Pathophysiological mechanism of post-lobectomy air leaks

Casha, Aaron; Bertolaccini, Luca; Camilleri, Liberato; Manche, Alexander; Gauci, Marilyn; Melikyan, Gor; Gatt, Ruben; Dudek, Krzysztof; Solli, Piergiorgio; Grima, Joseph N.

doi:10.21037/jtd.2018.05.116

Cited by 10 publications

(11 citation statements)

References 30 publications

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“…[13][14][15] Access to the Chest During surgical access to the chest, a breach in the visceral pleura and parenchyma may occur. Radionucleide imaging studies of pneumothorax suggest that particles as small as 5-10 nm may be released, 11,[18][19][20][21][22][23] which may be more significant if the underlying lung is subjected to positive pressure in the event of inadequate exclusion. The working group; therefore, recommended interrupting ventilation and using utmost care when opening the intercostal space or inserting an initial thoracoscopic trocar.…”

Section: Lung Isolation and Patient Positioningmentioning

confidence: 99%

“…The working group emphasized the importance of air leak prevention, because pleural tears and parenchymal staple lines may leak air and generate aerosol when the lung is re-expanded under positive pressure. [19][20][21][22][23] Although their efficacy is somewhat controversial, the use of tissue reinforcement and/or tissue sealants may be considered to promote staple line integrity, 18,[29][30][31] as can limiting ventilation pressures because some evidence suggests this may reduce strain on staple lines. 31,32 Nevertheless, because the potential for air leak is inherent to lung surgery, the working group suggested that lung re-expansion proceed only once the pleural cavity has been excluded from the operating room environment.…”

Section: Conduct Of the Surgical Proceduresmentioning

confidence: 99%

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Minimizing the Risk of Aerosol Contamination During Elective Lung Resection Surgery

et al. 2020

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Background: In the setting of the COVID-19 pandemic, the conduct of elective cancer surgery has become an issue because of the need to balance the requirement to treat patients with the possibility of transmission of the virus by asymptomatic carriers. A particular concern is the potential for viral transmission by way of aerosol which may be generated during perioperative care. There are currently no guidelines for the conduct of elective lung resection surgery in this context. Methods: A working group composed of 1 thoracic surgeon, 2 anesthesiologists and 1 critical care specialist assessed the risk for aerosol during lung resection surgery and proposed steps for mitigation. After external review, a final draft was approved by the Committee for the Governance of Perioperative and Surgical Activities of the Hôpital Maisonneuve-Rosemont, in Montreal, Canada. Results: The working group divided the risk for aerosol into 6 time-points: (1) intubation and extubation; (2) Lung isolation and patient positioning; (3) access to the chest; (4) conduct of the surgical procedure; (5) procedure termination and lung re-expansion; (6) chest drainage. Mitigating strategies were proposed for each time-point. Conclusions: The situation with COVID-19 is an opportunity to re-evaluate operating room protocols both for the purposes of this pandemic and similar situations in the future. In the context of lung resection surgery, specific time points during the procedure seem to pose specific risks for the genesis of aerosol and thus should be the focus of attention.

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Section: Lung Isolation and Patient Positioningmentioning

confidence: 99%

Section: Conduct Of the Surgical Proceduresmentioning

confidence: 99%

Minimizing the Risk of Aerosol Contamination During Elective Lung Resection Surgery

et al. 2020

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“…The gravitational model cannot explain lack of postural inequality in the prone position and heterogeneity of ventilation and perfusion distribution at the same vertical level with persistent heterogeneity in the absence of gravity [49]. The non-symmetrical fractal branching of the bronchial and pulmonary vascular anatomy is now considered to be the most important factor causing heterogeneity of perfusion and ventila- in the upper lobes and also on the right compared to the left due to the loss of chest wall conformational support leading to high pleural stress [75].…”

Section: Pulmonary Vasculaturementioning

confidence: 99%

Common Pathophysiological Pathways for Apical and Upper Lobe Lung Disease

R¹,

Manche²,

Gauci³

et al. 2018

J Infect Dis Epidemiol

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“…To do so, a surgical stapler squeezes tissue around the tumor to cut and seal the healthy tissue from the tumor bearing one. After chest surgery, 28-60% of patients suffer from air leaks [1]- [4]. Patients routinely require a chest tube (drain) until the leak resorbs [2], [5], which results in longer hospital stays and increased care costs [6].…”

Section: Introductionmentioning

confidence: 99%

“…al. [1]. They concluded that lower lobes leak most because they need to reshape to fit the rib cage bullet-shape exposing them to higher mechanical stress.…”

Section: Introductionmentioning

confidence: 99%

Air leaks: stapling affects porcine lungs biomechanics

Bonnet¹,

Tabiai²,

Rakovich

et al. 2021

Preprint

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During thoracic operations, surgical staplers resect cancerous tumors and seal the spared lung. However, post-operative air leaks are undesirable clinical consequences: staple legs wound lung tissue. Subsequent to this trauma, air leaks from lung tissue into the pleural space. This affects the lung's physiology and patients' recovery. The objective is to biomechanically and visually characterize porcine lung tissue with and without staples in order to gain knowledge on air leakage following pulmonary resection. Therefore, a syringe pump filled with air inflates and deflates eleven porcine lungs cyclically without exceeding 10 cmH2O of pressure. Cameras capture stereo-images of the deformed lung surface at regular intervals while a microcontroller simultaneously records the alveolar pressure and the volume of air pumped. The raw images are then used to compute tri-dimensional displacements and strains with the Digital Image Correlation method (DIC). Air bubbles originated at staple holes of inner row from exposed porcine lung tissue due to torn pleural on costal surface. Compared during inflation, left upper or lower lobe resections have similar compliance (slope of the pressure vs volume curve), which are 9% lower than healthy lung compliance. However, lower lobes statistically burst at lower pressures than upper lobes (p-value<0.046) in ex vivo conditions confirming previous clinical in vivo studies. In parallel, the lung deformed mostly in the vicinity of staple holes and presented maximum shear strain near the observed leak location. To conclude, a novel technique DIC provided concrete evidence of the post-operative air leaks biomechanics. Further studies could investigate causal relationships between the mechanical parameters and the development of an air leak.

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Pathophysiological mechanism of post-lobectomy air leaks

Cited by 10 publications

References 30 publications

Minimizing the Risk of Aerosol Contamination During Elective Lung Resection Surgery

Minimizing the Risk of Aerosol Contamination During Elective Lung Resection Surgery

Common Pathophysiological Pathways for Apical and Upper Lobe Lung Disease

Air leaks: stapling affects porcine lungs biomechanics

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