Mercedes de la Torre

University of A Coruña, La Corogne, Galicia, Spain

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Publications (34)74.08 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Owing to advances in video-assisted thoracic surgery (VATS), the majority of pulmonary resections can currently be performed by VATS in a safe manner with a low level of morbidity and mortality. The majority of the complications that occur during VATS can be minimized with correct preoperative planning of the case as well as careful pulmonary dissection. Coordination of the whole surgical team is essential when confronting an emergency such as major bleeding. This is particularly important during the VATS learning curve, where the occurrence of intraoperative complications, particularly significant bleeding, usually ends in a conversion to open surgery. However, conversion should not be considered as a failure of the VATS approach, but as a resource to maintain the patient's safety. The correct assessment of any bleeding is of paramount importance during major thoracoscopic procedures. Inadequate management of the source of bleeding may result in major vessel injury and massive bleeding. If bleeding occurs, a sponge stick should be readily available to apply pressure immediately to control the haemorrhage. It is always important to remain calm and not to panic. With the bleeding temporarily controlled, a decision must be made promptly as to whether a thoracotomy is needed or if the bleeding can be solved through the VATS approach. This will depend primarily on the surgeon's experience. The operative vision provided with high-definition cameras, specially designed or adapted instruments and the new sealants are factors that facilitate the surgeon's control. After experience has been acquired with conventional or uniportal VATS, the rate of complications diminishes and the majority of bleeding events are controlled without the need for conversion to thoracotomy.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 10/2015; DOI:10.1093/ejcts/ezv333 · 3.30 Impact Factor
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    ABSTRACT: Thanks to the experience gained through the improvement of video-assisted thoracoscopic surgery (VATS) technique, and the enhancement of surgical instruments and high-definition cameras, most pulmonary resections can now be performed by minimally invasive surgery. The future of the thoracic surgery should be associated with a combination of surgical and anaesthetic evolution and improvements to reduce the trauma to the patient. Traditionally, intubated general anaesthesia with one-lung ventilation was considered necessary for thoracoscopic major pulmonary resections. However, thanks to the advances in minimally invasive techniques, the non-intubated thoracoscopic approach has been adapted even for use with major lung resections. An adequate analgesia obtained from regional anaesthesia techniques allows VATS to be performed in sedated patients and the potential adverse effects related to general anaesthesia and selective ventilation can be avoided. The non-intubated procedures try to minimize the adverse effects of tracheal intubation and general anaesthesia, such as intubation-related airway trauma, ventilation-induced lung injury, residual neuromuscular blockade, and postoperative nausea and vomiting. Anaesthesiologists should be acquainted with the procedure to be performed. Furthermore, patients may also benefit from the efficient contraction of the dependent hemidiaphragm and preserved hypoxic pulmonary vasoconstriction during surgically induced pneumothorax in spontaneous ventilation. However, the surgical team must be aware of the potential problems and have the judgement to convert regional anaesthesia to intubated general anaesthesia in enforced circumstances. The non-intubated anaesthesia combined with the uniportal approach represents another step forward in the minimally invasive strategies of treatment, and can be reliably offered in the near future to an increasing number of patients. Therefore, educating and training programmes in VATS with non-intubated patients may be needed. Surgical techniques and various regional anaesthesia techniques as well as indications, contraindications, criteria to conversion of sedation to general anaesthesia in non-intubated patients are reviewed and discussed. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 04/2015; DOI:10.1093/ejcts/ezv136 · 3.30 Impact Factor
  • Diego Gonzalez-Rivas · Ricardo Fernandez · Mercedes de la Torre · Cesar Bonome ·
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    ABSTRACT: Intubated general anesthesia with one-lung ventilation was traditionally considered necessary for thoracoscopic major pulmonary resections. However, non-intubated thoracoscopic lobectomy can be performed by using conventional and uniportal video-assisted thoracoscopic surgery (VATS). These non-intubated procedures try to minimize the adverse effects of tracheal intubation and general anesthesia but these procedures must only be performed by experienced anesthesiologists and skilled thoracoscopic surgeons. Here we present a video of a uniportal VATS left upper lobectomy in a non-intubated patient, maintaining the spontaneous ventilation.
    Journal of Thoracic Disease 03/2015; 7(3):494-5. DOI:10.3978/j.issn.2072-1439.2015.01.05 · 1.78 Impact Factor
  • S. Mintegi · B. Gómez · M. de la Torre ·

