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Yukitoshi Satoh - One of the best experts on this subject based on the ideXlab platform.
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Intraoperative Prevention and Postoperative Treatment of Air Leakage in Lung Surgery
Kyobu geka. The Japanese journal of thoracic surgery, 2017Co-Authors: Masahito Naito, Yukitoshi SatohAbstract:The intraoperative and postoperative air leakages in Lung Surgery are caused by factors related to patients as well as the surgical technique employed. Prevention and management of air leakage caused by these varied factors are essential for thoracic surgeons. The factors related to patients, such as severe emphysema, smoking history, and insufficient lobulation, should be evaluated before Surgery. Although time-consuming, careful and reliable surgical techniques are required. After the Lung Surgery, management of drain is essential for controlling air leakage. Rethoracotomy is one of the treatment options that can be employed when conservative treatment does not improve the air leakage. At present, complete way of management of air leakage has not been established;therefore, thoracic surgeons should work toward developing a definite intraoperative and postoperative air leakage management in Lung Surgery.
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Management of chest drainage tubes after Lung Surgery
General Thoracic and Cardiovascular Surgery, 2016Co-Authors: Yukitoshi SatohAbstract:Since chest tubes have been routinely used to drain the pleural space, particularly after Lung Surgery, the management of chest tubes is considered to be essential for the thoracic surgeon. The pleural drainage system requires effective drainage, suction, and water-sealing. Another key point of chest tube management is that a water seal is considered to be superior to suction for most air leaks. Nowadays, the most common pleural drainage device attached to the chest tube is the three-bottle system. An electronic chest drainage system has been developed that is effective in standardizing the postoperative management of chest tubes. More liberal use of digital drainage devices in the postoperative management of the pleural space is warranted. The removal of chest tubes is a common procedure occurring almost daily in hospitals throughout the world. Extraction of the tube is usually done at the end of full inspiration or at the end of full expiration. The tube removal technique is not as important as how it is done and the preparation for the procedure. The management of chest tubes must be based on careful observation, the patient’s characteristics, and the operative procedures that had been performed.
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Ultra powered stapling system for general Lung Surgery
Kyobu geka. The Japanese journal of thoracic surgery, 2014Co-Authors: Yukitoshi Satoh, Masahito Naito, Shoko Hayashi, Hirotsugu Yamazaki, Masashi Mikubo, Kazu ShiomiAbstract:OBJECTIVE Stapling systems can significantly improve Lung tissue approximation during open and video-assisted thoracic Surgery. We here evaluated an iDrive Ultra powered stapling system for Lung resection. MATERIALS AND METHODS The iDrive Ultra powered stapling system( Covidien) is the powered version of the EndoGIA stapling system. It comprises hand-held control unit combined with a loading unit,which is a powered EndoGIA- cartridges, for use in open and minimally invasive thoracic Surgery. The mounted control unit has uses as follows:controlling the accurate placement of the cartridge by orientating the tip of the rigid shaft;and controlling the closure of the stapler and the firing. From April to July 2013, the system was used for a consecutive series of 15 patients during thoracic Lung Surgery. RESULTS There were 6 women and 9 men, with a mean age of 62 years. The following procedures were performed:lobectomies, segmentectomies, and wedge resections. The system was used for stapling Lung parenchyma for wedge resection(5 patients), segmentectomy( 2 patients), or fissure division (9 patients). There were no stapling failures and no complications related to use of the staplers. CONCLUSIONS The new powered and handy stapling system is safe and efficient for Lung resection.
