CTSNet is sponsored in part by an educational grant from. This procedure helps to prevent fluid from collecting in the affected area and is used for the treatment of mesothelioma, a. Safety and efficacy of video-assisted thoracic surgical techniques for the treatment of spontaneous pneumothorax. Keywords: Often, a small apical pneumothorax is seen which is usually of no significance and resolves over the next 2 to 4 weeks. Two intercostal drains were inserted through the anterior and lateral incisions and placed on continuous suction to 2–5 kPa. In one patient, initial VATS pleurectomy for SSP was abandoned in favour of open pleurectomy because of poor visualisation caused by pleural adhesions. Open pleurectomy is a viable alternative to treat re-do cases and complicated SSP. Early ambulation and discharge should be a reasonable goal. Epub 2004 Feb 2. Next, the inferior margin of the cut edge of the pleura is stripped and resected as described above (Video 8 below). Naunheim K, Mack M, Hazelrigg SR, et al. Occasionally, extreme anxiety over placement of a chest tube or fear of another pneumothorax may be reason to perform surgery at the first episode of pneumothorax. Since then VATS pleurectomy has attracted enormous enthusiasm among thoracic surgeons treating spontaneous pneumothorax •Pleurectomy reduces the chance of symptomatic recurrence of spontaneous pneumothorax, on that . Certain relevant issues in optimising the surgical management for SP like role of CT-scan in every case of SP, efficacy of VATS for re-do cases, justification of talc pleurodesis in PSP, surgery following first episode of SP and multi-centric randomised trial based on therapies stratified as per Vandeschueren 4-stage system will require more clinical studies in future to achieve desired evidence. This leads to loss of the negative intrapleural pressure and lung collapse. Conclusion: The operation is performed under general anesthesia with single lung ventilation. However, two patients in each group had postoperative hospital stay exceeding 20 days as they required multidisciplinary review regarding concurrent problems. Im Buch gefunden – Seite 221Atypische. triportale. VATS-Bullaresektion. mit. Pleurektomie. bei. Pneumothorax. Op-Bericht,. Klinik. für. Viszeral-,. Transplantations-,. Thorax-. [. VATS was the main modality used for primary spontaneous pneumothorax (PSP) (21 vs. 8). Surgical Treatment of Spontaneous Pneumothorax: Pleural Abrasion or Pleurectomy? Czerny M, Salat A, Fleck T, et al. It is passed under the ring clamp and is applied to the lung parenchyma inferior to the ring clamp to include a margin of normal lung parenchyma. Standard statistical tests were used to calculate odds ratios and 95% CI. The superior segment of the lower lobe is inspected for any other blebs, as is the rest of the lung. Im Buch gefunden – Seite 241Handelt es sich um einen inkompletten, nicht-apikalen Pneumothorax, so empfiehlt ... Verschluß des Lungenlecks und die gleichzeitige parietale Pleurektomie. It is used following recurrent episodes of collapsed lungs (spontaneous pneumothorax) to help the surface of the lung to stick to the chest wall and so preventing further lung collapse. eCollection 2015. Clipboard, Search History, and several other advanced features are temporarily unavailable. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Thoracoscopic pleurectomy and blebectomy have become the standard of care in the management of spontaneous pneumothorax. 2019 Jul;49(7):587-592. doi: 10.1007/s00595-019-01785-x. After the operation, patients were extubated in the operating room and transferred to the high dependency unit, where they were started on a patient-controlled analgesia (PCA) system using bolus doses (1 mg) of morphine with a lockout time of 5 min and no background infusion. The technique of VATS ligation of pleural bullae and parietal pleurectomy for the treatment of spontaneous pneumothorax was first described in 1991 [5]. Cardillo G, Carleo F, Giunti R, et al. Patients who have had a second episode of spontaneous pneumothorax are those most likely to be considered for thoracoscopic pleurectomy and apical blebectomy. 