Uniportal surgical biopsy, without orotraqueal intubation, without thoracic drainage in intersticial pulmonary disease: initial results

Souza, Juliano Mendes de; Pereira, Ighor Ramon Pallu Doro; Borgmann, Ariela Victória; Chiaradia, Rafael Enrique; Boscardim, Paulo Cesar Buffara

doi:10.1590/0100-6991e-20202914

Cited by 3 publications

(1 citation statement)

References 14 publications

(30 reference statements)

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“…A new development is the introduction of nonintubated, sedated, uniportal SLB (39,40). This has already demonstrated encouraging results but is not currently performed routinely in the UK.…”

Section: Looking Forward: Who Should Be Doing Slb and How?mentioning

confidence: 99%

A realist (re)view on surgical lung biopsy in interstitial lung disease: who, how, when and at what risk?

Brunswicker¹,

Tan²,

Garner³

et al. 2022

Shanghai Chest

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Interstitial lung disease (ILD) is a heterogenous group of conditions which cause scarring of lung parenchyma. It poses a diagnostic challenge for clinicians, especially if radiological and pathophysiological features are indeterminate. Surgical lung biopsy (SLB) may be offered in the diagnostic workup for patients with suspected ILD; however, the delicate balance between risk and benefit in these patients remains a challenge. We reviewed key recommendations from international societies and further explored the evidence using snowball sampling. We then used the realist review method to build a best-fit approach to risk-benefit considerations for patients undergoing SLB. SLB allows for diagnostic certainty which informs prognosis.It allows quicker treatment and reduces diagnostic uncertainty. However, mortality and morbidity vary significantly between centres and patient cohorts. Recent studies suggest outcomes are markedly more favourable for elective SLB compared to non-elective SLB. Comprehensive risk-benefit assessment and discussion, as well as patient evaluation in the context of a dedicated multi-disciplinary team are crucial to achieve the best outcomes for this complex patient group. The complex balance between patient selection, urgency of surgery, volume of work, training needs and outcomes continues to evade equilibrium. Going forward, further research, continued monitoring, robust patient selection processes and multidisciplinary shared decision-making are some ways to optimise outcomes whilst minimizing risk. Novel surgical approaches as well as advances in interventional techniques might offer further benefit in future.

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Section: Looking Forward: Who Should Be Doing Slb and How?mentioning

confidence: 99%

A realist (re)view on surgical lung biopsy in interstitial lung disease: who, how, when and at what risk?

Brunswicker¹,

Tan²,

Garner³

et al. 2022

Shanghai Chest

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Drainology: Leveraging research in chest-drain management to enhance recovery after cardiothoracic surgery

Lobdell,

Perrault,

Drgastin

et al. 2024

JTCVS Techniques

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Spontaneous Ventilation Thoracoscopic Lung Biopsy in Undetermined Interstitial Lung Disease: Systematic Review and Meta-Analysis

Patirelis,

Elia,

Cristino

et al. 2024

JCM

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Thoracoscopic surgical biopsy has shown excellent histological characterization of undetermined interstitial lung diseases, although the morbidity rates reported are not negligible. In delicate patients, interstitial lung disease and restrictive ventilatory impairment morbidity are thought to be due at least in part to tracheal intubation with single-lung mechanical ventilation; therefore, spontaneous ventilation thoracoscopic lung biopsy (SVTLB) has been proposed as a potentially less invasive surgical option. This systematic review summarizes the results of SVTLB, focusing on diagnostic yield and operative morbidity. A systematic search for original studies regarding SVTLB published between 2010 to 2023 was performed. In addition, articles comparing SVTLB to mechanical ventilation thoracoscopic lung biopsy (MVTLB) were selected for a meta-analysis. Overall, 13 studies (two before 2017 and eleven between 2018 and 2023) entailing 675 patients were included. Diagnostic yield ranged from 84.6% to 100%. There were 64 (9.5%) complications, most of which were minor. There was no 30-day operative mortality. When comparing SVTLB to MVTLB, the former group showed a significantly lower risk of complications (p < 0.001), whereas no differences were found in diagnostic accuracy. The results of this review suggest that SVTLB is being increasingly adopted worldwide and has proven to be a safe procedure with excellent diagnostic accuracy.

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Uniportal surgical biopsy, without orotraqueal intubation, without thoracic drainage in intersticial pulmonary disease: initial results

Cited by 3 publications

References 14 publications

A realist (re)view on surgical lung biopsy in interstitial lung disease: who, how, when and at what risk?

A realist (re)view on surgical lung biopsy in interstitial lung disease: who, how, when and at what risk?

Drainology: Leveraging research in chest-drain management to enhance recovery after cardiothoracic surgery

Spontaneous Ventilation Thoracoscopic Lung Biopsy in Undetermined Interstitial Lung Disease: Systematic Review and Meta-Analysis

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