Video-Assisted Thoracic Surgery

2016 ◽  
Author(s):  
Scott J. Swanson ◽  
Abby White
Keyword(s):  
Thoracic Surgery ◽  
Early Stage ◽  
Thoracoscopic Surgery ◽  
Mediastinal Lymph Node ◽  
Wedge Resection ◽  
Hospital Length Of Stay ◽  
Port Placement ◽  
Video Assisted ◽  
Trocar Placement ◽  
Video Assisted Thoracoscopic Surgery

Since the early 1990s, video-assisted thoracoscopic surgery (VATS) has revolutionized surgical care. The era of VATS is sufficiently mature that enough data have accrued to compare the efficacy of VATS with that of open procedures. In this regard, anatomic pulmonary resection by VATS has led to significant reductions in morbidity, mortality, and hospital length of stay, allowing patients a more expeditious return to regular activities. VATS has been used in the treatment of both benign and malignant diseases of the chest. Furthermore, VATS may be used in selected patients with early-stage lung cancer without breaching oncologic surgical principles. This review covers the case for VATS technology; operative planning; basic thoracoscopy operative technique; VATS procedures for pleural disease, pulmonary wedge resection, spontaneous pneumothorax and bullous disease, lung volume reduction surgery, lobectomy, mediastinal lymph node dissection, pericardial window, mediastinal masses, management of thoracic trauma, sympathectomy and splanchnicectomy; and cost considerations. Figures show preoperative evaluation; proper patient position in the operating room, with the patient propped on pontoons; triangulation technique for port placement in relation to intrathoracic structures and targets; thoracoscope and trocar placement; video and monitors; wedge resection with lung compression clamp; tissue-reinforced stapler  inserted into the chest; endoleader looped around the superior pulmonary vein; endoleader looped around the truncus anterior and its branch; and division of the upper lobe bronchus. Tables list indications and relative contraindications for VATS procedures, basic instruments and equipment used for VATS procedures, and operative steps for VATS lobectomy.   This review contains 10 highly rendered figures, 3 tables, and 35 references Key words: Video-assisted thoracoscopic surgery; VATS; Minimally invasive thoracic surgery; Thoracoscopy; Rigid thoracoscope; Flexible thoracoscope; Thoracoport

scholarly journals Robotic video-assisted thoracoscopic surgery using conventional thoracoscopic access

2020 ◽  
Vol 28 ◽  
pp. 93-100
Author(s):  
Vu Huu Vinh ◽  
Dang Dinh Minh Thanh ◽  
Nguyen Viet Dang Quang ◽  
Truong Cao Nguyen
Keyword(s):  
Thoracic Surgery ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Operation Time ◽  
Tumour Resection ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted ◽  
Tube Removal ◽  
Conventional Open Surgery ◽  
Video Assisted Thoracoscopic Surgery

Video assisted thoracic surgery (VATS) has been widely used and confirmed to be effective and less invasive compared with conventional open surgery. Robotic video-assisted thoracic surgery (R-VATS) is VATSusing a surgeon-controlled robotic system. R-VATS has been increasingly performed worldwide but not in Vietnam. Wehave started implementing r-VATS since July 2018, using conventional thoracoscopic accesses (trocars) and reported our initial results after 18 months of implementation with 116 cases. 57 cases of lobectomy, 9 cases of wedge resection,19 cases of thymectomy, 28 cases of mediastinal tumour resection, 1 case of esophagectomy, 1 case of oesophageal leiomyoma resection, and 1 case of diaphragm plication. 110 cases had good outcomes with no complications, 5 cases suffered from haemothorax that lasted for more than 5 days. Onepatient died after 35 days due to pneumonia. The operation time was comparable to that ofc- VATS. Average time to chest tube removal was 2 days. Time from surgery to discharge was comparable to that ofc-VATS.

scholarly journals Robotic pulmonary lobectomy for lung cancer treatment: program implementation and initial experience

2016 ◽  
Vol 42 (3) ◽  
pp. 185-190 ◽  
Author(s):  
Ricardo Mingarini Terra ◽  
Pedro Henrique Xavier Nabuco de Araujo ◽  
Leticia Leone Lauricella ◽  
José Ribas Milanez de Campos ◽  
Herbert Felix Costa ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Thoracic Surgery ◽  
Thoracoscopic Surgery ◽  
Sao Paulo ◽  
Pathological Examination ◽  
São Paulo ◽  
Pulmonary Lobectomy ◽  
Video Assisted ◽  
Tertiary Teaching ◽  
Video Assisted Thoracoscopic Surgery

