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Richard A. Jonas - One of the best experts on this subject based on the ideXlab platform.
Circulation, 1995Co-Authors: Jonah Odim, Michael Portzky, Aldo R. Castaneda, David Zurakowski, John E Mayer, Redmond P. Burke, Gil Wernovsky, Richard A. JonasAbstract:
Background Since 1990, sternotomy has been the preferred approach for construction of a modified Blalock-Taussig shunt (MBTS) at Children’s Hospital, Boston, Mass. In retrospect, we sought to test the hypothesis that this approach yields less mortality and morbidity than the traditional Thoracotomy approach. Methods and Results One hundred four primary MBTSs with polytetrafluoroethylene grafts were constructed in patients from January 1988 through December 1992. Fifty-two shunts were constructed by Thoracotomy approach and 52 by sternotomy approach. Fifteen of the Thoracotomy patients were less than one month of age (8 less than 7 days), while 36 of the sternotomy patients were less than 1 month of age (20 less than 7 days). There were 10 shunt failures and 3 hospital deaths in the thoractomy group and 4 shunt failures with 6 hospital deaths in the sternotomy group. The overall hospital mortality rate for the group was 8.7% (9 of 104). The operative route was not a significant predictor of hospital mortal...
Journal of the American College of Cardiology, 1995Co-Authors: Redmond P. Burke, Gil Wernovsky, Howard M. Rosenfeld, Richard A. JonasAbstract:
Objectives. This study evaluated our early experience with video-assisted thoracoscopic vascular ring division and compared this approach with division by means of a conventional open Thoracotomy. Background. Video-assisted thoracoscopic techniques reduce surgical trauma and have been applied to several adult thoracic procedures; however, pediatric applications have been limited. We developed instruments and techniques for video-assisted thoracoscopic vascular ring division in the pediatric population. Methods. We compared patient characteristics, operative results and postoperative hospital courses of all patients undergoing vascular ring division by a video-assisted approach with a historical control group of all patients undergoing division by an open Thoracotomy between January 1991 and December 1992. Results. Eight patients (median age 5 months, range 40 days to 5.5 years; median weight 6.2 kg, range 1.8 to 17.1) underwent video-assisted thoracoscopic vascular ring division. Four had a double aortic arch with an atretic left arch and a left ligamentum, and four had a right aortic arch with aberrant left subclavian artery and a left ligamentum. All eight had successful ring division with symptomatic relief and no mortality. A limited Thoracotomy was performed in three patients to divide patent vascular structures, and the hospital period was prolonged in one because of chylothorax. These eight patients were compared with a historical cohort of eight pediatric patients having vascular ring division performed by a conventional Thoracotomy. The two groups did not differ in age, weight, intensive care unit or postoperative hospital stay, duration of intubation or thoracostomy tube or hospital charges. Total operating room time was longer for the group undergoing video-assisted operation. Conclusions. Early results for video-assisted thoracoscopic vascular ring division are comparable to those of the conventional surgical approach. With further refinement in technique and instrumentation, video-assisted surgical intervention may become a viable alternative to open Thoracotomy for management of the symptomatic vascular ring.
Paolo Bagioni - One of the best experts on this subject based on the ideXlab platform.
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: Luciano Solaini, F. Prusciano, Paolo BagioniAbstract:
The use of video-assisted thoracic surgery (VATS) in the treatment of pleural empyema has been proposed since the early 1990s, but among surgeons, its use varies considerably, and the results are discordant. This report aims to provide a retrospective assessment of the authors’ experience and the literature on VATS in an effort to ascertain rational criteria for the use of this technique. Over a period of 12 years, a total of 120 cases of pleural empyema were recorded. The patients were assessed with chest x-ray, computed tomography, ultrasound, and thoracentesis. On the basis of clearly defined clinical and radiographic parameters, 38 patients underwent VATS immediately, whereas the remaining 82 were treated initially by means of tube thoracostomy. The latter was found to be sufficient for only 10 patients. Consequently, for the remaining 72 patients, it was decided to proceed also with VATS. The procedure was performed completely by VATS in 101 patients (91.8%), whereas in 9 patients (8.2%) it was necessary to convert to Thoracotomy. The postoperative course was uneventful for 98 of the 110 patients (89%), whereas the remaining 12 patients experienced complications, including one case of persistent empyema (0.9%) treated by Thoracotomy. The mean chest tube duration was 6 days (range, 3–25 days). The mean postoperative hospital stay was 7.1 days (range, 5–17 days). Of the 80 patients completing a 6-month follow-up evaluation, the results were considered good for 72, moderately good for 8, and less than satisfactory for 2 patients. In conclusion, the authors consider VATS to be the technique of first choice for the treatment of pleural empyema when the disease is advanced or tube thoracostomy fails. It provides excellent results with a low level of invasiveness and considerably reduces the need for Thoracotomy. These results can be achieved with good videothoracoscopic experience and the use of a very precise technique.
