Median Drainage Time Research Articles

Surgical Management Of Congenital Thoracic Disorders: A 15-Year Center Experience.

Congenital thoracic disorders represent a spectrum of fetal lung bud development abnormalities, which may affect breathing capacity and quality of life. We aim to evaluate the impact of surgery in the treatment of 4 major congenital conditions. We performed a retrospective cohort analysis of patients who underwent surgical treatment in our tertiary center, from 2007 to 2022. Over the 15-year period, we treated 33 patients, with a male predominance of 55%. 22 patients (67%) were asymptomatic. When symptomatic, the recurrence of respiratory infections was the most common clinical presentation (18%). In 13 patients (39%), diagnosis was achieved through fetal ultrasonography. This study encompassed 13 patients with pulmonary sequestration (39%), 11 patients with bronchogenic cysts (33%), 7 patients with congenital pulmonary airway malformation (21%) and 2 patients with congenital lobar emphysema (6%). Considering solely lung malformation conditions, we accounted 22 patients with a median age of 3 [1-67] years-old. Surgery comprised bilobectomy (9%), lobectomy (77%), lobectomy with wedge resection (5%), segmentectomy (5%) and wedge resection (5%). Concerning bronchogenic cysts, we treated 11 patients with a median age of 19 [14-66] years-old. We identified 1 hilar, 1 intrapulmonary and 9 mediastinal lesions, of which 4 were paraesophageal, 4 were subcarinal and 1 was miscellaneous. Overall, surgery was conducted by thoracotomy in 61% of patients, VATS in 33% and RATS in 6%. The median drainage time was 3 [1-40] days and median hospital stay was 4 [1-41] days. There were no cases of mortality. Ensuing, 94% of patients experienced clinical improvement after surgery. Early diagnosis of congenital thoracic malformations increased considerably with the improvement in imaging technology and prenatal screening. Treatment may include expectant conservative treatment. However, in selected cases, surgery may play an important role in symptomatic control and prevention of disease progression.

Chest drains after open paediatric lung resections: not always required.

Chest drains are often a great source of pain and anxiety in paediatric patients. While there is growing evidence to support the selective omission of chest drains after thorascopic lung resection in children, the safety of this practice following open lung resection has yet to be evaluated. Chest drains are not routinely placed at our institution. We therefore aimed to describe our experience of selective chest drain placement in children undergoing open lung resection, and report the safety and complication profile of this practice. Retrospective review of all open lung resections performed at Wellington Regional Hospital, in children < 16 years of age, from June 2009 to June 2022. Clinical, radiological and operative outcomes were identified and analyzed. The cohort was divided into two groups - those that had a chest drain placed intraoperatively, and those that did not. 35 children underwent open lung resection over the study period. The mean operative age was 8.0 ± 5.4 months, with the most common resection being a lobectomy (80%). Eight children (23%) did not have a chest drain placed, whereas the remaining 29 children (77%) had at least one drain placed intraoperatively, with a median drainage time of 3.0 days. Length of stay was significantly shorter in children who did not have a chest drain placed intraoperatively, compared to those that did (2.5 vs. 5.0 days, p = 0.019). There were no significant differences observed in complication or reintervention rates between the two groups. Similarly, there were no significant differences in the incidence of a residual pneumothorax or effusion on the pre-discharge CXR between the groups. Chest drains may not always be required following open paediatric lung resection. The selective omission of a chest drain following open lung resection, does not appear to result in a significantly higher rate of complications or reintervention, and is associated with significantly shorter hospital length of stay.

Can wells in the vadose zone be backflushed to regain infiltration capacity? Concept and laboratory test

Vadose zone wells (VZW), or drywells, allow for high infiltration rates combined with small area demand. Nevertheless, they are rarely used for managed aquifer recharge, since turbid water leads to gradual clogging and a reduction in infiltration capacity. Established redevelopment measures require backflushing, which is commonly considered impossible for VZWs, making them “non regenerable”. In this study, the possibility of backflushing a VZW is discussed. Key to the underlying approach is isolating the lower (clogged) section of a well and saturating its surrounding with water by infiltration via the upper (unclogged) screen. Subsequently, underpressure sucks water from the surrounding soil into the isolated section. The approach was tested with and without a gravel pack, on laboratory scale, showing a successful reversal of flow direction in both cases. The degree of redevelopment was quantified by measuring the drainage time of the well, which increased from initially 45 s without gravel pack and 40 s with gravel pack to 9,500 and 11,000 s, respectively, after clogging. After backflushing, the well with gravel pack showed a median drainage time of 95 s, which remained stable over ten cycles of clogging and backflushing. In contrast, drainage time of the well without gravel pack increased continuously to >170 s, even after vibrator application. In conclusion, it can be stated that the backflush of a VZW with the presented approach is possible and has an effect on the well’s infiltration capacity, though it seems more effective for wells with gravel pack.

