ORCID Profile
0000-0003-2450-4257
Current Organisations
Chang Gung Memorial Hospital
,
Chang Gung University
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Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.ASJSUR.2018.07.002
Abstract: Transumbilical approach has been shown to be feasible to perform lung wedge resection and anatomic lobectomy. This study uses a canine model to assess the feasibility of transumbilical segmentectomy. Transumbilical segmentectomy was performed in 10 beagle dogs using a 3-cm umbilical incision combined with a 2.5-cm diaphragmatic incision. We evaluated the surgical outcomes, operative complications, physiologic changes, hemodynamic changes, and inflammatory changes of the procedures. Transumbilical segmentectomy was successfully completed in eight of ten animals. There was one mortality complication related to lung injury causing hemodynamic collapse. Another animal required conventional thoracotomy to complete the surgery due to limited working space. There were no notable events in the postoperative period for all eight dogs that completed the segmentectomy via the transumbilical approach. This animal study demonstrates that the pulmonary segmentectomy can be performed with current standard endoscopic instruments via a single transumbilical incision.We believe that advancing surgical innovation and good collaboration between multi-disciplinary research teams will further establish clearer roles for transumbilical segmentectomy in thoracic surgery.
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.NEDT.2022.105526
Abstract: Acute care and critical care are among the most challenging tasks in nursing, which requires information, knowledge, and skills across multiple areas. Scenario simulations can teach nursing students how to respond to these challenges in a safe environment, which can also reduce the stress of acute and critical care prior to exposure to a clinical setting. However, few studies have examined whether scenario simulations of acute and critical care can improve the abilities of nursing students. To examine the effects of acute and critical care scenario simulations for nursing students. A quasi-experimental design. A department of nursing at a university. A total of 88 senior nursing students enrolled in a course in acute and critical care nursing volunteered to participate. The experience provided by scenario simulations was guided by the best practice standards of the International Nursing Association for Clinical Simulation and Learning, which recommends outcome measures include a change in knowledge, skills, and attitudes. Students completed three self-assessment instruments before and after completion of the course: simulation learning effectiveness, self-reflection and insight, and satisfaction with the simulation format. Comparisons of pre-test and post-test scores on the self-assessment instruments evaluated the effects of the simulation learning. Post-test scores for subscale of self-regulation for simulation learning effectiveness and insight were significantly higher compared with pre-test scores (t = -2.85, p < 0.01 and t = -5.23, p < 0.001, respectively). There was also a significant increase for learning satisfaction in post-test, compared with pre-test (t = -3.70, p < 0.001). The use of scenario simulations for teaching acute and critical care nursing improved self-regulation, insight and learning satisfaction for undergraduate nursing students.
Publisher: Public Library of Science (PLoS)
Date: 12-02-2019
Publisher: SAGE Publications
Date: 06-11-2015
Abstract: Purpose. Transthoracic thoracoscopic approach is the gold standard in surgical treatment for thoracic disease. However, it is associated with significant chronic postoperative wound discomfort. Currently, limited data are available regarding the subxiphoid approach to the thoracic cavity. The present study is aimed to evaluate the performance of a subxiphoid anatomic pulmonary lobectomy (SAPL) in a canine model. Methods. The SAPL procedure was performed in 10 beagle dogs using a 3-cm incision over the xiphoid process. After thoracic exploration, SAPL was performed under flexible bronchoscopy guidance. The pulmonary vessel was ided with Ligasure and secured with a suture ligature. The bronchus was ided with endostapler. Surgical outcomes were evaluated by the success of SAPL and operative complications. Results. SAPL was successfully completed in 9 animals. One animal required conventional thoracotomy to resuture the pulmonary artery stump. Another animal encountered small middle lobe laceration after SAPL and died at 8 days postoperation due to respiratory distress. Conclusion. Subxiphoid anatomic pulmonary lobectomy is technically feasible. Refinement of endoscopic instruments combined with more research evidences may facilitate the development of subxiphoid platform in thoracic surgery.
Publisher: SAGE Publications
Date: 23-09-2021
Abstract: Background. To date there are no practical platforms for performing natural orifice transluminal endoscopic surgery in the thoracic cavity. This study evaluates the feasibility of transumbilical thoracosopy for lung biopsy and pericardial window creation. Methods. Eleven dogs (6 in the nonsurvival group and 5 in the survival group) were used for this study. A homemade metallic tube was advanced into the abdominal cavity via a 12-mm umbilical incision. The metallic tube was advanced into the thoracic cavity through a subxyphoid diaphragmatic incision under video guidance. Access to the thoracic cavity was achieved by a flexible bronchoscope via the metallic tube. Surgical lung biopsy and pericardial window creation were performed using an electrocautery loop and needle knife. The animals were euthanized 20 minutes after the surgery was complete (nonsurvival group) or 14 days postsurgery (survival group) for necropsy evaluation. Results. Eight pericardial window creations and 21 of 22 preplanned lung biopsies were completed in a median time of 72.18 minutes (range 50-105 minutes). One dog in the nonsurvival group died after tension pneumothorax due to postprocedure massive air leaks. In the survival group, the postoperative period was uneventful in all 5 dogs. Autopsies revealed no signs of vital organ injury and complete healing of the diaphragmatic incision occurred in all animals. Conclusions. The study demonstrated that transumbilical thoracoscopic surgical lung biopsy and pericardial window creation is feasible. The safety and efficacy of the transumbilical approach need to be verified by a more detailed survival study.
Publisher: Oxford University Press (OUP)
Date: 10-2005
DOI: 10.1016/J.EJCTS.2005.06.041
Abstract: Hydrothorax developing from pleuroperitoneal communication as a complication of peritoneal dialysis was first described in 1967 [Edward SR, Unger AM. Acute hydrothorax-a new complication of peritoneal dialysis. JAMA 1967 199:853-5. ]. The incidence of hydrothorax is approximately 1.6-2% of continuous ambulatory peritoneal dialysis (CAPD) patients. The key to successful therapy is obliteration of the transdiaphragmatic route of dialysate leakage with video-assisted thoracoscopic surgery (VATS). The method in which air leakage is checked intraoperatively is the preferred choice and better than all other procedures.
Publisher: AME Publishing Company
Date: 06-2018
Publisher: Oxford University Press (OUP)
Date: 2006
DOI: 10.1016/J.EJCTS.2005.10.024
Abstract: Tracheal stenosis of ventilator-dependent patient is generally managed via dilation and long trachesostomy tube. This study reports four ventilator patients with tracheal stenosis managed with Montgomery T tube via rigid bronchoscopy. The respiratory symptoms improved in all patients. Three of the patients were weaned from ventilator shortly following treatment.
Publisher: MDPI AG
Date: 19-08-2021
Abstract: The differences in chest computed tomography (CT) image quality may affect the tumor stage. The aim of this study was to compare the image quality and accuracy of chest CT via central vein and peripheral vein enhancement. Fifty consecutive patients were enrolled from a tertiary medical center in Taiwan from May 2016 to March 2019. All the patients received a chest CT via central vein enhancement prior to neoadjuvant concurrent chemoradiation in order to compare the chest CT that was obtained via the peripheral vein. In addition, blind independent central reviews of chest CT via central vein and peripheral vein enhancement were conducted. For T and N stage, chest CT via central vein enhancement had a greater consistency with endoscopic ultrasonography and positron-emission tomography-computed tomography findings (kappa coefficients 0.4471 and 0.5564, respectively). In addition, chest CT via central vein enhancement also showed excellent agreement in the blind independent central review (kappa coefficient 0.9157). The changes in the T and N stage resulted in stage migration in 16 patients. Chest CT via central vein enhancement eliminated peripheral vein regurgitation and also provided more precise clinical staging. This study is registered under the registered NCT number 02887261.
Publisher: Wiley
Date: 17-08-2009
DOI: 10.1002/LARY.20615
Abstract: To determine whether stent-to-vocal fold distance influences morbidity following stent placement for tracheal stenosis. Fifty-five stent procedures (46 Montgomery T-tube [Boston Medical Products, Westborough, MA] and 9 Dumon stents [Novatech, Grasse, France]) were performed in 40 patients enrolled in this study. The most common complication of stenting for tracheal stenosis was granulation (23 procedures, 41.82%). Of 43 procedures where the stent upper edge was located at or below the vocal folds, granulation occurred in 21 procedures (48.84%). Of 12 procedures where the stent edge was located above the vocal fold, granulation occurred in two procedures, or 16.67% (odds ratio = 4.773, P = .0458, chi(2) test). Among patients in whom the stent edge was located at or below the vocal folds, the granulation complication rate was higher in those with a stent-to-vocal fold distance of <10 mm. Multivariate analysis revealed that the stent-to-vocal fold distance independently predicted granulation formation an inverse correlation was identified between stent-to-vocal fold distance and granulation severity (n = 43, r = -.501, P = .0006 Spearman ranking test). Receiver operating characteristic curve analysis further demonstrated that a stent-to-vocal fold distance cutoff value between 9.5 and 11 mm had the best accuracy in predicting granulation formation. A stent-to-vocal fold distance of 10 mm was found to be a critical distance for discriminating granulation formation. Optimal stent-to-vocal fold distance should routinely be evaluated before stent placement.
