Duration Of Air Leak Research Articles

The effectiveness of blood amount used in pleurodesis to prevent prolonged air leakage.

This study aims to investigate the effects of different amounts of blood used in autologous blood patch pleurodesis on clinical outcomes in patients with secondary spontaneous pneumothorax. Between January 2015 and April 2019, a total of 42 patients (36 males, 6 females; mean age 52.1±16.0 years; range, 25 to 83 years) with SSP treated in our clinic with persistent air leakage for more than seven days were retrospectively analyzed. The patients were divided into two groups as receiving 60 mL autologous blood patch pleurodesis (Group 1, n=20) and 120 mL autologous blood patch pleurodesis (Group 2, n=22). Data including age, gender, operation side, complications, recurrence rates, time to tube withdrawal, and length of hospital stay were recorded and compared between the groups. The mean duration of air leakage was 3.3±2.4 (range, 1 to 11) days, the mean number of pleurodesis was 1.6±0.7 (range, 1 to 3), the mean time to tube withdrawal was 5.2±3.3 (range, 1 to 16) days, the mean length of hospitalization was 7.1±3.6 (range, 3 to 18) days. There were statistically significant differences in all variables analyzed between Group 1 and Group 2 (p<0.001). Autologous blood patch pleurodesis is an effective and safe method in the treatment of prolonged air leakage in secondary spontaneous pneumothorax. In addition, 120 mL of blood seems to be more effective option for pleurodesis.

Dual-port operations in surgery of bullous lung emphysema

The purpose of the study is to assess the perioperative period and the immediate results of dual-port operations in patients with bullous emphysema. Material and methods. The analysis of the perioperative period and the immediate results of two-port operations in patients with bullous emphysema of the lungs were performed. This surgical intervention was performed in 36 cases with bullous emphysema of the lungs (men – 31, women – 5). The average age of patients was 28.91 years. In all cases, the diagnosis was made on multispiral computer tomography of the chest. The duration of the surgical intervention, the periods of lung spread, the duration of the pleural drainage standing, the assessment of the pain syndrome, intra- and postoperative complications were assessed. Results and discussion. The intervention duration ranged from 70 to 125 minutes at the stage of implementation of the dual-port operations procedure. Now the intervention duration does not exceed 80 minutes for most cases. There were not registered any intraoperative complications. The duration of air leakage through pleural drainage was up to 1 day in 27 (75 %) patients. The duration of postoperative pain in most cases (28) did not exceed 1 day. Early postoperative complications were in 2 cases (1 intrapleural bleeding; 1 – postoperative wound seroma). These complications were cured in both cases. The proposed access method for the surgery of bullous emphysema of the lungs can be used in a wide clinical practice. To determine the location of this method, it is necessary to compare it with other minimally invasive interventions.

Use of thopaz in patients of empyema thoracis undergoing decortication.

Introduction:The management of empyema thoracis has evolved over the years. After all lung surgeries chest drain is required, however they suffer from inter observer variability and impair mobility of the patient. However, the newer digital thoracic drain system are portable and have alarms for various situations, furthermore they eliminate inter-observer variability. One such device is Thopaz™ (Medela inc, Switzerland). We wanted to compare efficacy of Thopaz™ with our conventional intercostal chest tube drain in patients undergoing decortications for empyema thoracis.Materials and Methods:One hundred patients were enrolled in study and were randomized into conventional and thopaz group with 50 patients in each group with help of opaque envelopes.Results:Both the groups were comparable in demographic parameters. Majority of the patients in our study were children and young adults. Majority of empyema thoracis involved right side with nontubercular empyema thoracis being the most common cause of decorticartion. Patients managed with Thopaz had a significantly shorter air leak duration, shorter duration of postdecortication chest tube placement and shorter postoperative hospital stay. All postoperative complications were less in Thopaz group.Conclusions:Patients with empyema thoracis undergoing open decortications when managed with digital chest drainage system (Thopaz) experienced faster reduction in air leak, a shorter duration of chest tube placement and in hospital stay. Thopaz usage is also associated with reduction in rate of postoperative complications. We recommend that this digital chest tube drainage system is a very useful tool in armamentarium of thoracic surgeon after lung surgeries.

