Importance of preoperative imaging with 64-row three-dimensional multidetector computed tomography for safer video-assisted thoracic surgery in lung cancer

Akiba, Tadashi; Marushima, Hideki; Harada, Junta; Kobayashi, Susumu; Morikawa, Toshiaki

doi:10.1007/s00595-009-3965-1

Cited by 57 publications

(47 citation statements)

References 7 publications

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“…An increasing number of literature reports suggest that, within this protocol, computed tomography should be routinely performed before each thoracotomy or video-assisted thoracoscopic surgery in order to detect the potential variations described above. This form of examination may reduce the number of dangerous vascular complications [13][14][15][16].…”

Section: Venous Systemmentioning

confidence: 99%

Thoracic surgery Anatomic variations of pulmonary vessels relevant with regard to lung tissue resections – literature review and personal experiences

Polaczek¹,

Religioni²,

Orłowski³

2013

kitp

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StreszczenieMałoinwazyjne metody anatomicznych resekcji miąższu płuc-nego stają się klinicznym standardem. Wymagają one od chirurga świetnej znajomości anatomii operowanego obszaru. Stworzono kompleksowy opis anatomii prawidłowej oraz znanych z piśmiennictwa zmienności naczyń płucnych na uży-tek torakochirurgii. Przeanalizowano również 642 przypadki zabiegów resekcji miąższu płucnego u pacjentów z rakiem niedrobnokomórkowym płuca operowanych w Klinice Chirurgii Instytutu Gruźlicy i Chorób Płuc w Warszawie, poszukując wzmianek o zmiennościach anatomicznych dostrzeżonych w trakcie zabiegu. Wyniki tej analizy zostały porównane z danymi z piśmiennictwa. Zmienność w obrębie układu tętniczego opisano w 8,72% przypadków, a układu żylnego w 3,12% przypadków. Częstość ta jest niższa, niż zakładana na postawie danych dostępnych w piśmiennictwie. Opisano natomiast kilka bardzo rzadkich, ale potencjalnie niebezpiecznych odmian. Słowa kluczowe: tętnice płucne, żyły płucne, zmienność.Kardiochirurgia i Torakochirurgia Polska 2013; 10 (3) 232 THORACIC SURGERY AbstractThe less invasive methods of lung tissue resection are becoming a clinical standard. This obligates surgeons to be well trained in the field of anatomy. Thus, we decided to create a comprehensive description of normal anatomy as well as anatomical variations of pulmonary vessels for the purpose of thoracic surgery procedures. We also retrospectively analyzed a database of 642 patients with lung cancer who underwent lung tissue resection at the Department of Surgery of the National Tuberculosis and Lung Diseases Research Institute in Warsaw (Poland), searching for descriptions of the anatomic variations observed during the surgical procedures. The results were subsequently compared to existing literature data. Variations of the arterial system were found in 8.72% of cases. Variations of the venous system were described in 3.12%. The frequency of variations in our database is lower than previously suspected based on the literature data. Nevertheless, several rare and potentially dangerous variations were described.

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Section: Venous Systemmentioning

confidence: 99%

Thoracic surgery Anatomic variations of pulmonary vessels relevant with regard to lung tissue resections – literature review and personal experiences

Polaczek¹,

Religioni²,

Orłowski³

2013

kitp

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show abstract

“…Patients scheduled for thoracic surgery in Jikei University Kashiwa Hospital are routinely examined by computed tomography (Aquilion 64; Toshiba, Tokyo, Japan) after intravenous administration of an iodinated contrast 3,4) the data are transferred to the picture archiving and communication system (PACS).…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic Lobectomy for Treating Cancer in a Patient with an Unusual Vein Anomaly

Akiba

Marushima

Kamiya

et al. 2011

ATCS

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Various anatomical variants in pulmonary veins can have a serious effect on patients undergoing lung surgery. We present a case of a patient with an unusual pulmonary vein variation. Preoperative review of the patient's three-dimensional 64-row multidetector computed tomography imaging allowed us precise simulation and good orientation of the patient's vascular variant anatomy during surgery. Upper lobectomy through thoracoscopic approach was performed successfully in the case where the middle lobe vein might have been divided without preoperative anatomical evaluation by 3D CT images.

