Journal Article

F-058NEW VIDEO-ASSISTED THORACOSCOPIC PLEURECTOMY TECHNIQUE FOR PATIENTS WITH RECURRENT SPONTANEOUS PNEUMOTHORAX

Kirill Gestkov, B. Barsky and O. Kuznetsova

in Interactive CardioVascular and Thoracic Surgery

Published on behalf of European Association for Cardio-Thoracic Surgery

Volume 18, issue suppl_1, pages S15-S15
Published in print June 2014 | ISSN: 1569-9293
Published online June 2014 | e-ISSN: 1569-9285 | DOI: http://dx.doi.org/10.1093/icvts/ivu167.58
F-058NEW VIDEO-ASSISTED THORACOSCOPIC PLEURECTOMY TECHNIQUE FOR PATIENTS WITH RECURRENT SPONTANEOUS PNEUMOTHORAX

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  • Cardiovascular Medicine
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Objectives: Pleurectomy with or without lung resection by video-assisted thoracic surgery (VATS) is the most popular approach for patients with recurrent spontaneous pneumothorax (RSP). One of the main complications following pleurectomy is intrapleural bleeding. We propose a technique that allows to reduce intra- and postoperative bleeding following pleurectomy.

Methods: From February 2002 to December 2013, 725 patients with RSP were treated. Lung resections were done in 695 (96%) cases. Male/female rate was 552/173 (76/24%) with an average age of 32.5 (20-46) years. Four hundred and nine patients (56.4%) had right-sided disease. According to the pleural cavity obliteration technique we divided patients in two groups: Group I – pleurectomy (proposed technique) (n = 467) and Group II – electrocautery pleurodesis (n = 258). Our technique: the 1st trocar was inserted along the midaxillary line in the 4-5th intercostal space. Two additional trocars were inserted along the anterior and posterior axillary lines in the 6th and 7th intercostal spaces. Pleurectomy technique includes: 1st step: subpleural infiltration using long needle and crystalloid solution. This manipulation allows to peel the pleura without blood loss. 2nd step: L-shape incision along the paravertebral line 1 cm above the costo-vertebral joints and along the 8th intercostal space. The 3rd step: pleurectomy by twisting motion using rigid clamp.

Results: We found a significant difference between groups in intraoperative blood loss (60 ± 20 ml in Group I vs 5 ± 15 ml in Group II, P < 0.05), and did not find any difference in postoperative bleeding. Pleural drainages were removed after 2.8 (1.0; 11.0) and 6.2 (3.0; 18.0) days (P < 0.05) and median hospital stay was 8 ± 5.6 and 14 ± 9.2 days (P < 0.05) for the Group I and II respectively.

Conclusions: The proposed technique is easy to use, allows to perform pleurectomy without significant blood loss and provides results comparable to traditional pleural cavity obliteration techniques.

Disclosure: No significant relationships.

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine ; Cardiothoracic Surgery

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