Multicenter randomized study on the comparison between electronic and traditional chest drainage systems

BackgroundIn patients submitted to major pulmonary resection, the postoperative length of stay is mainly influenced by the duration of air leaks and chest tube removal. The measurement of air leaks largely relies on traditional chest drainage systems which are prone to subjective interpretation. Difficulty in differentiating between active air leaks and bubbles due to a pleural space effect may also lead to tentative drain clamping and prolonged time for chest drain removal. New digital systems allow continuous monitoring of air leaks, identifying subtle leakage that may be not visible during daily patient evaluation. Moreover, an objective assessment of air leaks may lead to a reduced interobserver variability and to an optimized timing for chest tube removal.MethodsThis study is a prospective randomized, interventional, multicenter trial designed to compare an electronic chest drainage system (Drentech™ Palm Evo) with a traditional system (Drentech™ Compact) in a cohort of patients undergoing pulmonary lobectomy through a standard three-port video-assisted thoracic surgery approach for both benign and malignant disease. The study will enroll 382 patients in three Italian centers. The duration of chest drainage and the length of hospital stay will be evaluated in the two groups. Moreover, the study will evaluate whether the use of a digital chest system compared with a traditional system reduces the interobserver variability. Finally, it will evaluate whether the digital drain system may help in distinguishing an active air leak from a pleural space effect, by the digital assessment of intrapleural differential pressure, and in identifying potential predictors of prolonged air leaks.DiscussionTo date, few studies have been performed to evaluate the clinical impact of digital drainage systems. The proposed prospective randomized trial will provide new knowledge to this research area by investigating and comparing the difference between digital and traditional chest drain systems. In particular, the objectives of this project are to evaluate the feasibility and usefulness of digital chest drainages and to provide new tools to identify patients at higher risk of developing prolonged air leaks.Trial registrationClinicalTrials.gov, NCT03536130. Retrospectively registered on 24 May 2018.

P2.17-12 Robotic Assisted Segmentectomy - Intravenous vs Intrabronchial Fluorescence Thoracoscopy to Identify the Intersegmental Plane

Increasingly earlier detection of small lung cancers may permit the possibility of anatomical sublobar resection. Robotic assisted thoracic surgery (RATS) facilitates complex segmentectomy but identification of the intersegmental boundary remains a drawback to minimally invasive techniques. We have employed two contrasting methods using either intravenous (IV) or intrabronchial (IB) indocyanine green (ICG) and compared the efficacy. The location of the lesion was identified on CT reconstruction. Patients were allocated to either method by surgeon preference. IV ICG was injected during RATS after division of the target segmental artery. A novel aerosolized IB technique (by fibreoptic bronchoscopy) was used to inject the target segmental bronchus before RATS. All operations were performed using the Da Vinci Xi robot (Intuitive Surgical, Sunnyvale, CA, USA) and near infrared thoracoscopy (Firefly®). IV ICG was administered in 18 patients and IB ICG was given in 13 patients. The intersegmental plane was identified by the fluorescence demarcation line, which was then divided using the robotic stapler. On univariate analysis, there were no intergroup differences between IV and IB in the patient demographics (median age 70.5 years vs 71 years), number of staple firings (8 vs 10, p>0.05), success in identifying the intersegmental plane (94 vs 100% respectively, p>0.05), postoperative air leak duration (2 vs 3 days, p >0.05), or TNM staging of tumours (T1 64% vs 86% respectively, p>0.05). The total anaesthetic time (230 vs 290 mins, p<0.05) and the operative duration (171.5 vs 193.5 mins, p<0.05) were significantly less in the IV ICG group. In IB ICG, more than half of the segmentectomies involved the apical segment of either lower lobe (5 R S6, 1 L S6; 3 L S1-3, 2L S4-5), whereas in IV ICG more complex segmentectomies were performed (2 R S1-2, 2 R S6, 2 R S7-10; 2 L S1-2, 5 L S1-3, 2 L S4-5, 1 L S7-10, 1 L S7-8). There was no mortality nor major complications in either group. One case was converted to thoracotomy due to extensive adhesions in the IV ICG group. In the same group, there was one R1 resection due to parietal pleura involvement.TableComparison between IV and IB ICG in RATS segmentectomiesTotal number of patientsIV ICG (n=18)IB IVG (n=13)Excluded patients1 case converted to thoracotomy1 wedge resection (frozen section negative)1 lobectomy (abnormal anatomy)Patient age (median, range)70.5 (35-84)71 (50-89)Sex (M/F)11/77/6Target segments (R/L)R S1-2 2R S6 2R S7-10 2L S1-2 2L S1-3 5L S4-5 2L S7-10 1L S7-8 1R S6 5L S1-3 3L S4-5 2L S6 1Operative duration (median, range)171.5 mins (111-228)193.5 mins (178-275)No of staple firings (median, range)8 (2-14)10 (7-15)Success in identifying the intersegmental plane (%)16/17 (94%)11/11 (100%)Major complications00Conversion to VATS or open1(adhesions)0Tumour clearance (%)R0 16/17 (94%)R0 11/11 (100%)NSCLC (%)NSCLC 14/17 (82%)NSCLC 7/11 (63%)T-status in NSCLC (%)T1 9/14 (64%)T1 6/7 (86%) Open table in a new tab In RATS segmentectomy, identification of the intersegmental plane is facilitated by the intraoperative use of ICG. Both IV and IB routes are feasible with comparable results. As the IV route appears to reduce the use of theatre time, a future randomized comparison is suggested.