Publisher: MDPI AG
Date: 24-04-2021
DOI: 10.3390/JPM11050344
Abstract: Intravenous ports serve as vascular access and are indispensable in cancer treatment. Most studies are not based on a systematic and standardized approach. Hence, the aim of this study was to demonstrate long-term results of port implantation following a standard algorithm. A total of 2950 patients who underwent intravenous port implantation between March 2012 and December 2018 were included. Data of patients managed following a standard algorithm were analyzed for safety and long-term outcomes. The cephalic vein was the predominant choice of entry vessel. In female patients, wire assistance without use of puncture sheath was less likely and echo-guided puncture via internal jugular vein (IJV) with use of puncture sheath was more likely to be performed, compared to male patients (p 0.0001). The procedure-related complication rate was 0.07%, and no pneumothorax, hematoma, catheter kinking, catheter fracture, or pocket erosion was reported. Catheter implantations by echo-guided puncture via IJV notably declined from 4.67% to 0.99% (p = 0.027). Mean operative time gradually declined from 37.88 min in 2012 to 23.20 min in 2018. The proposed standard algorithm for port implantation reduced the need for IJV echo-guided approach and eliminated procedure-related catastrophic complications. In addition, it shortened operative time and demonstrated good functional results.
Publisher: Georg Thieme Verlag KG
Date: 04-2011
Abstract: The present study aimed to determine whether stent diameter influences granulation tissue formation following stent placement for major airway stenosis. Forty-two stent procedures (32 tracheal stents, 3 carinal stents, and 7 bronchial stents) were performed in 40 patients. Seventy-nine stent edge regions (62 tracheal, 17 bronchial stents) were evaluated in this study. Granulation tissue formation was encountered in 11 patients (28.21%). Of the 34 upper ends of evaluated tracheal stents, granulation tissue formation was observed in 6 (17.65%), whereas granulation tissue formation was observed in 2 (7.14%) of the 28 lower ends of tracheal stents evaluated. Of the 17 bronchial stent edge regions, granulation tissue formation occurred in 3 (17.65%) ( P = 0.4352). The rate of granulation tissue formation was higher in those patients with a stent-to-airway diameter ratio of > 90% ( P < 0.0001). Receiver operating characteristic curve analysis further demonstrated that a cut-off stent-to-airway diameter ratio of 90% was effective in predicting granulation tissue formation (AUC: 0.897, Std. error = 0.036, P < 0.0001, 95% CI = 0827-0.968, n = 79). A stent-to-airway diameter ratio of 90% was found to be the critical cut-off point for predicting granulation tissue formation. Therefore, the optimal stent-to-airway diameter ratio should be ascertained before stent placement.
Publisher: Public Library of Science (PLoS)
Date: 31-10-2018
Publisher: Wiley
Date: 09-2007
DOI: 10.1111/J.1440-1843.2007.01126.X
Abstract: Stenting is an effective method of treating airway stenosis. However, airway obstruction due to mucus plugging is problematic. Treatment of this has mainly been conservative. This report describes a patient with complicated tracheal stenosis treated with silicone hood stent, who experienced repeated episodes of airway obstruction due to sputum accumulation. A novel method of sputum clearance and self-care, using a long endotracheal tube within the silicone stent, is described. This procedure resulted in a stable and patent airway, and the patient was discharged smoothly after the procedure. No further respiratory symptom occurred during the follow-up period.
Publisher: Springer Science and Business Media LLC
Date: 21-02-2009
DOI: 10.1007/S00268-009-9928-2
Abstract: The benefit of bullae ablation for the management of primary spontaneous pneumothorax (PSP) has been established. However, various modalities for bullae ablation have been reported from different centers. The present study aimed to assess whether endoloop ligation of bullae was as effective as staple bullectomy for preventing the recurrence of pneumothorax. Between January 1993 and December 2003, 226 patients (203 men and 23 women) with PSP were recorded and retrospectively reviewed. One hundred thirty (57.5%) patients were treated with endoloop ligation of bullae and the other 96 (42.5%) were treated with staple bullectomy. Mechanical abrasion was performed in all patients after bullae ablation. The recurrence rate of pneumothorax was 6.2% (8 patients) in the endoloop ligation group and 17.7% (17 patients) in the staple bullectomy group (p = 0.006). The postoperative complication rate was 14.6 and 20.8% in the endoloop ligation and staple bullectomy groups, respectively (p = 0.221). The long-term chest discomfort rate after endoloop ligation and staple bullectomy was 14.6 and 13.5%, respectively (p = 0.819) Endoloop ligation of bullae is as effective as mechanical staple bullectomy for the management of bullae in primary spontaneous pneumothorax.
Publisher: Springer Science and Business Media LLC
Date: 23-05-2014
DOI: 10.1007/S00464-014-3561-3
Abstract: Transthoracic thoracoscopic lobectomy is the preferred method of surgical treatment for early lung cancer. Current methods require a transthoracic approach and are associated with chronic postoperative pain in up to 25% of patients. Single-port transumbilical uniport surgery may offer advantages over multiport surgery with less postoperative pain and better cosmetic results. The aim of this study was to evaluate the feasibility of a transumbilical anatomic lobectomy of the lung (TUAL) in a canine model. TUAL was performed in 12 beagle dogs using a 3-cm umbilical incision combined with a 2.5-cm diaphragmatic incision. Variables evaluated for surgical outcomes were operating time, operative complications, body rectal temperature, respiratory rate, white blood cell count, and arterial blood gases. TUAL was successfully completed in ten animals. There were six bleeding complications related to surgery. In four animals, an avulsion of pulmonary vessel causes intraoperative bleeding, requiring simultaneous pulmonary artery and bronchus resections. In one animal, slipping of endoclip after vessel clipping caused perioperative bleeding. The other animal encountered bleeding complication during dissection of inferior pulmonary vein. Both animals required conventional thoracotomy to complete the surgery. TUAL in the canine model is feasible but associated with significant morbidity. With further development and refinement of instruments, comparative studies between the novel transumbilical lobectomy and the current video-assisted transthoracic lobectomy will clarify the role of transumbilical lobectomy in thoracic surgery.
Publisher: SAGE Publications
Date: 07-10-2014
Abstract: Purpose. Transumbilical single-port surgery has been associated with less postoperative pain and offers better cosmetic outcomes than conventional 3-port laparoscopic surgery. This study compares the safety and efficacy of transumbilical thoracoscopy and conventional thoracoscopy for lung wedge resection. Methods. The animals (n = 16) were randomly assigned to the transumbilical thoracoscopic approach group (n = 8) or conventional thoracoscopic approach group (n = 8). Transumbilical lung resection was performed via an umbilical incision and a diaphragmatic incision. In the conventional thoracoscopic group, lung resection was completed through a thoracic incision. For both procedures, we compared the surgical outcomes, for ex le, operating time and operative complications physiologic parameters, for ex le, respiratory rate and body temperature inflammatory parameters, for ex le, white blood cell count and pulmonary parameters, for ex le, arterial blood gas levels. The animals were euthanized 2 weeks after the surgery for gross and histologic evaluations. Results. The lung wedge resection was successfully performed in all animals. There was no significant difference in the mean operating times or complications between the transumbilical and the conventional thoracoscopic approach groups. With regard to the physiologic impact of the surgeries, the transumbilical approach was associated with significant elevations in body temperature on postoperative day 1, when compared with the standard thoracoscopic approach. Conclusions. This study suggests that both approaches for performing lung wedge resection were comparable in efficacy and postoperative complications.
Publisher: Wiley
Date: 16-08-2006
DOI: 10.1111/J.1445-2197.2006.03882.X
Abstract: The Montgomery T-tube (T-tube) is an effective device for relieving tracheal stenosis when lesions are inappropriate for surgical reconstruction. Several techniques have been developed for the insertion of the T-tube in difficult conditions. The aim of this study was to present our experience using a rigid bronchoscope for T-tube insertion. A retrospective chart review of patients with tracheal stenosis who underwent T-tube insertion between April 2002 and July 2005 was conducted. Thirty-seven patients underwent 53 T-tube placements. Successful stent placement was achieved in all 37 patients. The T-tube was not tolerated in six patients because of granulation obstruction of the upper limb or sputum impaction. Thirty-one patients had good long-term results and enjoy adequate airway with the T-tube. There was no procedure-related mortality and there were no complications. Rigid bronchoscopic insertion of the T-tube for tracheal stenosis is a safe and an effective procedure. It ensures the correct placement of the T-tube when the technique described by Montgomery fails.