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Clinical report on a computer-controlled hand-actuated stapling system for general Lung Surgery: the first application in Japan
General Thoracic and Cardiovascular Surgery, 2009Co-Authors: Yukitoshi Satoh, Yoshio Matsui, Fumihiro Ogawa, Hideki Amano, Hidenori Hara, Kenji Nezu, Akira IyodaAbstract:Objective Computer-controlled stapling systems can improve Lung tissue approximation during thoracic Surgery. We report our experience with a handy system with computer-controlled placement of staples for Lung resection in Japan. Methods The iDrive system is the improved second version of the SurgAssist stapling system. It comprises a self-contained computer microprocessor and hand-held control unit combined with a digital loading unit (a power linear cutter with a blue or green cartridge) for use in open and minimally invasive thoracic Surgery. The mounted control unit has two uses: (1) controlling accurate placement of the cartridge by orientating the tip of the rigid and curved shaft and (2) controlling the closure of the stapler and the firing. Each cartridge contains a programmed electronic device that triggers activation of the appropriate program in the self-contained microprocessor. The compression level on Lung tissue is determined by the computer. Results From March to October 2008, the iDrive system was used 53 times in a consecutive series of 39 patients during open thoracic Lung Surgery. There were 12 women and 27 men. The following procedures were performed: lobectomy, segmentectomy, and wedge resection. The power linear cutters were used for stapling Lung parenchyma for wedge resection in 6 patients, bullectomy in 1, segmentectomy in 2, and fissure division in 33. There were no stapling failures and no complications related to the staplers. Conclusion The new computer-controlled stapling system may be safe and efficient for Lung parenchymal tissue resection during open thoracic Surgery.
Shugeng Gao - One of the best experts on this subject based on the ideXlab platform.
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International expert consensus on the management of bleeding during VATS Lung Surgery.
Annals of translational medicine, 2019Co-Authors: Lunxu Liu, Jiandong Mei, Shugeng Gao, Todd L. Demmy, Yang Liu, Yunchao HuangAbstract:Intraoperative bleeding is the most crucial safety concern of video-assisted thoracic Surgery (VATS) for a major pulmonary resection. Despite the advances in surgical techniques and devices, intraoperative bleeding is still not rare and remains the most common and potentially fatal cause of conversion from VATS to open thoracotomy. Therefore, to guide the clinical practice of VATS Lung Surgery, we proposed the International Interest Group on Bleeding during VATS Lung Surgery with 65 experts from 10 countries in the field to develop this consensus document. The consensus was developed based on the literature reports and expert experience from different countries. The causes and incidence of intraoperative bleeding were summarised first. Seven situations of intraoperative bleeding were collected based on clinical practice, including the bleeding from massive vessel injuries, bronchial arteries, vessel stumps, and bronchial stumps, Lung parenchyma, lymph nodes, incisions, and the chest wall. The technical consensus for the management of intraoperative bleeding was achieved on these seven surgical situations by six rounds of repeated revision. Following expert consensus statements were achieved: (I) Bleeding from major vascular injuries: direct compression with suction, retracted Lung, or rolled gauze is useful for bleeding control. The size and location of the vascular laceration are evaluated to decide whether the bleeding can be stopped by direct compression or by ligation. If suturing is needed, the suction-compressing angiorrhaphy technique (SCAT) is recommended. Timely conversion to thoracotomy with direct compression is required if the operator lacks experience in thoracoscopic angiorrhaphy. (II) Bronchial artery bleeding: pre-emptive clipping of bronchial artery before bronchial dissection or lymph node dissection can reduce the incidence of bleeding. Bronchial artery bleeding can be stopped by compression with the suction tip, followed by the handling of the vascular stump with energy devices or clips. (III) Bleeding from large vessel stumps and bronchial stumps: bronchial stump bleeding mostly comes from accompanying bronchial artery, which can be clipped for hemostasis. Compression for hemostasis is usually effective for bleeding at the vascular stump. Otherwise, additional use of hemostatic materials, re-staple or a suture may be necessary. (IV) Bleeding from the Lung parenchyma: coagulation hemostasis is the first choice. For wounds with visible air leakage or an insufficient hemostatic effect of coagulation, suturing may be necessary. (V) Bleeding during lymph node dissection: non-grasping en-bloc lymph node dissection is recommended for the nourishing vessels of the lymph node are addressed first with this technique. If bleeding occurs at the site of lymph node dissection, energy devices can be used for hemostasis, sometimes in combination with hemostatic materials. (VI) Bleeding from chest wall incisions: the chest wall incision(s) should always be made along the upper edge of the rib(s), with good hemostasis layer by layer. Recheck the incision for hemostasis before closing the chest is recommended. (VII) Internal chest wall bleeding: it can usually be managed with electrocoagulation. For diffuse capillary bleeding with the undefined bleeding site, compression of the wound with gauze may be helpful.
