Pulmonary Bullae Resection Research Articles

Assessment of intercostal nerve block analgesia and local anesthetic infiltration for thoracoscopic pulmonary bullae resection: a comparative study

ObjectiveThe purpose of this study was to compare the analgesic effects of intercostal nerve block (ICNB) and local anesthetic infiltration (LAI) on postoperative pain and recovery following thoracoscopic resection of pulmonary bullae.MethodsA total of 160 patients undergoing thoracoscopic pulmonary bullae resection were randomly assigned to receive either ICNB (n = 80) or LAI (n = 80). An experienced anesthesiologist administered ultrasound guided ICNB at the T4 and T7 levels with 5 mL of 0.375% ropivacaine hydrochloride for the ICNB group. Instead, the LAI group received 10 mL of the same concentration of ropivacaine hydrochloride at the same concentration used for ICNB for infiltration anesthesia at the incision sites. Out of the initial cohort, 146 patients completed the study (ICNB group, n = 71; LAI group, n = 75). The collected data included preoperative clinical characteristics, visual analog scale (VAS) scores for pain at various time points post-surgery (6, 12, 24, 48, and 72 h). Additionally, the Quality of Recovery-15 (QoR-15) questionnaire was administered 24 h after surgery, and sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI).ResultsNo significant differences were found in drainage volume, use of additional analgesics, duration of chest tube placement, or hospital stay between the two groups. However, the ICNB group had significantly lower VAS scores and QoR-15 scores 24 h postoperatively (p < 0.05), indicating better pain management and recovery. The ICNB group also reported better sleep quality, as reflected by lower PSQI scores.ConclusionICNB provides superior analgesia compared to LAI after thoracoscopic resection of pulmonary bullae, significantly improving postoperative recovery.

A Green Lantern for the Surgeon: A Review on the Use of Indocyanine Green (ICG) in Minimally Invasive Surgery.

Indocyanine green (ICG) fluorescence imaging has revolutionized surgical practice across various medical and surgical specialties. This article reviews the clinical applications of ICG in abdominal, urological, thoracic, and gynecological surgery. ICG fluorescence imaging has been widely adopted in general surgery for various applications, including perfusion assessment, intraoperative visualization of the ureter, and tumor localization. It is particularly valuable in evaluating anastomotic leaks and aiding in precise tumor resection during minimally invasive surgeries. Studies have shown mixed results on its effectiveness in reducing anastomotic leak rates, highlighting the need for further research. In thoracic surgery, ICG facilitates the identification and resection of pulmonary bullae, as well as the precise localization of pulmonary nodules during video-assisted surgery. In urology, ICG aids in localizing renal tumors and guiding selective arterial occlusion during partial nephrectomy. Its role in identifying the lymphatic pathway in prostate cancer and sentinel lymph node biopsy in gynecological cancer is also discussed. Despite its benefits, the use of ICG fluorescence faces challenges such as limited tissue penetration, the potential for false results, a lack of standardized protocols, and high equipment costs. Nonetheless, it remains a powerful tool that could improve surgical outcomes.

A clinical study of efficacy of polyglycolic acid patch in surgery for pneumothorax:a systematic review and meta-analysis

ObjectivesA polyglycolic acid (PGA) patch is often used in pulmonary bullae resection, but consensus has not been reached on its effect on patient recovery. The aim of the study is to conduct a systematic review and meta-analysis of studies of polyglycolic acid for bullectomy.MethodsA comprehensive literature search was performed using ScienceDirect, EMBASE, Ovid MEDLINE, PubMed, The Cochrane Library, Scopus, and Google Scholar. Clinical trials that compared PGA versus non-PGA for bullectomy were selected. The clinical endpoints included postoperative recurrence, average postoperative air leakage, prolonged air leaks, drainage tube removal time, and postoperative hospital stay.ResultsA total of eight articles (1095 patients) were included. Compared to the non-PGA approach, the PGA approach was associated with lower rates of postoperative recurrence (95% confidence interval [CI]: 0.16 to 0.39, p < 0.00001),) and of prolonged air leaks (95% CI: 0.29 to 0.72, p = 0.0007); a shorter time of drainage tube removal (95% CI: − 1.36 to − 0.13, p = 0.02); The time of average postoperative air leakage, postoperative hospital stay and operative time did not show a significant difference between the two groups.ConclusionsThese results suggest that the use of PGA patch might can prevent the postoperative recurrence of spontaneous pneumothorax and decrease the rates of prolonged air leaks. More large-scale, high-quality randomized controlled trials are required to confirm our finding.