ABSTRACT Objective: To describe the implementation of a robotic thoracic surgery program at a public tertiary teaching hospital and to analyze its initial results. Methods: This was a planned interim analysis of a randomized clinical trial aimed at comparing video-assisted thoracoscopic surgery and robotic surgery in terms of the results obtained after pulmonary lobectomy. The robotic surgery program developed at the Instituto do Câncer do Estado de São Paulo, in the city of São Paulo, Brazil, is a multidisciplinary initiative involving various surgical specialties, as well as anesthesiology, nursing, and clinical engineering teams. In this analysis, we evaluated the patients included in the robotic lobectomy arm of the trial during its first three months (from April to June of 2015). Results: Ten patients were included in this analysis. There were eight women and two men. The mean age was 65.1 years. All of the patients presented with peripheral tumors. We performed right upper lobectomy in four patients, right lower lobectomy in four, and left upper lobectomy in two. Surgical time varied considerably (range, 135-435 min). Conversion to open surgery or video-assisted thoracoscopic surgery was not necessary in any of the cases. Intraoperative complications were not found. Only the first patient required postoperative transfer to the ICU. There were no deaths or readmissions within the first 30 days after discharge. The only postoperative complication was chest pain (grade 3), in two patients. Pathological examination revealed complete tumor resection in all cases. Conclusions: When there is integration and proper training of all of the teams involved, the implementation of a robotic thoracic surgery program is feasible and can reduce morbidity and mortality.

scholarly journals May awake video-assisted thoracoscopic surgery with thoracic epidural anesthesia use routinely for minimaly invasive thoracic surgery procedures in the future?

2018 ◽  
Vol 5 (5) ◽  
pp. 1602
Author(s):  
Gonul Sagiroglu ◽  
Fazli Yanik ◽  
Yekta A. Karamusfaoglu ◽  
Elif Copuroglu
Keyword(s):  
Thoracic Surgery ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Thoracoscopic Surgery ◽  
Lung Ventilation ◽  
Thoracic Epidural Anesthesia ◽  
One Lung Ventilation ◽  
Thoracic Epidural ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Background: In the last years thoracic surgery developed in greater extent with equipments and techniques in one lung ventilation. Still general anesthesia in one lung ventilation approved as gold standard. In thoracic surgery most performed surgeries are plerural decortication and lung biopsy. Avoidance of intubation in Video Assisted Thoracoscopic Surgery (VATS) procedures gains us some advantages in postoperative period; a better respiratory parameters, survival and morbidity mortality rates, reduced hospitalization time and costs, reduced early stress hormone and immune response.  Methods: In this study, we reported our experience of 24 consecutive patients undergoing VATS with Thoracic Epidural Anesthesia (TEA) between December 2015 through July 2016 to evaluate the feasibility, safety and indication of this innovative technique whether it will be a gold standart in thoracic surgeries or not in the future.Results: Operation procedures included wedge resection in 11 (46%) patients (eight of them for pneumothorax, three of them for diagnosis), in 10 (42%) patients pleural biopsy (eight of them used talc pleurodesis), in two (8%) patients air leak control with fibrin glue and in one (4%) patient bilateral thoracal sympathectomy for hyperhidrosis.  We used T4-5 TEA space for 17 (72%) of patients, while we used T4-6 TEA space for 7 (28%) of patients. TEA block reached the desired level after the mean 26.4±4.3 minutes (range 21-34 min). There was no occurrence of hypotension and bradycardia during and after TEA. One (4%) patient required conversion to general anesthesia and tracheal intubation because of significant diaphragmatic contractions and hyperpne. Conversion to thoracotomy was not needed in any patient.Conclusions: We conclude that nVATS procedure with aid of TEA is feasibile and safety with minimal adverse events. The procedure can have such advantages as early mobilization, opening of early oral intake, early discharge, patient satisfaction, low pain level. Nevertheless, there is a need for randomized controlled trials involving wider case series on the subject.

scholarly journals Video-Assisted Thoracoscopic Surgery vs Thoracotomy for Non-Small Cell Lung Cancer Greater Than 5 cm: Is VATS a feasible approach for large tumors?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Güntuğ Batihan ◽  
Kenan Can Ceylan ◽  
Ozan Usluer ◽  
Şeyda Örs Kaya
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Thoracoscopic Surgery ◽  
Small Cell ◽  
Small Cell Lung ◽  
Postoperative Results ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background VATS lobectomy is a recommended surgical approach for patients with early-stage lung cancer. However, it is still controversial in locally advance disease. This study was conducted to compare intraoperative and postoperative results of VATS and thoracotomy in patients with tumors greater than 5 cm. Methods From January 2014 to December 2018, 849 patients underwent lobectomy or pneumonectomy for the treatment of non-small-cell lung cancer at our center. The inclusion criterion of this study was patients who underwent anatomic lung resection for lung cancer with tumors larger than 5 cm((≥ T3). The patients were divided into two groups: those who underwent video-assisted thoracoscopic surgery (n = 24) and those who underwent thoracotomy (n = 36). Patient characteristics, intraoperative and postoperative results were evaluated by review of the hospital records. Results In the VATS group, mean drainage time and postoperative length of hospital stay were significantly shorter than the thoracotomy group. Kaplan–Meier survival curves showed that overall and recurrence-free survival was longer in the VATS group and this result was statistically significant. Conclusions According to the results of this study, we emphasize that VATS is a feasible surgical procedure for tumors larger than 5 cm.

scholarly journals Is tubeless uniportal video-assisted thoracic surgery for pulmonary wedge resection a safe procedure?

