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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
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.
Pulmonary Mucormycosis with a Staphylococcus epidermidis Co-infection
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Albert Pai, Kalpaj R. Parekh, Evgeny V. Arshava
Survival beyond two weeks is unusual if untreated, and the survival approaches 3% [2,4]. The optimal strategy is bimodal therapy with IV liposomal amphotericin B and aggressive surgical resection of the involved lung. Oral posaconazole or isavuconazonium are used as step-down antifungals for responders of amphotericin B or for salvage therapy, but either type of medication is ineffective without surgical intervention. Surgery may range from wedge resection to anatomic resections including segmentectomy, lobectomy, or pneumonectomy [2,3]. The extent of resection is ultimately dependent on the amount of diseased lung with an ultimate goal to prevent contamination of the contralateral lung [4]. Video-assisted thoracoscopic surgery (VATS) or thoracotomy are acceptable approaches based on the amount of anticipated chest wall involvement or on the functional status of the patient. Surgery should be performed as soon as possible after diagnosis in order to minimize the risk of dissemination and erosion into the pulmonary vessels. Finally, reversal of host impairment is recommended to maximize recovery.
Advantages and feasibility of intercostal nerve block in uniportal video-assisted thoracoscopic surgery (VATS)
Published in Postgraduate Medicine, 2023
Due to advances in endoscopic instrumentation, some thoracoscopic surgical procedures are now being performed using only a single incision. In 1998, Yamamoto et al. [17] demonstrated successful wedge resection for spontaneous pneumothorax using a single 2 cm skin incision. However, initial uniportal VATS was primarily used for procedures such as sympathetic nerve resection, pleural dissection, and lung and mediastinal biopsy for intrathoracic lesions [2,18]. With rapid technological advancements, Rocco et al. [19] reported their experience in uniportal thoracoscopic mediastinal biopsy and lung wedge resection in 2004. Since the first uniportal VATS lobectomy performed by Gonzalez-Rivas, the techniques and reliability of this procedure have considerably improved [20]. Moreover, views on the use of the single-port method have also changed, hence its use has developed rapidly. The potential advantages of uniportal VATS include reduced access trauma, lesser postoperative pain, faster rehabilitation, and greater patient satisfaction [5,21]. However, acute pain following uniportal VATS remains a problem [22]. The reasons may be as follows: (1) surgical incisions can damage the intercostal nerve; (2) intraoperative operations may cause injury to the surgical incision, inducing an inflammatory response and production of a large amount of pain mediators; (3) the protective sheath is located in the intercostal space, which compresses the nerve; and (4) stimulation and fixation of the closed thoracic drainage tube after surgery.
Optimal diagnostic strategies for pleural diseases and identifying high-risk patients
Published in Expert Review of Respiratory Medicine, 2023
D N Addala, P Denniston, A Sundaralingam, N M Rahman
Pleural biopsies under direct vision using a fibre-optic camera (Figure 2b) to assess the macroscopic appearance of the pleura, diaphragm, and lung and guide biopsy targets remains the gold standard investigation for diagnosing unexplained exudative pleural effusions. Medical thoracoscopy (MT or local anesthetic thoracoscopy) is typically undertaken by pleural or respiratory physicians, with conscious sedation in a spontaneously breathing patient and usually occurs as a day case procedure. Surgical thoracoscopy (video-assisted thoracoscopic surgery, VATS) is conducted under general anesthetic and requires single lung ventilation, and thus requires a patient that is fit enough to survive these. Both techniques allow for highly effective diagnostic pleural sampling and inspection of the pleural space, however key differences arise in regard to the technical feasibility between the two, length of stay associated and the extent of therapeutic interventions that can be delivered contemporaneously.
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.