Video-Assisted Thoracoscopic Conservative Repair of Postoperative Lobar Torsion

Sakai, Mitsuaki; Kurimori, Kou; Saeki, Yusuke; Kitazawa, Shinsuke; Kobayashi, Keisuke; Iguchi, Kesato; Satô, Yukio

doi:10.1016/j.athoracsur.2014.07.080

Cited by 15 publications

(19 citation statements)

References 4 publications

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“…31 During VATS, preservation of the pulmonary ligament can also potentially prevent LT. 34 In the context of reoperation for reposition, these techniques may also be applicable. Sakai and colleagues 35 attached the middle lobe to the lower lobe using over-and-over sutures after detorsion. However, every maneuver has both pros and cons.…”

Section: Discussionmentioning

confidence: 99%

Predictors of survival in lung torsion: A systematic review and pooled analysis

Dai

Xie

Wang

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

105

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Section: Discussionmentioning

confidence: 99%

Predictors of survival in lung torsion: A systematic review and pooled analysis

Dai

Xie

Wang

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

105

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“…This can be accomplished with CTA preoperatively and/or intraoperative transesophageal echo. Re-expansion pulmonary edema can also occur and may require prolonged mechanical ventilation and frequent therapeutic bronchoscopy [44]. If the torsion is incomplete it may be possible to preserve the twisted lobe.…”

Section: Treatment Strategiesmentioning

confidence: 99%

Postlobectomy Early Complications

Ziarnik

Grogan

2015

Thoracic Surgery Clinics

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INTRODUCTIONThe most effective management of postoperative crises is prevention. This starts with preoperative preparation and patient screening. There are many factors that can be controlled and improved by the patient, including but not limited to, smoking cessation, cardiopulmonary rehab and teaching/setting peri-operative expectations. Equally as important is patient selection, which is influenced by pulmonary function tests, cardiopulmonary reserve, and pre-existing comorbidities. After the operation, the care team can also greatly improve outcomes with aggressive cardiopulmonary therapies, ambulation, vigilant monitoring and frequent assessments of the patient. Even when all of these guidelines are followed not all early complications can be avoided.A recent review of the National Cancer Database by Rosen et al found a 2.6% mortality from lobectomy [1]. Morbidity associated with lobectomy is 10% to 50%, and increases in the elderly [2]. The population being treated by thoracic surgeons continues to age and the complexity of the operations is increasing as neoadjuvant therapies become more prevalent. Early postoperative crises after lobectomy will occur, necessitating prompt and effective management strategies. The most common complications after pulmonary resection are listed below in Table 1, in this chapter we will focus on the early complications after lobectomy [3].For the purposes of this chapter we will define early post-operative crisis as those that develop within 48 hours of the operation. AIR LEAKProlonged air leak is the most common complication after pulmonary resection, with a reported incidence of 15-18% [4]. Prolonged air leak is defined as a leak lasted more than 7 days after pulmonary resection. Cerfolio et al reported an incidence of 25% on postoperative day 1 and 20% on postoperative day 2 [5,6] U.S. Department of Veterans AffairsPublic Access Author manuscript VA Author ManuscriptVA Author Manuscript VA Author Manuscript parenchymal air leaks post-operatively and a variety of factors that influence any given patients propensity for developing an air leak. Patient factors that increase risk of developing an air leak include emphysematous lungs, larger parenchymal resection and therefore less parenchymal apposition to chest wall, and inadequate drainage of air by thoracostomy tube(s). PREVENTION STRATEGIES1. Bronchial stump buttressing with a muscle flap. In patients with an infected pleural space or who are on chronic immunosuppression, coverage of the stump with vascularized muscle may prevent bronchial stump breakdown [7]. The intercostal muscle is an excellent coverage option and is harvested from the intercostal space upon entry into the chest at the level of the thoracotomy. It is important to plan ahead, as this muscle needs to be harvested prior to placing the rib spreader in an open operation to prevent crushing the vascular supply. Dissection is begun on the inferior rib and the muscle is mobilized using a periosteal elevator posteriorly to the paraspinous muscle. Attention is...

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“…The optimal type of intervention remains controversial depending on the lung status visualized by thoracotomy. If the involved lobe demonstrates viability, detorsion may offer the possibility for lung salvage [ 15 ]. However few reports noted rapid deterioration of patients after detorsion in a simulation to ischemia-reperfusion injury when intervention was delayed [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Left Lung Torsion: Complication of Lobar Resection for an Early Stage Lung Adenocarcinoma

Mansour

Moussaly

Yassine

et al. 2016

Case Reports in Critical Care

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Lobar torsion is a fatal but fortunately rare occurrence following lung resection. Early clinical signs and radiographic features may be nonspecific resulting in diagnostic delay. A high index of suspicion is vital for early diagnosis and intervention to avoid further parenchymal necrosis and deadly gangrene. We report a case of left lower lobe torsion in a 76-year-old female following elective upper lobectomy for underlying lung adenocarcinoma. Diagnosis was made following highly suggestive radiographic findings prompting bronchoscopy and revision thoracotomy. An emergency detorsion failed to restore lung viability and was followed by completion pneumonectomy. The patient recovered and was discharged on the seventh postoperative day.

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Video-Assisted Thoracoscopic Conservative Repair of Postoperative Lobar Torsion

Cited by 15 publications

References 4 publications

Predictors of survival in lung torsion: A systematic review and pooled analysis

Predictors of survival in lung torsion: A systematic review and pooled analysis

Postlobectomy Early Complications

Left Lung Torsion: Complication of Lobar Resection for an Early Stage Lung Adenocarcinoma

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