Advantages of wound retractor device versus rigid trocar at camera port in video-assisted thoracic surgery—a single institution experience

Raveglia, Federico; Cioffi, Ugo; Simone, Matilde De; Rizzi, Alessandro; Leporati, A.; Tinelli, Carmine; Chiarelli, Marco; Baisi, Alessandro

doi:10.21037/jovs.2018.03.15

Cited by 8 publications

(4 citation statements)

References 11 publications

(8 reference statements)

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“…This will also minimize fulcrum effects which may otherwise result in local trauma to the chest wall, increased bleeding, and intercostal nerve injury. Incorrect positioning of the low posterior trocar is a technical error that, although surmountable, definitely increased the level of difficulty in the case described (9).…”

Section: Discussionmentioning

confidence: 91%

Thoracoscopic S2 segmentectomy by a posterior approach for a central metastasis: a case report

Rakovich¹

2022

J Vis Surg

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Central metastases are an ideal indication for anatomic sublobar resection. This allows adequate, safe resection, with preservation of lung function and decreased morbidity. This paper illustrates a case of S2 segmentectomy for a central metastasis and highlights key technical considerations. The author finds that a direct posterior approach to S2 facilitates the operation, minimizing dissection and allowing sparing of the horizontal fissure which may reduce the potential for prolonged air leak. Sparing tissue planes may also facilitate redo-surgery and increase therapeutic options in the event of future metastatic disease. Anatomic sublobar resection requires attention to detail. Planning is very important, and advanced imaging including 3D reconstruction and 3D printing is increasingly being considered for this purpose. Intraoperatively, correct positioning of trocars and deliberate, purposeful retraction are key. Finally, a challenge specific to the resection of central S2 segment lesions is the requirement for sufficient space at the base of the segment to allow parenchymal division with negative margins. Methodical identification, dissection, and division of the segmental venous drainage is an important step that allows the space at the base of the segment to open up. This space can then be dissected widely in order to position the stapler and complete the resection, even for lesions at the very root of the segment.

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Section: Discussionmentioning

confidence: 91%

Thoracoscopic S2 segmentectomy by a posterior approach for a central metastasis: a case report

Rakovich¹

2022

J Vis Surg

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“…Most of the new instruments were introduced by companies such as Scanlan International (St. Paul, MN, USA), Pilling Surgical (Horsham, PA, USA), Thoramet (Rotherford, NJ, USA) among others. A consensus in the literature is the benefit of using the soft tissue retractor [8][9] . Studies on the impact of how specific instruments interfere in the conduct and success of a surgical procedure are scarce, many of them limited to presenting innovation [10][11][12][13][14][15][16][17][18] .…”

Section: Introductionmentioning

confidence: 99%

Thoracoscopic instruments do not interfere in the outcome of uncomplicated, experimental, video-assisted pulmonary lobectomy

Oliveira

Castro

2020

Rev. Col. Bras. Cir.

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Objective: Since its first report, video-assisted thoracic surgery (VATS) lung lobectomy was carried out with the use of conventional surgical instruments, used in laparoscopy and open thoracotomy. These instruments are expensive, not standardized and there are a variety of models and manufacturers. The aim of this study was to determine the impact of the use of these instruments on the experimental pulmonary lobectomy. Methods: We used a modified surgical simulator that uses a porcine heart-lung block filled with tomato sauce, and tested specific (Group 1) and regular (Group 2) instruments. Each group includes 15 experiments. Results: The median total time, excluding the time spent to correct the lesions, was 45.08 and 45.81 minutes, respectively in Group 1 and Group 2. There was no statistical difference between the total times (p=0.58). The only statistically different was seen for partial times regarding the elapsed time to cut and suture of lung fissures (p=0.03 and 0.04, respectively). There were more direct lesions and indirect leaks in Group 2, but without statistical significance (p=1.000 and p=0.203, respectively). The mean time spent for the diagnosis and correction of these events was 1.77 minutes with a standard deviation of 1.18 for Group 1 and 2.72 ± 1.11 minutes for Group 2 (p=0.044). Conclusion: The use of minimally invasive instruments is not associated with time improvement spent with experimental video-assisted lung lobectomy and does not lead to a faster or safer surgery. The use of VATS instruments makes correction of adverse events faster when they occur.

