[Show abstract][Hide abstract] ABSTRACT: Purpose:
Unexpected intraoperative bleeding during thoracoscopic surgery, necessitating emergency conversion to thoracotomy, is gradually being reported. We reviewed our experience of encountering unexpected bleeding during thoracoscopic surgery.
We defined "unexpected intraoperative bleeding" as the need for hemostatic procedures with angiorrhaphy, with or without a sealant. The location, cause, and management of injured vessels, and perioperative outcomes were investigated and compared with those for patients without injured vessels.
Between 2007 and 2014, a total of 241 thoracoscopic anatomical pulmonary resections were performed at our hospital. Twenty (8.3 %) of these patients required hemostatic procedures with angiorrhaphy, with or without a sealant. The main injured vessels were the pulmonary artery (n = 13) and vein (n = 3) and the main causes of injury were related to technical issues with energy devices and staplers. There were no morbidities related to intraoperative bleeding. The operation time and blood loss were significantly greater in the patients with vessel injury than in those without vessel injury, but perioperative morbidities and the duration of chest tube insertion (4.5 vs. 3.5 days, average, p = 0.20) and postoperative hospital stay (12.7 vs. 11.0 days, average, p = 0.08) were not significantly different.
The frequency of unexpected bleeding was relatively high in this series, but its management and outcomes were satisfactory in terms of safety.
[Show abstract][Hide abstract] ABSTRACT: Patients with significant central airway obstruction are frequently within hours or days of death from suffocation. For inoperable patients due to either physiological or oncological criteria, therapeutic interventional pulmonology provide rapid palliation that can be lifesaving and improve quality of life (QOL). This retrospective study reports our experience with the placement of an airway stent in patients with inoperable malignant disease or postoperative tracheobronchial stenosis, as well as high feasibility of simulating airway stent placement using a three-dimensional (3D) printed airway model. The medical records of 50 patients who had undergone placement of airway stents at our institution between April 2005 and December 2014 were reviewed. Recently, we used a 3D printed airway model for planning of stent placement before intervention. Primary diagnosis was malignant disease in 47 cases, and postoperative bronchial anastomotic stenosis after bronchoplasty in 3 cases. The airway stents included 45 silicon stents (Y stent, n=30; straight stent, n=15), 4 double stents with silicon and metallic stent, and 1 metallic stent. Extracorporeal membrane oxygenation (ECMO) was used during stent placement in 5 cases to prevent critical hypoxic complication. Improvements in respiratory status after stenting were recognized in 42 of the 50 patients (84%). Median survival and 1 year survival rate in the 47 patients with malignant disease were 152 days (range 11-1,417 days) and 23.8%, respectively. Significantly longer survival was observed in 26 patients who received post-procedural chemotherapy and/or radiotherapy compared with 21 patients who did not receive additional therapy (median survival : 259 days vs 47 days, p=0.008). Interventional pulmonology including airway stenting for central airway obstruction can provide relief of dyspnea and improve survival in patients with additional treatment after stent placement. Also, a 3D printed airway model is a useful simulation tool for understanding anatomy before a procedure and determination of placement of an airway stent.
No preview · Article · Jan 2015 · Nihon Kikan Shokudoka Gakkai Kaiho
[Show abstract][Hide abstract] ABSTRACT: Duodenal duplication cysts are relatively rare congenital anomalies that occur most often in infants and children. We report a case of a 13-year-old boy who presented with duodenal obstruction caused by bleeding of a duodenal duplication cyst. Operative findings and hispathological examination confirmed the diagnosis. We treated him with subtotal excision of the duodenal duplication cyst and mucosal stripping and ablation of the remaining mucosa
Preview · Article · Jan 2011 · Acta medica Nagasakiensia