1,721,256 research outputs found
VATS biopsy for undetermined interstitial lung disease under non-general anesthesia: comparison between uniportal approach under intercostal block vs. three-ports in epidural anesthesia.
Full text linkObjective: Video-assisted thoracoscopic (VATS) biopsy is the gold standard to achieve diagnosis in
undetermined interstitial lung disease (ILD). VATS lung biopsy can be performed under thoracic epidural
anesthesia (TEA), or more recently under simple intercostal block. Comparative merits of the two
procedures were analyzed.
Methods: From January 2002 onwards, a total of 40 consecutive patients with undetermined ILD
underwent VATS biopsy under non-general anesthesia. In the first 20 patients, the procedures were
performed under TEA and in the last 20 with intercostal block through a unique access. Intraoperative and
postoperative variables were retrospectively matched.
Results: Two patients, one from each group, required shift to general anesthesia. There was no 30-day
postoperative mortality and two cases of major morbidity, one for each group. Global operative time was
shorter for operations performed under intercostal block (P=0.041). End-operation parameters significantly
diverged between groups with better values in intercostal block group: one-second forced expiratory flow
(P=0.026), forced vital capacity (P=0.017), oxygenation (P=0.038), PaCO2 (P=0.041) and central venous
pressure (P=0.045). Intraoperative pain coverage was similar. Significant differences with better values in
intercostal block group were also experienced in 24-hour postoperative quality of recovery-40 questionnaire
(P=0.038), hospital stay (P=0.033) and economic expenses (P=0.038). Histology was concordant with
radiologic diagnosis in 82.5% (33/40) of patients. Therapy was adjusted or modified in 21 patients (52.5%).
Conclusions: Uniportal VATS biopsies under intercostal block can provide better intraoperative and
postoperative outcomes compared to TEA. They allow the indications for VATS biopsy in patients with
undetermined ILD to be extended
Surgical Techniques for Myasthenia Gravis: Video-Assisted Thoracic Surgery
No full textComplete removal of thymus, perithymic tissue, and mediastinal fat is considered an effective treatment
for improving the course of the myasthenia gravis.
Thymectomy can be safely carried out by video-assisted thoracic surgery approach through 3 accesses
as well as a unique surgical port.
The procedures can be accomplished either bilaterally or unilaterally according to the surgeon’s
preference through the left or the right hemithorax.
Whatever the video-assisted thoracic surgery approach results are equivalent in terms of operative
trauma, perioperative and postoperative morbidity, hospital stay, patient’s satisfaction, quality of
life, and neurologic outcome as well
Nonintubated Video-Assisted Wedge Resections in Peripheral Lung Cancer
No full textWedge resection in lung cancer is considered a suboptimal procedure, but in elderly and/or frail
patients is a reliable and safer alternative.
Nonintubated thoracic surgery may allow reduction of operative time, postoperative morbidity, hospital
stay, and global economical expenses.
Nonintubated modality can allow the recruitment of patients considered otherwise marginal for a
surgical treatment.
The nonintubated video-assisted thoracic surgery approach is less traumatic, with less immunologic
impairment, which may affect postoperative oncological long-term results
Early closure of the postpneumonectomy bronchopleural fistula by pedicled diaphragmatic flaps
No full textIn the past, several methods for closure of postpneumonectomy bronchopleural fistula have been proposed. Herein we describe a technique to close a bronchopleural fistula using a mobilized diaphragmatic flap sutured directly to the fistula edges. This maneuver improves the blood supply to the bronchial stump and may reduce residual pleural cavity. To prevent bacterial contamination of the pleural space, the procedure should be performed immediately after the diagnosis
Malignant pleural mesothelioma: factors influencing the prognosis
No full textMalignant pleural mesothelioma (MPM) is a highly severe primary tumor of the pleura mainly related to exposure to asbestos fibers. The median survival after symptom onset is less than 12 months. Conventional medical and surgical therapies--either as single lines or combined--are not wholly effective. No universally accepted guidelines have yet been established for patient selection and the use of therapeutic strategies. In addition, retrospective staging systems have proved inadequate at improving therapeutic outcomes. Therapy is currently guided by gross tumor characteristics and patient features; however, these seem less accurate than the biological fingerprint of the tumor. A number of clinical prognostic factors have been considered in large multicenter series and independently validated. A series of novel biomarkers can predict the evolution of the disease. Here we summarize the principal and novel factors that influence prognosis and are thus potentially useful for selecting patients for targeted therapy
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