Ribcage kinematics during exercise justifies thoracoscopic versus postero-lateral thoracotomy lobectomy prompt recovery†

LoMauro, Antonella; Aliverti, Andréa; Chiesa, Melania; Cattaneo, M.; Privitera, Emilia; Tosi, Davide; Nosotti, Mario; Santambrogio, Luigi; Palleschi, Alessandro

doi:10.1093/ejcts/ezx174

Cited by 9 publications

(17 citation statements)

References 24 publications

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“… 8 Clinical studies on pulmonary function after lobectomy evidenced a reduction in volume variation on the side of surgery. 45 , 46 …”

Section: Resultsmentioning

confidence: 99%

“…Clinical studies reported a decrease in spirometry parameters (FVC and FEV1) after lobectomy, indicating an overall reduction of pulmonary function. 5 , 7 , 46 , 52 However, poor literature exists about local alteration of pulmonary function and fluid dynamics consequences. A recent clinical study on postoperative patients demonstrated the difficulty in measuring lobar ventilation redistribution through functional imaging (especially for surgery on the left side), due to the mediastinum shifting and geometry readaptation.…”

Section: Discussionmentioning

confidence: 99%

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Computational fluid dynamics of the airways after left‐upper pulmonary lobectomy: A case study

Tullio

Aliboni

Pennati

et al. 2021

Numer Methods Biomed Eng

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Pulmonary lobectomy is the gold standard intervention for lung cancer removal and consists of the complete resection of the affected lung lobe, which, coupled with the re-adaptation of the remaining thoracic structures, decreases the postoperative pulmonary function of the patient. Current clinical practice, based on spirometry and cardiopulmonary exercise tests, does not consider local changes, providing an average at-the-mouth estimation of residual functionality. Computational Fluid Dynamics (CFD) has proved a valuable solution to obtain quantitative and local information about airways airflow dynamics. A CFD investigation was performed on the airway tree of a leftupper pulmonary lobectomy patient, to quantify the effects of the postoperative alterations. The patient-specific bronchial models were reconstructed from pre-and postoperative CT scans. A parametric laryngeal model was merged to the geometries to account for physiological-like inlet conditions. Numerical simulations were performed in Fluent. The postoperative configuration revealed fluid dynamic variations in terms of global velocity (+23%), wall pressure (+48%), and wall shear stress (+39%). Local flow disturbances emerged at the resection site: a high-velocity peak of 4.92 m/s was found at the left-lower lobe entrance, with a local increase of pressure at the suture zone (18 Pa). The magnitude of pressure and secondary flows increased in the trachea and flow dynamics variations were observed also in the contralateral lung, causing altered lobar ventilation. The results confirmed that CFD is a patient-specific approach for a quantitative evaluation of fluid dynamics parameters and local ventilation providing additional information with respect to current clinical approaches. K E Y W O R D Scomputational fluid dynamics, imaged-based, pulmonary lobectomy, tracheobronchial tree modeling Marta Tullio and Lorenzo Aliboni equally contributed to this study.

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“… 8 Clinical studies on pulmonary function after lobectomy evidenced a reduction in volume variation on the side of surgery. 45 , 46 …”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Computational fluid dynamics of the airways after left‐upper pulmonary lobectomy: A case study

Tullio

Aliboni

Pennati

et al. 2021

Numer Methods Biomed Eng

Self Cite

View full text Add to dashboard Cite

show abstract

“…A secondary endpoint of our study is the evaluation of early postoperative respiratory function, measured by pulmonary function tests. There is no doubt that the greatest impact on respiratory function is attributable to the parenchymal sacrifice following the pulmonary lobectomy itself; nevertheless, the type of surgical insult of the chest wall is significant as well [24]. Hence, multiple chest wall incisions can potentially impact the decreased respiratory function more than a single incision.…”

Section: Discussionmentioning

confidence: 99%

Uniportal and three-portal video-assisted thoracic surgery pulmonary lobectomy for early-stage lung cancer (UNIT trial): study protocol of a single-center randomized trial