2015 Jun 4;10(6):e0127857. Next, a subtotal parietal pleurectomy is performed. Since then VATS pleurectomy has attracted enormous enthusiasm among thoracic surgeons treating spontaneous pneumothorax. Prevention and treatment information (HHS). Pneumothoraces are classified according to the aetiology as spontaneous (which may be primary or secondary depending on the underlying pathology) or traumatic. Spontaneous pneumothorax (SP) is divided into primary and secondary pneumothorax. One elderly patient with SSP who had underwent open pleurectomy died due to respiratory failure in hospital after the operation. The purpose of this study was to assess whether pleurectomy or pleural abrasion was associated with lower postoperative recurrence. The surgery was performed by one surgeon and each patient received an explanation by the surgeon about the differences between the VATS and open pleurectomy to make a choice for himself or herself. The article "Incidence of chronic pain after minimal-invasive surgery for spontaneous pneumothorax", by Passlick, Born, Sienel, and Thetter, followed 60 patients who underwent a Video-Assisted Pleurodesis or Pleurectomy. Mithiran H, Leow L, Ong K, Liew T, Siva D, Liang S, Tam JKC. Morbidity from the thoracoscopic approach is primarily from recurrence (0-5%), bleeding (1-5%), prolonged air leak (1-8%), and chronic chest wall pain (20%) [14, 23, 24]. Im Buch gefunden – Seite 268Lediglich in 6 Fällen war eine Thorakotomie mit parietaler Pleurektomie ... Pleurodese bei 103 Patienten mit Spontanpneumothorax Anteil Patienten ( % ) 100 ... Videothoracoscopic treatment of primary spontaneous pneumothorax: a 6-year experience. Chest drainage was significantly more in open group (1027.1 ml vs. 652.8 ml; P=0.04). Risk factors for postoperative recurrence of spontaneous pneumothorax treated by video-assisted thoracoscopic surgery, Copyright © 2021 European Association for Cardio-Thoracic Surgery, Copyright © 2021 Oxford University Press. J Minim Access Surg. This site is not optimized for Internet Explorer 8 (or older). There was no significant difference in the operative blood loss between the two groups, however, there was a considerable difference in consumables used in operating theatre costing £67.88 in open pleurectomy as compared to £25.32 in VATS pleurectomy. Im Buch gefunden – Seite 960Ganz exzeptionell kann auch eine Pleurektomie erforderlich werden. Pneumothorax und Pneumomediastinum 78.2 78.2.1 Pneumothorax Ätiologie und Pathogenese ... This is begun by dividing the pleura in the line of the working incision (4th or 5th space) posteriorly, adjacent to the spine, and working anteriorly till the incision is reached. 2004 Mar;18(3):466-71. doi: 10.1007/s00464-003-9067-z. Doddolia C, Barlésib F, Fraticellib A, et al. Ayed AK. 2002, Churchill Livingstone: Philadelphia. photograph showing a localized pleurectomy. Materials and Methods: Statistically compared variables between the 2 groups were . Im Buch gefunden – Seite 3766 Beim traumatischen Pneumothorax achtet man besonders auf ... Pleurodese und/oder Pleurektomie Wie ist der weitere klinische Therapieverlauf? Thirty-one and 26 patients underwent open and video-assisted thoracoscopic surgery (VATS) pleurectomy, respectively. On follow-up examination as an outpatient at 6–8 weeks after operation, the following details were recorded. In conclusion, the findings from this study suggest that VATS pleurectomy is a cost-effective, patient friendly modality for PSP. Ng C, Maier HT, Kocher F, Jud S, Lucciarini P, Öfner D, Schmid T, Augustin F. World J Surg. Secondary spontaneous pneumothorax (SSP) occurs in the presence of underlying lung disease, usually emphysematous bullae. Axillary thoracotomy versus videothoracoscopy for the treatment of primary spontaneous pneumothorax. The bulla was grasped with an endograsp or an endobabcock and excised with the 30 mm endo GIA stapling device. Does continuation of antifibrotics before lung transplantation influence post-transplant outcomes in patients with idiopathic pulmonary fibrosis? Primary pneumothorax is a disease that usually affects, young, otherwise healthy adults. We differ with Cardillo et al. About 17-23 cases of pneumothorax occur per 100,000 people per year. Pleural abrasion, argon beam coagulation of the pleura and pleurodesis using agents other than talc are less successful in preventing a recurrence of the pneumothorax [16-21]. Santillan-Doherty P, Argote-Greene LM, Guzman-Sanchez M. Thoracoscopic management of primary spontaneous pneumothorax. Im Buch gefunden – Seite 239Schlüsselwörter: Prophylaxe – Infektion – Blutung – Pneumothorax ... 