Long Jiang1, Jun Liu1, Diego Gonzalez-Rivas2, Yaron Shargall3, Martin Kolb4, Wenlong Shao1, Qinglong Dong5, Lixia Liang5, Jianxing He6. 1. Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China. 2. Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain. 3. Department of Surgery, Division of Thoracic Surgery, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. 4. Department of Medicine, Pathology and Molecular Medicine, McMaster University, Firestone Institute for Respiratory Health, Hamilton, Ontario, Canada. 5. Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. 6. Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China. Electronic address: drhe_jianxing@163.com.
Abstract
OBJECTIVES: To describe and assess the techniques of spontaneous-ventilation video-assisted thoracoscopic surgery (SV-VATS) for tracheal/carinal resections and compare the outcomes with the conventional thoracoscopic intubated method. METHODS: From May 2015 to November 2016, some 18 consecutive patients with malignant or benign diseases invading distal trachea and carina who met the criteria for SV were treated by SV-VATS resection. To evaluate the feasibility of this novel technique, they were compared with a control group consisting of 14 consecutive patients with the same diseases who underwent VATS resection using intubated general anesthesia from October 2014 to April 2015. Data were collected with a median follow-up of 10.2 months 75 (range: 1-27). RESULTS: The SV-VATS group consisted of 4 carinal resections and 14 tracheal resections. In the control group, 2 patients underwent carinal resection and 12 underwent tracheal resection. Median operative time was shorter in the SV-VATS group compared with the intubated group (162.5 minutes vs 260 minutes), as was the median time for tracheal end-to-end anastomosis (22.5 minutes vs 45 minutes) and carinal reconstruction (40 minutes vs 86 minutes). The lowest oxygen saturation during the procedure was 94.2% ± 4.9% in SV-VATS group and 93.9% ± 4.5% in the control group. The peak carbon dioxide level at the end of expiration was greater in the SV-VATS group (47.7 ± 4.2 mm Hg vs 39.1 ± 5.7 mm Hg). No conversion to tracheal intubation was needed in the SV-VATS group. Postoperative complications occurred in 6 patients in the SV-VATS group and 9 in the control group. Patients who underwent SV-VATS had a trend toward shorter postoperative hospital stays (11.5 ± 4.3 days vs 13.2 ± 6.3 days). One recurrence (SV-VATS group) and 2 deaths (one in each group) were observed during follow-up. CONCLUSIONS: SV-VATS is a feasible procedure in tracheal and carinal resection and reconstruction in highly selected patients. It can be a valid alternative to conventional intubated VATS for airway surgery.
OBJECTIVES: To describe and assess the techniques of spontaneous-ventilation video-assisted thoracoscopic surgery (SV-VATS) for tracheal/carinal resections and compare the outcomes with the conventional thoracoscopic intubated method. METHODS: From May 2015 to November 2016, some 18 consecutive patients with malignant or benign diseases invading distal trachea and carina who met the criteria for SV were treated by SV-VATS resection. To evaluate the feasibility of this novel technique, they were compared with a control group consisting of 14 consecutive patients with the same diseases who underwent VATS resection using intubated general anesthesia from October 2014 to April 2015. Data were collected with a median follow-up of 10.2 months 75 (range: 1-27). RESULTS: The SV-VATS group consisted of 4 carinal resections and 14 tracheal resections. In the control group, 2 patients underwent carinal resection and 12 underwent tracheal resection. Median operative time was shorter in the SV-VATS group compared with the intubated group (162.5 minutes vs 260 minutes), as was the median time for tracheal end-to-end anastomosis (22.5 minutes vs 45 minutes) and carinal reconstruction (40 minutes vs 86 minutes). The lowest oxygen saturation during the procedure was 94.2% ± 4.9% in SV-VATS group and 93.9% ± 4.5% in the control group. The peak carbon dioxide level at the end of expiration was greater in the SV-VATS group (47.7 ± 4.2 mm Hg vs 39.1 ± 5.7 mm Hg). No conversion to tracheal intubation was needed in the SV-VATS group. Postoperative complications occurred in 6 patients in the SV-VATS group and 9 in the control group. Patients who underwent SV-VATS had a trend toward shorter postoperative hospital stays (11.5 ± 4.3 days vs 13.2 ± 6.3 days). One recurrence (SV-VATS group) and 2 deaths (one in each group) were observed during follow-up. CONCLUSIONS:SV-VATS is a feasible procedure in tracheal and carinal resection and reconstruction in highly selected patients. It can be a valid alternative to conventional intubated VATS for airway surgery.
Authors: Francisco Lirio; Carlos Galvez; Sergio Bolufer; Juan Manuel Corcoles; Diego Gonzalez-Rivas Journal: J Thorac Dis Date: 2018-08 Impact factor: 2.895