93 research outputs found
Risk factors and impact of conversion from VATS to open lobectomy: analysis from a national database.
No full textOBJECTIVE:
The objective of the study is to analyse the causes and impact of conversion from VATS to thoracotomy identifying any possible pre-operative risk factors and related consequences.
METHODS:
Data from patient who underwent VATS lobectomy (VATS-L) for NSCLC at VATS Group participating centres were retrospectively analysed and divided in two groups: patients treated with VATS-L and patients who suffered from conversion. Predictors of conversion were assessed with univariate and multivariable exact logistic regression. Complications were evaluated as dependent variables of conversion in a Cox multivariable logistic regression model.
RESULTS:
A total of 4629 patients underwent planned VATS-L for NSCLC and of these, 432 (9.3%) required conversion; the most frequent causes were bleeding (30.4%) and fibro-calcified hilar lymph nodes (23.9%). The independent risk factors at multivariable analysis model were sex male (OR 1.458, p < 0.01), age older than 70 years (OR 1.248, p = 0.036) and the clinically node-positive disease (OR 2.258, p < 0.01). The mortality rate was similar, but the percentage of patients who suffered from any complication (41.7% vs 24.4%, p < 0.01), the complication rate (65% vs 32.2%, p < 0.01), chest tube duration (p < 0.01) and the hospitalisation rate (p < 0.01) were higher for patients converted. Atrial fibrillation (OR 1.471, p = 0.019), prolonged air leak (OR 1.403, p = 0.043), blood transfusions (OR 4.820, p < 0.01), sputum retention (OR 1.80, p = 0.027) and acute kidney failure (OR 2.758, p = 0.03) were significantly associated with conversion at multivariable analysis.
CONCLUSIONS:
Conversion is associated with increased surgical morbidity, blood loss and hospital stay. Sex male, old age and the clinical involvement of lymph nodes were the strongest predictors of conversio
Surgeon-Powered Robotics: Left Upper Lobectomy With Fully Wristed VATS Instruments
No full textThis video demonstrates the first VATS Left upper lobectomy using ArtiSential® wristed instruments.For the first time in VATS, there are now instruments that are as versatile as robotic instruments. These instruments have the additional advantage of tactile feedback, the ability to do one’s own staple firings, and allow the surgeon to be with the patient in case of emergencies. It is also much cheaper than current robotic systems.The author calls this “surgeon-powered robotics” because they can now achieve robotic-style surgery without any automation, and it includes full range of movement coming from the surgeon. The author also endeavors to use an automated camera holder to further close the gap between robotics and VATS. More videos will come as they continue to use these exciting instruments.DisclosureJoel Dunning received these instruments for free from the company.</p
COLOR OF CREATORSHIP - Author\u27s Response
No full textThis essay is the author\u27s response to three reviews of The Color of Creatorship written by notable intellectual property scholars and published in the IP Law Book Review
Correction to: Predictors of nodal upstaging in patients with cT1-3N0 non-small cell lung cancer (NSCLC): results from the Italian VATS Group Registry (Surgery Today, (2020), 50, 7, (711-718), 10.1007/s00595-019-01939-x)
No full textIn the original publication, Carlo Curcio was not included in the author list. The correct author list is included in this Correction. Also an Appendix listing VATS author group is included in this correction
Rosai-Dorfman Disease Presenting as Isolated Subglottic Mass- an Extremely Rare Presentation
No full textThe impoverished representations of brains in vats
No full textIn this article, the notion that brains in vats with perceptual experiences of the same type as ours could perceptually represent other entities than shapes is challenged. Whereas it is often held that perceptual experiences with the same phenomenal character as ours could represent computational properties, the present author argues that this is not the case for shapes. His argument is in brief that the phenomenal character of a normal visual experience exemplifies shapes - phenomenal shapes - which functions as the vehicle for our perceptual representation of shapes. Due to the unique mereological structure of shapes, phenomenal shapes are unable to reliably track any property but shapes. In so far as reliable tracking is a necessary condition for perceptual representation, phenomenal shapes can consequently and contrary to received wisdom only represent shapes.</p
The differences in quality of life between open thoracotomy and video-assisted thoracoscopic surgery (VATS): a literature review
No full textAbstract
