Prolonged air leak after lung resection can be predicted by air leak flow rates measured in the early post-operative period using a Digital Chest Drain System

Posters: no. P-203OBJECTIVES: Air leaks frequently complicate lung resection surgery, but predicting which resolve spontaneously and which progress to Prolonged Air Leakage (PAL) has hitherto been difficult. METHODS: Clinical data for 124 consecutive patients who received curative major lung resection by a single surgeon and who had complete chest drainage records were reviewed. All patients had one chest tube connected to either a conventional water seal chest drain system (group WS: n=69, 56%) or a digital chest drain system (group D: n=55, 44%) depending on availability of …published_or_final_versio

Non-intubated uniportal anatomical lung resection: a propensity score matched analysis shows faster recovery is possible even in the early experience

OBJECTIVES: Non-intubated uniportal video-assisted thoracoscopic surgery (VATS) has gained considerable interest for major lung resections in recent years. However, characteristics of the learning curve and whether benefits can be shown in the early experience of adapting this technique have hitherto not been investigated ...postprin

Non-steroidal anti-inflammatory drugs increase recurrence risk following surgical pleurodesis for primary pneumothorax

This open access journal suppl. entitled: 23rd European Conference on General Thoracic SurgerySession 8 - Mixed Thoracic 1: no. F-083OBJECTIVES: Non-steroidal anti-inflammatory drugs (NSAID) have been shown to reduce the histopathological quality of pleurodesis in animal studies, but their effect on pleurodesis in humans has not been investigated. METHODS: During January 1999 - January 2003 - when NSAIDs were still commonly used following pneumothorax surgery - 176 consecutive patients received video-assisted thoracic surgery (VATS) pleurodesis for primary pneumothorax (exclusions: secondary pneumothorax or previous pleurodesis). Recurrence defined as any new clinically or radiographically detected ipsilateral pneumothorax following surgery was ...postprin

Application of a fast track surgery protocol for video-assisted thoracoscopic thymectomy in non-thymomatous myasthenia gravis: a case-control study

Session 16 - MITIG VATS Session no. F-144This open access journal suppl. entitled: 23rd European Conference on General Thoracic SurgeryOBJECTIVES: The use of fast-track surgery (FTS) management has rarely been assessed in the treatment of non-thymomatous myasthenia gravis (NTMG) using video-assisted thoracic surgery (VATS). METHODS: FTS management was applied in 68 consecutive patients receiving VATS thymectomy for NTMG. Our FTS protocol included: maintenance of each patient’s original anti-cholinesterase and steroid therapy perioperatively; no plasmapharesis or immunoglobulin therapy preoperatively; avoidance or minimization of central lines, chest tubes and ICU stays postoperatively; and specific management of postop respiratory difficulties without ‘knee-jerk’ assumption of myasthenic crisis. These patients were matched for multiple demographic and ...postprin

The influence of prior VATS experience in the learning curvefor single-port VATS lobectomy: a multicenter comparative study

OBJECTIVES: Competency in VATS lobectomy is estimated to be complete after 50 cases. We aimed to ex¬plore the impact of previous multiport VATS lobectomy competency in completing this work¬load of Single-Port procedures ...postprin

Reporting guidelines for surgical technique could be improved: a scoping review and a call for action.

To identify reporting guidelines related to surgical technique and propose recommendations for areas that require improvement. A protocol-guided scoping review was conducted. A literature search of MEDLINE, the EQUATOR Network Library, Google Scholar, and Networked Digital Library of Theses and Dissertations was conducted to identify surgical technique reporting guidelines published up to December 31, 2021. We finally included 55 surgical technique reporting guidelines, vascular surgery (n = 18, 32.7%) was the most common among the clinical specialties covered. The included guidelines generally showed a low degree of international and multidisciplinary cooperation. Few guidelines provided a detailed development process (n = 14, 25.5%), conducted a systematic literature review (n = 13, 23.6%), used the Delphi method (n = 4, 7.3%), or described post-publication strategy (n = 6, 10.9%). The vast majority guidelines focused on the reporting of intraoperative period (n = 50, 90.9%). However, of the guidelines requiring detailed descriptions of surgical technique methodology (n = 43, 78.2%), most failed to provide guidance on what constitutes an adequate description. Our study demonstrates significant deficiencies in the development methodology and practicality of reporting guidelines for surgical technique. A standardized reporting guideline that is developed rigorously and focuses on details of surgical technique may serve as a necessary impetus for change

Airway and Esophageal Stenting in Patients with Advanced Esophageal Cancer and Pulmonary Involvement

