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

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

Limited Resection for Lung Cancer: current role

Sublobar resection for lung cancer-whether non-anatomic wedge resection or anatomic segmentectomy - has been performed for many decades. That it has never become a mainstream strategy for treating primary lung cancer is mainly due to evidence from the late 20th Century demonstrating that it offers inferior results compared to conventional lobectomy in terms of survival and loco-regional recurrence rates. In recent years, however, emerging clinical evidence has begun to suggest otherwise. In selected patients with small tumors up to 2 cm diameter located in the periphery of the lung, it has been shown that survival after sublobar resection may approach that of postlobectomy. More importantly, the latest revisions to the adenocarcinoma classification system has further helped to identify candidates for sublobar resection - with tumors showing radiological features of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) being associated with potentially good outcomes after this type of surgery. The refinement of criteria to select patients that may benefit from sublobar resection has helped fuel the current resurgence of interest. Recent evidence has been less successful at demonstrating that sublobar resection delivers less morbidity than lobectomy. However, such comparison with lobectomy may not be the point. Current evidence simply does not support sublobar resection as a competitor to lobectomy as routine management for lung cancer. Instead, sublobar resection has been proven to be safe and feasible in patients who may not be candidates at all for lobectomy. In that sense, the role of sublobar resection may be to offer the hope of resectional therapy to selected patients who would otherwise have been denied surgery.link_to_OA_fulltex

Metastasis to the lung ‐ current trends in surgical management

Controversies in Resection of Metastase

Pneumothorax: Evolving Indications for Surgery

Commentlink_to_OA_fulltex

The AME Special Competition 2015: 4 rounds, 27 contestants, countless lessons learned about China.

link_to_OA_fulltex

Large volume drainage of malignant pleural effusions: risks and benefits

Case ReportsOpen Access JournalPURPOSE: To prevent Re-expansion Pulmonary Edema (RPE) when draining malignant pleural effusions (MPEs), the maximum drainage on a single occasion has often been arbitrarily limited to 1L. Few studies have addressed the potential risks and benefits of draining larger volumes. METHODS: Seventy-four consecutive patients with large, symptomatic MPEs received chest tube insertion by a Cardiothoracic Surgery unit. At the surgeon’s discretion, maximum daily drainage in 32 patients (43%) was limited to 1L. Drainage volumes, clinical progress and serial chest X-rays were assessed for all patients. RESULTS: In the first hour, the mean volume drained in this cohort overall was 773ml, and over 1L was drained in 30 patients (41%). No patient developed clinical or radiographical RPE as defined by established diagnostic criteria. Five patients (6.8%) developed self-limiting coughing for less than 20 minutes, but no association with initial drainage of over 1L was observed (p=0.32). No other drainage-related complications were experienced by any patient. In patients for whom no maximum daily drainage limit was set, within 24 hours symptomatic improvement was noted in 93% and complete resolution of the MPE on chest X-ray was observed in 40%. This compares to 84% and 28% respectively in those who had limits set, although the differences fell short of statistical significance. In 65 patients for whom chemical pleurodesis was planned at the time of chest tube insertion, the mean interval between tube insertion and pleurodesis was significantly shorter in patients for whom no maximum daily drainage limit was set (4.1 days versus 5.8 days, p=0.04). CONCLUSION: For large, symptomatic MPEs, drainage of 1L or more in a single sitting appears to be safe.link_to_OA_fulltex