Mendogni

Mazzucco

Palleschi

et al. 2021

Trials

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Background Video-assisted thoracoscopic surgery (VATS) lobectomy is currently the recommended approach for treating early-stage non-small cell lung cancer (NSCLC). Different VATS approaches have been proposed so far, and the actual advantages of one technique over the other are still under debate. The aim of our study is to compare postoperative pain and analgesic drug consumption in uniportal VATS and triportal VATS for pulmonary lobectomy in early-stage lung cancer patients. Methods This study is a single-center, prospective, two-arm, parallel-group, randomized controlled trial. It is designed to compare uniportal video-assisted thoracic surgery (u-VATS) and three-port video-assisted thoracic surgery (t-VATS) in terms of postoperative pain. The trial will enroll 120 patients with a 1:1 randomization. The primary outcome is the assessment of analgesic drug consumption. Secondary outcomes are postoperative pain measurement, evaluation of postoperative pulmonary function, and metabolic recovery after pulmonary lobectomy. Discussion The choice of which VATS approach to adopt for treating patients undergoing pulmonary resection mostly depends on the surgeon’s preferences; therefore, it is hard to prove whether one VATS technique is superior to the other. Moreover, postoperative analgesic protocols vary consistently among different centers. To date, only a few studies have evaluated the effects of the most popular VATS techniques. There is no evidence about the difference between multiport VATS and u-VATS in terms of postoperative pain. We hope that the results of our trial will provide valuable information on the outcomes of these different surgical approaches. Trial registration ClinicalTrials.gov NCT03240250. Registered on 07 August 2017; retrospectively registered.

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“…A secondary endpoint of our study is the evaluation of early postoperative respiratory function, measured by pulmonary function tests. There is no doubt that the greatest impact on respiratory function is attributable to the parenchymal sacri ce following the pulmonary lobectomy itself; nevertheless, the type of surgical insult of the chest wall is signi cant as well [25]. Hence, multiple chest wall incisions can potentially impact the decreased respiratory function more than a single incision.…”

Section: Discussionmentioning

confidence: 99%

Uni-portal and three-portal video-assisted thoracic surgery pulmonary lobectomy for early stage lung cancer (UNIT trial): study protocol of a single-center randomized trial

Mendogni

Mazzucco

Palleschi

et al. 2021

Preprint

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BackgroundVideo-assisted thoracoscopic surgery (VATS) lobectomy is currently the recommended approach for treating early-stage non-small cell lung cancer (NSCLC). Different VATS approaches have been proposed so far, and the actual advantages of one technique over the other are still under debate. The aim of our study is to compare postoperative pain and analgesic drug consumption in uniportal VATS and triportal VATS for pulmonary lobectomy in early-stage lung cancer patients. MethodsThis study is a single-centre, prospective, two-arm, parallel-group, randomized controlled trial. It is designed to compare uniportal video-assisted thoracic surgery (u-VATS) and three-ports video-assisted thoracic surgery (t-VATS) in terms of post-operative pain. The trial will enrol 120 patients with a 1:1 randomization. The primary outcome is the assessment of analgesic drug consumption. Secondary outcomes are postoperative pain measurement, evaluation of postoperative pulmonary function, and metabolic recovery after pulmonary lobectomy. DiscussionThe choice of which VATS approach to adopt for treating patients undergoing pulmonary resection mostly depends on the surgeon’s preferences; therefore, it is hard to prove whether one VATS technique is superior to the other. Moreover, postoperative analgesic protocols vary consistently among different centres. To date, only a few studies have evaluated the effects of the most popular VATS techniques. There is no evidence about difference between multi-ports VATS and u-VATS in terms of postoperative pain. We hope that the results of our trial will provide valuable information on the outcomes of these different surgical approaches.Trial registrationClinicalTrials.gov. NCT03240250; registered 08/07/2017; retrospectively registered; https://clinicaltrials.gov/ct2/show/NCT03240250?term=NCT03240250&draw=2&rank=1

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Ribcage kinematics during exercise justifies thoracoscopic versus postero-lateral thoracotomy lobectomy prompt recovery†

Abstract: clinicaltrials.gov (NCT02910453).

Cited by 9 publications

References 24 publications

Computational fluid dynamics of the airways after left‐upper pulmonary lobectomy: A case study

Computational fluid dynamics of the airways after left‐upper pulmonary lobectomy: A case study

Uniportal and three-portal video-assisted thoracic surgery pulmonary lobectomy for early-stage lung cancer (UNIT trial): study protocol of a single-center randomized trial

Uni-portal and three-portal video-assisted thoracic surgery pulmonary lobectomy for early stage lung cancer (UNIT trial): study protocol of a single-center randomized trial

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