A prospective randomized trial comparing completion technique of fissures for lobectomy: Stapler versus precision dissection and sealant

Droghetti, Andrea; Schiavini, A; Muriana, Piergiorgio; Folloni, Anna; Picarone, Mauro; Bonadiman, Cinzia; Sturani, C; Paladini, R; Muriana, Giovanni

doi:10.1016/j.jtcvs.2008.04.014

Cited by 49 publications

(42 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The incidence of prolonged air leak (PAL) is a common complication after pulmonary major surgeries, which incidences reported 7.6-10% in several studies (1)(2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

The efficacy of thoracoscopic fissureless lobectomy in patients with dense fissures

et al. 2016

View full text Add to dashboard Cite

Background: Prolonged air leakage after a lobectomy remains a frequent complication in patients with dense fissures. To avoid postoperative air leakage, we used the "thoracoscopic fissureless technique" for patients with dense fissures. A thoracoscopic approach is useful for the fissureless technique because it gives a good operative view from various angles without dividing the fissure. In this study, we compared the perior intraoperative results of thoracoscopic fissureless lobectomies to traditional lobectomies with fissure dissection for pulmonary artery (PA) exposure in order to identify the efficacy of thoracoscopic fissureless lobectomy.Methods: Between April 2012 and November 2015, 175 patients underwent a thoracoscopic lobectomy with three or four ports, of whom 14 underwent a fissureless lobectomy because of dense fissures. We compared the characteristics and perioperative outcomes of the patients who underwent the fissureless technique (fissureless technique group, n=14) and the traditional fissure dissection technique for PA exposure (traditional technique group, n=161). In our department, fissureless lobectomy is indicated for patients with a fused fissure (fissural grade III or IV as proposed by Craig in 1997) or inflammation makes it difficult to expose the PA, while the traditional technique is used for other patients.Results: Although the fissureless technique group had longer operation time than the traditional technique group (P=0.0045), there was no significant inter-group difference about blood loss (P=0.85), occurrence rate of intraoperative massive bleeding (P=0.6) or conversion rate to thoracotomy (P=0.31). According to postoperative results, there was no significant inter-group difference in duration of chest tube drainage (P=0.56), length of postoperative hospital stay (P=0.14), or morbidity rate (P=0.16). No mortality occurred in either group.Conclusions: A thoracoscopic fissureless lobectomy is feasible and safe, and useful to avoid postoperative air-leakage in patients with dense fissures.

show abstract

“…The incidence of prolonged air leak (PAL) is a common complication after pulmonary major surgeries, which incidences reported 7.6-10% in several studies (1)(2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

The efficacy of thoracoscopic fissureless lobectomy in patients with dense fissures

et al. 2016

View full text Add to dashboard Cite

show abstract

“…19 In recent years, TachoSil (Takeda Pharma), a ready-to-use, fixed combination of a collagen sponge coated with a dry layer of the biologically active human coagulation factors fibrinogen and thrombin, was introduced into the market and was used mainly as a hemostatic agent in visceral, thoracic, gynecological, and urological surgery. 9,13,16,17,[29][30][31] In liver surgery, TachoSil was superior to argon-beam laser hemostasis in a controlled parallel group trial. 13 Several animal studies could prove a beneficial effect of TachoSil in hemostasis compared with other sealant techniques.…”

mentioning

confidence: 99%

Risk factors for postoperative CSF leakage after elective craniotomy and the efficacy of fleece-bound tissue sealing against dural suturing alone: a randomized controlled trial