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Clinical guidelines on perioperative management strategies for enhanced recovery after Lung Surgery
Translational lung cancer research, 2019Co-Authors: Shugeng Gao, Serena Barello, Liang Chen, Chun Chen, Guowei Che, Kaican Cai, Roberto Crisci, Antonio D’andrilli, Andrea DroghettiAbstract:The concept of enhanced recovery after Surgery (ERAS) was first developed in Denmark in 1997 by Dr. Kehlet (1). ERAS is designed to optimize perioperative management, improve patient prognosis, reduce complications, shorten hospital stay, and lower cost (2-5). In recent years, this multi-disciplinary and multi-modal perioperative rehabilitation concept has been widely applied in open and endoscopic procedures including colorectal Surgery (6,7), gynecological Surgery (8,9), liver Surgery (10,11), breast Surgery (12,13), urologic Surgery (14,15), and spinal Surgery (16-18). Advances in thoracic Surgery, especially the popularization of minimally invasive techniques, have dramatically expanded or changed the concept of surgical treatment (19-21). Early recovery from thoracic Surgery is now routine (22-24). In Jan 2019, the European Society of Thoracic Surgeons published guidelines for enhanced recovery after Lung Surgery (25) on: preoperative counselling, nutritional screening, smoking cessation, rehabilitation for high-risk patients, avoidance of fasting, carbohydrate loading, avoidance of preoperative sedatives, venous thromboembolism prophylaxis, prevention of hypothermia, short-acting anesthetics to facilitate early emergence, regional anesthesia, nausea and vomiting control, opioid-sparing analgesia, euvolemic fluid management, minimally invasive Surgery, early chest drain removal, avoidance of urinary catheters, and early mobilization after Surgery. The Lung is a unique organ in that it receives the total cardiac output and acts as a giant filter for systemic venous blood (26). It is, in addition, an open organ; through the airway, the alveoli interact with the surrounding environment. Due to its unique anatomy and physiology, the Lung is susceptible to injuries caused by a variety of harmful endogenous and exogenous factors (27). Perioperative risk factors and treatment measures can result in damage to the Lungs, which in turn can lead to postoperative pulmonary complications (PPCs) (e.g., atelectasis and pneumonia) and pleural complications, affecting early and long-term recovery (28-30), and accounting for up to 84% of all deaths (31). Perioperative airway and protective ventilatory management in Lung Surgery are an important part of ERAS (32,33). Given the circumstances, we have established clinical guidelines based primarily on an extensive literature review, with discussion and consensus focused on the issue of perioperative airway management for enhanced recovery following Lung Surgery. In addition, we will briefly review other perioperative measures designed toward the goal of ERAS for thoracic Surgery.
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Systematic Review and Meta-analysis of Atrial Fibrillation Prophylaxis After Lung Surgery.