Estimation of the efficiency of the use of «early» valve bronchoblocation at complications after thoracoscopic operations in patients with bullous emphysema

The OBJECTIVE of the study was to evaluate the effectiveness of the use of «early» (up to 3 days) valve bronchial blocking in the complication of postoperative period in patients with bullous emphysema. MATERIAL AND METHODS. For the period from 2009 to 2017, 32 patients with bullous pulmonary emphysema had a long (more than 3 days) air leakage from the pleural cavity. Depending on the time of the valve bronchial blocker installation, the patients were divided into 2 groups: 1 group («late» blocking): the valve bronchial blocker was placed later than 3 days after the operation (11 patients); 2 group («early» blocking): the valve bronchial blocker was placed for 2–3 days from the operation (21 patients). RESULTS. During the first two days, air discharge through the pleural drainage was discontinued in 16 patients of the «early» blocking group and in 2 patients of the «late» blocking group (р=0.0022). The duration of air leakage in the «early» blocking group was 1.59 days less (44.91 %) than in patients of the «late» blocking group (р=0.0024). The positive blocking effect was fixed in 85.71 % (18) of the patients of the group with «early» blocking, which was 3.6 times higher than in the patients of the «late» blocking group (р= 0.04). The frequency of repeated intervention in the «early» blocking group was 3.81 times less than in the «late» blocking group (54.54 % vs. 14.28 %) (р=0.08). CONCLUSION. «Early» valve bronchoblocation (performed on the 2–3rd day of the postoperative period) had an indisputable advantage in comparison with bronchial blocking performed at the time of more than 3 days postoperative period, allowing reliably faster lung dilatation and eliminating air discharge through drainage from the pleural cavity, without resorting to repeated interventions, which was important, both for the surgeon and for the patient.

Thoracoscopic versus open lobectomy: short-term outcomes

Video-assisted thoracoscopic surgery (VATS) lobectomy for patients with early-stage non-small cell lung cancer (NSCLC) has spread worldwide and it has become a safe and viable alternative to thoracotomy. The aim of this review was to analyse the evidence presents in the current literature in order to assess the safety and efficacy of VATS versus open lobectomy, in terms of short-term outcomes. To identify relevant articles for inclusion in our analysis, we performed a search of PubMed/Medline database. We looked for randomized controlled trials, case series and comparative studies that reported outcomes following VATS or open lobectomy for NSCLC. Morbidity rates are reduced to 7.7–24.1% and mortality to 0.8–2.5% by the VATS approach. The reported lower morbidity rates included less intraoperative bleeding; shorter duration of air leak; lower incidence of post-operative pneumonia, atelectasis requiring bronchoscopy and atrial fibrillation. Furthermore, VATS lobectomy showed shorter chest tube duration; shorter length of hospital stays; reduced post-operative pain and inflammation; a better pulmonary function in the early post-operative phase, when compared with thoracotomy. Summarizing, thoracoscopic approach represents a valid alternative technique to treat NSCLC compared with standard thoracotomy; it offers patients a faster recovery and a better quality of life and allows high-risk patients to benefit from curative surgical treatment. VATS lobectomy might become the choice surgical approach for early-stage NSCLC.

