International expert consensus on the management of bleeding  during VATS lung surgery

Liu, Lunxu; Mei, Jiandong; He, Jie; Demmy, Todd L.; Gao, Shugeng; Li, Shanqing; He, Jianxing; Liu, Yang; Huang, Yunchao; Xu, Shidong; Hu, Jian; Chen, Liang; Zhu, Yuming; Luo, Qingquan; Mao, Weimin; Tan, Qunyou; Chen, Chun; Li, Xiaofei; Zhang, Zhu; Jiang, Gening; Xu, Lin; Fu, Jianhua; Li, Hui; Wang, Qun; Liu, Deruo; Tan, Liang; Zhang, Qinghua; Fu, Xiangning; Jiang, Zhongmin; Chen, Haiquan; Fang, Wentao; Zhang, Xun; Li, Yin; Tong, Ti; Yu, Zhentao; Liu, Yongyu; Zhi, Xiao; Yan, Tao; Zhang, Xingyi; Pu, Qiang; Che, Guowei; Lin, Yi‐Dan; Ma, Lin; Embún, Raul; Aragón, Javier; Evman, Serdar; Kocher, Gregor J.; Bertolaccini, Luca; Brunelli, Alessandro; González-Rivas, Diego; Dunning, Joel; Liu, Huiping; Swanson, Scott J.; Borisovich, Ryabov Andrey; Sarkaria, Inderpal S.; Sihoe, Alan D. L.; Nagayasu, Takeshi; Miyazaki, Takuro; Chida, Masayuki; Kohno, Tadasu; Agasthian, Thirugnanam; Soukiasian, H.J.; Onaitis, Mark W.; Liu, Chia‐Chuan

doi:10.21037/atm.2019.11.142

Cited by 33 publications

(33 citation statements)

References 58 publications

(88 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Importantly, these events were self-limiting. Major complications observed were assessed as not related to the treatment or device, instead reflecting the known complications of surgical lobectomy (persistent air leak is reported in 10% of patients following VATS lobectomy [13], major vascular injury in 3–8% [14, 15]).…”

Section: Discussionmentioning

confidence: 99%

Bronchoscopic Thermal Vapour Ablation for Localized Cancer Lesions of the Lung: A Clinical Feasibility Treat-and-Resect Study

et al. 2021

View full text Add to dashboard Cite

Background: Bronchoscopic thermal vapour ablation (BTVA) is an established and approved modality for minimally invasive lung volume reduction in severe emphysema. Preclinical data suggest potential for BTVA in minimally invasive ablation of lung cancer lesions. Objectives: The objective of this study is to establish the safety, feasibility, and ablative efficacy of BTVA for minimally invasive ablation of lung cancers. Methods: Single arm treat-and-resect clinical feasibility study of patients with biopsy-confirmed lung cancer. A novel BTVA for lung cancer (BTVA-C) system for minimally invasive treatment of peripheral pulmonary tumours was used to deliver 330 Cal thermal vapour energy via bronchoscopy to target lesion. Patients underwent planned lobectomy to complete oncologic care. Pre-surgical CT chest and post-resection histologic analysis were performed to evaluate ablative efficacy. Results: Six patients underwent BTVA-C, and 5 progressed to planned lobectomy. Median procedure duration was 12 min. No major procedure-related complications occurred. All 5 resected lesions were part-solid lung adenocarcinomas with median solid component size 1.32±0.36 cm. Large uniform ablation zones were seen in 4 patients where thermal dose exceeded 3 Cal/mL, with complete/near-complete necrosis of target lesions seen in 2 patients. Tumour positioned within ablation zones demonstrated necrosis in >99% of cross-sectional area examined. Conclusion: BTVA of lung tumours is feasible and well tolerated, with preliminary evidence suggesting high potential for effective ablation of tumours. Thermal injury is well demarcated, and uniform tissue necrosis is observed within ablation zones receiving sufficient thermal dose per volume of lung. Treatment of smaller volumes and ensuring adequate thermal dose may be important for ablative efficacy.

show abstract

Section: Discussionmentioning

confidence: 99%

Bronchoscopic Thermal Vapour Ablation for Localized Cancer Lesions of the Lung: A Clinical Feasibility Treat-and-Resect Study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In addition, preventive clamping can reduce pulmonary artery pressure, which may facilitate lymph node dissection-for lymph nodes or tumors with severe adhesions to blood vessels, pulmonary artery clamping can facilitate a difficult dissection [20,21]. Also, the reduced tension in the distal pulmonary artery greatly lowers the risk of pulmonary artery rupture during dissection [20,21]. Even if the pulmonary artery ruptures during dissection, no major bleeding will occur, and the repair can be unhurried.…”

Section: Discussionmentioning

confidence: 99%

“…This clamping technique occupies very minimal space with simple instrumentation [ 8 – 10 ], providing sufficient operating space for pulmonary artery repair and minimizes instrumentation interference. In addition, preventive clamping can reduce pulmonary artery pressure, which may facilitate lymph node dissection—for lymph nodes or tumors with severe adhesions to blood vessels, pulmonary artery clamping can facilitate a difficult dissection [ 20 , 21 ]. Also, the reduced tension in the distal pulmonary artery greatly lowers the risk of pulmonary artery rupture during dissection [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Pretreatment clamping of pulmonary artery during uniportal thoracoscopic lobectomy

