Incidence, Management, and Outcomes of Intraoperative Catastrophes During Robotic Pulmonary Resection

Publication date: November 2019Source: The Annals of Thoracic Surgery, Volume 108, Issue 5Author(s): Christopher Cao, Robert J. Cerfolio, Brian E. Louie, Franca Melfi, Giulia Veronesi, Rene Razzak, Gaetano Romano, Pierluigi Novellis, Savan Shah, Neel Ranganath, Bernard J. ParkBackgroundIntraoperative catastrophes during robotic anatomical pulmonary resections are potentially devastating events. The present study aimed to assess the incidence, management, and outcomes of these intraoperative catastrophes for patients with primary lung cancers.MethodsThis was a retrospective, multiinstitutional study that evaluated patients who underwent robotic anatomical pulmonary resections. Intraoperative catastrophes were defined as events necessitating emergency thoracotomy or requiring an additional unplanned major surgical procedure. Standardized data forms were collected from each institution, with questions on intraoperative management strategies of catastrophic events.ResultsOverall, 1810 patients underwent robotic anatomical pulmonary resections, including 1566 (86.5%) lobectomies. Thirty-five patients (1.9%) experienced an intraoperative catastrophe. These patients were found to have significantly higher clinical TNM stage (P = .031) and lower forced expiratory volume in 1 second (81% vs 90%; P = .004). A higher proportion of patients who had a catastrophic event underwent preoperative radiotherapy (8.6% vs 2.3%; P = .048), and the surgical procedures performed diffe...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research

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CONCLUSIONS: The 4-year cost of surgical resection for NSCLC was substantial and increased with pathologic stage. Among Stage I lobectomy patients, those selected for minimally invasive surgery had lower costs, particularly through 90 days. Potential avenues for improving the value of surgical resection include judicious use of post-operative intensive care and earlier detection and treatment of disease. PMID: 33031776 [PubMed - as supplied by publisher]
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
Conclusions: VATS approach of sleeve resections, which is performed cautiously even by thoracotomy, is becoming more common. These operations, which could be performed in experienced centers, offer a postoperative period of less morbidity to the patients with the advantage of reduced postoperative pain, drainage time, and hospital stay.
Source: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques - Category: Surgery Tags: Original Articles Source Type: research
Identifying the optimal approach for patients with lung cancer with higher operative risk is key. This analysis evaluates our institutional experience with robotic vs traditional open thoracotomy for lobectomy in lung cancer patients considered high-risk (HR).
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Thoracic surgery Source Type: research
The objective of this study was to compare long-term outcomes of open versus minimally invasive (MIS) segmentectomy for early stage non-small-cell lung cancer (NSCLC), which has not been evaluated using national studies. Outcomes of open versus MIS segmentectomy for clinical T1, N0, M0 NSCLC in the National Cancer Data Base (2010-2015) were evaluated using propensity score matching. Of the 39,351 patients who underwent surgery for stage IA NSCLC from 2010-2015, 770 underwent segmentectomy by thoracotomy and 1,056 by MIS approach (876 thoracoscopic [VATS], 180 robotic).
Source: Seminars in Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: THORACIC – Original Submission Source Type: research
Authors: Jiang Y, Su Z, Liang H, Liu J, Liang W, He J Abstract As the computer processing technique and display technology evolved dramatically, the surgical approach to early-stage non-small cell lung cancer (NSCLC) has made a rapid progress within the past few years. Currently, the gold standard for NSCLC is lobectomy. After the introduction of video-assisted thoracoscopic surgery (VATS), lung resection can now be conducted mini-invasively, enabling better prognosis for patients and better operation condition for surgeons. At the very beginning, the conventional two-dimensional (2D) system enabled operators to ha...
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research
This study was conducted to compare intraoperative an...
Source: Journal of Cardiothoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Research article Source Type: research
Fuster Rafael Aguiló Esther Barreiro Immune profile of B and T cells and tertiary lymphoid structures (TLSs) may differ in tumors of lung cancer (LC) patients with/without chronic obstructive pulmonary disease (COPD), and may also influence patient survival. We sought to analyze: (1) TLSs, germinal centers (GCs), B and T cells, and (2) associations of the immune biomarkers with the patients’ 10-year overall survival (OS). TLSs (numbers and area), B [cluster of differentiation (CD) 20], and T (CD3), and GCs cells were identified in both tumor and non-tumor specimens (thoracotomy) from 90 LC-COPD pat...
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Article Source Type: research
CONCLUSION: Operations below the currently valid minimum quantity threshold should no longer be carried out. There are many indications that the minimum quantity in Germany should be raised to ≥20 resections/year/hospital in order to comprehensively improve the quality. Prehabilitation programs with endurance, strength and intensive breathing training as well as nutritional therapy improve patient outcome. The current treatment of esophageal cancer is stage-dependent and incorporates endoscopic resection of (sub)mucosal low-risk tumors (T1m1-3 or T1sm1 low risk), primary esophagectomy of submucosal high-risk tumors (T1a...
Source: Der Chirurg - Category: Surgery Authors: Tags: Chirurg Source Type: research
CONCLUSIONS: In the present cohort of LC patients with resectable tumors and relatively well-preserved nutritional status, the parameters BMI and blood albumin and protein levels measured prior to thoracotomy predicted OS, especially in those with COPD. These are clinically relevant findings, since values of those nutritional parameters were within the normal ranges in the majority of the analyzed patients. A thorough nutritional preoperative assessment should be included in the study of patients with resectable LC, particularly in those with chronic airway obstruction. ABBREVIATIONS: BMI, body mass index; LC, lung ca...
Source: Archivos de Bronconeumologia - Category: Respiratory Medicine Authors: Tags: Arch Bronconeumol Source Type: research
We report herein a patient with lung cancer who underwent video-assisted thoracoscopic surgery right lower lobectomy. During surgery, pneumomediastinum and air leakage from mediastinal fatty tissue were detected. Furthermore, bronchial injury to the membranous part of the left main bronchus was incidentally detected. Hence, we switched from video-assisted thoracoscopic surgery to posterolateral thoracotomy and repaired this bronchial injury using a continuous suture technique under right femoral venoarterial extracorporeal membrane oxygenation support. The intraoperative findings could offer a clue for early detection and ...
Source: General Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
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