Forecasting pulmonary air leak duration following lung surgery using transpleural airflow data from a digital pleural drainage device.

Prolonged air leak (PAL) is often the limiting factor for hospital discharge after lung surgery. Our goal was to develop a statistical model that reliably predicts pulmonary air leak resolution by applying statistical time series modeling and forecasting techniques to digital drainage data. Autoregressive Integrated Moving Average (ARIMA) modeling was used to forecast air leak flow from transplural air flow data. The results from ARIMA were retrospectively internally validated with a group of 100 patients who underwent lung resection between December 2012 and March 2017, for whom digital pleural drainage data was available for analysis and a persistent air leak was the limiting factor for chest tube removal. The ARIMA model correctly identified 82% (82/100) of patients as to whether or not the last chest tube removal was appropriate. The performance characteristics of the model in properly identifying patients whose air leak would resolve and who would therefore be candidates for safe chest tube removal were: sensitivity 80% (95% CI, 69-88%), specificity 88% (95% CI, 68-97%), positive predictive value 95% (95% CI, 86-99%), and negative predictive value 59% (95% CI, 42-79%). The false positive and false negative rate was 12% (95% CI, 12-31%) and 20% (95% CI, 12-31%). We were able to validate a statistical model that that reliably predicted resolution of pulmonary air leak resolution over a 24-hour period. This information may improve the care of patients with chest tube by optimizing duration of pleural drainage.

Air Leak Management Program With Digital Drainage Reduces Length of Stay After Lobectomy

Air leaks can impede recovery from lung resection. To help prevent and manage air leaks, we developed a comprehensive program that includes using precompression of lung staple lines, sealant, fissureless video-assisted thoracoscopic (VATS) lobectomy, a digital drainage system, and endobronchial valve placement for prolonged air leak. We assessed the effectiveness of this program on air leak duration, hospital length of stay (LOS), and chest tube duration in our high-risk veteran population. Using a prospectively maintained database, we retrospectively analyzed data from 226 patients whounderwent lung resection for cancer by VATS lobectomy in a Veterans Affairs center. Patients were divided into two groups. Group A (n= 134; historical controls) underwent lobectomy from July 2009 through October 2013; group B (n= 92; intervention group) underwent lobectomy from November 2013 through July 2016 and received care per the comprehensive program. The median hospital LOS was significantly shorter in group B than in group A patients (5 days versus6 days, respectively; p= 0.0001). Group B had a shorter median chest tube duration (2 days versus 3 days, p= 0.027). Prolonged air leak (more than 5 days) occurred in 5.4% of group B and 9.7% of group A patients (p=0.24). Prolonged LOS (more than 14 days) was less frequent in group B (1.1%) than in group A (8.2%, p=0.030). Multivariable analysis showed that predictors of decreased air leak duration, chest tube duration, and LOS included undergoing surgery in the later period (group B). Our comprehensive program was associated with reduced chest tube days and hospital LOS.

External suction versus simple water-seal on chest drainage following pulmonary surgery: an updated meta-analysis.

