Adverse factors and postoperative neuropathic pain in challenging video-assisted thoracoscopic surgery

Homma, Takashi; Shimada, Yasuhiro; Tanabe, Keitaro; Akemoto, Yushi; Ojima, Toshihiro; Yamamoto, Yutaka; Kitamura, Naoya; Yoshimura, Naoki

doi:10.21037/apm-20-1729

Cited by 9 publications

(14 citation statements)

References 26 publications

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“…Previously, we have reported on neuropathic pain after thoracic surgery (15)(16)(17). The risk factors for neuropathic pain were preoperative use of hypnotic medication, thoracotomy, and duration of surgery ≥2.5 h, and VATS was negatively associated with postoperative neuropathic pain (15).…”

Section: The Development Of Minimally Invasive Approachesmentioning

confidence: 99%

“…In cases of severe adhesion, bronchoplasty, angioplasty, and large tumors with a minimum diameter ≥5 cm, VATS tended to take a long period or convert to thoracotomy. The patients who underwent VATS with operation time longer than 5 hours and converted to thoracotomy, had significantly higher postoperative neuropathic pain (71.4% vs. 22.0%; P<0.0001) (17). It was difficult to eliminate postoperative neuropathic pain, and further improvements are needed.…”

Section: The Development Of Minimally Invasive Approachesmentioning

confidence: 99%

“…Ideally, patients should be asymptomatic after surgery. Our previous studies showed that multidimensional approaches are necessary to achieve symptom-free status, including less invasive surgical approaches, additional pain control methods, and the time effect (15)(16)(17).…”

Section: The Development Of Minimally Invasive Approachesmentioning

confidence: 99%

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Decreased postoperative complications, neuropathic pain and epidural anesthesia-free effect of uniportal video-assisted thoracoscopic anatomical lung resection: a single-center initial experience of 100 cases

Homma¹,

Shimada²,

Tanabe³

2022

J Thorac Dis

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Background: We aimed to analyze perioperative complications, postoperative neuropathic pain, and the necessity of epidural anesthesia in uniportal video-assisted thoracoscopic surgery (U-VATS) compared to conventional multiportal VATS (M-VATS) for anatomical lung resection. Methods: This retrospective study included all patients who underwent elective VATS lobectomy and segmentectomy between April 2016 and December 2019. The exclusion criteria were as follows: age ≤19 years, planned thoracotomy, re-operation in thoracic surgery, median sternotomy, robot-assisted thoracic surgery, simultaneous resection of extrathoracic organs, locally invasive lung tumor with bronchoplasty or angioplasty, past or current neuropathic pain, and a large tumor with a minimum diameter ≥5 cm. M-VATS had 4 ports approach. U-VATS port positions were placed by extending the thoracoscope port of M-VATS. Results: U-VATS patients showed significant differences compared to M-VATS patients: smaller intraoperative bleeding (1 vs. 30 mL; P=0.0010), shorter operative time (141 vs. 183 min; P<0.0001), posthospitalization (5 vs. 8 days; P=0.0002), fewer complications (23.9% vs. 40.9%; P=0.048), less acute pain, less postoperative neuropathic pain (32.4% vs. 52.1%; P=0.027) and shorter duration of neuropathic pain (30 vs. 60 days; P=0.041). For the postoperative neuropathic pain and pain score until postoperative day 5, there were no differences between the groups with and without epidural anesthesia. Conclusions: As a single-center initial experience, U-VATS lobectomy and segmentectomy seemed safe and minimally invasive based on not only postoperative neuropathic pain and complications but also time management. U-VATS would provide better pain control, without epidural anesthesia.

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Section: The Development Of Minimally Invasive Approachesmentioning

confidence: 99%

Section: The Development Of Minimally Invasive Approachesmentioning

confidence: 99%

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Decreased postoperative complications, neuropathic pain and epidural anesthesia-free effect of uniportal video-assisted thoracoscopic anatomical lung resection: a single-center initial experience of 100 cases

Homma¹,

Shimada²,

Tanabe³

2022

J Thorac Dis

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“…In lung cancer surgery, severe adhesions were subdivided into three groups depending on the location: whole thoracic cavity, locally invasive, and vascular sheath adhesions. Chest ultrasound sonography is useful for assessing adhesions throughout the thoracic cavity [ 67 , 68 ]. Cine MRI would be effective in imaging areas not accessible by ultrasonography.…”

Section: Energy Devices In Lung Cancer Surgerymentioning

confidence: 99%

Advances and safe use of energy devices in lung cancer surgery

Homma

2022

Gen Thorac Cardiovasc Surg

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Objectives A clear understanding of energy devices would help achieve high effectiveness and safety and guide the selection of devices. The present review aimed to elucidate the efficacy and adverse events of energy devices in lung cancer to guide the selection of appropriate devices depending on the situation. Methods Four major databases were searched electronically for relevant articles published until 16 April 2021. The reference lists of the identified papers were examined. We excluded (1) irrelevant studies, (2) manuscripts published in languages other than English and Japanese, (3) duplicates, and (4) studies for which the full text was not available in the databases. The results and key information obtained were summarized by means of a narrative approach. Results A total of 78 papers were included in the review and these were categorized according to the main topic of investigation as follows: (1) electrosurgery-related injuries, (2) fundamentals of electrosurgery, (3) monopolar devices, (4) bipolar electrosurgical devices, (5) ultrasonic energy devices, (6) energy devices in lung cancer surgery, (7) operating room fire risks, and (8) basic principles of surgery. Conclusions Understanding energy devices could help us use them in a more effective and safer manner. Knowledge of their selection criteria (suitability), merits, risks, and safety precautions relevant to each process of lung cancer surgery could guide appropriate selection.

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“…In a retrospective analysis of thoracic surgery in Japan, 10/14 patients (71.4%) who converted from minimally invasive videoassisted thoracoscopic surgery to invasive thoracotomy reported postoperative neuropathic pain. Of these, three patients developed intractable symptoms (15). In a second retrospective analysis of 200 Italian patients who underwent lung resection via minithoracotomy or videoassisted thoracoscopic surgery, the overall incidence of CPSP was 35%.…”

Section: Introductionmentioning

confidence: 97%

Mirogabalin treatment of postoperative neuropathic pain after thoracic surgery: study protocol for a multicenter, randomized, open-label, parallel-group, interventional trial

Doi¹,

Miyazaki²,

Tsuchiya³

et al. 2021

J Thorac Dis

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Adverse factors and postoperative neuropathic pain in challenging video-assisted thoracoscopic surgery

Cited by 9 publications

References 26 publications

Decreased postoperative complications, neuropathic pain and epidural anesthesia-free effect of uniportal video-assisted thoracoscopic anatomical lung resection: a single-center initial experience of 100 cases

Decreased postoperative complications, neuropathic pain and epidural anesthesia-free effect of uniportal video-assisted thoracoscopic anatomical lung resection: a single-center initial experience of 100 cases

Advances and safe use of energy devices in lung cancer surgery

Mirogabalin treatment of postoperative neuropathic pain after thoracic surgery: study protocol for a multicenter, randomized, open-label, parallel-group, interventional trial

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