Can the Realization of an External Wirsungostomy be an Option for High-Risk Pancreatic Anastomosis After Pancreaticoduodenectomy?

Clinically relevant postoperative pancreatic fistula (POPF) occurs in 15-20% of patients after pancreaticoduodenectomy (PD) and reintervention in the setting of Grade C POPF remains associated with a mortality rate of up to 25%. In patients at high risk of POPF, PD with external wirsungostomy (EW) could be a safe alternative that avoids pancreatico-enteric anastomosis while preserving the remnant pancreas. Of the 155 consecutive patients who underwent PD from November 2015 to December 2020, 10 patients were managed using an EW, all with a fistula risk score (FRS) ≥ 7 and BMI ≥30kg/m2, and/or major associated abdominal surgery. The pancreatic duct was cannulated with a polyethylene tube to allow good external drainage of the pancreatic fluid. We retrospectively analyzed postoperative complications and endocrine and exocrine insufficiencies. The median alternative FRS was 36.9% [22.1-45.2]. There was no postoperative death. The 90-day overall severe complication (grade ≥3) rate was 30% (n = 3 patients), no patient required reoperation, and 2 hospital readmissions occurred. 3 patients experienced Grade B POPF (30%), managed using image-guided drainage for 2 patients. The external pancreatic drain was removed after a median drainage time of 75days [63-80]. Two patients presented with late symptoms (> 6months) warranting interventional management (pancreaticojejunostomy and transgastric drainage). Six patients experienced significant weight loss (> 2kg) 3months after surgery. One year after surgery, 4 patients still complained of diarrhea and were treated with transit-delaying drugs. One patient presented new-onset diabetes one year after surgery, and 1 of the 4 patients with preexisting diabetes experienced worsening disease. EW after PD might be a solution to reduce post-operative mortality following PD in high-risk patients.

Surgical perspective in neoadjuvant chemoimmunotherapy for stage II-III non-small cell lung cancer.

BackgroundThere are many studies on neoadjuvant immunotherapy for locally advanced non‐small cell lung cancer (NSCLC) patients. Expert consensus recommends neoadjuvant immunotherapy for patients with resectable stage IB–IIIA NSCLC. However, there are few clinical studies or cases to verify this.MethodsData were collected from all NSCLC patients who underwent surgical resection after neoadjuvant chemoimmunotherapy admitted to the Affiliated Hospital of Xuzhou Medical University and Xuzhou Central Hospital between September 2020 and April 2021. Data collected included patient information, relevant examination results, intraoperative parameters, postoperative complications, pathological changes, and 90‐day mortality.ResultsIn total, 25 patients achieved R0 resection. Eleven (44%) patients completed surgery by thoracotomy, and three (12%) procedures were changed from minimally invasive procedures due to dense adhesions of hilar lymph nodes, which rendered it difficult to dissect the blood vessels. Thirteen (52%) patients achieved a major pathological response (MPR) with eight (32%) of these patients having a pathological complete response (pCR). Twenty‐two (88%) patients showed radiological regression, and three (12%) patients had stable disease. The median drainage time was 8.50 (3–27) days. Thirteen (52%) postoperative complications were observed, but none were above grade 3.ConclusionsIn this study, neoadjuvant chemoimmunotherapy was found to reduce tumor volume, cause pathological downstaging, and raise the surgical resection rate of patients with locally advanced NSCLC, and achieve a 100% R0 resection rate. There was an acceptable rate of postoperative complications. Thus, neoadjuvant chemoimmunotherapy is safe and practical.

Randomized Trial of Deep Vein Thrombosis Chemoprophylaxis with Bemiparin and Enoxaparin in Patients with Moderate to High Thrombogenic Risk Undergoing Plastic and Reconstructive Surgery Procedures.