The decision to apply simple water-seal drainage or the addition of an external suction to the simple water-seal drainage following pulmonary surgery is made based on the surgeon's experience or preference and has remained controversial. This meta-analysis aimed to assess the effects of the addition of suction to simple water-seal on the postoperative outcomes. PubMed, EMBASE and Web of Science were searched from their inception to 30 August 2017. The risk ratio and the weight mean difference were calculated for dichotomous and continuous outcomes, respectively, each with 95% confidence intervals (CIs). The heterogeneity and risk of bias were also assessed. A total of 10 randomized controlled trials enrolling 1601 patients were included. Overall, compared with simple water-seal, the addition of external suction reduced the occurrence of postoperative pneumothorax (risk ratio 0.35, 95% CI 0.13-0.93; P = 0.04) and other cardiopulmonary complications (risk ratio 0.65, 95% CI 0.48-0.89; P = 0.008), and increased the duration of chest tube drainage (weight mean difference 0.92 days, 95% CI 0.04-1.81, P = 0.04). However, the effect difference between the 2 groups was not significant regarding air leak duration, length of hospital stay and the occurrence of prolonged air leak. The stability of these studies was strong. No evidence of publication bias was detected. The addition of suction to simple water-seal made no difference to air leak duration, hospital stay or the occurrence of prolonged air leak following pulmonary surgery. In patients where there is concern about a residual or increasing pneumothorax, the addition of suction may be applied selectively.

Uniportal versus multiport video-assisted thoracoscopic surgery for anatomical lung resections: a glance at a dilemma.

IntroductionAs the number of operations performed by videothoracoscopy is increasing, there is also a tendency to decrease the number of port incisions. Apart from the reduced number of surgical incisions, there are a few reports and systematic reviews that demonstrate some potential advantages of the uniportal video-assisted thoracoscopic surgery, but the impact of the reduced incisions in the clinical setting still remains uncertain.AimTo compare uniportal video-assisted thoracoscopic surgery to multiport video-assisted thoracoscopic surgery for anatomical lung resections in patients with malignant and benign lung diseases.Material and methodsFrom August 2010 to April 2016, a total of 102 patients with malignant and benign lung diseases underwent videothoracoscopic lobar and sublobar lung resections in our department. Comorbidities, tumor stage, tumor localization, mortality, operative time, pain visual analogue scale, length of hospital stay, perioperative blood loss, duration and amount of postoperative drainage and air leak, number of harvested lymph nodes and complication rates were analyzed.ResultsNo significant difference was found in the duration of chest tube drainage, pain visual analogue scale score, length of hospital stay, perioperative blood loss, amount of postoperative drainage, number of harvested lymph nodes or complication rate. There was no surgical mortality in either of the two groups. However, operative time was shorter (189 min vs. 256 min, p < 0.005) in the multiport group than in the uniportal group.ConclusionsCompared with the uniportal approach, the multiport approach is associated with a significantly shorter operative time in our study.

Use of Bioglue\u2122 to seal a difficult to treat air leak in a complicated empyema patient

Surgical sealants have been used in thoracic surgery in an effort to reduce air leak duration, intercostal drain duration, length of stay and complications. They are instilled over a defect usually treated with other means. We herein present the technique of controlling a difficult to treat defect by directly instilling Bioglue™ alone into a crater, caused during empyema Video-assisted thoracic surgery in a 50-year-old patient with a trapped lung. This deep crater had caused a significant air leak rendering intraoperative ventilation challenging. After instillation, the dependent lung was kept blocked. With this technique, the Bioglue™ polymerized and the air leak was dramatically decreased making ventilation and eventually extubation of the patient feasible. Instillation of Bioglue™ directly into a large lung defect could be a choice of action to decrease complicated air leaks, otherwise impossible to treat with other means, in patients with trapped lung.

Digital chest drainage is better than traditional chest drainage following pulmonary surgery: a meta-analysis.

In this systematic review with meta-analysis, we sought to determine the current strength of evidence for or against digital and traditional chest drainage systems following pulmonary surgery with regards to hard clinical end points and cost-effectiveness. PubMed, EMBASE and Web of Science were searched from their inception to 31 July 2017. The weighted mean difference (WMD) and the risk ratio were used for continuous and dichotomous outcomes, respectively, each with 95% confidence intervals (CIs). The heterogeneity and risk of bias were also assessed. A total of 10 randomized controlled trials enrolling 1268 patients were included in this study. Overall, digital chest drainage reduced the duration of chest tube placement (WMD -0.72 days; 95% CI -1.03 to -0.40; P < 0.001), length of hospital stay (WMD -0.97 days; 95% CI -1.46 to -0.48; P < 0.001), air leak duration (WMD -0.95 days; 95% CI -1.51 to 0.39; P < 0.001), and postoperative cost (WMD -443.16 euros; 95% CI -747.60 to -138.73; P = 0.004). However, the effect differences between the 2 groups were not significant for the duration of a prolonged air leak and the percentage of patients discharged home on a device. The stability of these studies was strong. No publication bias was detected. It may be necessary to use a digital chest drainage system for patients who underwent pulmonary surgery to reduce the duration of chest tube placement, length of hospital stay and air leak duration.