Clinical significance of CCBE1 expression in lung cancer.

Lymph node metastasis (LNM) is one of the major causes of cancer-associated morbidity and mortality in patients with lung cancer following radical pulmonary carcinoma resection. The present study aimed to investigate the relationship between the expression of collagen and calcium-binding epidermal growth factor domain-containing protein 1 (CCBE1) and lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1) in tumor tissue with the clinical prognosis of lung cancer. The present study included 40 patients with lung cancer that underwent pulmonary carcinoma resection, including 10 patients with LNM, and 10 control patients who underwent pulmonary bullae resection. CCBE1 and LYVE1 expression was assessed in samples from normal and tumor tissue using polymerase chain reaction, western blot analysis and immunohistochemistry. CCBE1 expression appeared to be decreased in lung tumor tissue and further downregulated in samples from patients with LNM, and was revealed to be correlated with poor clinical outcome. Conversely, LYVE1 expression appeared to be upregulated in lung cancer tissue. In conclusion, the present results suggested that CCBE1 and LYVE1 may have potential as biomarkers for the identification of lung cancer patients at a high risk of LNM.

Application of external suction combined with multiaperture catheter after lung bullae resection

Objective We applied external suction to carry out lung expansion after lung bullae resection, and evaluate the clinical value. Methods 122 patients undergoing video-assisted thoracoscopic pulmonary bullae resection were randomized into group A (n=65) and group B (n=57). In group A, we used negative pressure suction to carry out lung expansion, while manual hyperinflation was used in group B. The development of pulmonary atelectasis, reexpansion pulmonary edema and non-surgical side pneumothorax were recorded, and the chest tube drainage duration was recorded finally. Results The development of pulmonary atelectasis, reexpansion pulmonary edema and non-surgical side pneumothorax between the two groups had no statistically significant difference (P>0.05). In 58 patients (58/65) chest tube was removed within 7 days in group A, and 48 patients (48/57) in group B. For these patients, the mean duration of chest tube (days) was shorter in group A [(3.71±1.20) days] than in group B [(4.58±1.27) days] (P 0.05). Conclusion External suction combined with multiaperture catheter is safe and effective for lung expansion after lung bullae resection. This treatment shortens the duration of chest tube placement, but it can not reduce the incidence of postoperative complications. Key words: Pulmonary bullae; Negative pressure suction; Manual lung expansion; Complication

Safety and efficacy of using bronchial occluder in patients undergoing thoracoscopy pulmonary bulla surgery

Objective The purpose of this study was to compare the safety and efficacy of using bronchial blockers tube(BB) versus double cavity bronchial catheter in thoracoscopy pulmonary bulla surgery. Methods Eighty patients with pulmonary bulla. were randomly divided into two groups(n=40): group A received a double cavity bronchial tube, group B received the bronchial occluder. The general information, intubation success rate, blood gas analysis at different time points immediately after anesthesia(T0), 20 min after one-lung ventilation(T1), 60 min after one-lung ventilation(T2) and 60 min after two-lung ventilation(T3) and the occurrence of adverse reactions were recorded. Results Compared with group A, the intubation success rate of group B was higher(P 0.05). In contrast with T0 and T3, airway plateau pressure(Pplat) and peak airway pressure(Ppeak) of the above groups were dramatically increased at T1 and T2(P<0.05). Besides, Pplat and Ppeak from group B were lower than those from group A(P<0.05). After extubation, 11 patients from group A had a hoarseness and sore throat, the incidence rate was 27.5%; In group B(3 cases), rate of the same adverse reactions was 7.5%. The occurrence rates of adverse effect after extubation were statistically significant between the two groups(P<0.05). Conclusions In contrast with double lumen catheter, applying bronchial occluder in thoracoscopy pulmonary bulla surgery is a more effective and safer way to reduce blood gas changes during operation and postoperative discomfort. Key words: Double lumen catheter; Bronchial blockers tube; Pulmonary bulla resection

Endo-GIA stapler vs.suture for spontaneous pneumothorax under video-assisted single port thoracoscope

