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Clinical Research Advances of Video-Assisted Thoracic Surgery
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Clinical Research Advances of Video-Assisted Thoracic Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (15 July 2022) | Viewed by 9113

Special Issue Editor

Dr. Alberto Testori

E-Mail Website
Guest Editor
Thoracic Surgery Division, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Interests: thoracic surgery

Special Issue Information

Dear Colleagues,

Post-operatory pain is related to various complications such as the risk of organ impairment, prolonged hospital stay (length of stay), morbidity, readmissions ad delayed convalescence. Accurate pain management allows an early mobilization which is fundamental to reduce the risk of post-operatory complications. For these reasons various authors consider postoperative pain to be an interesting postoperative surgical parameter to be evaluated, although its multifaceted nature makes it a difficult outcome to measure analyze. The issue was analyzed from various points of view, such as surgical techniques, inflammatory responses, anesthetic, and analgesic treatment.

Post-operative pain is intrinsic to surgical procedures, especially in thoracic surgery, which was associated with pulmonary impairment following lung resections, together with underlying comorbidities that have a strong impact on postoperative outcomes.

So, we are pleased to invite you to analyze post-operatory pain, how to manage it, and the impact of mini-invasive surgery. In this Special Issue, original research articles and reviews are welcome.

Dr. Alberto Testori
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Published Papers (4 papers)