Deep vein thrombosis (DVT) is a common complication during postoperative convalescence characterized by hypercoagulability, vascular endothelium damage and blood stasis. It increases noticeably in peri/postoperative phases of surgery procedures. Pulmonary embolism secondary to iliofemoral DVT is a frequent cause of death. Adult patients scheduled for plastic and reconstructive surgery (PRSx) with moderate to high thrombogenic risk were selected. We evaluated the efficacy and safety of bemiparin compared to enoxaparin as chemoprophylaxis for DVT. Following balanced general anesthesia techniques, patients were randomly assigned for subcutaneous enoxaparin 40IU (Group-E) or bemiparin 3500IU (Group-B) q24h starting 6h after procedure conclusion for at least 10days. All patients were evaluated for DVT through Doppler ultrasound mapping of the lower limbs. Seventy-eight patients were evaluated, mostly women (83%), physical status ASA II (59%), ASA III (10%); Caprini's thrombogenic risk score 3-4 (moderate) 58%, 5-6 (high) 29%, > 6 (too high) 13%; demographics, clinical variables and scores were similar between groups. Median drainage time in breast surgery was 4days in both groups (p = 0.238). In the case of abdominal surgery, median was 14days in Group-E versus 13days in Group-B (p = 0.059). No DVT was detected in either group. DVT was prevented with bemiparin, without significant bleeding increase nor adverse events; moreover, the cost of bemiparin is lower than enoxaparin. Bemiparin can be considered as alternative drug for DVT chemoprophylaxis in PRSx procedures. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Lymphangiographic Interventions to Manage Postoperative Chylothorax.

BackgroundPostoperative chylothorax may be caused by iatrogenic injury of the collateral lymphatic ducts after thoracic surgery. Although traditional treatment could be considered in most cases, resolution may be slow. Radiological interventions have recently been developed to manage postoperative chylothorax. This study aimed to compare radiological interventions and conservative management in patients with postoperative chylothorax.MethodsWe retrospectively reviewed periprocedural drainage time, length of hospital stay, and nil per os (NPO) duration in 7 patients who received radiological interventions (intervention group [IG]) and in 9 patients who received conservative management (non-intervention group [NG]).ResultsThe baseline characteristics of the patients in the IG and NG were comparable; however, the median drainage time and median length of hospital stay after detection of chylothorax were significantly shorter in the IG than in the NG (6 vs. 10 days, p=0.036 and 10 vs. 20 days, p=0.025, respectively). NPO duration after chylothorax detection and total drainage duration were somewhat shorter in the IG than in the NG (5 vs. 7 days and 8 vs. 14 days, respectively).ConclusionThis study showed that radiological interventions reduced the duration of drainage and the length of hospital stay, allowing an earlier return to normal life. To overcome several limitations of this study, a prospective, randomized controlled trial with a larger number of patients is recommended.

Validity of a disposable catheter to drain urine overnight in neurogenic bladder.

Overnight catheter drainage (OCD) is introduced to avoid overdistention of the bladder at night-time when clean intermittent catheterization proves ineffective for daytime management of neurogenic bladder. We adopted OCD using disposable silicone no-balloon (DSnB) catheters, with the distal end outside the body opening into diapers. OCD using DSnB catheter, however, had risks of retrograde bacterial contamination. Therefore, in this study, the validity of equipping DSnB catheters with check valves to prevent retrograde bacterial contamination was examined. For the invitro study, excised saline-filled swine bladders were drained using DSnB catheters with or without check valves, and the time required for intravesical pressure to reach 5cmH2 O was measured. For the invivo study, in cross-over experiments comparing DSnB catheters with and without check valves, OCD using DSnB catheters for 10h was performed in rabbits under analgesia. Bacterial growth from urine samples before and after OCD and residual urine volume were examined. For the invitro experiment, the median drainage time was 368.2s (range, 88-1,085s) and 344.7s (range, 28-840s) with and without check valves, respectively (n = 6), which was not significantly different. For the invivo experiment, in cross-over experiments (n = 8) new bacterial growth rates after OCD did not differ, and median residual urine volume was 17.1mL (range, 0-75mL) and 1.2mL (range, 0-5mL) with and without check valves, respectively (P = 0.055). Installing a check valve in the DSnB catheter did not decrease new bacterial growth, while tending to increase residual urine volume. DSnB catheters without check valves appear to be better for continuous drainage of urine from bladder.

