Predictors of conversion to thoracotomy for video-assisted thoracoscopic lobectomy: A retrospective analysis and the influence of computed tomography–based calcification assessment

Samson, Pamela; Guitron, Julian; Reed, Michael F.; Hanseman, Dennis J.; Starnes, Sandra L.

doi:10.1016/j.jtcvs.2012.05.028

Cited by 92 publications

(116 citation statements)

References 11 publications

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“…Among the varied reasons for increased rates of complications, conversion to open surgery or planned conventional open surgery is the presence of difficult hilar or interlobar lymphadenopathy (6)(7)(8). This difficult to manage lymphadenopathy can be seen in the post induction setting, leading to a potentially increased risk of pulmonary arterial injury (7,9,10). While many thoracic surgeons advocate prompt conversion to thoracotomy in the setting of pulmonary arterial injury, with experience a minimally invasive approach to repair can be safe and effective.…”

Section: Textmentioning

confidence: 99%

Management of pulmonary arterial bleeding in the post induction setting

Edwards¹,

Balderson²,

D’Amico³

2016

J. Vis. Surg.

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TextThoracoscopic lobectomy is now considered the standard of care for surgical management of early stage pulmonary malignancy, offering many advantages over thoracotomy (1)(2)(3)(4)(5). Among the varied reasons for increased rates of complications, conversion to open surgery or planned conventional open surgery is the presence of difficult hilar or interlobar lymphadenopathy (6)(7)(8). This difficult to manage lymphadenopathy can be seen in the post induction setting, leading to a potentially increased risk of pulmonary arterial injury (7,9,10). While many thoracic surgeons advocate prompt conversion to thoracotomy in the setting of pulmonary arterial injury, with experience a minimally invasive approach to repair can be safe and effective. We present a case of pulmonary arterial injury during a thoracoscopic left upper lobectomy in the post induction setting, demonstrating tamponade of the injury, with subsequent proximal control and suture repair of the defect. Figure 1 is a video presenting a two incision thoracoscopic left upper lobectomy complicated by a pulmonary arterial injury incurred while dissecting post induction adherent lymphadenopathy off of the ongoing pulmonary artery distal to the take off of the truncus anterior. At the outset of the video, a sponge ball has been placed overlying the injury to achieve tamponade. We then address the fissure, performing blunt dissection using a thoracoscopic suction and lymph node grasper to raise the pulmonary parenchyma off of the underlying pulmonary arterial branches. The lingular and ascending branches of the pulmonary artery are then divided using a curved tip vascular load of the endoscopic stapler. The truncus anterior branch of the pulmonary artery is dissected out with a thoracoscopic right angle and lymph node grasper and is divided using a curved tip vascular load of the endoscopic stapler as is Methods: We present a case of pulmonary arterial injury complicating dissection of the pulmonary artery during thoracoscopic left upper lobectomy. Ethical approval was obtained from the institutional ethics board and written consent was obtained from the patient.Results: Thoracoscopic management of pulmonary arterial bleeding is demonstrated. We show maintenance of a thoracoscopic approach with establishment of proximal pulmonary arterial control, allowing suture repair of an injury to the ongoing pulmonary artery.Conclusions: While pulmonary arterial injury may be a significant problem during thoracoscopic lobectomy, minimally invasive approaches to repair are safe and effective. another ascending branch of the pulmonary artery. The left upper lobe bronchus is then divided with a regular load of the endoscopic stapler. The left upper lobe is then placed in a retrieval bag and removed from the chest cavity. The sponge ball is then lifted to check for hemostasis and ongoing bleeding is encountered. It is easily controlled with repeated tamponade. We then employ the thoracoscopic suction and lymph node grasper to dissect proximally on the left pulmonary artery...

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Section: Textmentioning

confidence: 99%

Management of pulmonary arterial bleeding in the post induction setting

Edwards¹,

Balderson²,

D’Amico³

2016

J. Vis. Surg.

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“…However, conversion is due to prolongation of the operative time and an increase in blood loss, including emergency hemorrhage. Hanna, et al 30) classifi ed the causes of conversion into four types: intraoperative complications, technical problems, anatomical problems, and oncological conditions, and it is important to recognize these, make efforts to avoid conversion, 31) learn troubleshooting, and prepare for an emergency. 32,33) The merits of thoracoscopic surgery have been clarifi ed, and the usefulness of its active application for the elderly has been described.…”

Section: Thoracoscopic Lobectomy For Primary Lung Cancermentioning

confidence: 99%

Systematic Review of Published Studies on Safety and Efficacy of Thoracoscopic and Robot-Assisted Lobectomy for Lung Cancer

Nakamura

2014

ATCS

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The safety and effi cacy of thoracoscopic and robot-assisted lobectomies for primary lung cancer were reviewed in the literature. Thoracoscopic surgery is less invasive compared to thoracotomy, and it has been reported to be superior with regard to the outcome. In addition, the operability of a surgical robot (da Vinci) is favorable and supplements the disadvantages of conventional endoscopic surgery. Robot-assisted lobectomy has been reported to be comparable to thoracoscopic surgery with regard to the safety and effi cacy based on analysis of perioperative results and superior with regard to the operability and length of the learning curve. However, a high cost and a long operative time are of concern. Since robot-assisted surgery has been performed only in early cases, the continuation of a comparative investigation may be necessary.

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“…Several demographic and clinical factors such as older age, history of the granulomatous disease, current COPD or smoker, and reduced forced expiratory volume in 1 second (FEV 1 ) have been identified to be predictors of intraoperative conversion (7)(8)(9). Additionally, recent studies revealed that computed tomography (CT) images with hilar lymph node calcification could predict intraoperative conversion, which was associated with adhesion of lymph nodes to hilar structures and subsequent difficulty in the dissection of hilum (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Additionally, recent studies revealed that computed tomography (CT) images with hilar lymph node calcification could predict intraoperative conversion, which was associated with adhesion of lymph nodes to hilar structures and subsequent difficulty in the dissection of hilum (8)(9)(10). However, even lymph nodes without calcification on CT images revealed extensive perihilar granulomatous inflammation during the operation, which required conversion to thoracotomy (9,10). Using 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT, noncalcified lymph nodes with high FDG uptake have been associated with chronic granulomatous or anthracofibrotic pathology of lymph nodes when they show attenuation higher than that of surrounding great vessels, especially in an endemic region for tuberculosis (11,12).…”

Section: Introductionmentioning

confidence: 99%

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