BACKGROUND: Most inoperable patients with esophageal-advanced cancer (EGC) have a poor prognosis. Esophageal stenting, as part of a palliative therapy management has dramatically improved the quality of live of EGC patients. Airway stenting is generally proposed in case of esophageal stent complication, with a high failure rate. The study was conducted to assess the efficacy and safety of scheduled and non-scheduled airway stenting in case of indicated esophageal stenting for EGC. METHODS AND FINDINGS: The study is an observational study conducted in pulmonary and gastroenterology endoscopy units. Consecutive patients with EGC were referred to endoscopy units. We analyzed the outcome of airway stenting in patients with esophageal stent indication admitted in emergency or with a scheduled intervention. Forty-four patients (58+/-\-8 years of age) with esophageal stenting indication were investigated. Seven patients (group 1) were admitted in emergency due to esophageal stent complication in the airway (4 fistulas, 3 cases with malignant infiltration and compression). Airway stenting failed for 5 patients. Thirty-seven remaining patients had a scheduled stenting procedure (group 2): stent was inserted for 13 patients with tracheal or bronchial malignant infiltration, 12 patients with fistulas, and 12 patients with airway extrinsic compression (preventive indication). Stenting the airway was well tolerated. Life-threatening complications were related to group 1. Overall mean survival was 26+/-10 weeks and was significantly shorter in group 1 (6+/-7.6 weeks) than in group 2 (28+/-11 weeks), p<0.001). Scheduled double stenting significantly improved symptoms (95% at day 7) with a low complication rate (13%), and achieved a specific cancer treatment (84%) in most cases. CONCLUSION: Stenting the airway should always be considered in case of esophageal stent indication. A multidisciplinary approach with initial airway evaluation improved prognosis and decreased airways complications related to esophageal stent. Emergency procedures were rarely efficient in our experience

International expert consensus on the management of bleeding during VATS lung surgery

Intraoperative bleeding is the most crucial safety concern of video-assisted thoracic surgery (VATS) for a major pulmonary resection. Despite the advances in surgical techniques and devices, intraoperative bleeding is still not rare and remains the most common and potentially fatal cause of conversion from VATS to open thoracotomy. Therefore, to guide the clinical practice of VATS lung surgery, we proposed the International Interest Group on Bleeding during VATS Lung Surgery with 65 experts from 10 countries in the field to develop this consensus document. The consensus was developed based on the literature reports and expert experience from different countries. The causes and incidence of intraoperative bleeding were summarised first. Seven situations of intraoperative bleeding were collected based on clinical practice, including the bleeding from massive vessel injuries, bronchial arteries, vessel stumps, and bronchial stumps, lung parenchyma, lymph nodes, incisions, and the chest wall. The technical consensus for the management of intraoperative bleeding was achieved on these seven surgical situations by six rounds of repeated revision. Following expert consensus statements were achieved: (I) Bleeding from major vascular injuries: direct compression with suction, retracted lung, or rolled gauze is useful for bleeding control. The size and location of the vascular laceration are evaluated to decide whether the bleeding can be stopped by direct compression or by ligation. If suturing is needed, the suction-compressing angiorrhaphy technique (SCAT) is recommended. Timely conversion to thoracotomy with direct compression is required if the operator lacks experience in thoracoscopic angiorrhaphy. (II) Bronchial artery bleeding: pre-emptive clipping of bronchial artery before bronchial dissection or lymph node dissection can reduce the incidence of bleeding. Bronchial artery bleeding can be stopped by compression with the suction tip, followed by the handling of the vascular stump with energy devices or clips. (III) Bleeding from large vessel stumps and bronchial stumps: bronchial stump bleeding mostly comes from accompanying bronchial artery, which can be clipped for hemostasis. Compression for hemostasis is usually effective for bleeding at the vascular stump. Otherwise, additional use of hemostatic materials, re-staple or a suture may be necessary. (IV) Bleeding from the lung parenchyma: coagulation hemostasis is the first choice. For wounds with visible air leakage or an insufficient hemostatic effect of coagulation, suturing may be necessary. (V) Bleeding during lymph node dissection: non-grasping en-bloc lymph node dissection is recommended for the nourishing vessels of the lymph node are addressed first with this technique. If bleeding occurs at the site of lymph node dissection, energy devices can be used for hemostasis, sometimes in combination with hemostatic materials. (VI) Bleeding from chest wall incisions: the chest wall incision(s) should always be made along the upper edge of the rib(s), with good hemostasis layer by layer. Recheck the incision for hemostasis before closing the chest is recommended. (VII) Internal chest wall bleeding: it can usually be managed with electrocoagulation. For diffuse capillary bleeding with the undefined bleeding site, compression of the wound with gauze may be helpful

Вихретоковый анизотропный термоэлектрический первичный преобразователь лучистого потока

Представлена оригинальная конструкция первичного преобразователя лучистого потока, который может служить основой для создания приемника неселективного излучения с повышенной чувствительностью