20mal eine rein apikale und 26mal eine subtotale scharfe Pleurektomie vorgenommen; ... Rizwan Qureshi, Ann Nugent, Javed Hayat, Muhammad Qureshi, Robert Norton, Should surgical pleurectomy for spontaneous pneumothorax be always thoracoscopic?, Interactive CardioVascular and Thoracic Surgery, Volume 7, Issue 4, August 2008, Pages 569–572, https://doi.org/10.1510/icvts.2007.174755. The mean age was 15.7±1.2years, and 79.7% (n=51) of patients were male. Hazelrigg SR, Landreneau RJ, Mack M, et al. Recurrence was significantly lower in patients who underwent pleurectomy rather than pleural abrasion (8.8% vs. 40%, p<0.01). The aim of this study was to compare postoperative pain after a videothoracoscopic lobectomy versus a mini-thoracotomy . VATS was the main modality used for primary spontaneous pneumothorax (PSP) (21 vs. 8). Gossot D, Galetta D, Stern JB, et al. The effect of pleural abrasion on the treatment of primary spontaneous pneumothorax: a systematic review of randomized controlled trials. Results of thoracoscopic pleural abrasion for primary spontaneous pneumothorax. In 1956, Gaensler [4] reported the first series of patients with recurrent spontaneous pneumothorax, in whom parietal pleurectomy was performed as a major therapeutic measure. Im Buch gefunden – Seite 228B. partielle Pleurektomie, Dekortikation, Zystenligatur) seitigem Pneumothorax) ▭ Infusionsthorax (z. B. nach ZVK-Anlage über V. subclavia und Befahren des ... Adachi H, Kigoshi H, Kikuchi A, Ito H, Masuda M. J Thorac Dis. Neo-generation of neogenetic bullae after surgery for spontaneous pneumothorax in young adults: a prospective study. A.P. Bilateral operations can be performed under the same anesthetic without difficulty by approaching the pleural cavities through their respective sides [10, 11]. Recurrence of PSP is significantly reduced in patients undergoing pleurectomy compared to pleural abrasion. Once a bleb is identified it is held with a ring clamp and an EndoGIA stapler with a blue or green load (45/60mm length; 3.5/4.8mm staple) is introduced into the chest. Disclaimer, National Library of Medicine Im Buch gefunden – Seite 3113 Indikationen Pneumothorax, Emphysemblase, Pleurektomie, diagnostische Keilresektion, bei interstitiellen Lungenerkrankungen, nicht maligne Rundherde, ... We agree with Waller et al. Thoracoscopic pleurectomy and blebectomy have become the standard of care in the management of spontaneous pneumothorax. Surgical intervention in the setting of SSP is associated with a much higher morbidity than it is in the setting of PSP [2] and has been conventionally considered only as a last resort [3]. PLoS One. Pleural abrasion; Pleurectomy; Pleurodesis; Primary spontaneous pneumothorax. The incision was closed in layers using absorbable material, including the pericostal sutures. Drainage/decortication (empyema stage III) Esophageal procedures. pp 1202-6. J Thorac Cardiovasc Surg 1995;109:1198-1204, Changing the Perceptions of Women in Cardiothoracic Surgery, Interview: Betty Tong Discusses What Led Her to a CT Surgery Career. Bullectomy was performed in 23 (74.19%) patients of open and 17 (65.38%) patients of VATS pleurectomy group using a median of two staple cartridges per patient range of 1–4. Surg Laparosc Endosc Percutan Tech. Successful pneumothorax management should regard cause and extent of the air leak and must be directed towards elimination of the causative lesion, rapid and full expansion of the lung, minimal risk of recurrence, low or no morbidity and mortality, low cost and short hospital stay [6]. First episodes are often managed with thoracostomy tube, whereas recurrent episodes typically prompt surgery involving apical bleb resection and pleurodesis, either via pleurectomy or pleural abrasion. Im Buch gefunden – Seite 48961.3 • Pneumothorax Diagnostik Die Ausbildung eines Spannungspneumothorax ist beim PSP ... Bullaresektion und Pleurodese mittels partieller Pleurektomie. Im Buch gefunden – Seite 16Beim primären Spontanpneumothorax ist die Altersverteilung zwischen Männern und Frauen identisch. 2. ... 