Video-Assisted Mini-Thoracotomy Versus Anterior Thoracotomy Mitral Valve Replacement: Intraoperative Time and Hospitalization

Objectives: Minimally invasive mitral valve surgery (MIMVS) was introduced to avoid a full sternotomy through smaller or alternative chest wall incisions to reduce complications. We present our experience with MIMVS through two of its techniques. Methods: This prospective single-centre study was conducted on a total of 34 cases, divided into two groups: Group A (VAMVR) included 17 patients who underwent video-assisted mitral valve replacement. Group B (ATMVR) included 17 patients who underwent right anterior thoracotomy mitral valve replacement, comparing intraoperative procedures and the results of both techniques .Results: In the studied cases, the mean intraoperative time was 4.38 ± 0.69 hours, which widely ranged from 3 to 6 hours, with no significant difference between both techniques. It was 4.35 ± 0.7 hours in VAMVR and 4.41 ± 0.7 in ATMVR. mean ventilation time of 3.96 ± 1.08 hours. The mechanical ventilation time was 4.24 ± 1.1 hours in VAMVR cases and 3.68 ±1.1 hours in the ATMVR group. The mean overall ICU stay duration was 1.75 ± 0.33 days, with no impact of the technique used on this time, as it was 1.71 ± 0.25 days in VAMVR patients and 1.79 ± 0.4 in ATMVR patients. The total hospital stay time was about 5.71 ± 0.91 days, ranging from 4 to 8 days, with no impact of the procedure used on this time as it was 5.6 ± 0.94 days in VAMVR cases and 5.8 ± 0.88 days in ATMVR cases. Conclusions: There was no impact of the technique used in MIMVS, whether video-assisted or right anterior thoracotomy mitral valve replacement, on intraoperative time and ICU and hospital stays

Resection and anastomosis for benign tracheal stenosis: Single institution experience of 18 cases

Introduction: Tracheal stenosis is a complex condition caused by altered inflammatory response to injury and subsequent excessive circumferential scar formation. Surgical resection, wherever possible, offers the best long-term results. Nonsurgical methods provide immediate relief to all can be curative in few but mostly serve as an excellent bridge to surgery in majority. The purpose of this study is to retrospectively evaluate the outcome following surgery for benign tracheal stenosis at our center. Materials and Methods: This retrospective analysis was conducted on 18 patients who underwent resection and anastomosis for tracheal stenosis at our center between March 2012 and December 2015. Their records were analyzed for demography, history, clinical presentation, computed tomography, bronchoscopy details, preoperative interventions, indications for and details of surgery, the procedure performed, postoperative complications, and course during 6 months follow-up. Results: The patients had a varied list of pathologies for which they were either intubated or tracheostomized. The length of stenosis ranged between 1 cm and 4 cm. The diameter of stenotic segment ranged between 0 mm and 10 mm. Average length of resected segment was 3 cm, and number of tracheal rings resected ranged from 2 to 9. Postoperative complications occurred in four patients (22.22%). All our patients were in the “excellent outcome” category at discharge as well as at 3 months follow-up. Conclusions: Surgical management of tracheal stenosis is challenging and requires multidisciplinary team approach. Thorough preoperative preparation and multidisciplinary planning regarding need for and timing of surgery, meticulous intraoperative technique, and aggressive postoperative care is key to successful surgery, which can provide long-lasting cure to these patients

A Delphi Consensus report from the "Prolonged Air Leak: A Survey" study group on prevention and management of postoperative air leaks after minimally invasive anatomical resections

OBJECTIVES This study reports the results of an international expert consensus process evaluating the assessment of intraoperative air leaks (IAL) and treatment of postoperative prolonged air leaks (PAL) utilizing a Delphi process, with the aim of helping standardization and improving practice. METHODS A panel of 45 questions was developed and submitted to an international working group of experts in minimally invasive lung cancer surgery. Modified Delphi methodology was used to review responses, including 3 rounds of voting. The consensus was defined a priori as >50% agreement among the experts. Clinical practice standards were graded as recommended or highly recommended if 50-74% or >75% of the experts reached an agreement, respectively. RESULTS A total of 32 experts from 18 countries completed the questionnaires in all 3 rounds. Respondents agreed that PAL are defined as >5 days and that current risk models are rarely used. The consensus was reached in 33/45 issues (73.3%). IAL were classified as mild (400 ml/min; 74%). If mild IAL are detected, 68% do not treat; if moderate, consensus was not; if severe, 90% favoured treatment. CONCLUSIONS This expert consensus working group reached an agreement on the majority of issues regarding the detection and management of IAL and PAL. In the absence of prospective, randomized evidence supporting most of these clinical decisions, this document may serve as a guideline to reduce practice variation

A Delphi Consensus report from the "Prolonged Air Leak: A Survey" study group on prevention and management of postoperative air leaks after minimally invasive anatomical resections

Objectives: This study reports the results of an international expert consensus process evaluating the assessment of intraoperative air leaks (IAL) and treatment of postoperative prolonged air leaks (PAL) utilizing a Delphi process, with the aim of helping standardization and improving practice. Methods: A panel of 45 questions was developed and submitted to an international working group of experts in minimally invasive lung cancer surgery. Modified Delphi methodology was used to review responses, including 3 rounds of voting. The consensus was defined a priori as >50% agreement among the experts. Clinical practice standards were graded as recommended or highly recommended if 50-74% or >75% of the experts reached an agreement, respectively. Results: A total of 32 experts from 18 countries completed the questionnaires in all 3 rounds. Respondents agreed that PAL are defined as >5 days and that current risk models are rarely used. The consensus was reached in 33/45 issues (73.3%). IAL were classified as mild (<100 ml/min; 81%), moderate (100-400 ml/min; 71%) and severe (>400 ml/min; 74%). If mild IAL are detected, 68% do not treat; if moderate, consensus was not; if severe, 90% favoured treatment. Conclusions: This expert consensus working group reached an agreement on the majority of issues regarding the detection and management of IAL and PAL. In the absence of prospective, randomized evidence supporting most of these clinical decisions, this document may serve as a guideline to reduce practice variation