Publisher: Springer Science and Business Media LLC
Date: 24-05-2012
DOI: 10.1245/S10434-012-2402-7
Abstract: Extensive lymph node dissection (LND) is beneficial in primarily resected esophageal cancer patients. Such benefit was believed to be seen in neoadjuvant chemoradiotherapy (CRT)-treated patients, but evidence was inconsistent. We hypothesized that CRT might offset the benefit of LND in certain subgroup of patients, especially in major responders. The clinical pathological data and survival of esophageal squamous cell carcinoma patients who received curative resection after CRT between 1996 and 2007 were analyzed. On the basis of the mean LND number of the cohort, patients were ided into two groups: group 1, lower LND, and group 2, higher LND. The cohort comprised 303 patients (295 men and 8 women) with a mean age of 55.4 years. There were 179 patients in group 1 and 124 patients in group 2. One hundred one patients had pathological complete response (pCR). There were more pCR in group 1 (38 vs. 26.6%, P = 0.039) and more lymph node positive cases in group 2 (16 vs. 27.4%, P = 0.018). Extent of LND had no survival difference in the entire cohort (overall survival 32 vs. 38%, P = 0.31). With the stratification analysis according to tumor response, inadequate LND exhibited negative impact in patients who did not experience pCR (P = 0.027). Without adequate LND, the survival of ypTxN0 was equally poor as ypN-positive cases (overall survival 15 vs. 16%, P = 0.791). In the pCR group, the extent of LND had an impact on survival. The effect of LND was influenced by tumor response after CRT. There is a strong survival benefit for extensive LND after CRT in esophageal squamous cell carcinoma, especially in non-pCR patients.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.JTCVS.2017.11.079
Abstract: The use of image-guided video-assisted thoracoscopic surgery for simultaneous localization and removal of small solitary pulmonary nodules in a hybrid operation room using C-arm cone-beam computed tomography is gaining momentum. We sought to assess the effect of the learning curve on procedural parameters and clinical outcomes of image-guided video-assisted thoracoscopic surgery for treating patients with small solitary pulmonary nodules. Clinical variables and treatment outcomes of the 30 initial patients with solitary pulmonary nodules who were treated with image-guided video-assisted thoracoscopic surgery at Chang Gung Memorial Hospital (Taiwan) were prospectively analyzed. Two sequential groups (groups I and II, n = 15 each) were compared with regard to localization time, radiation doses, and success rates. We used the Pearson's correlation coefficient to investigate the association between the surgical experience and the procedural time. In the entire cohort, the median size of solitary pulmonary nodules on preoperative computed tomography images was 6 mm (interquartile range, 4.5-9 mm), and their median distance from the pleural surface was 10 mm (interquartile range, 5-15 mm). The median tumor depth-to-size ratio was 1.4 (interquartile range, 0.7-2.5). The clinical parameters were similar between the 2 groups. There was an inverse association between the surgical experience and the procedural time (Pearson's r = -0.6873 P < .001). A significant reduction in localization time (median, 24 vs 49 minutes, respectively P < .001) and radiation exposure (median, 70.7 vs 224 mGy, respectively P < .001) was noted in group II (late patients) compared with group I (early patients). Notably, the success rates in groups II and I were similar (93.3% vs 86.7%, respectively P = . 876). Our data demonstrate a significant learning curve for image-guided video-assisted thoracoscopic surgery in the treatment of solitary pulmonary nodules as evidenced by decreased localization time and radiation exposure occurring with increased surgical experience.
Publisher: Springer Science and Business Media LLC
Date: 23-11-2020
DOI: 10.1186/S13244-020-00932-0
Abstract: With recent transformations in medical education, the integration of technology to improve medical students’ abilities has become feasible. Artificial intelligence (AI) has impacted several aspects of healthcare. However, few studies have focused on medical education. We performed an AI-assisted education study and confirmed that AI can accelerate trainees’ medical image learning. We developed an AI-based medical image learning system to highlight hip fracture on a plain pelvic film. Thirty medical students were ided into a conventional (CL) group and an AI-assisted learning (AIL) group. In the CL group, the participants received a prelearning test and a postlearning test. In the AIL group, the participants received another test with AI-assisted education before the postlearning test. Then, we analyzed changes in diagnostic accuracy. The prelearning performance was comparable in both groups. In the CL group, postlearning accuracy (78.66 ± 14.53) was higher than prelearning accuracy (75.86 ± 11.36) with no significant difference ( p = .264). The AIL group showed remarkable improvement. The WithAI score (88.87 ± 5.51) was significantly higher than the prelearning score (75.73 ± 10.58, p 0.01). Moreover, the postlearning score (84.93 ± 14.53) was better than the prelearning score ( p 0.01). The increase in accuracy was significantly higher in the AIL group than in the CL group. The study demonstrated the viability of AI for augmenting medical education. Integrating AI into medical education requires dynamic collaboration from research, clinical, and educational perspectives.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2015
Publisher: Oxford University Press (OUP)
Date: 23-09-2011
DOI: 10.1111/J.1442-2050.2011.01243.X
Abstract: The optimal treatment for patients with local esophageal cancer (cT2N0 disease) has not yet been defined. We sought to determine whether neoadjuvant chemoradiotherapy (CRT) can improve prognosis compared with direct esophagectomy in this patient group. Between 1994 and 2005, patients with cT2N0 esophageal squamous cell carcinoma who underwent either neoadjuvant CRT or surgery as first-line treatment were retrospectively reviewed. We collected information on their demographic characteristics, staging modality, clinical and pathological stages, perioperative course, and survival. The study endpoints included tumor recurrence, disease-specific survival (DSS), and overall survival rate. Of the 71 eligible patients, 14 received an esophagectomy first, whereas the remaining 57 received neoadjuvant CRT first. Despite the high pathological complete response (pCR) rate of 37% after neoadjuvant CRT, routine neoadjuvant CRT did not translate into better survival compared to direct surgery (5-year DSS: 39% vs. 68%, P= 0.17). The dramatic survival difference between pCR and non-pCR patients (5-year DSS: 85% vs. 4%, P < 0.001) accounts for these unsatisfactory results. In our series, the administration of neoadjuvant CRT to patients with clinical stage T2N0 esophageal squamous cell carcinoma did not significantly improve outcomes compared with direct esophagectomy.
Publisher: Wiley
Date: 2007
DOI: 10.1111/J.1445-2197.2006.03840.X
Abstract: Background: Airway stenting is an alternative approach for relieving airway stenosis when lesions are inappropriate for single‐stage reconstruction. The aim of this study was to present our experience using airway stent in the management of patients with tracheal stenosis. Methods: This study retrospectively reviewed 45 patients who underwent airway stenting during a 2‐year period. Between June 2002 and August 2004, 45 patients underwent rigid bronchoscopy for tracheal stenosis using an Ultraflex stent (Microvasive Boston Scientific, Boston, MA, USA), Hood stent (Hood Laboratories, Pembroke, MA, USA) and Montgomery T‐tube (Boston Medical, Westborough, MA, USA). Clinical improvement, intraoperative, early and late postoperative complications were evaluated. Results: Ultraflex stent was used in 14 patients, Hood stent in 9 and Montgomery T‐tube in 22. The overall clinical improvement was 95.5%. Four per cent of the patients (2/45) had intraoperative complications, 8.8% (4/45) had early postoperative complications and 51% (23/45) had late postoperative complications. No significant difference was determined between stent type and complication rates. Conclusion: Rigid bronchoscopic insertion of airway stents for tracheal stenosis is a safe and effective procedure. No difference exists between stent type and clinical improvement, intraoperative and early and late postoperative complications.
Publisher: AME Publishing Company
Date: 10-2016
Publisher: Mary Ann Liebert Inc
Date: 08-2013
Abstract: Chronic wound discomfort and intercostal neuralgia are well-known postoperative complications of video-assisted thoracoscopic surgery (VATS). To explore the possibility of a surgical platform that would cause less postoperative discomfort and avoid these complications, this study evaluated the feasibility of transumbilical lung wedge resection in a canine model. Twelve dogs (4 in the nonsurvival group and 8 in the survival group) were used in this study. Transumbilical thoracoscopy was performed using a homemade metallic tube via umbilical and diaphragmatic incisions with the animal in a supine position. After thoracic exploration, wedge resection was performed on the lung using an endoscopic stapling device placed through the transumbilical and transdiaphragmatic incisions under direct bronchoscopic guidance. The animals were sacrificed 30 minutes after the procedure (nonsurvival group) or 14 days postsurgery (survival group) for necropsy and histological evaluations. Eleven preplanned lung wedge resections were completed in a median time of 101 minutes (range, 65-175 minutes) with one exception due to inadequate stapling in the early phase of the experiment. There was one death directly related to postoperative massive airleaks and sepsis in the survival group. The other 7 animals had an uneventful postoperative period. Necropsies at 2 weeks after surgery confirmed successful lung resections and revealed no evidence of vital organ injury. Two animals exhibited complete healing of the diaphragmatic incision. Liver herniation was identified in 1 of 5 animals with partial wound healing. This preliminary animal study demonstrates that large lung wedge resection can be performed with mechanical staplers via a single transumbilical incision. Future studies will investigate the cardiopulmonary and immunologic effects of transumbilical VATS compared with conventional VATS.
Publisher: JMIR Publications Inc.
Date: 09-06-2021
DOI: 10.2196/23980
Abstract: The COVID-19 pandemic has stunted medical education activities, resulting in most conferences being cancelled or postponed. To continue professional education during this crisis, web-based conferences can be conducted via livestream and an audience interaction platform as an alternative. The unprecedented COVID-19 pandemic has affected human connections worldwide. Conventional conferences have been replaced by web-based conferences. However, web-based conferencing has its challenges and limitations. This paper reports the logistics and preparations required for converting an international, on-site, multidisciplinary conference into a completely web-based conference within 3 weeks during the pandemic. The program was revised, and a teleconference system, live recording system, director system setup, and broadcasting platform were arranged to conduct the web-based conference. We used YouTube (Alphabet Inc) and WeChat (Tencent Holdings Limited) for the web-based conference. Of the 24 hours of the conventional conference, 21.5 hours (90%) were retained in the web-based conference via live broadcasting. The conference was attended by 71% (37/52) of the original international faculties and 71% (27/38) of the overall faculties. In total, 61 out of 66 presentations (92%) were delivered. A special session—“Dialysis access management under the impact of viral epidemics”—was added to replace precongress workshops and competitions. The conference received 1810, 1452, and 1008 visits on YouTube and 6777, 4623, and 3100 visits on WeChat on conference days 1, 2, and 3, respectively. Switching from a conventional on-site conference to a completely web-based format within a short period is a feasible method for maintaining professional education in a socially responsible manner during a pandemic.