4. ist eine Pleurektomie kontraindiziert. The indications for operation are now well established, and a more aggressive surgical approach is advocated since thoracoscopic intervention has a relatively low morbidity, a high rate of prevention of recurrent pneumothorax, and is permanent. It would help to standardise future clinical practice to prevent treatment failure. VATS Partial Pleurectomy Versus VATS Pleural Abrasion: Significant Reduction in Pneumothorax Recurrence Rates After Pleurectomy. All rights reserved. A technique of performing bilateral blebectomy through a unilateral approach has been described, but the ability to perform a pleurectomy is not known [12]. The operation is 95-98% successful in preventing pneumothorax, with decreased morbidity as compared to posterolateral thoracotomy [3-6]. Evaluation of the German National Register for Congenital Heart Defects, About Interactive CardioVascular and Thoracic Surgery, About the European Association for Cardio-Thoracic Surgery, About the European Board of Cardiovascular Perfusion, https://doi.org/10.1510/icvts.2007.174755, Receive exclusive offers and updates from Oxford Academic. Postoperative recurrence of spontaneous pneumothorax in younger patients: is it a matter of age, lung apex dystrophy or just a difficult air leak valuation through "a hole in a thorax" in video-assisted thoracic surgery? Maruyama R, Anai H. Video-assisted thoracoscopic surgery for bilateral spontaneous pneumothorax in supine position: the use of a pillow beneath the back for intercostal space widening. However, a large series in Europe has demonstrated this method to be safe and without long term consequence [14, 17]. 2019 Aug;43(8):2099-2105. doi: 10.1007/s00268-019-05001-2. 2018 Oct;42(10):3256-3262. doi: 10.1007/s00268-018-4640-8. In patients with diffuse bullous lung disease associated with SSP, technical difficulties were posed by the presence of patchy pleural adhesions (a sequel of prolonged intercostals drainage) and multiple blebs. The affected part of the lung is then resected by firing the stapler (Video 3 below). Copyright © 2017 Elsevier Inc. All rights reserved. We report our experience regarding efficacy of VATS and open pleurectomy as a therapeutic modality for spontaneous pneumothorax. Apical pleurectomy is considered equivalent to total pleurectomy with one series showing a lower recurrence rate when a complete pleurectomy is performed. The remaining mediastinal and diaphragmatic pleural surfaces can be abraded to irritate these surfaces using a Bovie electrocautery scratch pad held with a ring clamp (Video 9 below). Purpose: Im Buch gefunden – Seite 283Eine Computertomographie wird bei einem ventralen Pneumothorax durchgeführt. ... jPleurodese und Pleurektomie Bei rezidivierenden Pneus oder Pleuraergüssen ... Comparisons were made with Kruskal–Wallis tests and χ2-test as appropriate. Furthermore, in a prospective, randomised comparison, Hazelrigg and associates [13] found no reduction in the postoperative respiratory dysfunction when a muscle sparing rather than the standard postero-lateral thoracotomy was used. They were successfully managed with re-do open pleurectomy with no further recurrence. The overall recurrence rate was 23.4% (n=15). The median operating time was significantly longer in open group (72.4 vs. 55 min; P=0.005). Therefore divers, pilots, submarine personnel, and those that work or live in the wilderness or space are suitable patients [1]. 2019 Jan 23;14(1):20. doi: 10.1186/s13019-019-0848-4. •While air leaks may occur in the future, the adhesions will prevent the lung collapsing. 2 days ago i was working out doing a bending exercise when i developed this weird shortness of breath ( which was i guess due to the excercise ) but with it was some pain like discomfort sensation in my lower rib area on the left side where the ribs end . Chest tube drainage can be high for the first 48 hours, after which a marked decrease is seen. Ling ZG, Wu YB, Ming MY, Cai SQ, Chen YQ. With the patient under general anaesthesia using single lung ventilation, a limited postero-lateral thoracotomy was made through the 5th intercostals space, sparing the serratus anterior and the rhomboid muscles. Im Buch gefunden – Seite 895The pneumothorax patient needs urgent Surgicaltherapy by drainage over minimal thoracotomy and a ... Bullae-Resektion mit parietaler Pleurektomie (VATS). The operation is 95-98% successful in preventing pneumothorax, with decreased morbidity as compared to posterolateral thoracotomy [3-6]. A review of the literature reveals that thoracoscopic management of spontaneous pneumothorax is not standardized and that multiple procedures are used in different combinations. A 10 mm video-thoracoscope (mainly 0° telescope) was inserted via 10.5 mm thoraco-port, and the thoracic cavity inspected. Im Buch gefunden – Seite 67Bei Pneumothorax: Aspiration, Interkostaldrainage, Pleurodese oder partielle Pleurektomie (bei rekurrierendem oder therapierefraktärem Pneumothorax).

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