Efficiency of Incentive Spirometry for Video-Assisted Thoracoscopic Surgery for Esophagectomy

Abstract

: Transthoracic subtotal esophagectomy for esophageal cancer is a highly invasive procedure, associated with high mortality and morbidity rates. We examined the use of video-assisted thoracoscopic and laparoscopic surgery for esophagectomy VATS-E . Further, incentive spirometry IS is commonly used in perioperative rehabilitation for esophagectomy. We investigated whether pulmonary complications after VATS-E are related to changes in the perioperative IS volumes and whether such changes could be predictive of these complications. This study included 63 patients who underwent VATS-E from June 2008 to December 2009. IS volumes before and after surgery were recorded for all patients. The perioperative IS volumes and clinicopathological factors were correlated with the incidence of postoperative pneumonia and atelectasis. Nine patients 14.5% had postoperative pneumonia, and thirteen 22.2% had atelectasis. Univariate analysis showed an increased risk of atelectasis in patients with diabetes and an increased risk of pneumonia in patients with a long operating time and for whom the lung was adhered to the thoracic wall. The vital capacity VC correlation coef cient was 0.674. Further, the risk of pneumonia was high in patients with 13% less than the minimum IS volume/preoperative VC ratio and 22% with less than the average IS volume/preoperative VC ratio. Multivariate regression models for pneumonia showed the same results regarding the IS volume/VC ratio. The results indicated that IS volumes could be used to predict the incidence of complications after VATS-E, and thereby facilitate early application of interventions to prevent pulmonary complications.

Evaluation of Surgical Stress Associated with Video-assisted Thoracic Surgery for Esophageal Cancer According to Interleukin-6 Variation in Pleural Cavity Lavage Fluid

“…In 1996, we introduced video-assisted thoracic surgery for esophageal cancer VATS-E in the left lateral decubitus position to reduce the extent of surgical stress caused by esophagectomy 2,3 . We have conducted several studies examining esophageal cancer and VATS-E [4][5][6][7] . In 2010, we started employing arti cial pneumothorax AP using carbon dioxide gas in VATS-E to further reduce surgical stress.…”