Management of urinary-tract fistulas using reversible balloon nephrostomy: a single-center retrospective analysis of 56 patients

To evaluate the effectiveness of balloon nephrostomy (BN) for treating urinary tract fistulas. In a single-center retrospective analysis, 56 patients were treated using BN between 2003 and 2014. All causes of urinary tract fistula were included. We assessed the effectiveness of drainage, complications, and the types of reconstruction surgery used. Success was defined as fistula closure without surgery. The cohort consisted of 25 males (54%) and 31 females (55%) with a median age of 63years who underwent BN for a urinary fistula secondary to surgery, i.e., urologic (40%; n = 22), gynecologic (34%; n = 19), or digestive (20%; n = 11). Of these patients, 48 (86%) had a history of cancer (49% had a tumor progression). Median drainage time was 90days (10-583), with an average of three successive readjustments needed per patient. We obtained a 21% success rate (n = 12), morbidity was 6.5% (urinary sepsis, renal abscess, ureteral stricture), and 7% of patients developed ureteral stricture after balloon removal. There was no recurrence of any fistula within a median follow-up time of 15.2months. This minimally invasive procedure can be used for selected urinary tract fistulas with few complications. It can also be used safely in populations that have several comorbidities.

Rapid percutaneous nephrostomy catheter placement in neonates with the trocar technique.

The purpose of this study was to assess the efficacy of a modified percutaneous nephrostomy procedure for grade III-IV hydronephrosis in neonates. Eleven neonates (five girls, six boys) with a mean age of 13.7days±9.9 (SD) (range, 4-28days) with pronounced hydronephrosis had percutaneous nephrostomy using a modified procedure. In all patients, percutaneous nephrostomy was performed with a trocar catheter under ultrasound guidance and then the catheter was placed into the collecting system without prior dilatation. Technical success was achieved in all patients. There were no major procedure-related complications. There was no perirenal hematoma on control ultrasound examinations and no hematuria was observed after the procedure. The median drainage time was 75days (range: 42-120days). Two children had urinary tract infection, which was controlled by using antibiotics. The trocar nephrostomy is a practical and feasible method, which can be used for neonates with grade III-IV hydronephrosis.

Repeated lung volume reduction surgery is successful in selected patients.

Lung volume reduction surgery (LVRS) improves dyspnoea, quality of life and may even prolong survival in carefully selected patients with end-stage emphysema. The benefit may be sustained for several years and vanishes with the natural progression of the disease. Data on repeated surgical treatment of emphysema are scarce. The aim of this study was to evaluate the safety, effects and outcomes of repeated LVRS (Re-LVRS) in patients no longer benefiting from their initial LVRS. Between June 2002 and December 2013, 22 patients (9 females) with advanced emphysema underwent Re-LVRS at a median of 60 months (25-196) after their initial LVRS. While initial LVRS was performed thoracoscopically as a bilateral procedure, Re-LVRS was performed unilaterally by a video-assisted thoracoscopic technique in 19 patients and, due to adhesions, by thoracotomy in 3 patients. Pulmonary function test (PFT) was performed at 3 and 12 months postoperatively. Lung function at Re-LVRS was similar to that prior to the first LVRS. The 90-day mortality rate was 0%. The first patient died 15 months postoperatively. The median hospitalization time after Re-LVRS was significantly longer compared with the initial LVRS [14 days, interquartile range (IQR): 11-19, vs 9 days, IQR: 8-14; P = 0.017]. The most frequent complication was prolonged air leak with a median drainage time of 11 days (IQR: 6-13); reoperations due to persistent air leak were necessary in 7 patients (32%). Five patients (23%) had no complications. Lung function and Medical Research Council (MRC) score improved significantly for up to 12 months after Re-LVRS, with results similar to those after initial bilateral LVRS. The average increase in the forced expiratory volume in 1 s (FEV1) was 25% (a 7% increase over the predicted value or 0.18 l) at 3 months, and the mean reduction in hyperinflation, assessed by relative decrease in RV/TLC (residual volume/total lung capacity), was 12% at 3 months (a decrease of 8% in absolute ratios). The mean MRC breathlessness score decreased significantly after 3 months (from 3.7 to 2.2). Re-LVRS can be performed successfully in carefully selected patients as a palliative treatment. It may be performed as a bridge to transplantation or in patients with newly diagnosed intrapulmonary nodules or during elective cardiac surgery. Morbidity is acceptable and outcomes may be satisfactory with significantly improved lung function and reduced dyspnoea for at least 12 months postoperatively.