Bronchoscopic valve placement for the treatment of persistent air leaks.

Persistent air leaks (PALs) are associated with increased morbidity, prolonged hospital stay, and increased treatment costs. Endobronchial 1-way valves have been recently used as a potential less invasive treatment option. We sought to investigate the effects of valve therapy in treating this condition. The patients with evidence of continuous air leak flow whose chest tubes remained in place for more than 7 days were treated with bronchoscopic closure using 1-way valves. The source of the air leak was identified by the Chartis system.A total of 11 patients (1 woman, 10 men; mean age, 68 years) who underwent valve placement were eligible to be enrolled from January 2015 through January 2017. Six patients had postoperative PAL, and 5 had a secondary spontaneous pneumothorax. The number of used valves varied from 1 to 3 (median 1). The resolution of the leak was complete in 8 patients (72.7%), whose mean duration of air leak before and after valve deployment was 58.5 and 4.5 days, respectively. There were no complications related to the valve deployment.Bronchoscopic placement of 1-way valves is a safe procedure that could help manage patients with prolonged PALs. A prospective randomized trial with cost-efficiency analysis is necessary to better define the role of this bronchoscopic intervention and demonstrate its effect on air leak duration.

Application of the coaxial smart drain in patients with a large air leak following anatomic lung resection: a prospective multicenter phase II analysis of efficacy and safety.

The presence of air leak following lung resection remains a frequent problem, which may prolong hospital stay and increase hospital costs. In the past, some studies documented the efficacy of soft and flexible chest tube in patients who underwent thoracic surgery. Nevertheless, safety in case of post-operative large air or liquid leak remains questionable. The objective of this study was to verify through a multicentre study the safety and the effectiveness of the coaxial chest tube in a consecutive series of selected patients who underwent anatomical pulmonary resection and with an active and large air leak. Between October 2016 and September 2017, data from patients submitted to anatomical lung resection with curative intent and operated in two Department of Thoracic Surgery of two different were prospectively collected. The inclusion criteria consisted in the presence of an air leak greater than 50 mL/min measured with a digital drainage system during the 3 postoperative hours. A descriptive statistic was used to report the incidence of complications assumed to be associated with the use of the coaxial drain. Forty-eight consecutive patients (27 males) submitted to lobectomy (37 patients: 77%) or anatomic segmentectomies (11 patients) were included in the analyses. Thirty-four operations (71%) were performed by video-assisted thoracic surgery (VATS). The median duration of chest tubes was 13 days [interquartile range (IQR), 4-19] and the median duration of air leak was 9 days (IQR, 2-17.5). No patient had undrained postoperative pleural effusion judged to require an additional chest tube placement. There were 12 (25%) cases of clinically or radiologically significant surgical emphysema; in none of these patients any additional procedure or re-operation was required, and they were treated conservatively by increasing the level of suction. Our experience with this novel Coaxial Drain was satisfactory with no clinically relevant complication caused using this drain, no need to insert additional drain or replace the existing one with another drain a duration of air leak and chest tubes as well as the incidence of subcutaneous emphysema that was in line with what observed in the daily practice in similar highly selected patients with large air leak.

Can a standardised Ventilation Mechanical Test for quantitative intraoperative air leak grading reduce the length of hospital stay after video-assisted thoracoscopic surgery lobectomy?