Publisher: Springer Science and Business Media LLC
Date: 11-08-2017
DOI: 10.1007/S00268-017-4179-0
Abstract: Radical lymph node dissection (LND) along the bilateral recurrent laryngeal nerve (RLN) is a surgically challenging procedure with a high rate of morbidity. Here, we assessed in a retrospective manner the adequacy of LND along the RLN performed with robot-assisted thoracoscopic esophagectomy (RATE) versus video-assisted thoracoscopic esophagectomy (VATE) in patients with esophageal squamous cell carcinoma (ESCC). This was a single-center, retrospective, propensity-matched study. ESCC patients who underwent McKeown esophagectomy and bilateral RLN LND with a minimally invasive approach were ided into two groups according to the use of robot-assisted surgery or not (RATE vs VATE, respectively). Using propensity score matching, 34 balanced matched pairs were identified. The number of dissected nodes as well as the rates of RLN palsy and perioperative complications served as the main outcome measures. No conversion to open thoracotomy occurred in either group. Intraoperative blood loss and the need of blood transfusions did not show significant intergroup differences. The mean number of dissected nodes was similar in the two study groups, the only exception being the left RLN area. Specifically, the mean number of nodes removed from this region was 5.32 in the RATE group and 3.38 in patients who received VATE (p = 0.007). Notably, the RATE and VATE groups did not differ significantly with regard to rates of both RLN palsy (20.6 vs 29.4%, respectively, p = 0.401) and pulmonary complications (5.9 vs 17.6%, respectively, p = 0.259). Compared with VATE, RATE resulted in a higher lymph node yield along the left RLN without increasing morbidity.
Publisher: Oxford University Press (OUP)
Date: 08-2006
DOI: 10.1016/J.EJCTS.2006.04.041
Abstract: Stent placement may induce granulation tissue, occlude the stent lumen, and exacerbate respiratory symptoms. Microdebrider was designed to treat laryngeal papillomas and airway stenosis. However, little research exists on the management of airway stenosis following airway stenting with microdebrider. This study describes two cases of glottic stenosis caused by airway stenting successfully treated with mibrodebrider.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2015
DOI: 10.1016/J.IJSU.2015.02.027
Abstract: Single-port transumbilical surgery is a well-established platform for minimally invasive abdominal surgery. The aim of this study was to compare the hemodynamics and inflammatory response of a novel transumbilical technique with that of a conventional transthoracic technique in thoracic exploration and lung resection in a canine model. Sixteen dogs were randomly assigned to undergo transumbilical thoracoscopy (n = 8) or standard thoracoscopy (n = 8). Animals in the umbilical group received lung resection via a 3-cm transumbilical incision in combination with a 2.5-cm transdiaphragmatic incision. Animals in the standard thoracoscopy group underwent lung resection via a 3-cm thoracic incision. Hemodynamic parameters (e.g., mean arterial pressure, heart rate, cardiac index, systemic vascular resistance, and global end-diastolic volume index) and inflammatory parameters (e.g., neutrophil count, neutrophil 2',7' -dichlorohydrofluorescein [DCFH] expression, monocyte count, monocyte inducible nitric oxide synthase expression, total lymphocyte count, CD4+ and CD8+ lymphocyte counts, the CD4+/CD8+ratio, plasma Creactive protein level, interleukin-6 level) were evaluated before surgery, during the operation, and on postoperative days 1, 3, 7, and 14. Lung resections were successfully performed in all 16 animals. There were 2 surgery-related mortality complications (1 animal in each group). In the transumbilical group, 1 death was caused by early extubation before the animal fully recovered from the anesthesia. In the thoracoscopic group, 1 death was caused by respiratory distress and the complication of sepsis at 5 days after surgery. There was no significant difference between the two techniques with regard to the hemodynamic and immunologic impact of the surgeries. This study suggests that the hemodynamic and inflammatory changes with endoscopic lung resection performed by the transumbilical approach are comparable to those after using the conventional transthoracic approach. This information is novel and relevant for surgeons interested in developing new surgical techniques in minimally invasive surgery.
Publisher: Springer Science and Business Media LLC
Date: 26-09-2014
DOI: 10.1245/S10434-014-4068-9
Abstract: The use of video-assisted thoracoscopic surgery (VATS) in patients with thymoma remains controversial. We sought to evaluate the perioperative and oncological outcomes after VATS resection for stage I and II thymoma and to compare the outcomes with those obtained after median sternotomy (MST). Between 1991 and 2007, a total of 140 patients with stage I and II thymoma underwent surgery at the Chang Gung Memorial Hospital. Of them, 58 underwent MST, 61 VATS, and 21 thoracotomy. Using a propensity score based on four variables (myasthenia gravis, tumor size on CT images, age, and Masaoka stage), 48 VATS-treated patients were matched to 48 patients who received MST. Outcomes compared included perioperative complications, length of stay, tumor recurrence, and survival. No operative deaths occurred in this study. VATS was associated with fewer intraoperative blood loss, and more patients in the VATS group were extubated in the operating room after surgery compared with the MST group (37.5 vs. 12.5 %, respectively, P = 0.005). The mean length of stay was shorter in the VATS group than in the MST group (5.8 vs. 7 days, respectively P = 0.008). After a median follow-up of 53 months, five patients developed recurrent tumors (four pleural and one pericardial). No statistically significant differences were found in the 5-year survival rates between the two study groups. VATS appears feasible for patients with stage I and II thymoma and is associated with better perioperative outcomes than MST. The oncological outcomes are also similar.
Publisher: Springer Science and Business Media LLC
Date: 03-2004
DOI: 10.1007/S00464-003-8215-9
Abstract: Incisional recurrence after thoracoscopic surgery has been reported infrequently. In recent years, several reports of port-site recurrence after laparoscopic oncologic procedures have been published. This study evaluates the incidence of incisional recurrence among patients with intrathoracic malignancy after diagnostic and therapeutic thoracoscopy. The medical records of all patients with intrathoracic malignancies who underwent thoracoscopic procedures between 1992 and 1998 at Chang Gung Memorial Hospital Linkou Medical Center were reviewed. Information includes preoperative tumor status, thoracoscopic findings, primary tumor location, tumor pathology, procedures performed, and perioperative complications were recorded. A total of 1,069 patients with known intrathoracic malignancies underwent thoracoscopy. The mean follow-up time was 17.1 months (range, 1-68 months). Two recurrences at the incision were identified (0.19%). Both patients with incision-site recurrence had advanced intrathoracic disease at the time of thoracoscopy. The one patient had a malignant pleural effusion (T4), and the other had diffuse pleural metastasis. The incidence of incisional recurrence after thoracoscopic oncologic surgery is very low. When recurrence occurs at the incision, it is associated most commonly with advanced intrathoracic disease. Additional patients and a longer follow-up evaluation are required, however, to confirm this observation.
Publisher: The Society of Laparoscopic and Robotic Surgeons
Date: 2015
Publisher: Elsevier BV
Date: 05-2019
Publisher: Elsevier BV
Date: 11-2002
Abstract: Video-assisted thoracic surgery (VATS) has gained a prominent role in routine thoracic surgery practice. This study discusses the clinical aspects and utility of VATS in spontaneous hemopneumothorax (SHP). Of 363 spontaneous pneumothorax (SP) cases, 24 patients presented with SHP (6.6%). The clinical features, surgical indications, emergency VATS technique, and patient outcomes are discussed. All 24 patients were male (mean age, 25.3 years). Eleven patients were in hypovolemic shock, and their hemoglobin levels ranged from 6.7 to 12.7 g/dL therefore, they received fluid resuscitation and blood transfusion. The amount of blood drained through the chest tube varied from 200 to 3,500 mL. Emergency VATS revealed that 5 cases were simple hemothoraces and 19 cases were associated with pneumothorax. The cause of bleeding was identified by thoracoscopy, as from an aberrant vessel (n = 11), torn parietal pleura (n = 4), ruptured vascularized bullae (n = 2), and lung parenchyma (n = 1). Six patients had no evidence of an obvious bleeding site. Bullous lesions were at the apex of the upper lobe in 14 patients, and multiple lobar involvement was seen in 2 patients. All the bullae were resected with endoscopic stapler in eight patients and ligated with a homemade endoloop in eight patients. The mean operation time was 42 min. The mean chest tube removal time was 3.5 days after insertion, and mean postoperative stay was 4.5 days. There is no recurrence of SHP or SP during the follow-up period. SHP complicated by severe bleeding presents a potentially grave emergency. VATS may be considered as feasible treatment for patients with SHP.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.JSS.2011.03.016
Abstract: The thoracic cavity approach for natural orifice transluminal endoscopic surgery (NOTES) is technically challenging. The aim of this study was to evaluate the feasibility of a transoral endoscopic technique for a surgical lung biopsy and pericardial window creation Under general anesthesia, a 12 mm incision was made over the vestibulum oris region. Under video guidance, a homemade metallic tube was introduced through the incision, extending along the pre-tracheal space to the substernal space with blunt dissection technique, and used as the entrance into the thoracic cavity. A surgical lung biopsy and a pericardial window creation were performed in 12 canines, using the transoral NOTES technique. The transoral endoscopic surgical lung biopsy and pericardial window creation were successfully completed in 11 of the 12 canines. Intraoperative bleeding and death from an injury to the pulmonary hilum developed in one animal during the electrosurgical excision of lung tissue. Transoral surgical lung biopsy and pericardial window creation in canine models is technically feasible and can be used as a novel experimental platform for studies of NOTES for intra-thoracic surgery.