Journal of cardiovascular pharmacology, 2016Co-Authors: Liangze Zhang, Shugeng GaoAbstract:Atrial fibrillation (AF), which increases morbidity and mortality, is a common occurrence after thoracic Surgery and pulmonary resection. Despite several investigations on various prophylactic measures for AF prevention, the studies were not uniform and do not use similar controls making it difficult to arrive at a meaningful conclusion. In the present systematic analysis review, we evaluated the efficacy of different prophylactic approaches to prevent AF after Lung Surgery in randomized trials reported during 1991-2014. A total of 12 trials were identified that met the criteria set for this meta-analysis. Among different trials, amiodarone was found to be most effective in preventing postoperative AF (risk ratio, 0.22; P < 0.0001; 95% confidence interval: 0.09-0.54). There were no significant prophylactic effects by MgSO4 (risk ratio, 1.24; P < 0.007; 95% confidence interval, 0.27-5.68), digoxin, or Ca blockers. Single use of amiodarone was able to lower the incidence of AF from 39.2% to 8.3% and seemed to be safe with no major complications. Although several prophylactic measures have been tried to curtail the incidence of AF in patients after Lung Surgery, prophylaxis with amiodarone seems to be most effective of treatments studied.
Albert M. Nana - One of the best experts on this subject based on the ideXlab platform.
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Computer-Controlled Stapling System for Lung Surgery
The Annals of thoracic surgery, 2005Co-Authors: Dominique Gossot, Albert M. NanaAbstract:Purpose Current disposable hand-actuated staplers may pose reliability problems, especially with respect to the measurement of tissue thickness. We have evaluated a newly developed stapler with a computer-controlled placement of staples. Description The SurgAssist system (Power Medical Interventions, New Hope, PA) is comprised of a console that houses a computer, a remote control unit, a flexible shaft, and a cartridge. The remote control unit has two uses: (1) controlling the accurate placement of the cartridge by orientating the tip of the flexible shaft, and (2) controlling the closure of the stapler and the firing. Each cartridge contains a programmed electronic device that triggers the activation of the appropriate program in the main microprocessor. The compression level on the tissue is determined by the computer. Evaluation The system was used in a consecutive series of 38 patients, 26 times during open Lung Surgery and 12 times during video-assisted thoracic Surgery. The following open procedures were performed: three pneumonectomies, 15 lobectomies, three segmentectomies, and five wedge resections. The following video-assisted thoracic Surgery procedures were performed: eight wedge resections and four bullectomies for pneumothorax. There was no stapling failure and no complication related to the use of the stapler. During video-assisted thoracic Surgery, some ergonomic problems were encountered that will be overcome by redesign. Conclusions The computer-controlled stapling system may significantly improve tissue approximation during open and video-assisted thoracic Surgery.
P Zardo - One of the best experts on this subject based on the ideXlab platform.
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Simultaneous cardiac and Lung Surgery for incidental solitary pulmonary nodule: learning from the past.
The Thoracic and cardiovascular surgeon, 2011Co-Authors: R Zhang, B Wiegmann, S Fischer, N J Dickgreber, C Hagl, M Krüger, A Haverich, P ZardoAbstract:Incidental solitary pulmonary nodules (ISPN) detected prior to scheduled cardiac Surgery are rare but challenging. We evaluated the long-term outcome of patients with ISPN undergoing simultaneous cardiac and Lung Surgery. The clinical records of 33 consecutive patients with ISPN undergoing cardiac and Lung Surgery, either simultaneously (n = 30) or sequentially (n = 3), were retrospectively evaluated and completed by detailed follow-up. On histological examination, 14 cases (42.4%) of primary NSCLC were identified. Benign findings consisted mostly of hamartoma and inflammation. Malignant ISPN were larger in size (22.5 ± 12.4 vs. 13.6 ± 8.6 mm) and ISPN with a diameter >10 mm had a higher incidence of malignancy compared to those ≤10 mm (56.0% vs. 0%). Patients undergoing concomittant heart and Lung Surgery received either a wedge resection (n = 26) or a lobectomy (n = 4). The 5-year survival of patients with malignant ISPN was lower than that of patients with benign ISPN (43.6% vs. 85.6%). Our results corroborate a high incidence of malignancy in ISPN detected prior to scheduled cardiac Surgery. Simultaneous cardiac and Lung Surgery for NSCLC appears to be associated with a poor long-term outcome. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Simultaneous cardiac and Lung Surgery for incidental solitary pulmonary nodule: learning from the past.