We standardised a Ventilation Mechanical Test (VMT) after video-assisted thoracoscopic surgery (VATS) lobectomy that classifies intraoperative alveolar air leaks (IOAALs) in mild, moderate and severe. We assumed that mild IOAALs (<100 mL/min) are self-limiting, whereas severe IOAALs (>400 mL/min) must be treated. An IOAAL between 100 and 400 mL/min was defined moderate and constituted the study population of a prospective multicentre randomised trial on the use of a polymeric biodegradable sealant (ProgelTM Pleural Air Leak Sealant, Bard Davol, USA) in case of moderate IOAAL compared with no treatment. We assumed that the standardised VMT allows to accurately selected patients needing treatment, thus limiting unnecessary sealant use. We analysed data of the randomised trial to assess the cost-effectiveness of Progel treatment in VMT selected patients. This is a multicenter randomised controlled trial. Patients with moderate IOAAL were randomised to Progel (group A) or "no treatment" (group B).The primary efficacy endpoint of the study was the postoperative duration of air leakage. The secondary outcome measures included: mean time to chest drain removal, mean length of hospitalisation, the percentage of postoperative complications occurring within two months, and cost of treatment. Between January 2015 and January 2017, 255 VATS lobectomies were performed in 4 centres, 55 met the inclusion criteria, and they were randomly assigned to 2 different groups (28 in the Progel and 27 in the control group). The mean air leakage duration was statistically different between the two groups: in the group A was 1.60 vs. 5.04 days in group B (P<0.001). The average duration of chest drainage was statistically shorter in group A than in the control group (4.1 vs. 6.74 days; P=0.008). The mean time to hospital discharge was also statistically shorter in group A than in group B (5.75 vs. 7.85 days, P=0.026). In the Progel group, a statistically significant reduction of hospitalisation costs compared with the control group was observed (Progel group =12,905₤, Control group =39,690₤; P<0.001). Our standardised VMT helps in reducing the length of hospital stay after VATS lobectomy because in case of IOAALs between 100 and 400 mL/min the use of ProgelTM significantly reduces postoperative air leak, time to drain removal and length of hospitalisation compared with no treatment. This shorter hospital stays results in significant cost saving benefits. Selection of patients with standardised VMT is essential to limit unnecessary intraoperative sealant treatments, thus contributing to limit the costs.

Cost-effectiveness analysis of sealant impact in management of moderate intraoperative alveolar air leaks during video-assisted thoracoscopic surgery lobectomy: a multicentre randomised controlled trial.

Intraoperative alveolar air leak (IOAAL) is one of most common complications after video-assisted thoracoscopic surgery (VATS) lobectomy. The study aimed to evaluate if, in moderate IOAAL, intraoperative polymeric biodegradable sealant (ProgelTM) reduced postoperative air leak (PAL) and consequently was cost-effective. Patients with moderate IOAAL were randomised in a multicentre trial to intraoperative use of a sealant (Sealant group) or standard management of air leaks (Control group). Primary endpoint was the postoperative duration of air leakage. Secondary outcomes included: time to drainage removal, length of hospital stay, postoperative complications within 2 months, and cost analysis. Between January 2015 and January 2017, 255 VATS lobectomies were performed in four centres. Fifty-five met inclusion criteria and were randomly assigned to Sealant group [28] and Control group [27]. The mean air leakage duration was statistically different between groups (Sealant group =1.60 days, Control group =5.04 days; P<0.001). The average length of drainage was significantly (P=0.008) shorter in Sealant group (4.1 days) than in Controls (6.74 days). The mean time of hospital stay was statistically shorter in sealant group (Sealant =5.75 days, Control =7.85 days; P=0.026). Sealant group observed a statistically significant reduction of costs. In moderate IOAAL after VATS lobectomy, polymeric biodegradable sealants are safe and efficient. Compared with standard treatments, sealant significantly reduces PAL, time to drain removal and length of hospital stay resulting in significant costs benefits.