Diagnosis and management of biliary complications in pediatric living donor liver transplant recipients.

The incidence of biliary complications (BCs) after living donor liver transplantation (LDLT) can reach 40%. Published data on the pediatric population are limited, and treatment protocols vary. Our aim was to describe the clinical scenario for BCs and treatment approaches after LDLT. Between October 1995 and December 2012, 489 pediatric LDLT procedures were performed. BCs developed in 71 patients (14.5%). Biliary strictures (BSs) developed in 45 (9.2%) patients, and bile leaks (BLs) developed in 33 patients (6.7%). The BL diagnosis was clinical in all cases, and 69.7% of the patients underwent surgery. Nearly half of the BS cases had clinical features or suggestive ultrasound findings. Liver biopsy findings suggested BSs in 51.7%. Percutaneous transhepatic cholangiography was performed in 95.6% of the BS patients. The success rate was 77% [mean number of percutaneous biliary interventions (PBIs) = 3.9 ± 1.98, median drainage time = 8 months]. In conclusion, BL patients can be managed with conservative therapy, even though most of these patients will ultimately be treated with surgery. Diagnosing a BS requires a high degree of clinical suspicion because the available resources for its identification can fail in up to 50% of cases. A higher number of PBIs and the use of a drainage catheter for a longer time may be required to achieve better results with this technique.

212 * DIAGNOSTIC SURGICAL LUNG BIOPSIES FOR SUSPECTED INTERSTITIAL LUNG DISEASE: A RETROSPECTIVE STUDY OF 226 PATIENTS

Objectives: Interstitial lung disease (ILD) comprises a group of diseases with great diversity regarding treatment options and prognosis. High resolution CT (HRCT) and bronchoscopic transbronchial biopsy obtain a specificity and sensitivity of about 60-80%. Current guidelines for selected cases (idiopathic pulmonary fibrosis [IPF], usual interstitial pneumonia [UIP]) support a surgical biopsy for optimal diagnosis and treatment. Our goal is to evaluate the diagnostic yield of surgical biopsy and eventual changes in diagnosis and treatment. Methods: From January 2003 to January 2013, 226 patients, mean age 58.3 years, 62% male, underwent surgical lung biopsy for suspected ILD. Before surgical approach, a transbronchial biopsy and HRCT were performed in all the patients. Results: Two-hundred and twenty-two patients underwent a videothoracoscopic approach; in four cases a minithoracotomy was needed due to pleural adhesions. The right side was predominant (76.5%). There was one case of postoperative death, three cases of severe pulmonary failure and a pleural empyema treated surgically. In 12 cases a prolonged air leak occurred which resolved spontaneously. The diagnostic yield was 100% and treatment was changed in 57% of cases as a result of histological diagnosis. UIP has been the most frequent diagnosis (42%). Median drainage time and postoperative stay were 4.1 and 5.3 days respectively. Conclusions: We conclude that surgical approach, moreover if videothoracoscopic, is a powerful tool for the diagnosis of ILD. It results in a specific diagnosis for most of the patients and changes the treatment for more than half. A video-assisted thoracoscopic surgery technique is usually well tolerated, and is often also feasible in critical patients if carefully selected.

Complete video-assisted thoracoscopic surgery anatomic segmentectomy for clinical stage I lung carcinoma - technique and feasibility