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“…These advantages include less postoperative pain, shorter hospital stay, and a quicker return to daily activities [ 1 , 2 ]. However, VATS can still induce significant postoperative pain, which arises from damage to the intercostal nerves and thoracic wall muscles due to trocar insertion, as well as intercostal nerve compression or irritation caused by chest tube placement and pleural bleeding [ 3 , 4 ]. Uncontrolled acute postoperative pain can increase postoperative complications and length of hospital stay, lead to chronic postoperative pain, and result in a long-term decline in quality of life after surgery [ 5 ].…”

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confidence: 99%

Effect of an intravenous acetaminophen/ibuprofen fixed-dose combination on postoperative opioid consumption and pain after video-assisted thoracic surgery: a double-blind randomized controlled trial

Lee,

Choi,

Yoon

et al. 2024

Surg Endosc

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Background Video-assisted thoracoscopic surgery (VATS) often induces significant postoperative pain, potentially leading to chronic pain and decreased quality of life. This study aimed to evaluate the acetaminophen/ibuprofen combination effectiveness in reducing analgesic requirements and pain intensity in patients undergoing VATS. Study design This is a double-blinded randomized controlled trial. Methods Adult patients scheduled for elective VATS for lung resection were randomized to receive either intravenous acetaminophen and ibuprofen (intervention group) or 100 mL normal saline (control group). Treatments were administered post-anesthesia induction and every 6 h for three cycles. The primary outcome was total analgesic consumption at 24 h postoperatively. Secondary outcomes were cumulative analgesic consumption at 2 and 48 h; analgesic-related side effects at 2, 24, and 48 h; quality of recovery at 24 h and 48 h postoperatively; pain intensity at rest and during coughing; and rescue analgesics use. Chronic postsurgical pain (CPSP) was assessed through telephone interviews 3 months postoperatively. Results The study included 96 participants. The intervention group showed significantly lower analgesic consumption at 24 h and 48 h postoperatively (24 h: median difference: − 100 µg equivalent intravenous fentanyl [95% confidence interval (CI) − 200 to − 5 μg], P = 0.037; 48 h: median difference: − 140 μg [95% CI − 320 to − 20 μg], P = 0.035). Compared to the controls, the intervention group exhibited a significantly lower quality of recovery 24 h post-surgery, with no significant difference at 48 h. All pain scores except for coughing at 48 h post-surgery were significantly lower in the intervention group compared to the controls. No significant differences were observed between the groups in postoperative nausea and vomiting occurrence, hospital stay length, and CPSP. Conclusion Perioperative administration of acetaminophen/ibuprofen significantly decreased analgesic needs in patients undergoing VATS, providing an effective postoperative pain management strategy, and potentially minimizing the need for stronger analgesics.

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Advantages of wound retractor device versus rigid trocar at camera port in video-assisted thoracic surgery—a single institution experience

Abstract: patients who had WR showed less postoperative pain. Moreover, WR presented other advantages: camera protection by small bleeding from chest wall, adaptability with every chest wall thickness, absence of skin injury around the port. We suggest its use instead of rigid trocar.

Cited by 8 publications

References 11 publications

Thoracoscopic S2 segmentectomy by a posterior approach for a central metastasis: a case report

Thoracoscopic S2 segmentectomy by a posterior approach for a central metastasis: a case report

Thoracoscopic instruments do not interfere in the outcome of uncomplicated, experimental, video-assisted pulmonary lobectomy

Effect of an intravenous acetaminophen/ibuprofen fixed-dose combination on postoperative opioid consumption and pain after video-assisted thoracic surgery: a double-blind randomized controlled trial

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