Zhang¹,

Cai²,

Wang³

et al. 2020

BMC Surg

Self Cite

View full text Add to dashboard Cite

Background: Intraoperative pulmonary artery (PA) hemorrhage is one of the leading reasons for conversion from uniportal VATS to open thoracotomy, especially for the small incision (≤3 cm) uniportal VATS performed by our department. So, We designed a technology called pretreatment clamping of the pulmonary artery, which may be helpful to solve the problem. Methods: A retrospective analysis of 19 patients who had pulmonary artery bleeding during uniportal thoracoscopic lobectomy in which one group had undergone preventive pulmonary artery clamping, the clamping group (n = 11), and one group which did not receive preventive clamping, the non-clamping group (n = 8). We compared the rates of conversion from the uniportal VATS approach to open thoracotomy or multi-incision operation, duration of pulmonary artery repair, blood loss, length of postoperative hospital stay and postoperative complications of the two groups. Results: Compared to the non-clamping group, the clamping group had lower rates of conversion to open thoracotomy (0% vs 62.5%, p < 0.05) and lower rates of conversion to multi-incision operations (18.2% of nonclamping converted to 2-port approach vs 12.5% of clamping converted to 2-port approach and 12.5% converted to 3-port approach, p < 0.05). Duration of pulmonary artery repair was reduced in the clamping group (10.1 ± 3.2 min vs 18.3 ± 5.5 min, p < 0.05). The clamping group also had decreased blood loss (23.6 ± 11.2 ml vs 47.5 ± 14.9 ml, p<0.05). There were no significant differences in postoperative hospital stay and postoperative complications between the two groups. Conclusion: Pretreatment clamping of the pulmonary artery in VATS lobectomy can decrease conversion rates, decrease blood loss, shorten repairing time of the pulmonary artery, and feasibly can be applied in uniportal thoracoscopic lobectomy.

show abstract

“…Because of the minimal invasion associated with VATS its use in treating early-stage NSCLC has increased over years (8)(9)(10)(11)(12), and studies have demonstrated the advantages of VATS compared with open thoracotomy, including a lower morbidity rate (8,(13)(14)(15), shorter chest tube duration (13,14), less intraoperative blood loss (14), and shorter postoperative hospital stay (8,(13)(14)(15)(16)(17). However, the surgical skills of VATS need practice and training and there is potential risk of uncontrollable bleeding by VATS (18)(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

Perioperative comparison of video-assisted thoracic surgery and open lobectomy for pT1-stage non-small cell lung cancer patients in China: a multi-center propensity score-matched analysis

Xu¹,

Ni²,

Wu³

et al. 2021

Transl Lung Cancer Res

Self Cite

View full text Add to dashboard Cite

Background: Compared with open surgery, video-assisted thoracic surgery (VATS) has innovated the concept of the minimally invasive approach for non-small cell lung cancer (NSCLC) patients in past decades. This present study aimed to compare the perioperative and lymph node dissection outcomes between VATS lobectomy and open lobectomy for pathological stage T1 (pT1) NSCLC patients from both surgical and oncologic perspectives. Methods: This was a retrospective multicenter study. Patients who underwent surgical resection for pT1 NSCLC between January 2014 and September 2017 were retrospectively reviewed from 10 thoracic surgery centers in China. Perioperative and lymph node dissection outcomes of pT1 NSCLC patients who accepted VATS or open lobectomies were compared by propensity score matching (PSM) analysis. Results: Of the 11,360 patients who underwent surgery for pT1 NSCLC, 7,726 were enrolled based on the selection criteria, including 1,222 cases of open lobectomies and 6,504 cases of VATS lobectomies. PSM resulted in 1,184 cases of open lobectomies and 1,184 cases of VATS lobectomies being well matched by common prognostic variables, including age, sex, and surgical side. VATS lobectomy led to better perioperative outcomes, including less blood loss (133.5±200.1 vs. 233.3±318.4, P<0.001), lower blood transfusion rate (2.4% vs. 6.4%, P<0.001), shorter postoperative hospital stay (8.6±5.7 vs. 10.1±5.1, P<0.001), less chest drainage volume (1,109.5±854.0 vs. 1,324.1±948.8, P<0.001), and less postoperative complications(4.9% vs. 8.2%, P<0.001). However, open lobectomy had better lymph node dissection outcomes than VATS, with increased lymph node dissection numbers (16.1±9.4 vs. 13.7±7.7, P<0.001) and more positive lymph nodes being dissected (1.5±3.9 vs. 1.1±2.5, P=0.002). Compared with VATS, open lobectomy harvested more lymph node stations (5.5±1.9 vs. 5.2±1.8, P=0.001), including more pathological N2 (pN2) lymph node stations (3.4±1.4 vs. 3.1±1.3, P<0.001).Conclusions: VATS lobectomy was associated with better perioperative outcomes, such as less blood loss, lower blood transfusion rate, shorter postoperative hospital stay, less chest drainage volume and less postoperative complications. Open lobectomy has improved lymph node dissection outcomes, as more lymph

show abstract

International expert consensus on the management of bleeding during VATS lung surgery

Cited by 33 publications

References 58 publications

Bronchoscopic Thermal Vapour Ablation for Localized Cancer Lesions of the Lung: A Clinical Feasibility Treat-and-Resect Study

Bronchoscopic Thermal Vapour Ablation for Localized Cancer Lesions of the Lung: A Clinical Feasibility Treat-and-Resect Study

Pretreatment clamping of pulmonary artery during uniportal thoracoscopic lobectomy

Perioperative comparison of video-assisted thoracic surgery and open lobectomy for pT1-stage non-small cell lung cancer patients in China: a multi-center propensity score-matched analysis

Contact Info

Product

Resources

About