2020 ◽  
Vol 58 (Supplement_1) ◽  
pp. i70-i76 ◽  
Author(s):  
Chao-Yu Liu ◽  
Po-Kuei Hsu ◽  
Ka-I Leong ◽  
Chien-Kun Ting ◽  
Mei-Yung Tsou
Keyword(s):  
Thoracic Surgery ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Chest Drain ◽  
Safe Procedure ◽  
X Rays ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted ◽  
Clinically Significant ◽  
Pulmonary Wedge Resection

Abstract OBJECTIVES Tubeless uniportal video-assisted thoracic surgery (VATS), using a uniportal approach and non-intubated anaesthesia while avoiding postoperative chest drain insertion, for patients undergoing thoracoscopic surgery has been demonstrated to be feasible in selected cases. However, to date, the safety of the procedure has not been studied. METHODS We reviewed consecutive patients undergoing non-intubated uniportal VATS for pulmonary wedge resection at 2 medical centres between August 2016 and October 2019. The decision to avoid chest drain insertion was made in selected candidates. For those candidates in whom a tubeless procedure was performed, postoperative chest X-rays (CXRs) were taken on the day of the surgery [operation (OP) day], on postoperative day 1 and 1–2 weeks later. The factors associated with abnormal CXR findings were studied. RESULTS Among 135 attempts to avoid chest drain insertion, 13 (9.6%) patients ultimately required a postoperative chest drain. Among 122 patients in which a tubeless procedure was performed, 26 (21.3%) and 47 (38.5%) had abnormal CXR findings on OP day and postoperative day 1, respectively. Among them, 3 (2.5%) patients developed clinically significant abnormal CXRs and required intercostal drainage. Primary spontaneous pneumothorax was independently associated with a higher risk of postoperative abnormal CXRs. CONCLUSIONS Tubeless uniportal VATS for pulmonary wedge resection can be safely performed in selected patients. Most patients with postoperative abnormal CXRs presented subclinical symptoms that spontaneously resolved; only 2.5% of patients with postoperative abnormal CXRs required drainage.

scholarly journals Thoracic Paravertebral Block with Adjuvant Dexmedetomidine in Video-Assisted Thoracoscopic Surgery: A Randomized, Double-Blind Study

2019 ◽  
Vol 8 (3) ◽  
pp. 352 ◽  
Author(s):  
Boohwi Hong ◽  
ChaeSeong Lim ◽  
Hyemin Kang ◽  
Hongsik Eom ◽  
Yeojung Kim ◽  
...  
Keyword(s):  
Rating Scale ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Paravertebral Block ◽  
P Value ◽  
Double Blind Study ◽  
Thoracic Paravertebral Block ◽  
Video Assisted ◽  
Fentanyl Consumption ◽  
Video Assisted Thoracoscopic Surgery

Background: The addition of the adjuvant dexmedetomidine to a nerve block improves the quality of the block and reduces perioperative opioid consumption. The aim of this study was to assess the effect of dexmedetomidine as an adjuvant for the thoracic paravertebral block (TPVB) in postoperative pain control after video-assisted thoracoscopic surgery (VATS). Methods: Sixty-six males, aged 15–40 years, with spontaneous pneumothorax scheduled for VATS wedge resection were enrolled. Following surgery, ultrasound-guided TPVB was performed on the T3 and T5 levels with 30 mL of 0.5% ropivacaine, plus adjuvant dexmedetomidine 50 μg or normal saline. The primary outcome was cumulative fentanyl consumption at 24 h. Pain severity, the requirement for additional rescue analgesics, hemodynamic variations, and side effects were also evaluated. Results: Median postoperative cumulative fentanyl consumption at 24 h was significantly lower in the dexmedetomidine group (122.6 (interquartile range (IQR) 94.5–268.0) μg vs. 348.1 (IQR, 192.8–459.2) μg, p-value = 0.001) with a Hodges–Lehman median difference between groups of 86.2 (95% confidence interval (CI), 4.2–156.4) mg. Coughing numeric rating scale (NRS) was lower in the dexmedetomidine group at postoperative 2, 4, 8, and 24 h. However, resting NRS differed significantly only after 4 h postoperative. Conclusions: Dexmedetomidine as an adjunct in TPVB provided effective pain relief and significantly reduced opioid requirement in VATS.

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