Comparison of digital and traditional thoracic drainage systems for postoperative chest tube management after pulmonary resection: A prospective randomized trial

ObjectiveThe objective of this study was to evaluate whether a digital thoracic drainage system (group D) is clinically useful compared with a traditional thoracic drainage system (group T) in chest tube management following anatomic lung resection. MethodsPatients scheduled to undergo segmentectomy or lobectomy were prospectively randomized before surgery to group D or T. A stratification randomization was performed according to the following air leak risk factors: age, sex, smoking status, and presence of emphysema and/or chronic obstructive pulmonary disease. The primary end point was the duration of chest tube placement. ResultsNo statistically significant differences were found between groups D (n = 135) and T (n = 164) with regard to the duration of chest tube placement (median, 2.0 vs 3.0 days; P = .149), duration of hospitalization (median, 6.0 vs 7.0 days; P = .548), or frequency of postoperative adverse events (25.1% vs 20.7%; P = .361). In subgroup analyses of the 64 patients with postoperative air leak (20 in group D and 44 in group T), the duration of chest tube placement (median, 4.5 vs 4.0 days; P = .225) and duration of postoperative air leak (median, 3.0 vs 3.0 days; P = .226) were not significantly different between subgroups. ConclusionsThe use of a digital thoracic drainage system did not shorten the duration of chest tube placement in comparison to a traditional thoracic drainage system after anatomic lung resection.

Uniportal video-assisted thoracoscopic lobectomies in lung cancer management

OBJECTIVE. The study summarized personal surgical experience of uniportal video-assisted thoracoscopic (VATS) lobectomies for patients with stage I-II non-small cell lung cancer. MATERIAL AND METHODS. The authors have performed 72 VATS lobectomies for patients with stage I-II non-small lung cancer using modified minimally invasive single incision above anterior part of musculus latissimus dorsi. RESULTS. During the implementation period, there were carried out 2 (2,8 %) conversions to open thoracotomy. There weren’t observed lethal postoperative complications of VATS lobectomies. Other complications had 5 (6,9 %) patients. Postoperative pneumonia was in 1 (1,4 %) patient. Arrhytmia was noted in 4 (5,6 %) patients. The average operation time consisted of 227,4 min (from 60 to 460 min). Learning curve demonstrated a significant decrease of operation time with every following VATS lobectomy from 227,4 to 90,3 min (p=0,03). The quantity of removed regional lymph nodes estimated 14,2 ± 0,7 during uniportal VATS lobectomy. The median blood loss was 98,3 ml (from 10 to 300 ml). The average duration of air leak was 2,3 ± 0,65 days after uniportal VATS lobectomy. The mean term of drainage was 4,6 ± 0,53 days. CONCLUSIONS. The data obtained justified the feasibility, efficacy and safety of VATS lobectomies in patients with I-II stage of lung cancer.

A prospective randomized trial comparing homologous and autologous fibrin sealants for the control of alveolar air leak.

Postoperative air leak is a common complication seen after pulmonary resection. It is a significant reason of morbidity and also leads to greater hospital cost owing to prolonged length of stay. The purpose of this study is to compare homologous sealant with autologous one to prevent air leak following pulmonary resection. A total of 57 patients aged between 20 and 79 (mean age: 54.36) who underwent pulmonary resection other than pneumonectomy (lobar or sublobar resections) were analyzed. There were 47 males (83%) and 10 females (17%). Patients who intraoperatively had air leaks were randomized to receive homologous (Tisseel; n=28) or autologous (Vivostat; n=29) fibrin sealant. Differences among groups in terms of air leak, prolonged air leak, hospital stay, amount of air leak were analyzed. Indications for surgery were primary lung cancer in 42 patients (71.9%), secondary malignancy in 5 patients (8.8%), and benign disease in 10 patients (17.5%). Lobectomy was performed in 40 patients (70.2%), whereas 17 patients (29.8%) had wedge resection. Thirteen (46.4%) patients developed complications in patients receiving homologous sealant while 11 (38.0%) patients had complication in autologous sealant group (P=0.711). Median duration of air leak was 3 days in two groups. Time to intercostal drain removal was 3.39 and 3.38 days in homologous and autologous sealant group respectively (P=0.978). Mean hospital stay was 5.5 days in patients receiving homologous sealant whereas it was 5.0 days in patients who had autologous agent (P=0.140). There were no significant differences between groups in terms of measured maximum air leak (P=0.823) and mean air leak (P=0.186). There was no significant difference in the incidence of complications between two groups (P=0.711). Autologous and heterologous fibrin sealants are safe and acts similarly in terms of air leak and hospital stay in patients who had resectional surgery.