Publisher: Springer Science and Business Media LLC
Date: 11-11-2016
DOI: 10.1007/S00464-016-5329-4
Abstract: Pulmonary segmentectomy with radical lymphadenopathy has been considered effective to manage small primary lung cancers [1, 2]. This procedure provides the advantages of minimal invasive surgery and is reported sufficient for safe margin. However, segmentectomy is more difficult to be performed than lobectomy because intersegmental plane cannot be detected easily. Several methods have been reported for identifying the actual intersegmental plane [3-7], but the sensitivity of these methods is limited to the lung conditions like patients with emphysematous lung and needed skilled surgeon to perform. We demonstrated the technique of visualizing the intersegmental plane via fluorescence navigated with indocyanine green (ICG) injection intravenously during robotic S6 segmentectomy. This video presents a case that 70-year-old male who has past history of rectal cancer status post-LAR in 1991, HCC status post-RFA, and hepatitis C was found a lung nodule over superior segment of left lower lobe during regular examination. The nodule was considered metastatic tumor preoperatively. The segmental pulmonary artery and pulmonary bronchus to superior segment of left lower lobe were ligated firstly, and the intersegmental plane was seen clearly after ICG injection intravenously under fluorescence navigated. Intersegmental plane was marked by electrocautery, and then, the target segment was resected by endostapler. Patient tolerated the procedure well. Chest tube was removed by postoperative day 3, and he was discharged smoothly by postoperative day 5. There were no complications. Postoperative chest X-ray revealed good lung expansion. Not as preoperative expectation, the final pathology was consistent with caseating granulomatous inflammation. It is difficult to identify intersegmental plane during segmentectomy. ICG fluorescence-navigated segmentectomy provides immediate visualization of the intersegmental plane and makes the procedure easy and fast.
Publisher: Elsevier BV
Date: 12-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2018
Publisher: Wiley
Date: 03-08-2009
DOI: 10.1002/JSO.21362
Abstract: Pathological complete response (pCR) after chemoradiotherapy (CRT) is the best predictor of survival in patients with squamous cell carcinoma (SCC) of the esophagus. Although no adjuvant treatment is recommended for in iduals who achieve pCR, approximately 30% of these patients develop a recurrence. We applied an immunohistochemistry (IHC) stain on resected lymph nodes to evaluate the incidence of lymph node micrometastases (LNMs) and its prognostic significance. Between 1995 and 2004, paraffin-embedded specimens for evaluating the presence of LNM were available for 52 pCR patients. We performed IHC staining with the cytokeratin antibody AE1/AE3 on resected lymph nodes and correlated the pathological findings to cancer recurrence and survival. A total of 510 lymph nodes from 52 patients were examined. The incidence of LNM in pathological complete responders after CRT was 11.5%. Only six patients were found to have AE1/AE3-positive cells in the IHC staining. However, patients with LNM had a higher recurrence rate (50% vs. 22%, P = 0.16) and a reduced disease-free survival rate (44% vs. 75%, P = 0.16). Patients with LNM had a 3.6-fold higher probability to develop recurrence compared with those without LNM (P = 0.15). LNMs are uncommon in pathological complete responders but hold prognostic significance.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2015
Publisher: Springer Science and Business Media LLC
Date: 11-2002
DOI: 10.1007/S00464-001-8293-5
Abstract: Empyema frequently complicates the hospitalization of children and in advanced stages, it often requires surgical intervention. In this study, we investigated the use of video-assisted thoracic surgery (VATS) for the management of postpneumonic empyema in children who have had an unsatisfactory medical response. We did a retrospective review of the medical records of 51 consecutive patients with loculated empyema (mean age, 5 years range, 2 months to 15 years) hospitalized at Chang Gung Memorial Hospital between 1995 and 2000. All patients underwent debridement of the necrotic lung tissue and evacuation of the loculated empyema cavity using a VATS approach. The mean operating time for the 51 patients was 90 min (range, 50-210) mean blood loss was 70 cc. Fever subsided within 72 h postoperatively in all patients. On average, chest tubing was removed on the 7th postoperative day (range, 4-18 days). However, in one patient who suffered from a prolonged air leak, the chest tube was not removed until day 18. The mean postoperative stay for all patients was 13.7 days (range, 9-23). No deaths occurred, and all of the children made a good recovery. A follow-up revealed that one of the 51 children patient suffered a left upper lung abscess 7 months after discharge. Left upper lobectomy was performed in this case, and the patient was discharged uneventfully 10 days after the operation. VATS is a safe and effective treatment for pediatric empyema. Thoracoscopic-assisted surgery facilitates visualization, evacuation, and debridement of the necrotizing lung tissue. Early surgical intervention can avoid lengthy hospitalization and prolonged intravenous antibiotic therapy, and it can accelerate clinical recovery.
Publisher: Wiley
Date: 04-05-2012
DOI: 10.1002/JSO.23103
Abstract: Higher extent of lymph node dissection (LND) is beneficial in primarily resected esophageal cancer patients by providing accurate staging and better tumor control. Achieving pathological complete response (pCR) after chemoradiotherapy (CRT) also represents better outcome. We studied the controversial question whether higher LND could further improve survival after pCR. Between 1996 and 2007, Esophageal squamous cell carcinoma (ESCC) patients with pCR after CRT were included. Based on the median number of dissected lymph node, patients were ided into two groups (Group 1: Lower LND Group 2: Higher LND). We compared the demographic features, perioperative outcomes, recurrence, and survival between groups. The cohort comprised 101 patients (100 males and one female) with a mean age of 58 years. There were 56 and 45 patients in Group 1 and 2, respectively. Clinical features and perioperative outcome were similar between groups. During a mean follow-up of 78.8 months, 32 (33.7%) patients died of the disease and 35.8% of patients developed recurrence. There was no difference in locoregional (11.3% vs. 9.5%, P=0.78) or distant recurrence (22.6% vs. 33.3%, P=0.18) between the two groups. Patients with lowest LND also had similar outcomes as those with the highest LND. The 5-year disease specific survival rate was 65 and 64% in Group 1 and 2, respectively. In ESCC patients, the number of negative lymph nodes had no prognostic impact after pCR.
Publisher: JMIR Publications Inc.
Date: 31-08-2020
Abstract: he COVID-19 pandemic has stunted medical education activities, resulting in most conferences being cancelled or postponed. To continue professional education during this crisis, web-based conferences can be conducted via livestream and an audience interaction platform as an alternative. he unprecedented COVID-19 pandemic has affected human connections worldwide. Conventional conferences have been replaced by web-based conferences. However, web-based conferencing has its challenges and limitations. This paper reports the logistics and preparations required for converting an international, on-site, multidisciplinary conference into a completely web-based conference within 3 weeks during the pandemic. he program was revised, and a teleconference system, live recording system, director system setup, and broadcasting platform were arranged to conduct the web-based conference. e used YouTube (Alphabet Inc) and WeChat (Tencent Holdings Limited) for the web-based conference. Of the 24 hours of the conventional conference, 21.5 hours (90%) were retained in the web-based conference via live broadcasting. The conference was attended by 71% (37/52) of the original international faculties and 71% (27/38) of the overall faculties. In total, 61 out of 66 presentations (92%) were delivered. A special session—“Dialysis access management under the impact of viral epidemics”—was added to replace precongress workshops and competitions. The conference received 1810, 1452, and 1008 visits on YouTube and 6777, 4623, and 3100 visits on WeChat on conference days 1, 2, and 3, respectively. witching from a conventional on-site conference to a completely web-based format within a short period is a feasible method for maintaining professional education in a socially responsible manner during a pandemic.
Publisher: Springer Science and Business Media LLC
Date: 17-10-2010
DOI: 10.1007/S00464-010-1401-7
Abstract: The aim of this study was to evaluate the performance of a novel transtracheal endoscopic technique for thoracic evaluation and intervention in a large animal model. In 12 animals (6 pigs and 6 dogs) under general anesthesia, a tracheal incision was made on the right lateral wall of the lower trachea and used as an entrance for thoracic evaluation and intervention. Postoperative follow-up included endoscopy at 1 and 2 weeks after surgery and necropsy at 2 weeks after surgery. Transtracheal opening and thoracic exploration were achieved in all animals. Four animals (3 pigs and 1 dog) died as a result of complications from the procedure. At the follow-up endoscopy, healing at the tracheal opening region was noted in seven animals. The transtracheal approach to the thoracic cavity is technically feasible in both porcine and canine models (4/12 animals died). The canine model is perhaps more suitable than the porcine model for the study of the transtracheal approach to the thoracic cavity.
Publisher: Springer Science and Business Media LLC
Date: 26-09-2018
DOI: 10.1007/S00464-018-6467-7
Abstract: Our objective is to report on two centers' experience of intra-operative management of major vascular injury during single-port video-assisted thoracoscopic (SPVATS) anatomic resections, including bleeding control techniques, incidence, results, and risk factor analysis. Consecutive patients (n = 442) who received SPVATS anatomic lung resections in two centers were enrolled. The different clinical parameters studied included age, previous thoracic surgery, obesity (BMI > 30), tumor location, neoadjuvant therapy, and pleural symphysis. In addition, peri-operative outcomes were compared between the groups, with or without vessel injury. There were no intra-operative deaths in our study. Overall major bleeding incidence was 4.5%, whereby 70% of major bleeding episodes could be managed with SPVATS techniques. In order to determine risk factors possibly related to intra-operative bleeding, we used case control matching to homogenize our study population. After case control matching, pleural symphysis was significantly related in the univariate (p = 0.005, Odds ratio 4.415, 95% CI 1.424-13.685) and multivariate analysis (p = 0.006, Odds ratio 4.926, 95% CI 1.577-15.384). Operative time (p < 0.001), blood loss (p < 0.001), and post-operative hospital stay (p = 0.012) were longer in patients with major vascular injury. There were no differences in 30-day mortality and 90-day morbidity. In summary, major intra-operative bleeding episodes during SPVATS anatomic lung resections are acceptable and most such bleeding episodes can be safely managed with SPVATS techniques.