Hütter

Felten²,

Sailer³

et al. 2014

JNS

View full text Add to dashboard Cite

W hile performing cranial surgery, it is of utmost importance to achieve a tight and reliable closure of the dura mater. Cerebrospinal fluid leakage leads to increased morbidity, prolongation of hospital stay, surgical revision, and enhanced costs as well as possible surgical revisions. 15,19 The incidence of CSF leakage is reported to depend on the location of surgery (for example, more likely in the posterior fossa)15 but may also depend on the size of the craniotomy and dural opening or on patient-related factors such as immune status, age, or the underlying pathological process. Dural closure is usually achieved with an intended watertight suture and the addition of hemostyptic or hemostatic agents such as fibrin glue or cellulose collections.2,4,12 Several studies have described the use of sealants as useful in avoiding CSF leakage in supratentorial, 4,20,28,33 Object. Cerebrospinal fluid leakage is an immanent risk of cranial surgery with dural opening. Recognizing the risk factors for this complication and improving the technique of dural closure may reduce the associated morbidity and its surgical burden. The aim of this paper was to investigate whether the addition of TachoSil on top of the dural suture reduces postoperative CSF leakage compared with dural suturing alone and to assess the frequency and risk factors for dural leakage and potentially related complications after elective craniotomy.Methods. The authors conducted a prospective, randomized, double-blinded single-center trial in patients undergoing elective craniotomy with dural opening. They compared their standard dural closure by running suture alone (with the use of a dural patch if needed) to the same closure with the addition of TachoSil on top of the suture. The primary end point was the incidence of CSF leakage, defined as CSF collection or any open CSF fistula within 30 days. Secondary end points were the incidence of infection, surgical revision, and length of stay in the intensive care unit (ICU) or intermediate care (IMC) unit. The site of craniotomy, a history of diabetes mellitus, a diagnosis of meningioma, the intraoperative need of a suturable dural substitute, and blood parameters were assessed as potential risk factors for CSF leakage.Results. The authors enrolled 241 patients, of whom 229 were included in the analysis. Cerebrospinal fluid leakage, mostly self-limiting subgaleal collections, occurred in 13.5% of patients. Invasive treatment was performed in 8 patients (3.5%) (subgaleal puncture in 6, lumbar drainage in 1, and surgical revision in 1 patient). Diabetes mellitus, a higher preoperative level of C-reactive protein (CRP), and the intraoperative need for a dural patch were positively associated with the occurrence of the primary end point (p = 0.014, 0.01, and 0.049, respectively). Cerebrospinal fluid leakage (9.7% vs 17.2%, OR 0.53 [95% CI 0.23-1.15], p = 0.108) and infection (OR 0.18 [95% CI 0.01-1.18], p = 0.077) occurred less frequently in the study group than in the control group. TachoSil significantly reduc...

show abstract

“…Eight (53%) of the 15 studies showed a statistically significant difference in favour of TachoSil. Further, two randomized controlled trials showed that use of TachoSil in pulmonary surgery generated savings in the range of 98.00–205.50 Euros per patient when compared with standard techniques 22,23…”

Section: Resultsmentioning

confidence: 99%

Economic and outcomes consequences of TachoSil®: a systematic review

Colombo¹,

Bettoni²,

Matteo³

et al. 2014

VHRM

View full text Add to dashboard Cite

BackgroundTachoSil® is a medicated sponge coated with human fibrinogen and human thrombin. It is indicated as a support treatment in adult surgery to improve hemostasis, promote tissue sealing, and support sutures when standard surgical techniques are insufficient. This review systematically analyses the international scientific literature relating to the use of TachoSil in hemostasis and as a surgical sealant, from the point of view of its economic impact.MethodsWe carried out a systematic review of the PubMed literature up to November 2013. Based on the selection criteria, papers were grouped according to the following outcomes: reduction of time to hemostasis; decrease in length of hospital stay; and decrease in postoperative complications.ResultsTwenty-four scientific papers were screened, 13 (54%) of which were randomized controlled trials and included a total of 2,116 patients, 1,055 of whom were treated with TachoSil. In the clinical studies carried out in patients undergoing hepatic, cardiac, or renal surgery, the time to hemostasis obtained with TachoSil was lower (1–4 minutes) than the time measured with other techniques and hemostatic drugs, with statistically significant differences. Moreover, in 13 of 15 studies, TachoSil showed a statistically significant reduction in postoperative complications in comparison with the standard surgical procedure. The range of the observed decrease in the length of hospital stay for TachoSil patients was 2.01–3.58 days versus standard techniques, with a statistically significant difference in favor of TachoSil in eight of 15 studies.ConclusionThis analysis shows that TachoSil has a role as a supportive treatment in surgery to improve hemostasis and promote tissue sealing when standard techniques are insufficient, with a consequent decrease in postoperative complications and hospital costs.

show abstract

A prospective randomized trial comparing completion technique of fissures for lobectomy: Stapler versus precision dissection and sealant

Cited by 49 publications

References 27 publications

The efficacy of thoracoscopic fissureless lobectomy in patients with dense fissures

The efficacy of thoracoscopic fissureless lobectomy in patients with dense fissures

Risk factors for postoperative CSF leakage after elective craniotomy and the efficacy of fleece-bound tissue sealing against dural suturing alone: a randomized controlled trial

Economic and outcomes consequences of TachoSil®: a systematic review

Contact Info

Product

Resources

About

A prospective randomized trial comparing completion technique of fissures for lobectomy: Stapler versus precision dissection and sealant

Cited by 49 publications

References 27 publications

The efficacy of thoracoscopic fissureless lobectomy in patients with dense fissures

The efficacy of thoracoscopic fissureless lobectomy in patients with dense fissures

Risk factors for postoperative CSF leakage after elective craniotomy and the efficacy of fleece-bound tissue sealing against dural suturing alone: a randomized controlled trial

Economic and outcomes consequences of TachoSil&reg;: a systematic review

Contact Info

Product

Resources

About

Economic and outcomes consequences of TachoSil®: a systematic review