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    ABSTRACT: Thanks to the recent improvements in thoracoscopy, a great deal of complex lung resections can be performed without performing thoracotomies. During the last years, experience gained through video-assisted thoracoscopic techniques, enhancement of the surgical instruments and improvement of high definition cameras have been the greatest advances. The huge number of surgical videos posting on specialized websites, live surgery events and experimental courses has contributed to the rapid learning of minimally invasive surgery during the last years. Nowadays, complex resections, such as post chemo-radiotherapy resections, lobectomies with chest wall resection, bronchial and vascular sleeves are being performed by thoracoscopic approach in experienced centers. Additionally, surgery has evolved regarding the thoracoscopic surgical approach, allowing us to perform these difficult procedures by means of a small single incision, with excellent postoperative results.
    Journal of Thoracic Disease 10/2014; 6(Suppl 6):S674-81. DOI:10.3978/j.issn.2072-1439.2014.09.17 · 1.78 Impact Factor
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    ABSTRACT: Lymphadenectomy is an important part of lung cancer surgery. At the moment, video-assisted thoracoscopic (VATS) is the most common approach to remove these tumors, when it is technically possible. With our current experience in VATS in major resections we have obtained a radical videothoracoscopic mediastinal lymphadenectomy, and single-port provides us with the best anatomic instrumentation and a direct view.
    Journal of Thoracic Disease 10/2014; 6(Suppl 6):S665-8. DOI:10.3978/j.issn.2072-1439.2014.10.04 · 1.78 Impact Factor
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    ABSTRACT: Since the video-assisted thoracoscopic surgery (VATS) anatomic lobectomy for lung cancer was described two decades ago, many units have successfully adopted this technique. VATS lobectomy is a safe and effective approach for the treatment not only of early stage lung cancer but also for more advanced disease. It represents a technical challenge. As the surgeon's experience grows, more complex or advanced cases are approached using the VATS approach. However, as VATS lobectomy has been applied to more advanced cases, the rate of conversion to open thoracotomy has increased, particularly early in the surgeon's learning curve, mostly due to the occurrence of complications. The best strategy for facing complications of VATS lobectomy is to prevent them from happening. Avoiding complications is subject to an appropriate preoperative workup and patient selection. Planning for a VATS resection as safely as possible involves the consideration of the patient´s characteristics and the anticipated technical aspects of the case. Awareness of the possibility of intraoperative complications of VATS lobectomy is mandatory to avoid them, and the development of management strategies is necessary to limit morbidity if they occur.
    Journal of Thoracic Disease 10/2014; 6(Suppl 6):S669-73. DOI:10.3978/j.issn.2072-1439.2014.10.14 · 1.78 Impact Factor
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    Journal of Thoracic Disease 10/2014; 6(Suppl 6):S599-603. DOI:10.3978/j.issn.2072-1439.2014.08.44 · 1.78 Impact Factor
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    ABSTRACT: We introduce the training on uniportal video-assisted thoracoscopic (VATS) lobectomy in sheep. This animal model is helpful to learn the different view, the importance of lung exposure and the key points of the instrumentation. In this article we present three videos with the left upper lobectomy, the left lower lobectomy and the right upper lobectomy in the sheep.
    Journal of Thoracic Disease 10/2014; 6(Suppl 6):S656-9. DOI:10.3978/j.issn.2072-1439.2014.10.03 · 1.78 Impact Factor
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    ABSTRACT: The surgical approach to lung resections is evolving constantly. Since the video-assisted thoracoscopic surgery (VATS) anatomic lobectomy for lung cancer was described two decades ago, many units have successfully adopted this technique. The VATS lobectomy can be defined as the individual dissection of veins, arteries and bronchus, with a mediastinal lymphadenectomy, using a videothoracoscopic approach visualized on screen and involving 2 to 4 incisions or ports, with no rib spreading. However, the surgery can be performed by only one incision with similar outcomes. Since 2010, when the uniportal approach was introduced for major pulmonary resections, the technique has been spreading worldwide. This technique provides a direct view of the target tissue. The parallel instrumentation achieved during the single-port approach mimics the maneuvers performed during open surgery. It represents a less invasive approach than the multiport technique, and minimizes the compression of the intercostal nerve. As the surgeon's experience with the uniportal VATS lobectomy grows, more complex cases can be performed by using this approach, thus expanding the indications for single-incision thoracoscopic lobectomy.
    Journal of Thoracic Disease 10/2014; 6(Suppl 6):S660-4. DOI:10.3978/j.issn.2072-1439.2014.10.21 · 1.78 Impact Factor
