomy and lobectomy in 1951 and 1960. Bronchoplasty and arterioplasty were introduced to lung cancer surgery in the 1970s. Techniques for locally advanced lung cancer invading great vessels and/or the heart were described in the 1960s and were applied as clinical practice in the 1980s. Limited resection—that is, segmentectomy or partial resection of the lung—were examined as potential operations for lung cancer. However, the results of a randomized controlled trial revealed that local and/or regional recurrence occurred more frequently in the limited resection group than in the conventional lobectomy group and this translated into a survival difference. Video-assisted thoracoscopic surgery (VATS) lobectomy has been introduced as an option for early stage lung cancer and, in many centers, is the procedure of choice for a majority of pulmonary resections.
Clinical and economic benefits associated with the use of powered and tissue-specific endoscopic staplers among the patients undergoing thoracoscopic lobectomy for lung cancer
Published in Journal of Medical Economics, 2019
Seong Yong Park, Dae Joon Kim, Chung Mo Nam, Goeun Park, Goeun Byun, HyeJin Park, Ji Heon Choi
The study protocol was approved by the Institutional Review Board with a waiver for informed consent owing to the retrospective nature of the analysis (IRB No. 4-2017-0780). Two hundred and seventy-five patients who received VATS lobectomy at a single institution in Seoul, Korea between 2008 and 2016 were included in the analysis. All patients were diagnosed with lung cancer and were older than 19 years of age. Thoracotomy conversions from planned VATS lobectomy were included in the analysis to represent the full spectrum of outcomes and costs for the cohort. All procedures were similar for the operating surgeons regarding the dissection of hilar and mediastinal dissection and stapling technique. The choice of endoscopic stapler was made based on the operating surgeon’s preference. To focus the analysis on assessing the value of innovation on the same platform, only Ethicon-manufactured (Cincinnati, OH) endoscopic staplers and cartridges (or reloads) were included in this study.
Minimally invasive surgical approaches for lung cancer
Published in Expert Review of Respiratory Medicine, 2019
Hideki Ujiie, Alexander Gregor, Kazuhiro Yasufuku
In 1992, following the success of a minimally invasive approach for cholecystectomy, Lewis et al. published a series of 100 successive patients who underwent VATS [26]. The indications for VATS in this series were broad and included benign disease; however, there was considerable interest in the three patients who underwent VATS lobectomy with anatomic hilar dissection for lung cancer. Subsequently, several single-institution series began to appear in the literature describing their respective experiences with VATS lobectomy [27,28]. At that time, VATS was an investigational procedure; accordingly, the definition of VATS varied significantly.
Single-incision versus multiport video-assisted thoracoscopic surgery in the treatment of lung cancer: a systematic review and meta-analysis
Published in Acta Chirurgica Belgica, 2018
Zhang Yang, Zhenghai Shen, Qinghua Zhou, Yunchao Huang
Some limitation should be acknowledged in our analysis. Firstly, the significant heterogeneity was found in our analysis. Some factors, such as learning curve, the difference in instruments, the tumor stage, and no specific criteria were documented for some outcomes (such as chest tube removal, hospital stay, and some specific complication) may be the potential source of heterogeneity. Also, the baseline characteristics of included studies may not balance in each study. In the study by Chung et al. [14] the conversion rate of SITS was higher than multiport VATS (35.5 vs. 15%); the imbalanced baseline characteristics affected the outcomes. Secondly, as SITS was a newly developed technique, the authors limit their analysis to technical feasibility and safety; but no one reported the oncological outcome. Dissecting Lymph node thoroughly paly a very important role in the prognosis of lung cancer. But, how thoroughly was lymph node dissection performed according to the same criteria, especially N1 and N2 nodal stations? It is hard to evaluate because relevant studies did not provide detailed information. Thirdly, the sample size was relative too small to draw a convinced conclusion, 11 studies including a total of 1314 patients were included; also, 9 out of 11 studies come from Asia, which represents an important bias implying that results cannot be generalized worldwide. The last but the most important, except for one study conducted by Perna V et al., all studies were retrospective; so, a selection bias is most probable meaning that more straightforward procedures were performed by SITS. The only randomized study by Perna V et al. comes from Spain and in fact, these authors concluded that uniportal VATS lobectomy does not yield better postoperative outcomes than other VATS techniques.