Publisher: Elsevier BV
Date: 08-2011
Publisher: Wiley
Date: 29-05-2008
DOI: 10.1111/J.1445-2197.2008.04532.X
Abstract: Although elderly patients with thoracic disease were considered to be poor candidates for thoracotomy before, recent advances in preoperative and postoperative care as well as surgical techniques have improved outcomes of thoracotomies in this patient group. The aim of this study was to investigate surgical risk factors and results in elderly patients (aged > or =70 years) with thoracic empyema. Seventy-one elderly patients with empyema thoracis were enrolled and evaluated from July 2000 to April 2003. The following characteristics and clinical data were analysed: age, sex, aetiology of empyema, comorbid diseases, preoperative conditions, postoperative days of intubation, length of hospital stay after surgery, complications and mortality. Surgical intervention, including total pneumonolysis and evacuation of the pleura empyema cavity, was carried out in all patients. Possible influent risk factors on the outcome were analysed. The s le group included 54 men and 17 women with an average age of 76.8 years. The causes of empyema included parapneumonic effusion (n = 43), lung abscess (n = 8), necrotizing pneumonitis (n = 8), malignancy (n = 5), cirrhosis (n = 2), oesophageal perforation (n = 2), post-traumatic empyema (n = 2) and post-thoracotomy complication (n = 1). The 30-day mortality rate was 11.3% and the in-hospital mortality rate was 18.3% (13 of 71). Mean follow up was 9.4 months and mean duration of postoperative hospitalization was 35.8 days. Analysis of risk factors showed that patients with necrotizing pneumonitis or abscess had the highest mortality rate (10 of 18, 62.6%). The second highest risk factor was preoperative intubation or ventilator-dependency (8 of 18, 44.4%). This study presents the clinical features and outcomes of 71 elderly patients with empyema thoracis who underwent surgical treatment. The 30-day surgical mortality rate was 11.3%. Significant risk factors in elderly patients with empyema thoracis were necrotizing pneumonitis, abscess and preoperative intubation/ventilation. This study also suggested that surgical treatment of empyema thoracic in elderly patients is recommended after failed conservative treatment because of the acceptably postoperative complication and mortality rate.
Publisher: Georg Thieme Verlag KG
Date: 07-01-2012
Abstract: The benefits of video-assisted thoracoscopic surgery (VATS) for performing pulmonary metastasectomy are considered controversial. This case-matched study aimed to compare long-term outcomes after surgical resection of pulmonary metastases from colorectal cancer using different approaches (VATS vs. thoracotomy). Between 1997 and 2008, 143 patients with colorectal cancer who had received their first pulmonary metastasectomy were selected. Fifty-three patients underwent a surgical procedure that utilized a thoracotomy approach (Group 1), and 90 patients underwent a surgical procedure that used a VATS-based approach (Group 2). After being matched for tumor number, diameter (measured by computed tomography), and surgical procedure (wedge resection or lobectomy), 35 pairs of patients were finally enrolled. Study endpoints included tumor recurrence and survival. There was no hospital mortality in both groups. Within the mean follow-up period of 50 months, 47.1% patients developed a recurrence (52% at the pulmonary level and 48% at systemic level), and 52.9% of the patients were alive at the time of analysis. There was no difference between Groups 1 and 2 in terms of overall recurrences (54 vs. 40%, p = 0.23), all pulmonary recurrences (25.7 vs. 22.9%, p = 0.78), and same side lung recurrences (14.3 vs. 20%, p = 0.75). The 5-year overall survival (OS) after lung resection was 43 and 51% in Groups 1 and 2, respectively (p = 0.21). Our case-matched study showed that survival outcome of pulmonary metastasectomy using VATS is not inferior to that of open thoracotomy in selected cases.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2014
Publisher: Oxford University Press (OUP)
Date: 05-10-2018
DOI: 10.1093/EJCTS/EZY318
Abstract: With the increasing availability of hybrid operating rooms, single-stage tumour localization and removal under intraoperative computed tomography (CT) guidance is gaining popularity. The objective of this study was to describe the learning curve for this procedure. Over a 15-month period, a single team of thoracic surgeons without experience in intraoperative CT-guided lung tumour localization performed a total of 91 procedures in 89 patients. All these procedures were conducted in a hybrid operating room equipped with cone-beam CT and a laser navigation system. The learning curve was analysed using the cumulative sum method (target success rate 90%), whereas the moving average was used as an indicator of localization time. The mean lung tumour size on preoperative CT images was 7.81 mm, whereas their mean distance from the pleural surface was 10.16 mm. The localization time (mean 21.19 min) was inversely associated with the surgeon's experience (Pearson's r = -0.6601 P < 0.001). The moving average analysis revealed that localization time stabilized after 32 procedures. There were 6 failures of these, 2 occurred during lesion localization (as a result of needle puncture-related pneumothorax) and 4 during surgery (caused either by wire dislodgement or dye spillage). The cumulative sum analysis revealed that proficiency was achieved after 38 procedures. The mean localization time and success rates before and after procedure 38 were 32.13 min vs 13.34 min (P < 0.001) and 86.8% vs 98.1% (P = 0.078), respectively. The procedural time and success rates of intraoperative CT-guided lung tumour localization were optimized after 38 consecutive procedures.
Publisher: Springer Science and Business Media LLC
Date: 04-07-2019
Publisher: AME Publishing Company
Date: 07-2016
Publisher: MDPI AG
Date: 21-05-2021
DOI: 10.3390/JPM11060444
Abstract: More and more undetermined lung lesions are being identified in routine lung cancer screening. The aim of this study was to try to establish a malignancy prediction model according to the tumor presentations. From January 2017 to December 2018, 50 consecutive patients who were identified with suspicious lung lesions were enrolled into this study. Medical records were reviewed and tumor macroscopic and microscopic presentations were collected for analysis. Circulating tumor cells (CTC) were found to differ between benign and malignant lesions (p = 0.03) and also constituted the highest area under the receiver operation curve other than tumor presentations (p = 0.001). Since tumor size showed the highest sensitivity and CTC revealed the best specificity, a malignancy prediction model was proposed. Akaike information criterion (A.I.C.) of the combined malignancy prediction model was 26.73, which was lower than for tumor size or CTCs alone. Logistic regression revealed that the combined malignancy prediction model showed marginal statistical trends (p = 0.0518). In addition, the 95% confidence interval of combined malignancy prediction model showed less wide range than tumor size ≥ 0.7 cm alone. The calculated probability of malignancy in patients with tumor size ≥ 0.7 cm and CTC 3 was 97.9%. By contrast, the probability of malignancy in patients whose tumor size was 0.7 cm, and CTC ≤ 3 was 22.5%. A combined malignancy prediction model involving tumor size followed by the CTC count may provide additional information to assist decision making. For patients who present with tumor size ≥ 0.7 cm and CTC counts 3, aggressive management should be considered, since the calculated probability of malignancy was 97.9%.
Publisher: AME Publishing Company
Date: 05-2017
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.AVSG.2019.02.030
Abstract: Adequate tip location is crucial for intravenous port implantation because it can minimize catheter-related complications. Adequate tip location cannot be observed directly and needs to be confirmed by imaging tools. A quantified intravascular catheter length formula has been proposed and we attempt to compare its clinical effectiveness with anatomic landmark references. During the period from March 2012 to February 2013, 503 patients who received port implantation where implanted catheter length depended on carina level as confirmed by intraoperative fluoroscopy were assigned to Group A. From March 2013 to February 2014, 521 patients who received port implantation based on quantified intravascular catheter length formula were assigned to Group B. Clinical outcomes were compared. Catheter tip location of Group A, as revealed by intraoperative fluoroscopy and postoperative chest film, was 1.18 ± 0.51 and 1.1 ± 1.3 cm below carina, respectively. Catheter tip location of Group B, as revealed by intraoperative fluoroscopy and postoperative chest film, was 1.25 ± 1.05 and 1.05 ± 1.32 cm below carina, respectively. Similar catheter tip location was identified in both groups. The functional period of implanted ports, complication rate (3.58% and 2.53%), and incidence (0.049 and 0.0506 episodes/1,000 catheter days) were similar in both groups. The quantified intravascular catheter length formula can predict an adequate catheter length just as well as carina do and results in good catheter tip location. The formula could replace the clinical use of anatomic landmarks and serve as an easy tool for practitioners.
Publisher: Springer Science and Business Media LLC
Date: 15-08-2015
DOI: 10.1007/S00464-015-4412-6
Abstract: Safe pulmonary vessel sealing device plays a crucial role in anatomic lung resection. In 2014, we reported high rates of massive bleeding complications during transumbilical lobectomy in a canine model due to difficulty in managing the pulmonary vessel with an endostapler. In this animal survival series, we aimed to evaluate the outcome of pulmonary vessel sealing with an electrocautery device to simplify the transumbilical thoracic surgery. Under general anesthesia, a 3-cm longitudinal incision was made over the umbilicus. Under video guidance, a bronchoscope was inserted through the incision for exploration. The diaphragmatic wound was created with an electrocautery knife and used as the entrance into the thoracic cavity. Using the transumbilical technique, anatomic lobectomy was performed with electrosurgical devices and endoscopic vascular staplers in 15 canines. Transumbilical endoscopic anatomic lobectomy was successfully completed in 12 of the 15 animals. Intraoperative bleeding developed in three animals during pulmonary hilum dissection, where one animal was killed due to hemodynamic instability and the other two animals required thoracotomy to complete the operation. There were five delayed bleeding and surgical mortality cases caused by inadequate vessel sealing by electrosurgical devices. Postmortem examination confirmed correct transumbilical lobectomy in the twelve animals that survived the operations. Transumbilical anatomic lobectomy is technically feasible in a canine model however, the electrosurgical devices were not effective in sealing the pulmonary vessel in the current canine model.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2015
Publisher: Elsevier BV
Date: 2015
Abstract: N2-positive non-small cell lung cancer (NSCLC) exhibits extremely low survival rates. The role of surgery in operable locally advanced N2 NSCLC remains controversial. In this study, we tried to analyze the role of surgery in resectable N2 NSCLC and the relationship between survival and clinico-pathologic factors from a pathologic point of view. 108 resectable pathologic N2-positive NSCLC patients, diagnosed from January 2005 to July 2012, were enrolled in this study. We retrospectively reviewed the medical records, image studies, and pathology reports to collect the clinico-pathologic factors in these patients. Those who received lobectomy (p = 0.002) and had a metastatic lymph node ratio less than 0.4 (p = 0.01) had a better overall survival rate. In addition, our study also showed that perineural invasion may play a significant role in disease-free survival (p = 0.01) CONCLUSIONS: Metastatic lymph node ratio greater than 0.4 and non-anatomic resection were poor prognostic factors for disease-free survival. Anatomic resection for selected N2 patients may play a crucial role in the overall survival rate. Perineural invasion showed an adverse impact on disease-free survival, but further investigation is warranted.
