Spontaneous ventilation thoracoscopic thymectomy without muscle relaxant for myasthenia gravis: Comparison with “standard” thoracoscopic thymectomy

Jiang, Long; Depypere, Lieven; Rocco, Gaetano; Chen, Jin‐Shing; Li, Jun; Shao, Wenlong; Yang, Hanyu; He, Jianxing

doi:10.1016/j.jtcvs.2017.11.045

Cited by 38 publications

(32 citation statements)

References 38 publications

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“…Thoracoscopic surgery without endotracheal intubation could avoid intubation and mechanical ventilation-related side effects (15) . Several studies showed the technical feasibility and safety of this technique, complication rates was lower, including sore throat, nausea, irritable cough, urinary retention, with shorter length of hospital stay (16) . Hypercapnia might occur during operation, a laryngeal mask coulds be used to maintain satisfactory oxygenation, preventing gastric re ux and aspiration (17,18) .…”

Section: Discussionmentioning

confidence: 97%

Tubeless Uniportal Thoracoscopic Wedge Resection with Modified Air Leak Test and Chest Tube Drainage

Liu

Yang

Sun

2020

Preprint

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Background: To investigate whether tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage has better short-term outcomes than non-intubated approach with chest tube drainage.Methods: Data were collected retrospectively from January 2017 and December 2019. Tubeless group included 55 patients with pulmonary nodules underwent tubeless uniportal thoracoscopic wedge resection, 211 patients underwent non-intubated uniportal thoracoscopic wedge resection with chest tube drainage were included in drainage group. Peri-operative outcomes between two groups were compared. Results: After 1:1 matching, 110 patients remained for analysis, baseline demographic and clinical variables were comparable between the two groups. Mean incision size was 3 cm in both group. Mean operative time was 59.3 minutes in tubeless group and 52.8 minutes in drainage group. The detectable mean lowest SpO2 and mean peak EtCO2 during operation was acceptable in both groups. Conversion to intubated ventilation or thoracotomy was not required. No patient failed the air leak test and did not undergo a tubeless procedure. Mean postoperative hospital stay was 1.5 days in tubeless group and 2.5 days in drainage group. Residual pneumothorax or subcutaneous emphysema was not frequent and mild in tubeless group. Side effects were rare and mild, including cough and hemoptysis. No re-intervention or readmission occurred. The postoperative VAS score was significantly lower in tubeless group.Conclusions: Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage is feasible and safe for selected patients with peripheral pulmonary nodules, it might reduce post-operation pain and lead to faster recovery.

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Section: Discussionmentioning

confidence: 97%

Tubeless Uniportal Thoracoscopic Wedge Resection with Modified Air Leak Test and Chest Tube Drainage

Liu

Yang

Sun

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Thoracoscopic surgery without endotracheal intubation could avoid intubation and mechanical ventilationrelated side effects [15]. Several studies showed the technical feasibility and safety of this technique, complication rates was lower, including sore throat, nausea, irritable cough, urinary retention, with shorter length of hospital stay [16]. Hypercapnia might occur during operation, a laryngeal mask coulds be used to maintain satisfactory oxygenation, preventing gastric reflux and aspiration [17,18].…”

Section: Discussionmentioning

confidence: 99%

Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage

2020

View full text Add to dashboard Cite

Background To investigate whether tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage has better short-term outcomes than non-intubated approach with chest tube drainage. Methods Data were collected retrospectively from January 2017 and December 2019. Tubeless group included 55 patients with pulmonary nodules underwent tubeless uniportal thoracoscopic wedge resection, 211 patients underwent non-intubated uniportal thoracoscopic wedge resection with chest tube drainage were included in drainage group. Peri-operative outcomes between two groups were compared. Results After 1:1 matching, 110 patients remained for analysis, baseline demographic and clinical variables were comparable between the two groups. Mean incision size was 3 cm in both group. Mean operative time was 59.3 min in tubeless group and 52.8 min in drainage group. The detectable mean lowest SpO2 and mean peak EtCO2 during operation was acceptable in both groups. Conversion to intubated ventilation or thoracotomy was not required. No patient failed the air leak test and did not undergo a tubeless procedure. Mean postoperative hospital stay was 1.5 days in tubeless group and 2.5 days in drainage group. Residual pneumothorax or subcutaneous emphysema was not frequent and mild in tubeless group. Side effects were rare and mild, including cough and hemoptysis. No re-intervention or readmission occurred. The postoperative VAS score was significantly lower in tubeless group. Conclusions Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage is feasible and safe for selected patients with peripheral pulmonary nodules, it might reduce post-operation pain and lead to faster recovery.

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“…A recent study by Jiang et al [29] examined the use of spontaneous-ventilation video-assisted thoracic thymectomy (SV-VATT) in patients with MG, and demonstrated successful thymectomy without endotracheal intubation. However, this procedure requires excellent anesthetic technique and management, and can be technically challenging for a surgeon.…”

Section: Discussionmentioning

confidence: 99%

Early extubation after thymectomy is good for the patients with myasthenia gravis

et al. 2019

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ObjectivesPatients with myasthenia gravis (MG) often benefit from thymectomy, but the optimal timing of extubation following thymectomy in these patients remains unknown. This study of MG patients compared the effect of early and late extubation following thymectomy on clinical outcome.MethodsWe performed a study of data from 96 patients with MG who received thymectomy procedures, followed by early (< 6 h) or late (> 6 h) extubation, at our institution between October 2011 and November 2017. Patient clinical and demographic characteristics, preoperative data, and postoperative clinical outcomes were analyzed. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.ResultsThe patients in the early extubation group (n = 53) and late extubation group (n = 43) had similar preoperative clinical and demographic characteristics. However, the early extubation group had a significantly longer duration of MG (24 months vs. 12 months, P < 0.013) and a lower incidence of reintubation (11.3% vs. 37.2%, P = 0.003). Postoperative pulmonary infection was significantly more common in the late extubation group (39.5% vs. 11.3%, P = 0.001; adjusted odds ratio = 6.94, 95% CI 1.24–38.97). Also, patients in the late extubation group had a longer duration of ICU stay (6.4 ± 4.0 h vs. 4.3 ± 1.8 h; P = 0.003) and had a longer adjusted duration of ICU stay by 0.93 days (95% CI 0.02–1.85).ConclusionsOur analysis of patients with MG who received thymectomy procedures indicated that early extubation was associated with improved clinical outcomes, in particular with reduced risk of postoperative pulmonary infection and reduced ICU stay.Electronic supplementary materialThe online version of this article (10.1007/s10072-019-03941-0) contains supplementary material, which is available to authorized users.

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Spontaneous ventilation thoracoscopic thymectomy without muscle relaxant for myasthenia gravis: Comparison with “standard” thoracoscopic thymectomy

Abstract: SV-VATT is a feasible procedure in patients with MG. It might be beneficial by reducing postoperative myasthenic crisis and postoperative prolonged tracheal intubation. Further prospective research is needed.

Cited by 38 publications

References 38 publications

Tubeless Uniportal Thoracoscopic Wedge Resection with Modified Air Leak Test and Chest Tube Drainage

Tubeless Uniportal Thoracoscopic Wedge Resection with Modified Air Leak Test and Chest Tube Drainage

Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage

Early extubation after thymectomy is good for the patients with myasthenia gravis

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