Michael A Maddaus - One of the best experts on this subject based on the ideXlab platform.
surgery for early stage non small cell lung cancer a systematic review of the video assisted thoracoscopic surgery versus Thoracotomy approaches to lobectomyThe Annals of Thoracic Surgery, 2008Co-Authors: Bryan A Whitson, Shawn S Groth, Sue Duval, Scott J Swanson, Michael A MaddausAbstract:
Video-assisted thoracoscopic surgery (VATS) for lobectomy has been touted to provide superior outcomes, compared with Thoracotomy, for patients with early-stage non-small-cell lung cancer (NSCLC). However, supporting data are limited to case series and small observational studies. We hypothesized that a systematic review of the literature would enable a more objective evaluation of the evidence in order to determine the potential superiority of the VATS approach, compared with Thoracotomy, in terms of short-term morbidity and long-term survival. To identify relevant articles for inclusion in our analysis, we performed a systematic review of the MEDLINE database. We looked for randomized controlled trials, observational studies, and case series that reported outcomes after VATS or Thoracotomy lobectomy for NSCLC. For statistical testing, we used a two-sided approach (α = 0.05) under the hypothesis that VATS lobectomy is superior to Thoracotomy lobectomy. We screened 17,923 studies. After independent review of the abstracts by 2 reviewers, we included 39 studies (only one randomized controlled trial) in our analysis. In aggregate, these 39 studies involved 3256 Thoracotomy and 3114 VATS patients. The characteristics of the two groups were not significantly different. Compared with Thoracotomy, VATS lobectomy was associated with shorter chest tube duration, shorter length of hospital stay, and improved survival (at 4 years after resection), all statistically significant. Compared with lobectomy performed by Thoracotomy, VATS lobectomy for patients with early-stage NSCLC is appears to favor lower morbidity and improved survival rates.
Shigeharu Moriyama - One of the best experts on this subject based on the ideXlab platform.
video assisted thoracoscopic surgery for primary spontaneous pneumothorax evaluation of indications and long term outcome compared with conservative treatment and open ThoracotomyChest, 2005Co-Authors: Shigeki Sawada, Yoichi Watanabe, Shigeharu MoriyamaAbstract:
Study objectives Video-assisted thoracoscopic surgery (VATS) is effective for primary spontaneous pneumothorax. We sought to evaluate the outcome of VATS compared to conservative treatment and open Thoracotomy, and to discuss the indications for VATS in primary spontaneous pneumothorax. Design Retrospective study. Patients and interventions Primary spontaneous pneumothorax was diagnosed in 281 consecutive patients between January 1989 and April 2001. Mean age was 29.1 years. Mean follow-up period was 78.3 months (range, 13 to 163 months). For these patients, conservative treatment, open Thoracotomy, or VATS were performed, and the outcomes of the three treatments were evaluated. If recurrence occurred, outcome of treatment for the recurrence was also evaluated according to the number of times of recurrence. Results Recurrences were observed in 109 of 281 patients (38.8%). Forty-three patients (15.3%) had repeat recurrences. Regarding the outcome of the first episode, recurrence rates were 54.7% for conservative treatment, 7.7% for open Thoracotomy, and 10.3% for VATS. Recurrence rates after the second episode were 60.3% for conservative treatment, 0% for open Thoracotomy, and 18.6% for VATS. Overall recurrence rates of each treatment were 56.4%, 3.0%, and 11.7%, respectively. There was no statistical difference between the open Thoracotomy and VATS groups (p = 0.15). Hospital stays from operation until discharge were 11.5 days for open Thoracotomy and 4.1 days for VATS (p Conclusion The outcomes of VATS were very good compared to conservative treatment and equal to those of the open Thoracotomy, not only for the first episode but also for the case of recurrence. In terms of low morbidity, low invasiveness, and cosmetic issues, VATS is superior to open Thoracotomy. VATS is standard in cases of recurrence and should be considered for treatment at the first episode.
Meei-feng Huang - One of the best experts on this subject based on the ideXlab platform.
World Journal of Surgery, 2007Co-Authors: Yu-tang Chang, Hung-yi Chuang, Yu-jen Cheng, Shah-hwa Chou, Meei-feng HuangAbstract:
Introduction Primary spontaneous hemopneumothorax (PSHP) is a rare surgical emergency. The aim of this study was to compare the previous strategy of tube thoracostomy followed by Thoracotomy when complications developed with early video-assisted thoracic surgery (VATS) for PSHP. Methods Between November 1989 and May 2005, a total of 24 consecutive patients with PSHP were retrospectively reviewed. Before January 2000, there were 13 patients who were subjected to the treatment strategy of initial tube thoracostomy and underwent operation if the condition deteriorated or later complications occurred (group T). Under this strategy, all of these patients later required operations. After January 2000, another 11 patients were treated with VATS as soon as their condition stabilized after tube thoracostomy and resuscitation (group V). The data for the two groups were compared: sex, age, involved side, initial heart rate (HR) and mean blood pressure (BP), initial hemoglobin (Hb), preoperative blood loss, operating time, amount of blood transfusion, period of chest tube drainage (POD), length of hospital stay (LOS), complications, and length of follow-up. Results The sex, age, involved side, and the initial HR, BP, and Hb of the two groups were similar. The patients of group V had a significantly longer operating time [group V, 111 minutes (mean); group T, 85 minutes, P = 0.002]; less preoperative blood loss (group V, 946 ml; group T, 1687 ml, P = 0.003); less blood transfusion (group V, 465 ml; group T, 1044 ml, P = 0.002); shorter POD (group V, 4 days; group T, 7 days, P = 0.011); and shorter LOS (group V, 5 days; group T, 10 days, P = 0.002). No mortality or recurrence was noted in the entire series. Conclusions Our study suggests that surgery should be undertaken for PSHP as soon as possible after the clinical condition has stabilized. Under this strategy, VATS is an acceptable approach. It allows a shorter hospital stay and is exempt from unnecessary blood transfusion. Later complications, such as empyema and impaired lung reexpansion, can also be avoided.