Technique of video-assisted thoracoscopic left pneumonectomy

Hennon, Mark; Demmy, Todd L.

doi:10.21037/jovs.2017.02.06

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…The open PN and SL were performed using standard surgical procedure. Of note, when performing VATS PN we commonly adopt procedures described by Demmy et al ( 27 ). Patient follow up was determined by arrival to scheduled follow up appointments at the Roswell Park Thoracic Surgery Clinic.…”

Section: Methodsmentioning

confidence: 99%

Analyzing the impact of minimally invasive surgical approaches on post-operative outcomes of pneumonectomy and sleeve lobectomy patients

Nitsche¹,

Jordan²,

Demmy³

et al. 2023

J Thorac Dis

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Background: Some patients with non-small cell lung cancer (NSCLC) have superior short-and long-term outcomes with sleeve lobectomy rather than pneumonectomy. Originally sleeve lobectomy was reserved for patients with limited pulmonary function, however, the reported superior results allowed sleeve lobectomy to be performed in expanded patient populations. In a further attempt to improve post-operative outcomes surgeons have adopted minimally invasive techniques Minimally invasive approaches have potential benefits to patients such as decreased morbidity and mortality while maintaining the same caliber of oncologic outcomes. Methods:We identified patients at our institution who underwent sleeve lobectomy or pneumonectomy to treat NSCLC from 2007 to 2017. We analyzed these groups in respect to 30-and 90-day mortality, complications, local recurrence, and median survival. We included multivariate analysis to determine the impact of a minimally invasive approach, sex, extent of resection, and histology. Differences in mortality were analyzed using the Kaplan-Meier method using the log-rank test to compare the groups. A two-tailed Z test for difference in proportions was done to analyze complications, local recurrence, 30-day and 90-day mortality.Results: A total of 108 patients underwent sleeve lobectomy (n=34) or pneumonectomy (n=74) for treatment of NSCLC with 18 undergoing open pneumonectomy, 56 undergoing video-assisted thoracoscopic surgery (VATS) pneumonectomy, 29 undergoing open sleeve lobectomy, and 5 undergoing VATS sleeve lobectomy. There was no significant difference in 30-day mortality (P=0.064) but there was a difference in 90-day (P=0.007). There was no difference in complication rates (P=0.234) or local recurrence rates (P=0.779).The pneumonectomy patients had a median survival of 23.6 months (95% CI: 3.8-43.4 months). The sleeve lobectomy group had a median survival of 60.7 months (95% CI: 43.3-78.2 months) (P=0.008). On multivariate analysis extent of resection (P<0.001) and tumor stage (P=0.036) were associated with survival.There was no significant difference between the VATS approach and the open surgical approach (P=0.053).Conclusions: When considering patients undergoing surgery for NSCLC sleeve lobectomy resulted in lower 90-day mortality and better 3-year survival compared to patients undergoing PN. Having a sleeve lobectomy rather than a pneumonectomy and having earlier-stage disease lead to significantly improved survival on multivariate analysis. Having a VATS operation leads to a non-inferior post-operative outcome compared to open surgery.

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Section: Methodsmentioning

confidence: 99%

Analyzing the impact of minimally invasive surgical approaches on post-operative outcomes of pneumonectomy and sleeve lobectomy patients

Nitsche¹,

Jordan²,

Demmy³

et al. 2023

J Thorac Dis

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“…We previously described our general approach to advanced resections. 1 , 2 Briefly, the highly adaptable technique requires flexible 5-mm or 10-mm (3-dimensional) optics (Olympus Endoeye) and numerous thin shaft retractor instruments (Sontec) often filling the same ports ( Figure 1 ). We use a 3-incision upper lobe approach achieving the key elements of pleural exploration, adequate proximal PA exposure, sequential structure divisions (bronchus last), lymphadenectomy, and stump coverage.…”

Section: Methodsmentioning

confidence: 99%

Thoracoscopic right intrapericardial pneumonectomy

Hennon,

Demmy

2023

JTCVS Techniques

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The role of thoracoscopic pneumonectomy in surgical treatment of lung diseases

Порханов

Данилов²,

Kononenko³

et al. 2019

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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The objective was to estimate the immediate results of thoracoscopic pneumonectomies in various surgical lung diseases.Material and methods. Patients were divided into groups depending on the surgical access: thoracoscopy – group 1 (15 patients), thoracotomy – group 2 (30 patients). We performed 12 left-sided (80 %) and 3 right-sided (20 %) operations in group 1. We performed 23 left-sided (76.7 %) and 7 right-sided (23.3 %) operations in group 2.Results. The average duration of the operation in group 1 was (161±27) min (from 120 to 230 min), in group 2 – (128±34) min (from 75 to 180 min). The number of removed lymph nodes during lymphadenectomy in group 1 was (19±10) nodes (from 6 to 40), in group 2 – (18±9) nodes (from 6 to 38). The severity of the pain syndrome after surgery on the Visual Analogue Scale for Pain in group 1 was 2.4±0.3, in group 2 – (4.4±0.3) (p=0.04), duration of ICU stay in group 1 was (2.0±0.7) days (from 1.0 to 3.0), in group 2 – (4.1±1.2) days (3.0 to 6.0). There were no mortality in both groups.Conclusion. In carefully selected patients, thoracoscopy access during pneumonectomy demonstrates better immediate results comparing to thoracotomy (less pain syndrome, shorter duration of treatment in the ICU, hospital) with the same duration of operation and volume of lymph dissection.

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Technique of video-assisted thoracoscopic left pneumonectomy

Cited by 3 publications

References 14 publications

Analyzing the impact of minimally invasive surgical approaches on post-operative outcomes of pneumonectomy and sleeve lobectomy patients

Analyzing the impact of minimally invasive surgical approaches on post-operative outcomes of pneumonectomy and sleeve lobectomy patients

Thoracoscopic right intrapericardial pneumonectomy

The role of thoracoscopic pneumonectomy in surgical treatment of lung diseases

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