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    ABSTRACT: AimThere is limited evidence about the diagnostic value of urine dipsticks in young febrile infants. The aim of this study was to determine whether urine dipsticks would identify positive urine cultures in febrile infants of less than 90-days-of-age.Methods This study was a sub-analysis of a prospective multi-centre study developed in 19 Spanish paediatric emergency departments belonging to the Spanish Pediatric Emergency Research Network. It focused on febrile infants of less than 90-days-of-age admitted between October 2011 and September 2013. A positive urine culture was defined as the growth of ≥ 50,000 cfu/ml of a single pathogen collected by a sterile method.ResultsWe included 3,401 patients and 176 (12.8%) female patients and 473 (23.3%) males had a positive urine culture. The leukocyte esterase test showed a mean sensitivity of 82.1% and a mean specificity of 92.4%, with a greater mean negative predictive value for females than males (97.8 versus 94.1%) and a greater mean positive predictive value for males than females (79.4% versus 58%).Conclusion The leukocyte esterase test showed the same accuracy in young febrile infants as previously reported findings for older children. It predicted positive urine cultures and also revealed important gender differences.This article is protected by copyright. All rights reserved.
    Acta Paediatrica 08/2014; 104(1). DOI:10.1111/apa.12789 · 1.67 Impact Factor
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    ABSTRACT: OBJECTIVES General anaesthesia with single-lung ventilation was always considered a condition for thoracoscopic major pulmonary resections. However, nonintubated thoracoscopic lobectomy has been reported recently by using conventional video-assisted thoracoscopic surgery (VATS), epidural anaesthesia and vagus blockade. Here, we present a technique that reduces the surgical access trauma even more: single-incision VATS approach with no need for epidural or vagus blockade in a nonintubated patient.
    Interactive Cardiovascular and Thoracic Surgery 07/2014; 19(4). DOI:10.1093/icvts/ivu209 · 1.16 Impact Factor
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    ABSTRACT: Objectives: Conventional video-assisted thoracoscopic (VATS) lobectomy for advanced lung cancer is a feasible and safe surgery in experienced centers. The aim of this study is to assess the feasibility of uniportal VATS approach in the treatment of advanced non-small cell lung cancer (NSCLC) and compare the perioperative outcomes and survival with those in early-stage tumors operated through the uniportal approach. Methods: From June 2010 to December 2012, we performed 163 uniportal VATS major pulmonary resections. Only NSCLC cases were included in this study (130 cases). Patients were divided into two groups: (A) early stage and (B) advanced cases (>5 cm, T3 or T4, or tumors requiring neoadjuvant treatment). A descriptive and retrospective study was performed, comparing perioperative outcomes and survival obtained in both groups. A survival analysis was performed with Kaplan-Meier curves and the log-rank test was used to compare survival between patients with early and advanced stages. Results: A total of 130 cases were included in the study: 87 (A) vs. 43 (B) patients (conversion rate 1.1 vs. 6.5%, P=0.119). Mean global age was 64.9 years and 73.8% were men. The patient demographic data was similar in both groups. Upper lobectomies (A, 52 vs. B, 21 patients) and anatomic segmentectomies (A, 4 vs. B, 0) were more frequent in group A while pneumonectomy was more frequent in B (A, 1 vs. B, 6 patients). Surgical time was longer (144.9±41.3 vs. 183.2±48.9, P<0.001), and median number of lymph nodes (14 vs. 16, P=0.004) were statistically higher in advanced cases. Median number of nodal stations (5 vs. 5, P=0.165), days of chest tube (2 vs. 2, P=0.098), HOS (3 vs. 3, P=0.072), and rate of complications (17.2% vs. 14%, P=0.075) were similar in both groups. One patient died on the 58th postoperative day. The 30-month survival rate was 90% for the early stage group and 74% for advanced cases. Conclusions: Uniportal VATS lobectomy for advanced cases of NSCLC is a safe and reliable procedure that provides perioperative outcomes similar to those obtained in early stage tumours operated through this same technique. Further long term survival analyses are ongoing on a large number of patients.
    Interactive Cardiovascular and Thoracic Surgery 06/2014; 6(6):641-8. DOI:10.3978/j.issn.2072-1439.2014.05.17 · 1.16 Impact Factor
  • Diego Gonzalez-Rivas · Eva Fieira · Mercedes de la Torre · Maria Delgado ·
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    ABSTRACT: Lung cancer requiring double bronchial and vascular reconstruction of the pulmonary artery is a challenging procedure usually performed by thoracotomy. However, recent development of video-assisted thoracoscopic techniques allows experienced and skilled surgeons to perform these cases through a minimally invasive approach. Most of these complex thoracoscopic resections are performed by using 3 to 4 incisions. We present the first report of a right side combined vascular reconstruction and bronchoplasty performed through a single-incision video-assisted thoracoscopic surgery (VATS) technique.
    Journal of Thoracic Disease 06/2014; 6(6):861-3. DOI:10.3978/j.issn.2072-1439.2014.06.27 · 1.78 Impact Factor

