Muscle-sparing thoracotomy combined with mechanically stapled lung resection for benign lung disorders: functional results and quality of life

Abstract

We set out to review our experience with resection of benign lung lesions performed using mechanical stapling devices via a muscle-sparing thoracotomy, and provide data on long-term morbidity, functional results, and quality of life (QOL). Fifty-two patients with a benign lung disorder were included in the study. All underwent a lung resection with mechanical staplers via a muscle-sparing thoracotomy. Medical records were retrospectively searched for postoperative complications. Nineteen patients (36.5%) also underwent a final follow-up including clinical examination, radiological investigations, functional tests, and assessment of QOL by a standardized questionnaire. No intra-operative complications occurred. The resection was anatomical (lobectomy) in 28 (53%) children and wedge in 25 (47%). Five cases (9.6%) required secondary surgery. Of the 19 children undergoing long-term follow-up, 3 (16%) had musculoskeletal anomalies and 6 (31.5%) respiratory symptoms. All X-rays were normal. Spirometry was abnormal in 9 cases (47.3%). QOL was excellent/good in 17 cases (89.5%) and sufficient in 2 (10.5%). An abnormal spirometric pattern was significantly more frequent in cases with a poorer QOL. In conclusion, stapled resection via a muscle-sparing thoracotomy is a good option to perform lung resections. However, a muscle-sparing approach does not avoid entirely long-term musculoskeletal complications. QOL is good in nearly 90% of cases, but respiratory symptoms and abnormal spirometric function can be found in one third and half of the patients, respectively. An abnormal spirometry is more common in patients with a poorer QOL. Systematic radiological follow-up is unnecessary.

Infected Mediastinal Bronchogenic Cyst in a 12 Year Old Girl

“…12 Subsequent chest wall deformities, diminished pulmonary function, muscular atrophy, chronic pain and reduced rib cage dynamics are well documented. 12,14,15 These disadvantages and side effects are more troublesome in children than in adults because growth may result in further deterioration. 12 Video-assisted thoracoscopy on the other hand results in only a little impairment to the chest wall but it provides only limited access.…”

“…Muscle-sparing anterior (also referred to as axillary) thoracotomy preserves the latissimus dorsi, the pectoralis major and the serratus anterior muscle as well as the lateral thoracic artery and the long thoracic nerve. 15 Damage to the major muscles of the back and shoulder is thus avoided. 15 Nevertheless, muscle-sparing thoracotomy provides an excellent approach for the resection of lung malformations.…”

“…15 Damage to the major muscles of the back and shoulder is thus avoided. 15 Nevertheless, muscle-sparing thoracotomy provides an excellent approach for the resection of lung malformations. 14,15 In our case, we were able to separate the mediastinal bronchogenic cyst from all the tightly adhering surrounding structures such as the esophagus, phrenic nerve and lower pulmonary vein, and finally we were able to resect the cyst itself via the muscle-sparing thoracotomy without difficulties.…”

Staplers versus hand-sewing for pulmonary lobectomy: randomized controlled trial

“…Currently, the stapler is used as the standard instrument for dividing lung parenchyma in both the open thoracotomy approach and a videoassisted thoracoscopic approach. [4][5][6][7][8][9] In Thailand, the stapler has been used for at least 10 years in tertiary medical centers or medical schools, but this device is expensive and not included in all health insurance. Patients and their relatives must take responsibility for payment of 10,000-15,000 Thai baht (330-500 US dollars).…”