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Research

13 pages, 2460 KiB  
Article
Simultaneous Comparison of Subxiphoid and Intercostal Wound Pain in the Same Patients Following Thoracoscopic Surgery
by Yu-Wei Liu, Shah-Hwa Chou, Andre Chou and Chieh-Ni Kao
J. Clin. Med. 2022, 11(8), 2254; https://doi.org/10.3390/jcm11082254 - 18 Apr 2022
Cited by 1 | Viewed by 2562
Abstract
There is a lack of data comparing postoperative pain after subxiphoid and intercostal video-assisted thoracoscopic surgery (VATS). Pain is an individual’s subjective experience and, therefore, difficult to compare between different individuals subjected to either procedure. This study assessed reported pain at six postoperative [...] Read more.
There is a lack of data comparing postoperative pain after subxiphoid and intercostal video-assisted thoracoscopic surgery (VATS). Pain is an individual’s subjective experience and, therefore, difficult to compare between different individuals subjected to either procedure. This study assessed reported pain at six postoperative time points in the same patients receiving both subxiphoid and intercostal incisions for thoracic disease. Data from 44 patients who received simultaneous combined intercostal and subxiphoid VATS were retrospectively analyzed from August 2019 to July 2021. All patients received the same length of subxiphoid and intercostal incisions with or without drain placements. A numerical pain rating scale was administered on postoperative days (POD)-1, POD-2, POD-Discharge, POD-30, POD-90, and POD-180. Bilateral uniportal VATS was performed in 11 patients, and unilateral multiportal VATS was performed in 33 patients. In the unilateral VATS group, there were no differences in pain reported for both incisions in the early postoperative period. However, in the bilateral VATS group, subxiphoid wounds resulted in significantly higher pain scores on POD-1, POD-2, and POD-Discharge (p = 0.0003, 0.001, and 0.03, respectively). Higher late (3 and 6 months) postoperative pain was associated with intercostal incisions in both groups, as previously reported, whereas higher early (day 1, 2, and discharge) postoperative pain was more associated with subxiphoid incisions than intercostal incisions in the bilateral VATS group. Full article
(This article belongs to the Special Issue Clinical Research Advances of Video-Assisted Thoracic Surgery)
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7 pages, 215 KiB  
Article
Bronchoscopic Intra-Pleural Instillation of Fibrin Glue and Autologous Blood to Manage Persistent Air Leaks after Lung Resection
by Giorgio Maria Ferraroli, Gianluca Perroni, Veronica Maria Giudici, Alberto Antonicelli, Hiran Chrishantha Fernando, Vincenzo Ambrogi, Marco Alloisio, Emanuele Voulaz, Edoardo Bottoni, Maurizio Valentino Infante and Alberto Testori
J. Clin. Med. 2022, 11(7), 1934; https://doi.org/10.3390/jcm11071934 - 30 Mar 2022
Cited by 1 | Viewed by 1873
Abstract
Background: Persistent air leak is a common complication after lung resection causing prolonged length of stay and increased healthcare costs. Surgical intervention can be an option, but other more conservative approaches should be considered first. Here, we describe the use of flexible [...] Read more.
Background: Persistent air leak is a common complication after lung resection causing prolonged length of stay and increased healthcare costs. Surgical intervention can be an option, but other more conservative approaches should be considered first. Here, we describe the use of flexible bronchoscopy to apply fibrin glue and autologous blood sequentially to the damaged lung. We named the technique “flexible thoracoscopy”. Methods: Medical records from patients with persistent air leaks after lung resection were collected retrospectively. Depending on the type of aerostasis that was performed, two groups were created: flexible thoracoscopy and surgery (thoracotomy). Flexible thoracoscopy was introduced at our institution in 2013. We entered the pleural space with a bronchoscope following the same surgical pathway that was used for tube thoracostomy. Perioperative characteristics and outcomes were analyzed using R software (ver. 3.4.4). Results: From 1997 to 2021, a total of 23 patients required an intervention for persistent air leaks. Aerostasis was performed via flexible thoracoscopy in seventeen patients (69%) and via thoracotomy in six patients (31%). The median age was 70 years (22–82). Twenty patients were males (87%). There was no difference in age, sex distribution, BMI, comorbidities and FEV1%. An ASA score of 3 was more represented in the flexible thoracoscopy group; however, no evidence of a difference was found when compared to the thoracotomy group (p = 0.124). Length of in-hospital stay and chest tube duration was also similar between groups (p = 1 and p = 0.68, respectively). Conclusions: Aerostasis achieved either by flexible thoracoscopy or by thoracotomy showed similar results. We believe that flexible thoracoscopy could be a valid alternative to facilitate minimally invasive treatments for persistent air leaks. Further studies are needed to confirm these results. Full article
(This article belongs to the Special Issue Clinical Research Advances of Video-Assisted Thoracic Surgery)
7 pages, 1345 KiB  
Article
Postoperative Pain and Clinical Outcome Following Two- and Three-Port Video-Assisted Thoracoscopic Surgery for Secondary Spontaneous Pneumothorax
by Stephen Fung, Kefah Jaber, Marius Kivilis, Alexander Rehders, Anja Schauer, Levent Dizdar and Wolfram-Trudo Knoefel
J. Clin. Med. 2022, 11(5), 1404; https://doi.org/10.3390/jcm11051404 - 4 Mar 2022
Viewed by 1840
Abstract
Background: Two-port (2P) and three-port (3P) video-assisted thoracoscopic surgery (VATS) are well-established surgical methods for the treatment of complicated spontaneous pneumothorax (SP). However, a comparison between both techniques, in terms of clinical outcomes in patients with secondary spontaneous pneumothorax (SSP), is unreported. The [...] Read more.
Background: Two-port (2P) and three-port (3P) video-assisted thoracoscopic surgery (VATS) are well-established surgical methods for the treatment of complicated spontaneous pneumothorax (SP). However, a comparison between both techniques, in terms of clinical outcomes in patients with secondary spontaneous pneumothorax (SSP), is unreported. The aim of this study was to evaluate and compare postoperative pain, as well as clinical outcome, following 2P and 3P VATS for SSP in our institution. Methods: Between January 2008 and December 2020, we retrospectively analyzed the data of 115 SSP patients treated by VATS in our institution. Fifty-two patients underwent 2P-VATS, while 63 patients were treated by 3P-VATS. The total dose of analgesic use per stay (opioid and non-opioid), length of hospital stay (LOS), operation time, total area of pleurectomy, recurrence rates and postoperative complications were compared between both groups. Results: The 3P-VATS group had a significantly higher total dose of analgesic use compared with the 2P-VATS patients. The LOS and mean operation time were significantly shorter in the 2P-VATS group. A larger area of pleurectomy was resected using 3P-VATS compared to 2P-VATS. The postoperative complications and recurrence of SSP during a median follow-up period of 76.5 months were similar in both groups. Conclusion: 2P-VATS is a safe surgical technique. It is associated with a short LOS and less postoperative pain, and, thus, low analgesic use. Full article
(This article belongs to the Special Issue Clinical Research Advances of Video-Assisted Thoracic Surgery)
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6 pages, 855 KiB  
Article
Robotic and Video-Assisted Thoracic Surgery for Early-Stage Lung Cancer: Comparison of Long-Term Pain at a Single Centre
by Alberto Testori, Veronica Maria Giudici, Emanuele Voulaz, Marco Alloisio and Edoardo Bottoni
J. Clin. Med. 2022, 11(4), 1108; https://doi.org/10.3390/jcm11041108 - 19 Feb 2022
Cited by 3 | Viewed by 2011
Abstract
Backgrounds: Since the application of mini-invasive surgery to pulmonary lobectomy, various studies confirmed the feasibility and the safety of the technique, with equivalent oncological standards. However, there are no studies that compare long-term postoperative pain in minimally invasive thoracic surgery. Methods: Between 1 [...] Read more.
Backgrounds: Since the application of mini-invasive surgery to pulmonary lobectomy, various studies confirmed the feasibility and the safety of the technique, with equivalent oncological standards. However, there are no studies that compare long-term postoperative pain in minimally invasive thoracic surgery. Methods: Between 1 January 2019 and 28 February 2020, we analysed pain scores at 2 weeks, 3 months, 6 months, and 1 year after the operation, where 50 patients underwent a VATS lobectomy and 50 underwent a RATS lobectomy. Pain scores are obtained through a telephone questionnaire, according to a Numerical Rating Scale (NRS). Results: The medias of the NRS scores, at 2 weeks, 3 months, 6 months, and 1 year after the operation were similar in both groups. Group I was composed of 50 patients who underwent a video-assisted lobectomy, while Group II was composed of 50 patients who underwent a robotic-assisted lobectomy. Two weeks after surgery Group I had a NRS value of 2.96 and in Group II it was 2.86; three months after in Group I the value was 2.16 and in Group II it was 2.06; six months after Group I ‘s value was 1.62 and Group II’s was 1.56; one year after in Group I the value was 1.30 and in the Group II was 1.24. For each time interval, no statistically significant differences were found (p > 0.05). Conclusions: In our analysis, RATS and VATS did not have significant differences in post-operative and long-term pain. Full article
(This article belongs to the Special Issue Clinical Research Advances of Video-Assisted Thoracic Surgery)
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