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“…These high resolution scans, often available with three dimensional reconstruction, can provide valuable opportunities to identify standard and anomalous vascular variations prior to surgery in greater than 95% of cases (2)(3)(4)(5)(6). Imaging may also identify calcification of lymph nodes, which may predict a conversion rate of greater than 30% when hilar or central in location (3).…”

Section: Preoperative Radiologic Assessment Of Vascular and Anatomic mentioning

confidence: 99%

Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion

Safdie¹,

Sanchez²,

Sarkaria³

2017

J. Vis. Surg.

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Video assisted thoracic surgery (VATS) has become a routinely utilized approach to complex procedures of the chest, such as pulmonary resection. It has been associated with decreased postoperative pain, shorter length of stay and lower incidence of complications such as pneumonia. Limitations to this modality may include limited exposure, lack of tactile feedback, and a two-dimensional view of the surgical field. Furthermore, the lack of an open incision may incur technical challenges in preventing and controlling operative misadventures leading to major hemorrhage or other intraoperative emergencies. While these events may occur in the best of circumstances, prevention strategies are the primary means of avoiding these injuries. Unplanned conversions for major intraoperative bleeding or airway injury during general thoracic surgical procedures are relatively rare and often can be avoided with careful preoperative planning, review of relevant imaging, and meticulous surgical technique. When these events occur, a pre-planned, methodical response with initial control of bleeding, assessment of injury, and appropriate repair and/ or salvage procedures are necessary to maximize outcomes. The surgeon should be well versed in injuryspecific incisions and approaches to maximize adequate exposure and when feasible, allow completion of the index operation. Decisions to continue with a minimally invasive approach should consider the comfort and experience level of the surgeon with these techniques, and the relative benefit gained against the risk incurred to the patient. These algorithms may be expected to shift in the future with increasing sophistication and capabilities of minimally invasive technologies and approaches. hemorrhage within moments. While these events may occur in the best of circumstances, prevention strategies are the primary means of avoiding these injuries. When they do occur, premeditated and expedited intervention is the key to rescue (1). The current report focuses on the prevention and management of these emergency bleeding events in VATS pulmonary resections. Preoperative radiologic assessment of vascular and anatomic variationRigorous preoperative evaluation of fitness of surgery is a key component of any operative assessment. Preoperative identification and awareness of case-specific and patientspecific risk factors may help prevent hemorrhagic complications in most lung resections. These factors include body habitus, preoperative chemotherapy and radiation, bleeding diatheses including medical anticoagulants, previous thoracic surgery, lymph node calcification and/or granulomatous disease, tumor size and location.Computed chest tomography has become a standard of care in virtually all cases considered for major pulmonary resection. These high resolution scans, often available with three dimensional reconstruction, can provide valuable opportunities to identify standard and anomalous vascular variations prior to surgery in greater than 95% of cases (2-6). Imaging may also identify cal...

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Importance of preoperative imaging with 64-row three-dimensional multidetector computed tomography for safer video-assisted thoracic surgery in lung cancer

Abstract: 3D-MDCT imaging is useful for preoperatively understanding the individual thoracic anatomy in lung cancer surgery. This modality can therefore contribute to safer anatomical pulmonary operations, especially in VATS.

Cited by 57 publications

References 7 publications

Thoracic surgery Anatomic variations of pulmonary vessels relevant with regard to lung tissue resections – literature review and personal experiences

Thoracic surgery Anatomic variations of pulmonary vessels relevant with regard to lung tissue resections – literature review and personal experiences

Thoracoscopic Lobectomy for Treating Cancer in a Patient with an Unusual Vein Anomaly

Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion

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