Bleeding during Learning Curve of Thoracoscopic Lobectomy: CUSUM Analysis Results

Fiorelli, Alfonso; Cascone, Roberto; Carlucci, Annalisa; Natale, Giovanni; Noro, Antonio; Bove, Mary; Santini, Mario

doi:10.1055/s-0042-1742362

Cited by 4 publications

(7 citation statements)

References 31 publications

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“…ITNs that appear as cystic lesions on CT scan did not show a spinal extension in our study. Surgical removal in thoracoscopy of the entire lesion can be difficult because it can break the capsule during dissection 11 . After dissecting the pleura, the contents of the cystic lesion are aspirated to facilitate its mobilization and excision.…”

Section: Discussionmentioning

confidence: 99%

Intrathoracic neurogenic tumors (ITNs): Management of solid and cystic lesions

Natale

Forte²,

Messina

et al. 2023

Thoracic Cancer

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Background Intrathoracic neurogenic tumors (INTs) are derived from nerve tissue and grow within the chest. Preoperative diagnosis can be challenging and only complete surgical exeresis enables confirmation of the suspected diagnosis. Here, we analyzed our experience on management of paravertebral lesions with solid and cystic patterns. Methods A monocentric retrospective study was conducted, which included 25 consecutive cases of ITNs in the period from 2010 to 2022. These cases had been surgically treated by thoracoscopic resection alone, or in combination with neurosurgery in the case of dumbbell tumors. The demographic and operative data along with complications were recorded and analyzed. Results Twenty‐five patients were diagnosed with a paravertebral lesion of which 19 (76%) had solid features and six (24%) had cystic features. The most common diagnosis was schwannoma (72%), followed by neurofibroma (20%) and malignant schwannoma (8%). In four cases (12%) the tumor showed an intraspinal extension. None of the patients had recurrence until 6 months of follow‐up. Comparison between the VATS and thoracotomy procedures showed that outcome of discharge on the postoperative day, on average, was 2.61 ± 0.5 versus 3.51 ± 0.53, respectively (p‐value <0.001). Conclusion The treatment of choice for INTs is complete resection which is tailored to tumor size, location, and extension. In our study, paravertebral tumors with cystic characteristics were not associated with an intraspinal extension and did not show a different behavior from solid tumors.

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Section: Discussionmentioning

confidence: 99%

Intrathoracic neurogenic tumors (ITNs): Management of solid and cystic lesions

Natale

Forte²,

Messina

et al. 2023

Thoracic Cancer

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Section: Discussionmentioning

confidence: 99%

“…Unplanned conversion to thoracotomy remains a major concern in VATSL and it may discourage thoracic surgeons, especially in the early phase of the learning curve, from adopting this approach. 25 Despite the advantages of VATSL over thoracotomy lobectomy are well defined in literature; there are few and contrasting data regarding the consequences of unplanned converted VATSL on patients' outcome. Therefore, we planned a review study to evaluate whether unplanned converted VATS could increase the postoperative complications and negatively affect survival compared to successful VATSL and/or upfront thoracotomy lobectomy.…”

Section: Discussionmentioning

confidence: 99%

Did conversion to thoracotomy during thoracoscopic lobectomy increase post‐operative complications and prejudice survival? Results of best evidence topic analysis

Fiorelli

Forte²,

Santini

et al. 2022

Thoracic Cancer

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The potential complications related to unplanned conversion to thoracotomy remains a major concern in thoracoscopic lobectomy and may limit the wide adoption of this strategy. We reviewed the literature from 1990 until February 2022, analyzing all papers comparing successful thoracoscopic lobectomy versus converted thoracoscopic lobectomy and/or upfront thoracotomy lobectomy to establish whether unplanned conversion negatively affected outcomes. Thirteen studies provided the most applicable evidence to evaluate this issue. Conversion to thoracotomy was reported to occur in up to 23% of cases (range, 5%–16%). Vascular injury, calcified lymph nodes, and dense adhesions were the most common reasons for conversion. Converted thoracoscopic lobectomy compared to successful thoracoscopic lobectomy was associated with longer operative time and hospital stay in all studies, with higher postoperative complication rates in seven studies, and with higher perioperative mortality rates in four studies. No significant differences were found between converted thoracoscopic lobectomy and upfront thoracotomy lobectomy. Five studies evaluated long‐term survival, and in all papers conversion did not prejudice survival. Surgeons should not fear unplanned conversion during thoracoscopic lobectomy, but to avoid unexpected conversion that may negatively impact surgical outcome, a careful selection of patients is recommended–especially for frail patients.

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“…Regarding complications, a common concern during teaching and learning minimally invasive surgery is how to handle complications without compromising safety (24,32).…”

Section: Vats Teachingmentioning

confidence: 99%

“…The pulmonary artery may lead to catastrophic complications in the case of massive hemorrhage in the VATS scenario. Experience along with skills is mandatory to control it (19,32). From compression techniques to endoscopic suture, many solutions may come when facing a bleeding problem.…”

Section: Vats Teachingmentioning

confidence: 99%

The evolution of the contemporary thoracic surgeon: open surgery versus video-assisted thoracic surgery teaching—a clinical practice overview

Silva¹,

Calvinho²,

Olland³

et al. 2023

AME Surg J

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During the past few decades, thoracic surgery has been in constant evolution from open to more refined minimally invasive surgery techniques. Teaching and learning, in parallel with proficiency, competence and mastery are subject of debate nowadays. The aim of this paper is to describe the role of open surgery and video-assisted thoracic surgery (VATS) during training of the contemporary thoracic surgeon. The authors describe the learning process in different areas and phases throughout the paper. Open surgery, although less and less frequent, mainly for simple procedures, should not be under evaluated as it provides a unique source of learning opportunities. VATS, although globally adopted as the gold standard, must be part of any training program. Both open surgery and VATS provide complimentary learning methods and techniques and should happen simultaneously, not in a competitive way. Globally, despite the efforts from some institutions and experts, most countries do not present a unified and standardized approach to teaching new procedures. Introduction of standardized methods for quantification of training are recommended.Simulators, dry and wet labs and step-by-step programs should be implemented. The authors recommend implementation of surgical learning programs that have a rationale in their core that involves gradual evolution, including both open surgery and VATS to complement each other, and to create a training that is simultaneous and not competitive.

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Bleeding during Learning Curve of Thoracoscopic Lobectomy: CUSUM Analysis Results

Cited by 4 publications

References 31 publications

Intrathoracic neurogenic tumors (ITNs): Management of solid and cystic lesions

Intrathoracic neurogenic tumors (ITNs): Management of solid and cystic lesions

Did conversion to thoracotomy during thoracoscopic lobectomy increase post‐operative complications and prejudice survival? Results of best evidence topic analysis

The evolution of the contemporary thoracic surgeon: open surgery versus video-assisted thoracic surgery teaching—a clinical practice overview

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