Journal of thoracic disease
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Double-sleeve and carinal resections using the uniportal VATS technique: a single centre experience.
Video-assisted thoracic surgery (VATS) double-sleeve lobectomy and carinal resections are two of the most complex procedures in thoracic surgery. The uniportal approach provides an advantage for performing these procedures successfully; however, knowledge of the important technical details is required. This study describes the experience of implementing these procedures by Russian specialists. ⋯ This study results suggest that a uniportal VATS approach might be a feasible option for complex sleeve resections with acceptable postoperative outcomes in the advanced stages of lung cancer. To further evaluate the feasibility, safety, and efficacy of this technique, more experience would be required.
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Lung-protective ventilation with low tidal volumes remains the cornerstone for treating patient with acute respiratory distress syndrome (ARDS). Personalizing such an approach to each patient's unique physiology may improve outcomes further. ⋯ Estimations of transpulmonary pressures as well as individual's hemodynamics and respiratory mechanics should influence PEEP decisions as well as response to therapy (recruitability). This summary will emphasize the potential role of personalized therapy in mechanical ventilation.
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Tracheal resection and reconstruction (TRR) and laryngotracheal resection and reconstruction (LTRR) is commonly performed for post-intubation tracheal stenosis, tracheal tumor, idiopathic laryngotracheal stenosis (ILTS), and tracheoesophageal fistula (TEF). Ninety-five percent of patients have a good result from surgery. Complications occur in ~20% of patients, of which half are anastomotic complications. ⋯ Anastomotic complications that are managed aggressively typically yield good results. More than half of such patients will eventually have a satisfactory airway. However, an anastomotic complication is associated with a thirteen-fold increase in the risk of death following tracheal resection.
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Despite of the recent advanced with the video-assisted thoracoscopic surgery (VATS), the most common approach for bronchial and carinal resection is still the open surgery. The technical difficulties, the steep learning curve and the concerns about performing an oncologic and safe reconstruction in advanced cases, are the main reasons for the low adoption of VATS for sleeve resections. ⋯ The improvements of the surgical instruments, high definition cameras and recent 3D systems have greatly contributed to facilitate the adoption of uniportal VATS techniques for sleeve procedures. In this article we describe the technique of thoracoscopic bronchial sleeve, bronchovascular and carinal resections through a single incision approach.
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Sporadic case reports have shown that wedge resection and lobectomy can be performed via nonintubated video-assisted thoracoscopic surgery (VATS) with a single incision. We report the feasibility and safety of nonintubated uniportal VATS for resection of various lung lesions. ⋯ Nonintubated uniportal VATS is technically feasible, effective, and safe for diagnosis and treatment of various lung lesions in selected patients.