Thoracic and Cardiovascular Surgeon, 2011Co-Authors: R Zhang, B Wiegmann, S Fischer, N J Dickgreber, C Hagl, M Krüger, A Haverich, P ZardoAbstract:Background Incidental solitary pulmonary nodules (ISPN) detected prior to scheduled cardiac Surgery are rare but challenging. We evaluated the long-term outcome of patients with ISPN undergoing simultaneous cardiac and Lung Surgery. Methods The clinical records of 33 consecutive patients with ISPN undergoing cardiac and Lung Surgery, either simultaneously (n = 30) or sequentially (n = 3), were retrospectively evaluated and completed by detailed follow-up. Results On histological examination, 14 cases (42.4%) of primary NSCLC were identified. Benign findings consisted mostly of hamartoma and inflammation. Malignant ISPN were larger in size (22.5 ± 12.4 vs. 13.6 ± 8.6 mm) and ISPN with a diameter >10 mm had a higher incidence of malignancy compared to those ≤10 mm (56.0% vs. 0%). Patients undergoing concomittant heart and Lung Surgery received either a wedge resection (n = 26) or a lobectomy (n = 4). The 5-year survival of patients with malignant ISPN was lower than that of patients with benign ISPN (43.6% vs. 85.6%). Conclusions Our results corroborate a high incidence of malignancy in ISPN detected prior to scheduled cardiac Surgery. Simultaneous cardiac and Lung Surgery for NSCLC appears to be associated with a poor long-term outcome.
John Yee - One of the best experts on this subject based on the ideXlab platform.
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Computed tomography-guided platinum microcoil Lung Surgery: A cross-sectional study.
The Journal of thoracic and cardiovascular surgery, 2019Co-Authors: Anna L. Mcguire, Arthur Vieira, Kyle Grant, John R. Mayo, Tony Sedlic, James Choi, John YeeAbstract:Abstract Objective The study objective was to provide a 5-year update on our tertiary-level institutional experience with computed tomography–guided platinum microcoil Lung Surgery. Methods A retrospective cross-sectional study was conducted. All patients admitted to the Thoracic Service at Vancouver General Hospital to undergo computed tomography–guided microcoil Lung Surgery were included. Key primary outcome variables were successful nodule localization and severity of adverse events associated with placement. Secondary outcomes included nodule characteristics on preoperative computed tomography chest and nodule surgical pathology. Continuous variables were reported as mean (± standard deviation), and counts were reported as proportions n (%). Results A total of 97 Lung nodules were resected in 92 patients. Mean age was 65.3 (±10.6) years, and 59 (61%) were female. All 97 nodules (100%) were successfully localized using video-assisted thoracic Surgery wedge resection. There were 59 cases (60.8%) of placement-related events noted on computed tomography of the chest. All were minor and self-limited in nature and did not require treatment: pneumothorax 45 (46.4%), Lung hematoma 18 (18.6%), dislodgement 4 (4.1%), and hemoptysis 2 (2.1%). Mean nodule diameter was 13.2 mm (±6.7). Density was nonsolid in 27 (27.8%) and semi-solid in 27 (27.8%). There was a single case of positive surgical margin, and 4 (4.1%) went on to completion lobectomy. Non–small Lung cancer was identified in 66 nodules. Conclusions Computed tomography–guided platinum microcoil Lung Surgery is safe with a favorable clinical adverse event profile and is suitable for poor-risk patients. The method is efficient, yielding 100% diagnostic localization in our 5-year update. It eliminates the need for thoracotomy and palpation to localize worrisome subpleural tiny nodules. It is ideal for the management of changing nodules concerning for early Lung cancer and diagnosis of small indeterminate Lung nodules or metastases.
