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Video-assisted thoracic surgery is an optimal alternative to conventional thoracotomy for reoperations for ipsilateral pulmonary lesions.

ABSTRACT:

Background

Ipsilateral pulmonary reoperation is empirically considered a contraindication of video-assisted thoracic surgery (VATS) because of intrapleural adhesion and the destruction of anatomical structures caused by previous surgery. The purpose of this study was to present our experience of the use of VATS for ipsilateral reoperations.

Methods

The medical records of patients who underwent VATS reoperation or re-thoracotomy between January 2006 and March 2017 were retrospectively reviewed. Data were compared to assess the feasibility and safety of VATS for ipsilateral reoperations.

Results

The study enrolled 64 patients, including 36 patients who underwent attempted ipsilateral VATS reoperations (VATS group) and 28 who underwent conventional re-thoracotomy as a control with clinicopathological characteristics similar to those in the VATS group. Intrapleural severe adhesions were detected in 28 (77.8%) and 22 (78.6%) patients in the VATS and re-thoracotomy groups, respectively (P = 0.906), and their dissection required a longer period in the VATS group (P = 0.014). VATS reoperations were converted to re-thoracotomy or video-assisted mini re-thoracotomy in three patients because of bleeding or difficulty in dissecting hilar structures. There were no significant differences in resection methods, time to reoperation, intraoperative blood loss, or drainage time between the two groups. However, patients in the VATS group had a shorter hospital stay (P < 0.01) and fewer complications (P = 0.042).

Conclusion

VATS is an optimal alternative to re-thoracotomy for ipsilateral pulmonary lesions, regardless of intrapleural adhesions and the destruction of anatomical structures caused by former operations in selected patients.

SUBMITTER: Chen D

PROVIDER: S-EPMC6209788 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Publications

Video-assisted thoracic surgery is an optimal alternative to conventional thoracotomy for reoperations for ipsilateral pulmonary lesions.

Chen Donglai D Mao Rui R Kadeer Xiermaimaiti X Sun Weiyan W Zhu Erjia E Peng Qiao Q Chen Chang C

Thoracic cancer 20180828 11

<h4>Background</h4>Ipsilateral pulmonary reoperation is empirically considered a contraindication of video-assisted thoracic surgery (VATS) because of intrapleural adhesion and the destruction of anatomical structures caused by previous surgery. The purpose of this study was to present our experience of the use of VATS for ipsilateral reoperations.<h4>Methods</h4>The medical records of patients who underwent VATS reoperation or re-thoracotomy between January 2006 and March 2017 were retrospectiv ...[more]

PMID: 30152592

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Project description:BackgroundThe major limitations of widespread use of non-intubated thoracic surgery (NITS) is the fear of managing complications. Here we present our practice of converting from uniportal video-assisted thoracic surgery (VATS) NITS to open NITS in cases of surgical complications.MethodsThe study period was from January 26, 2017, to November 30, 2018. Total intravenous anesthesia was provided with propofol guided by bispectral index, and the airway was maintained with a laryngeal mask with spontaneous breathing. Local anesthesia with 2% lidocaine at the skin incision, and intercostal and vagus nerve blockades were induced using 0.5% bupivacaine. For conversion with surgical indications, a thoracotomy was performed at the incision without additional local or general anesthetics.ResultsIn 160 complete NITS procedures, there were 145 VATS NITS and 15 open NITS (9 conversions to open NITS and 6 intended NITS thoracotomies). In the 15 open NITS cases (2 pneumonectomies, 1 bilobectomy, 1 sleeve lobectomy, 7 lobectomies, 3 sublobar resections, 1 exploration), the mean operative time was 146.7 (105–225) and 110 (75–190) minutes in the converted and intended open NITS groups, respectively. There were no significant differences between systolic blood pressure (P=0.316; 95% CI, ?10.469 to 3.742), sat O2% (P=0.27; 95% CI, ?1.902 to 0.593), or propofol concentration in the effect site (P=0.053; 95% CI, ?0.307 to 0.002) but significant differences in pulse (P=0.007; 95% CI, ?10.001 to ?2.72), diastolic blood pressure (P=0.013; 95% CI, ?9.489 to ?1.420) and in end-tidal CO2 (P=0.016; 95% CI, ?7.484 to ?0.952) before versus after thoracotomy, but there was no clinical relevance of the differences.ConclusionsFor conversion with surgical indications during the VATS-NITS procedure, NITS thoracotomy can be performed safely at the site of the utility incision without the need for additional drugs, and the major lung resections can be performed through this approach.

Dataset Information

Video-assisted thoracic surgery is an optimal alternative to conventional thoracotomy for reoperations for ipsilateral pulmonary lesions.

Background

Methods

Results

Conclusion

Publications

Video-assisted thoracic surgery is an optimal alternative to conventional thoracotomy for reoperations for ipsilateral pulmonary lesions.

Similar Datasets

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