This paper describes a prospective, observational, single-centre study of 20 consecutive patients with clinical stage I lung carcinoma undergoing anatomical sublobar resections using complete video-assisted thoracoscopic surgery (cVATS). Thirteen male and seven female patients with a median age of 68 (range 57-84) years and a median of four (range 0-9) relevant comorbid conditions presented with five right-sided and 15 left-sided tumours, with a median diameter of 2.3 (range 1.0-5.2) cm. Thirteen segmentectomies, three bisegmentectomies and four trisegmentectomies with lymphadenectomy of the N1 stations and the mediastinum were performed, with a median duration of 212 (range 91-397) min, a conversion rate to open surgery of 20% and conversion to lobectomy of 10%. In five patients, we noted 10 postoperative adverse events but no transfusions, no readmissions and zero mortality. Median drainage time was six days, with a median hospital stay of 8.5 days. According to the pTNM classification, 10, three, one, and six patients were staged as Ia, Ib, IIb and IIIa, respectively. The distance between the tumour and the parenchymal stapling line exceeded the tumour diameter in 56%, 0% and 0% of T1a, T1b and T2 tumours, respectively. To conclude, cVATS anatomical sublobar resections are technically feasible. We observed a favourable postoperative course in 20 multimorbid or aged patients. In patients fit for lobectomy, the tumour diameter should not exceed 2 cm.

Percutaneous Cholecystostomy in Critically Ill Patients with a Cholecystitis: A Safe Option

Background: Cholecystectomy is the standard procedure in patients with acute cholecystitis. However, some patients might not be able to undergo immediate surgery because of severe sepsis or underlying comorbid conditions. Percutaneous cholecystostomy is a minimally invasive radiological procedure under local anesthesia which seems to be an effective alternative to conservative treatment or immediate laparoscopic/open cholecystectomy. Methods: We retrospectively analyzed 35 patients who underwent percutaneous cholecystostomy between 2003 and 2009. Results: Percutaneous cholecystostomy was technically successful in all patients. Symptoms resolved within 3 days in 33/35 patients. Two patients needed an emergency laparotomy. The catheter dislodged in 5 patients and was replaced in 2/5. The 30-day mortality rate was 3/35 (8.7%) due to gallbladder necrosis, myocardial infarction and multiorgan failure. Median length of hospital stay was 17 days and median drainage time was 28 days. 23 patients (66%) underwent open or laparoscopic cholecystectomy after a median interval of 44 days. Conclusion: Percutaneous cholecystostomy is an effective procedure and a good alternative for patients unfit to undergo immediate surgery because of severe sepsis or underlying comorbid conditions, preferably followed by interval cholecystectomy to prevent recurrent cholecystitis.

Pneumonia necrosante em crianças submetidas à toracoscopia por empiema pleural: incidência, tratamento e evolução clínica

To assess the incidence of necrotizing pneumonia (NP) in children submitted to thoracoscopy, comparing patients with and without NP in terms of the presentation and clinical evolution. A retrospective study of children with pleural empyema submitted to thoracoscopy. Thoracoscopy was performed in patients not previously submitted to thoracic drainage and in whom there was evidence of loculated effusion or pneumothorax, as well as in those previously submitted to thoracic drainage and in whom there was persistent pneumothorax or fever with purulent discharge. On the basis of the thoracoscopy findings, patients were distributed into two groups: those with NP (NP group) and those without (no-NP group). The study sample comprised 52 patients. Of the 24 patients with NP, 19 (79%) had undergone thoracic drainage prior to thoracoscopy, 11 (46%) presented with pneumothorax, and 16 (67%) developed bronchopleural fistula. In the NP group, the median drainage time and the median length of hospital stay were 18 and 19 days, respectively. Of the 28 patients without NP, 10 (36%) had undergone thoracic drainage prior to thoracoscopy, 9 (32%) presented pneumothorax, and 5 (18%) developed bronchopleural fistula. In the no-NP group, the median drainage time and the median length of hospital stay were 6 and 10 days, respectively. Pneumothorax should raise the suspicion of NP. Early thoracoscopy can be a valuable treatment option for NP in children because it hastens recovery in comparison with the medical treatment alone and avoids extensive late thoracotomy lung resections.