Publisher: Oxford University Press (OUP)
Date: 23-08-2017
DOI: 10.1093/EJCTS/EZX309
Abstract: This case series illustrates the feasibility of single-stage image-guided video-assisted thoracoscopic surgery for simultaneous localization and removal of small solitary pulmonary nodules (SPNs). The procedure was performed in a hybrid operating room using C-arm cone-beam computed tomography equipped with a laser-guided navigation system. Between October 2016 and January 2017, 12 consecutive patients presenting with SPNs underwent image-guided video-assisted thoracoscopic surgery. The feasibility and safety of the procedure were assessed through a retrospective review of the patients' clinical charts. The median size of SPNs was 5.5 mm [interquartile range (IQR) 4-6 mm], whereas their median distance from the pleural surface was 11.7 mm (IQR 6-11.3 mm). All of the lesions were visible on intraoperative C-arm cone-beam computed tomography images, and localization was successful in 10 patients thereafter, complete thoracoscopic resection was successfully performed. The median time required for the localization of SPNs was 45.5 min (IQR 36-60 min), whereas the median radiation exposure (expressed through the skin absorbed dose) was 223.2 mGy (IQR 180.3-321.3 mGy). Lesion localization was unsuccessful in 2 cases because to the development of pneumothorax induced by needle puncture. In such cases, a utility thoracotomy was required for the identification of SPNs. There was no operative mortality, and the median length of postoperative stay was 4 days (IQR 3.8-4 days). The results of our case series support the feasibility of image-guided video-assisted thoracoscopic surgery for detection and removal of SPNs. Future efforts should be tailored to decrease localization time and minimize radiation exposure.
Publisher: AME Publishing Company
Date: 06-2016
Publisher: AME Publishing Company
Date: 06-2016
Publisher: Springer Science and Business Media LLC
Date: 04-06-2018
DOI: 10.1007/S00464-018-6252-7
Abstract: Localization of non-visible, non-palpable small pulmonary nodules during video-assisted thoracoscopic surgery (VATS) remains challenging. We sought to investigate the feasibility and safety of image-guided video-assisted thoracoscopic surgery (iVATS) with near-infrared (NIR) marking in a hybrid operating room (OR). Both localization and surgery were performed by a single team of thoracic surgeons. Diluted indocyanine green (ICG quantity: 0.3-0.5 mL dye concentration: 0.125 mg/mL) was injected percutaneously to pinpoint the tumor's location under cone beam computed tomography (CBCT) guidance using a laser-guided navigation system. Real-time fluorescence images were intraoperatively obtained using a NIR thoracoscopic camera to guide subsequent resection. Between March and December 2017, 26 patients underwent NIR marking of small pulmonary nodules for iVATS. The median tumor size was 7 mm (interquartile range [IQR] 5.3-10.8 mm), whereas their median distance from the pleural surface was 5 mm (IQR 0.3-10.5 mm). Seven nodules (35%) were solid, whereas 17 (65%) were ground-glass opacities. All lesions were identifiable on intraoperative CBCT. The median time required for NIR localization was 13 min. An NIR(+) "tattoo" was identified in all cases, and no intraoperative conversion to thoracotomy occurred. The final pathological diagnoses were primary lung cancer (n = 11), metastatic cancer (n = 6), and benign lung tumor (n = 9). Adverse events were not observed, and the median length of post-operative stay was 4 days (IQR 3-4 days). Our data show that iVATS with NIR marking is useful, has no adverse effects, and can successfully localize difficult-to-identify small pulmonary nodules.
Publisher: Oxford University Press (OUP)
Date: 22-10-2019
DOI: 10.1093/EJCTS/EZZ292
Abstract: Computed tomography (CT)-guided localization of multiple ipsilateral pulmonary nodules remains challenging. Hybrid operating rooms equipped with cone-beam CT and laser navigation systems have the potential for improving clinical workflows and patient outcomes. Patients with multiple ipsilateral pulmonary nodules requiring localization were ided according to the localization method [preoperative CT-guided (POCT group) localization versus intraoperative CT-guided (IOCT group) localization]. The 2 groups were compared in terms of procedural efficacy, safety and radiation exposure. Patients in the IOCT (n = 12) and POCT (n = 42) groups did not differ in terms of demographic and tumour characteristics. Moreover, the success and complication rates were similar. Notably, the IOCT approach allowed multiple nodules to be almost simultaneously localized—resulting in a shorter procedural time [mean difference (MD) −15.83 min, 95% confidence interval (CI) −7.97 to −23.69 min] and lower radiation exposure (MD −15.59 mSv, 95% CI −7.76 to −23.42 mSv) compared with the POCT approach. However, the total time under general anaesthesia was significantly longer in the IOCT group (MD 34.96 min, 95% CI 1.48–68.42 min), despite a similar operating time. The excess time under anaesthesia in the IOCT group can be attributed not only to the procedure per se but also to a longer surgical preparation time (MD 21.63 min, 95% CI 10.07–33.19 min). Compared with the POCT approach, IOCT-guided localization performed in a hybrid operating room is associated with a shorter procedural time and less radiation exposure, albeit at the expense of an increased time under general anaesthesia.
Publisher: Public Library of Science (PLoS)
Date: 03-01-2013
Publisher: Elsevier BV
Date: 2011
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.JSS.2015.08.012
Abstract: A subxiphoid surgical approach to thoracic cavity operations has potential advantages such as preventing injuries to intercostal nerves and vessels due to the bypass of the intercostal space during thoracic surgery. The aim of this study was to compare the feasibility and efficacy of the subxiphoid and standard transthoracic approaches for anatomic pulmonary lobectomy in a canine model. Nineteen dogs were assigned for pulmonary lobectomy using either the subxiphoid (n = 10) or standard transthoracic approaches (n = 9). Each group underwent thoracic exploration and anatomic pulmonary lobectomy. Subxiphoid thoracoscopy was performed with a flexible bronchoscope via a 3-cm incision over the xiphoid process. In the conventional thoracoscopy group, approach to the thoracic cavity was obtained through a 3-cm incision over the seventh intercostal space. Physiological parameters (respiratory rate and body temperature) and blood s les (white blood cell counts and arterial blood gases) were collected during the preoperative and postoperative periods. Surgical outcomes data (operating time, operative complications, and body weight gain) were also collected and compared between the groups. The animals were sacrificed 14 d after surgery for necropsy evaluations. Anatomic pulmonary lobectomy was successfully performed without intraoperative and postoperative complications in all animals. There were no significant differences in the mean operating times or weight gain after surgery between the subxiphoid and the standard transthoracic approach groups. In terms of physiological and pulmonary parameters, there were no observed differences between the two surgical groups for respiratory rate, body temperature, white blood cell counts, and arterial blood gases at any time during the study. Necropsy confirmed the success of lobectomy without complication in all studied animals. This study demonstrated that the subxiphoid approach was comparable with the standard transthoracic approach for anatomic pulmonary lobectomy, in terms of feasibility and effectiveness.
Publisher: Elsevier BV
Date: 07-2023
DOI: 10.1016/J.AUCC.2022.08.006
Abstract: Improving the self-efficacy of intensive care unit nurses for delirium care could help them adapt to the changing situation of delirium patients. Validated measures of nurses' self-efficacy of delirium care are lacking OBJECTIVES: The objective of this study was to develop a Delirium Care Self-Efficacy Scale for assessing nurses' confidence about caring for patients in the intensive care unit and to examine the scale's psychometric properties. Draft scale items were generated from a review of relevant literature and face-to-face interviews with intensive care unit nurses content validity was conducted with a panel of five experts in delirium. A group of nurses were recruited by convenience s ling from intensive care units (N = 299) for item analysis of the questionnaire, assessment of validity, and reliability of the scale. Nurse participants were recruited from nine adult critical care units affiliated with a hospital in Taiwan. Data were collected from August 2020 to July 2021. Content validity index was 0.98 for the initial 26 items, indicating good validity. The critical ratio for item discrimination was 14.47-19.29, and item-to-total correlations ranged from 0.67 to 0.81. Principal component analysis reduced items to 13 and extracted two factors, confidence in delirium assessment and confidence in delirium management, which explained 66.82% of the total variance. Cronbach's alpha for internal consistency was 0.94 with good test-retest reliability (r = 0.92). High scale scores among participants were significantly associated with age (≥40 years), work experience in an intensive care unit (≥10 years), delirium education, and willingness to use delirium assessment tools. The newly developed Delirium Care Self-Efficacy Scale demonstrated acceptable reliability and validity as a measure of confidence for intensive care nurses caring for and managing patients with delirium in the intensive care unit.