Introduction:Thoracotomy is considered one of the most common surgical procedures related to pain. Patients may consider postoperative complications (such as pain) in the hospital as an acceptable risk, but patients are not ready to accept long-term disability that can affect the patient’s daily life.Methods:This article was conducted by analysis and synthesis from various references. The author uses “video-assisted thoracoscopic surgery-VATS” AND “Open Thoracotomy” AND “Quality of Life” as keywords to explore the literature from PubMed, Google Scholar, ProQuest, and Clinical Key. The related papers published in the last fifteen years were included and non-full-text papers were excluded. These papers were analyzed subsequently to answer the aim of this study.Results:We obtained a total of four articles that met our review criteria. Up to six journals were extracted from PubMed, Google Scholar, ProQuest, and Clinical Key. According to our review method considerations, many articles excluded by the year of publication criteria are out of date.Conclusions:Most studies still show VATS’s superiority over thoracotomy. There is a difference in the quality-of-life scores of patients after VATS compared to thoracotomy. VATS shows an improvement in quality of life after the procedure. VATS revealed significantly better results in physical function, physical role, bodily pain, and general health than open thoracotom
Correction To: Predictors of Nodal Upstaging in Patients With cT1-3N0 Non-Small Cell Lung Cancer (NSCLC): Results From the Italian VATS Group Registry
No full textIn the original publication, Carlo Curcio was not included in the author list. The correct author list is included in this Correction
Switching from Thoracoscopic to Robotic Platform for Lobectomy: Report of Learning Curve and Outcome
No full text© The Author(s) 2020. Objective: The optimal minimally invasive surgical management for patients with non-small-cell lung cancer (NSCLC) is unclear. For experienced video-assisted thoracoscopic surgery (VATS) surgeons, the increased costs and learning curve are strong barriers for adoption of robotics. We examined the learning curve and outcome of an experienced VATS lobectomy surgeon switching to a robotic platform. Methods: We conducted a retrospective review to identify patients who underwent a robotic or VATS lobectomy for NSCLC from 2016 to 2018. Analysis of patient demographics, perioperative data, pathological upstaging rates, and robotic approach (RA) learning curve was performed. Results: This study evaluated 167 lobectomies in total, 118 by RA and 49 by VATS. Patient and tumor characteristics were similar. RA had significantly more lymph node harvested (14 versus 10; P = 0.004), more nodal stations sampled (5 versus 4; P \u3c 0.001), and more N1 nodes (8 versus 6; P = 0.010) and N2 nodes (6 versus 4; P = 0.017) resected. With RA, 22 patients were upstaged (18.6%) compared to 5 patients (10.2%) with VATS (P = 0.26). No differences were found in perioperative outcome. Operative time decreased significantly with a learning curve of 20 cases, along with a steady increase in lymph node yield. Conclusions: RA can be adopted safely by experienced VATS surgeons. Learning curve is 20 cases, with RA resulting in superior lymph node clearance compared to VATS. The potential improvement in upstaging and oncologic resection for NSCLC may justify the associated investments of robotics even for experienced VATS surgeons
Sex differences in characteristics of atrial fibrillation recurrence post surgical pulmonary vein isolation
No full textBackground: Prior studies demonstrated that female sex is associated with arrhythmia recurrence after endovascular pulmonary vein isolation (PVI). However, it is unknown if the sexes differ in outcome after video assisted thoracoscopic (VATS) PVI. The aim of this study was therefore to compare characteristics of recurrent AF episodes in a matched male and female population, using implantable loop recorders for continuous rhythm monitoring. Methods: 40 matched (based on propensity score) males (age: 60.0 ± 7.71 (45–75)) and females (age: 62.0 ± 7.0 (37–74)) were retrieved from an existing database from a prior conducted study by the cardiothoracic department of the OLVG hospital (1) containing patients who received an implantable looprecorder and underwent a VATS PVI between 2012 and 2017. Patients were continuously monitored for a period of 12 months after VATS PVI and AF characteristics were compared. Results: An equal number of males and females had AF episodes during all periods (P > 0.05). The number of AF episodes was higher in females, during the first 6 months (P = 0.01, P = 0.034). During the entire follow up, the total AF duration was longer in females (P = 0.01, for all periods) with shorter inter - episode intervals (P = 0.001, P = 0001, P = 0.04) and a higher AF burden (P = 0.003, P = 0001, P = 0.006). After 3 months, AF recurrences during the night were more frequently observed in female patients (P = 0.001, P = 0.001). Conclusions: AF episodes occur frequently in both sexes after VATS PVI and warrant frequent rhythm monitoring. The observed sex differences in AF burden after VATS PVI, calls for intensive rhythm monitoring and aggressive treatment of recurrent AF epsiodes in females
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