Influence of suction on prolonged air leak after VATS lobectomies: a prospective randomized study

Background. Prolonged air leak is the most common postoperative complication following lung resection. Despite the huge number of researches concerning this problem, no consensus exists regarding the choice of the appropriate method of pleural space drainage after thoracoscopic surgery.Objective. To compare suction and water-seal regarding their influence on the incidence of prolonged air leak.Material and Methods. This prospective randomized trial included sixty patients who underwent VATS lobectomies on different diagnoses in the Center for Thoracic Surgery, Clinical Hospital no. 122 (St. Petersburg) from September 2018 until May 2020. The open-label randomized controlled trial involved two groups: control group (water-seal drainage) and suction group. Each group consisted of thirty patients. Ten patients were discharged with a Heimlich valve.Results. The incidence of prolonged air leak was 23%. Patients in the suction group had a higher duration of air leak than those in the control group (5.3 ± 1.3 vs 3.7 ± 0.9 days, р = 0.04). The number of air leak cases was slightly higher in the suction group (8 and 6 patients); however, the difference was not significant (р = 0.57). Both groups had no difference in the number of complications (р = 0.2). There were no cases of reoperation.Discussion. The advantage of water-seal is a lower risk of parenchymal defects. Suction may increase holes in visceral pleura, cause hyperexudation, leading to prolonged duration of drainage. At the same time, the use of suction may decrease residual pleural spaces, match visceral and parietal pleura, which may decrease the duration of air leak. A lot of studies on this issue was performed, however, their results are contradictory.Conclusion. Drainage of pleural space after VATS lobectomies may be safely performed with water-seal. In the case of increasing surgical emphysema or appearance of progressive dyspnea, suction should be applie

INITIAL EXPERIENCE OF THORACOSCOPIC LOBECTOMY PERFORMANCE WITH BRONCHOPLASTY

The article presents an initial Russian experience of video-thoracoscopic bronchoplastic lobectomies performed in 2 clinical cases of centric lung tumors. The upper bronchoplastic lobectomies with right lymphodissection were carried out on two patients in 2012. Complications weren’t observed in intraoperative and postoperative periods. There wasn’t relapse during two years after operation. Thus, the authors came to conclusion that thoracoscopic bronchoplastic lobectomies turned out to be safe and effective interventions in individual patients with centric tumor location, which wasn’t extended outside mouth of the lobar bronchus. The choice of candidates for thoracoscopic bronchoplasty was made using video-bronchoscopy, angio-computer tomography of the thorax and PET. This allowed avoiding an invasive staging and excluded patients with substantial extra-bronchial lesions

The first experience of application of ICG-fluorescence for detection of segmental plane formation in thoracoscopic segmentectomy

OBJECTIVE. The authors evaluated the first European experience of fluorescence thoracoscopy with indocyanine green (ICG) in light spectrum which was approximated to near-infrared (NIR) in thoracoscopic segmentectomy (VATS segmentectomy). MATERIALS AND METHODS. The study covered 21 patients who underwent thoracoscopic segmentectomy during 2016. The ICG (0,15 mg/kg of body weight) was injected intravenously after dominant pulmonary artery ligation during operation. The boundary line between areas was marked by electrocautery at the border of fluorescence. RESULTS. The well-defined fluorescence borders were observed in 18 out of 21 patients (85,7 %). The median duration of intensive ICG staining was 95 sec and that was enough to mark intersegmental plane. The intraoperative verification was unsuccessful in 2 patients due to technical reasons. The first attempt of identification for the patient with severe COPD had unconvincing results and an additional ICG injection was used to achieve the precise fluorescence. There wasn’t revealed any complications associated with ICG injection. CONCLUSIONS. The ICG fluorescence is safe and effective method of segmental plane location. The implementation of this method significantly facilitates in thoracoscopic segmentectomy. The NIR fluorescence imaging systems allow clinicians to work with lower doses of ICG