  • The Annals of Thoracic Surgery 08/2013; 96(2):745-745. · 3.85 Impact Factor
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    ABSTRACT: Video-assisted thoracoscopic surgery (VATS) was introduced nearly 2 decades ago and has experienced an exponential increase for lung cancer treatment. A pneumonectomy can be performed by video-assisted thoracoscopic surgery and the lung usually fits through the incision as usually used for VATS lobectomy. The most common approach for pneumonectomy is undertaken with 3 or 4 incisions, including a utility incision of about 3-6 cm. However, this resection is amenable by using only a single utility-incision. This chapter describes the technique for pneumonectomies by single-incision thoracoscopic approach with no rib spreading.
    Journal of Thoracic Disease 08/2013; 5(Suppl 3):S246-52. DOI:10.3978/j.issn.2072-1439.2013.07.44 · 1.78 Impact Factor

  • Journal of Thoracic Disease 08/2013; 5(Suppl 3):S226-33. DOI:10.3978/j.issn.2072-1439.2013.07.45 · 1.78 Impact Factor
  • Article: Reply.

    The Annals of thoracic surgery 08/2013; 96(2):745. DOI:10.1016/j.athoracsur.2013.06.025 · 3.85 Impact Factor
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    ABSTRACT: Over the past two decades, video-assisted thoracic surgery (VATS) has revolutionized the way thoracic surgeons diagnose and treat lung diseases. The major advance in VATS procedures is related to the major pulmonary resections. The best VATS technique for lobectomy has not been well defined yet. Most of the authors describe the VATS approach to lobectomy via 3 to 4 incisions but the surgery can be performed by only one incision with similar outcomes. This single incision is the same as we normally use for VATS lobectomies performed by double or triple port technique with no rib spreading. As our experience with VATS lobectomy has grown, we have gradually improved the technique for a less invasive approach. Consequently the greater the experience we gained, the more complex the cases we performed were, hence expanding the indications for single-incision thoracoscopic lobectomy.
    Journal of Thoracic Disease 08/2013; 5(Suppl 3):S234-45. DOI:10.3978/j.issn.2072-1439.2013.07.30 · 1.78 Impact Factor
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    ABSTRACT: Much effort has been put in the past years to create and assess accurate tools for the management of febrile infants. However, no optimal strategy has been so far identified. A sequential approach evaluating, first, the appearance of the infant, second, the age and result of the urinanalysis and, finally, the results of the blood biomarkers, including procalcitonin, may better identify low risk febrile infants suitable for outpatient management. To assess the value of a sequential approach ('step by step') to febrile young infants in order to identify patients at a low risk for invasive bacterial infections (IBI) who are suitable for outpatient management and compare it with other previously described strategies such as the Rochester criteria and the Lab-score. A retrospective comparison of three different approaches (step by step, Lab-score and Rochester criteria) was carried out in 1123 febrile infants less than 3 months of age attended in seven European paediatric emergency departments. IBI was defined as isolation of a bacterial pathogen from the blood or cerebrospinal fluid. Of the 1123 infants (IBI 48; 4.2%), 488 (43.4%) were classified as low-risk criteria according to the step by step approach (vs 693 (61.7%) with the Lab-score and 458 (40.7%) with the Rochester criteria). The prevalence of IBI in the low-risk criteria patients was 0.2% (95% CI 0% to 0.6%) using the step by step approach; 0.7% (95% CI 0.1% to 1.3%) using the Lab-score; and 1.1% (95% CI 0.1% to 2%) using the Rochester criteria. Using the step by step approach, one patient with IBI was not correctly classified (2.0%, 95% CI 0% to 6.12%) versus five using the Lab-score or Rochester criteria (10.4%, 95% CI 1.76% to 19.04%). A sequential approach to young febrile infants based on clinical and laboratory parameters, including procalcitonin, identifies better patients more suitable for outpatient management.
    Emergency Medicine Journal 07/2013; 31(1). DOI:10.1136/emermed-2013-202449 · 1.84 Impact Factor

Publication Stats

267 Citations
74.08 Total Impact Points


  • 2011-2015
    • University of A Coruña
      La Corogne, Galicia, Spain
    • Complejo Hospitalario Universitario a Coruña (CHUAC)
      La Corogne, Galicia, Spain
  • 2012-2014
    • Hospital Infantil Universitario Niño Jesús
      Madrid, Madrid, Spain
  • 2012-2013
    • Complexo Hospitalario Universitario A Coruña
      La Corogne, Galicia, Spain