Long-Term Outcomes of Video-Assisted Thoracic Surgery Lobectomy for Nonsmall Cell Lung Cancer

Although video-assisted thoracic surgery (VATS) lobectomy has been demonstrated to be safe and technically feasible for nonsmall cell lung cancer, it is infrequently performed in most hospitals. As a result, there has been no clear long-term outcome regarding this procedure until recently. We retrospectively analyzed the results of patients suffering from lung cancer who underwent VATS lobectomy between March 1996 and December 2003. Perioperative data were collected and long-term outcomes were assessed by a 5-year census. We successfully performed VATS procedures in 92 of 97 patients. The median operation time was 168 minutes and the median hospitalization period was 8.5 days. The median operative blood loss was 110 mL and the median drainage time was 3.3 days. The operative and postoperative (30-day) mortalities were 0% and 1.1%, respectively. The postoperative complications rate was 10.9%. The 5-year overall survival rates for stages I, II, and III or greater were 81.7%, 43.5%, and 22.2%, respectively. VATS lobectomy is a safe and feasible surgical procedure for nonsmall cell lung cancer and gives the same long-term outcomes as conventional open lobectomy.

Video‐Assisted Thoracic Surgery (VATS) Compares Favorably with Thoracotomy for the Treatment of Lung Cancer: A Five‐Year Outcome Comparison

Although video-assisted thoracic surgery (VATS) lobectomy has been demonstrated to be safe and technically feasible, it is infrequently performed in most Chinese hospitals and few thoracic surgeons have performed the operation. We have therefore reviewed our experience with all VATS lobectomies, attempting to define long- and short-term outcomes of these surgeries. We retrospectively analyzed the results in patients who underwent VATS lobectomy and open lobectomy between March 1996 and August 2003. The VATS surgery was performed with the endoscopic hilar dissection technique. Perioperative data were collected and long-term outcomes were assessed by 5-year census. We successfully performed VATS procedures in 113 of 120 patients. The median operative time was 152 min and the median hospitalization was 8.6 days. The median operative blood loss was 130 ml and the median drainage time was 3.5 days. The operative and perioperative (30-day) mortality rates were 0% and 0.9%, respectively; the postoperative complications rate was 10.6%. The 5-year overall survival rates for stage I, stage II, and stage III or greater non-small cell lung cancer (NSCLC), secondary pulmonary malignancy, and benign disease were 79.1%, 45.5%, 22.2%, 33.3%, and 88.6%, respectively. Video-assisted lobectomy is a safe and feasible surgical procedure, and it gives the same long-term results as conventional open lobectomy. The VATS approach to lobectomy is a beneficial alternative to standard thoracotomy for selected cases of pulmonary lesions.

Implementation of a user-friendly protocol for interpretation of air-leaks and management of intercostal chest drains after thoracic surgery

We prospectively audited the implementation of a protocol for management of air-leaks and intercostal drains after thoracic surgical procedures. Out of the 99 patients who underwent thoracic surgical procedures during a 3-month period, 41 presented a postoperative air-leak on day 1. The protocol was strictly followed in 95% of the cases. The median drainage-time and hospital-stay were 3 and 4 days, respectively. The incidence of insertion of postoperative drains was 3%. Most of the nursing staff found the protocol user-friendly and easy to apply. A protocol for the management of postoperative air-leaks and intercostal drains can be implemented with high-compliance low complications.

Buttressing the staple line in lung volume reduction surgery: a randomized three-center study

Background. The intention of buttressing the staple line in lung volume reduction surgery is to reduce air leaks and to shorten the hospital stay. A randomized three-center study was carried out to test this hypothesis. Methods. Sixty-five patients with a mean age of 59.2 ± 1.2 years underwent bilateral lung volume reduction surgery by video-assisted thoracoscopy using endoscopic staplers (ET 45B; Ethicon Endo-Surgery, Cincinnati, OH) either without or with bovine pericardium for buttressing (Peri-Strips Dry; Bio-Vascular, Inc, Saint Paul, MN). There were no differences between the control and treatment groups in lung function, degree of dyspnea, and arterial blood gases before and 3 months after LVRS. Results. Seven patients (3 in the treatment group) needed a reoperation because of persistent air leak. The median duration of air leaks was shorter in the treatment group (0.0 day [range, 0 to 28 days versus 4 days [range, 0 to 27 days); p < 0.001), confirmed by a shorter median drainage time in this group (5 days [range, 1 to 35 days] versus 7.5 days [range, 2 to 29 days); p = 0.045). Hospital stay was comparable between the two groups (9.5 days [range, 6 to 44 days] versus 12.0 days [range, 5 to 46 days]; p = 0.14). Conclusions. Buttressing the staple line significantly shortens the duration of air leaks and the drainage time. As hospital stay did not differ significantly between the two groups, cost-effectiveness may depend on the local situation.