Objective To analyze and discuss the clinical effect of the application of Endo-GIA stapler vs.suture in the treatment of spontaneous pneumothorax under video-assisted single port thoracoscope (VATS). Methods From March 2009 to March 2012, 92 cases of spontaneous pneumothorax were treated with VATS in our hospital.They were randomly divided into two groups with 48 cases in cutting seam group treated by Endo-GIA stapler in resection of pulmonary bullae, and rest 44 cases in suture group treated by silk in suture and ligation of pulmonary bullae.The clinical effect of these two methods were compared. Results There was no death,conversion to open chest surgery and severe complications after operation in 92 cases of these two groups.Recurrent pneumothorax happened in 5 cases.There were no significant difference in indicators such as tube indwelling time, cicatrisation of observation port and length of hospital stay between two groups[(2. 0±0. 4)d vs.(2. 0±0. 5)d,(5. 2±1. 9)d vs.(5. 8±2. 0)d,P> 0. 05].Bleeding volume in suture group was greater than that in cutting seam group.Operation time in suture was also longer than in cutting seam group.The operation cost in suture group was significantly less than in cutting seam group[(61± 6)ml vs.(90±9)ml,(43±7)min vs.(50±5)min, P< 0. 05] Conclusion These two operation methods were safe and effective.Endo-GIA stapler was applicable to a wide base, clusters of pulmonary bullae or multiple pulmonary bulla patients while suture method was suitable for single and narrow base pulmonary bulla patients. Key words: Pneumothorax,spontaneous; Linear stapler; Video-assisted single port thoracoscope

Comparison of thoracoscopic 2 hole and 3 hole for congenital pulmonary bulla resection

Objective To compare the effects of thoracoscopic 2 hole and 3 hole for congenital pulmonary bulla resection.Methods 38 cases of congenital pulmonary bulla patients,both in the VATS downlink congenital pulmonary bulla resection.According to the number of holes,thoracoscopic operation were divided into the two groups. To observe the use of group 19 cases of 2 holes,19 cases 3 holes were adopted in the control group.Pull the chest tube operation time,operation time of the two groups were compared after.and the average hospitalization time after opera-tion,postoperative analgesia drug application.Results The observation group operation time,operation time,pulling the chest tube after operation the average hospitalization time, analgesic drug application rate respectively were （46.89 ±9.11）min,（3.95 ±0.85） d,（7.37 ±1.34） d,21.1%,The control group were （66.05 ±12.09） min, （4.37 ±0.98）d,（7.32 ±1.57）d,52.6%.There were statistically significant differences in rate of the two groups in operation time,analgesic drug application.（t=-5.516,χ^2 =4.071,P〈0.05）;38 cases were cured,followed up for 3-24 months,no recurrence occurred in 1 cases.Conclusion Video assisted thoracic descending congenital pulmona-ry bulla resection,the 2 hole 3 hole more than minimally invasive,short operation time,postoperative analgesic use rate is low. Key words: Resection of lung bullae; Pulmonary bulla; Thoracoscopy, television

Clinical analysis on 38 cases of pulmonary bulla treatment with uniport video-assisted thoracoscope

Objective To assess the clinical efficacy and safety of uniport video-assisted thoracoscopic surgery in treatment of pulmonary bulla.Methods Clinical data of 38 patients with pulmonary bulla treated with uniport video-assisted thoracoscopic surgery were analyzed.Results 30 patients under general anesthesia and double-chamber tracheal intubation anesthesia and 8 patients under general anesthesia and single-chamber tracheal intubation and tracheal plugger anesthesia underwent the resection of their pulmonary bulla through the surgery with uniport video-assisted thoracoscope, and 2 patients therein were simultaneously treated with bilateral resection of pulmonary bulla.36 patients were treated successfully;1 patient was given another exploratory thoracotomy after his unilateral surgery because of progressive hemothorax and substantial pneumothorax;and 1 patient underwent respiratory failure after his unilateral surgery and was improved in respiration 2 days after the help of a respirator.The average time of operations were 52 minutes.It averagely took 3.2 days to remove closed thoracic drainage pipes.The post-operation hospital stays took 6 days.The post-operation follow-up took 7-39 months,without relapse and other compli-cations.No death occurred in this group.Conclusion It is safe and reliable to treat pulmonary bulla by the surgery with uniport video-assisted thoracoscope,which is in line with the concept of minimally invasive surgery and therefore deserves promotion. Key words: Pulmonary bulla resection; Single operation aperture; Thoracoscope

Simultaneous Bilateral Video-Assisted Thoracoscopic Surgery for the Treatment of Primary Spontaneous Pneumothorax.

We determined the feasibility and clinical efficacy of simultaneous bilateral video-assisted thoracoscopic surgery (VATS) for treating primary spontaneous pneumothorax (PSP). We performed a retrospective analysis of the efficacy of simultaneous bilateral resection of pulmonary bullae using VATS in 21 PSP patients that were treated at our hospital from February 2010 to August 2013. We found bilateral bullae in all patients through the intraoperative exploration. Surgical procedures were successfully completed in all patients without conversion to thoracotomy. The mean time of surgery was 128.76 ± 13.82 min (range 100–150 min). Total amount of intraoperative bleeding was 80–200 ml. Total drainage of bilateral thoracic ducts was 200–500 ml at the 1st postoperative day with a mean drainage of 321.42 ± 82.66 ml. Bilateral thoracic ducts were removed 4–8 days postoperatively with a mean time of 4.7 days. The duration of postoperative hospitalization was 5–9 days with a mean duration of 7 days. No patient had serious complication(s) and all patients were discharged after full recovery. The patients were followed up for 6–18 months after the surgery and no relapse occurred. In conclusion, treating the unilateral PSP by simultaneous bilateral VATS is safe and effective. It reduces patients’ risk of second surgery and also minimizes patients’ suffering and costs incurred.

Application of psychological nursing in the perioperative period nursing of thoracoscopic pulmonary bullae resection

Objective To summarize the experience of psychological nursing in the perioperative period nursing of thoracoscopic pulmonary bullae resection .Methods Sixty-four patients with thoracoscopic pulmonary bullae resection were chosen and divided into the control group （ n=35 ） and the experimental group （ n=29 ） according to the admission time .The control group received the routine perioperative period nursing , and the experimental group received the psychological nursing on the basis of the routine nursing .The operation time , blood loss , hospital time and drainage amount were compared between two groups .Results The average operation time was （72.4 ±14.5） min, and the blood loss during the operation was （93.4 ±23.6） ml in two groups, and no differences were found in the operation time and blood loss between two groups （ t=0.475, 0.863, respectively;P〉0.05）.The average hospital time and drainage amount were respectively （5.3 ±1.8）d and （45.3 ±12.4） ml in the experimental group, and were lower than those in the control group , and the differences were statistically significant （t=6.753,8.231, respectively;P〈0.05）.Conclusions Application of the psychological nursing in the perioperative period nursing of thoracoscopic pulmonary bullae resection can reduce the recurrence rate after the operation , and improve the rehabilitation and life quality , and shorten the hospital time. Key words: Thoracoscopy; Pulmonary bullae resection; Psychological nursing; Perioperative period

Thoracic Epidural Anesthesia for a Polymyositis Patient Undergoing Awake Mini-thoracotomy and Unroofing of a Huge Pulmonary Bulla

General anesthesia with one-lung ventilation is a conventional anesthetic strategy for most chest surgery, including resection of pulmonary bullae. However, this anesthetic management may cause alveolar barotrauma, hemodynamic instability, pulmonary atelectasis and long-term ventilator dependency. Here, we report a 64-year-old female with polymyositis and bronchiolitis obliterans organizing pneumonia who was scheduled for surgical intervention for a huge pulmonary bulla over the right upper lung. Under thoracic epidural anesthesia, with the patient maintaining clear consciousness and spontaneous breathing, a mini-thoracotomy was accomplished to unroof and partially resect the bulla. There were no perioperative complications, and the patient was satisfied with the anesthetic care. Pulmonary function tests and daily physical performance also improved postoperatively.

Bullous Emphysema: Progressive Incremental Exercise Testing to Evaluate Candidates for Bullectomy

Various tests of both function and anatomy have been used in patients being considered for surgical resection of giant pulmonary bullae. A young patient had an excellent response to removal of a large bulla in the right lung. In addition to roentgenographic evaluation, ventilation perfusion scanning, and routine preoperative pulmonary function studies, we performed progressive incremental exercise testing to determine both preoperative and postoperative ventilatory and cardiac measurements. We feel that progressive incremental exercise pulmonary function adds another dimension to the selection and follow-up of patients being considered for operative bullectomy.