Publisher: Oxford University Press (OUP)
Date: 03-03-2018
DOI: 10.1093/EJCTS/EZY067
Abstract: Single-port video-assisted thoracoscopic surgery (SPVATS) anatomical resection has been shown to be a feasible technique for lung cancer patients. Whether SPVATS has equivalent or better oncological outcomes for lung cancer patients remains controversial. The purpose of this study was to evaluate the perioperative and mid-term survival outcomes of SPVATS in 2 different medical centres. We retrospectively reviewed patients who underwent SPVATS anatomical resections between January 2014 and February 2017 in Coruña University Hospital's Minimally Invasive Thoracic Surgery Unit (Spain) and Chang Gung Memorial Hospital (Taiwan). Survival outcomes were assessed by pathological stage according to the American Joint Committee on Cancer (AJCC) 7th and 8th classifications. In total, 307 patients were enrolled in this study. Mean drainage days and postoperative hospital stay were 3.90 ± 2.98 and 5.03 ± 3.34 days. The overall 30-day mortality, 90-day morbidity and mortality rate were 0.7%, 20.1% and 0.7%, respectively. The 2-year disease-free survival and 2-year overall survival of the cohort were 80.6% and 93.4% for 1A, 68.8% and 84.6% for 1B, 51.0% and 66.7% for 2A, 21.6% and 61.1% for 2B, 47.6% and 58.5% for 3A, respectively, following the AJCC 7th classification. By the AJCC 8th classification, these were 92.3% and 100% for 1A1, 73.7% and 91.4% for 1A2, 75.2% and 93.4% for 1A3, 62.1% and 85.9% for 1B, 55.6% and 72.7% for 2A, 47.1% and 64.2% for 2B and 42.1% and 60.3% for 3A. Our preliminary results revealed that SPVATS anatomical resection achieves acceptable 2-year survival outcomes for early-stage lung cancer and is consistent with AJCC 8th staging system 2-year survival data. For advanced stage non-small-cell lung cancer patients, further evaluation is warranted.
Publisher: Elsevier BV
Date: 2023
Publisher: Cambridge University Press (CUP)
Date: 03-11-2008
DOI: 10.1017/S0022215108004052
Abstract: We evaluated the efficacy and safety of the extra-long Montgomery T tube for the management of major airway obstruction in tertiary care patients in Taiwan. Eleven patients with major airway stenosis treated with an extra-long Montgomery T tube between April 2004 and December 2006 were retrospectively reviewed. Five patients had tracheostomy stenosis, two had intubation stenosis, one had traumatic stenosis, one had corrosive stenosis, one had laser burn stenosis and one had tubercular stenosis. All patients underwent three-dimensional airway reconstruction and endoscopic evaluation of airway stenosis. After determining the severity and location of airway stenosis, rigid bronchotherapy and Montgomery T tube placement were performed by rigid bronchoscopy. The overall procedural success rate was 100 per cent. Three (27 per cent) patients were weaned from artificial ventilation, and all patients exhibited improved respiratory and functional status. No major post-operative complications or mortality were observed. At follow up (mean, 21.5 months), the decannulation rate was 27 per cent, and eight (73 per cent) patients had stable T tube ventilation. In four patients, granulation over the end of the T tube was controlled by endoscopic procedures. Three patients with stents above the vocal folds showed aspiration and required further intervention (i.e. one nasogastric feeding tube for nutrient supplement, one feeding jejunostomy and one stent shortening to decrease aspiration). The extra-long Montgomery T tube is an effective and safe method for treating major airway obstruction in the supra-glottic to lower tracheal region.
Publisher: AME Publishing Company
Date: 12-2016
Publisher: Springer Science and Business Media LLC
Date: 06-05-2021
DOI: 10.1186/S12909-021-02679-8
Abstract: Graduating from medical school and beginning independent practice appears to be a major transition for medical students across the world. It is often reported that medical graduates are underprepared for independent practice. Most previous studies on undergraduates’ preparedness are cross-sectional. This study aimed to characterize the development and trend of medical students’ preparedness and its association with other objective and subjective indicators from the undergraduate to postgraduate periods. This was a prospective cohort study. The participants were recruited and followed from two years before graduation to the postgraduate period. The preparedness for independent practice, professional identity, and teamwork experience were biannually measured using previously validated questionnaires. The participants’ basic demographic information, clinical learning marks from the last two years, and national board exam scores were also collected. A total of 85 participants completed 403 measurements in the 5 sequential surveys. The mean age at recruitment was 23.6, and 58 % of participants were male. The overall total preparedness score gradually increased from 157.3 (SD=21.2) at the first measurement to 175.5 (SD=25.6) at the fifth measurement. The serial in idual preparedness scores revealed both temporal differences within the same learner and in idual differences across learners. Despite the variations, a clear, steady increase in the overall average score was observed. Participants were least prepared in the domain of patient management at first, but the score increased in the subsequent measurements. The participants with better final preparedness had better professional identity ( p .01), better teamwork experience ( p 0.01), and higher average clinical rotation marks ( p .05). The preparedness for practice of medical students from the undergraduate to postgraduate periods is associated with their professional identity, teamwork experience, and objective clinical rotation endpoint. Although preparedness generally increases over time, educators must understand that there are temporal fluctuations and in idual differences in learners’ preparedness.
Publisher: Springer Science and Business Media LLC
Date: 16-08-2022
DOI: 10.1007/S10055-022-00664-0
Abstract: Before caring for patients, video instruction is commonly used for undergraduate medical students, and 360° virtual reality (VR) videos have gained increasing interest in clinical medical education. Therefore, the effect of immersive 360° VR video learning compared with two-dimensional (2D) VR video learning in clinical skills acquisition should be evaluated. This randomized, intervention-controlled clinical trial was aimed to assess whether immersive 360° VR video improves undergraduate medical students' learning effectiveness and reduces the cognitive load in history taking and physical examination (H& P) training. From May 1 2018 to October 30 2018, 64 senior undergraduate medical students in a tertiary academic hospital were randomized to receive a 10-min immersive 360° (360° VR video group n = 32) or 2D VR instructional video (2D VR video group n = 32), including essential knowledge and competency of H& P. The demographic characteristics of the two groups were comparable for age, sex, and cognitive style. The total procedure skill score, physical examination score, learner’s satisfaction score, and total cognitive load in the 360° VR video group were significantly higher than those in the 2D VR video group (effect sizes [95% confidence interval]: 0.72 [0.21–1.22], 0.63 [0.12–1.13], 0.56 [0.06–1.06], and 0.53 [0.03–1.03], respectively). This study suggested that a10-minute 360° VR video instruction helped undergraduate medical students perform fundamental H& P skills as effectively as 2D VR video. Furthermore, the 360° VR video might result in significantly better procedural metrics of physical examinations with higher learner satisfaction despite the higher cognitive load.
Publisher: Springer Science and Business Media LLC
Date: 07-02-2022
Publisher: Springer Science and Business Media LLC
Date: 06-04-2022
Publisher: Springer Science and Business Media LLC
Date: 02-05-2012
DOI: 10.1007/S00464-012-2296-2
Abstract: The success of natural orifice transluminal endoscopic surgery (NOTES) depends on an adequate exploration of surgical regions. Currently, limited data are available regarding the optimal position for the NOTES approach for thoracic surgery. This study therefore aimed to evaluate the effectiveness of transoral thoracic exploration in a canine model placed in a lateral decubitus position. A total of 14 dogs were used in this study. Transoral thoracoscopy was performed using a custom-made metal tube via an incision over the vestibular incision with the animal in a supine position. After thoracic exploration, the animal was placed in a lateral decubitus position. The thoracic intervention (surgical lung biopsy, pericardial window creation, and dorsal sympathectomy) was performed by passing a flexible bronchoscope through the lumen of a metal tube. The mean operative time for this procedure was 70 min (range 45-100 min). For 12 dogs, all procedures were completed without major complications. However, for one dog, the exploration of the thoracic cavity was incorrect (the right lower lobe had been misinterpreted as the left lower lobe). Another dog had minor bleeding because of an intercostal artery injury that occurred during sympathectomy. The posterior aspect of the thoracic cavity can be exposed via a transoral approach with the animal in a lateral decubitus position. This approach may be considered as an adjuvant to the supine approach, in which exploration of the posterior thoracic cavity is restricted.
Publisher: Elsevier BV
Date: 02-2017
Publisher: Research Square Platform LLC
Date: 08-09-2022
DOI: 10.21203/RS.3.RS-2021034/V1
Abstract: Background: There is a need to validate the reliability and validity of Direct Observation of Procedural Skills (DOPS) of knee joint mobilization for providing immediate feedback on the procedure. Additionally, it is crucial to examine whether the tools developed for on-site use can be applied off-site to prepare for future practice. The purpose of this study is to describe the implementation and clinimetric properties of a DOPS for knee joint mobilization evaluation (DOPSknee) on-site and off-site and to determine the pre-clinical competencies of physical therapy (PT) students at school. Methods: After the DOPSknee had been developed, 42 pre-clinical students from a single PT program were videotaped performing knee joint mobilization. Their performance was assessed in the standard manner by two clinical instructors using the DOPSknee. Assessments were conducted on-site and then off-site using the recorded videos after a time gap ranging from 1.5 months to 4.5 months. Results: The DOPSknee demonstrated a good level of on-site inter-rater reliability (intraclass correlation coefficient [ICC] = 0.78). It had a poor level of off-site inter-rater reliability (ICC = 0.37) and a poor to good level of intra-rater reliability between on-site and off-site evaluations (evaluator 1: ICC = 0.42 evaluator 2: ICC = 0.88). However, the DOPSknee was shown to have good reliability average measures between the on-site and off-site evaluations (average on-site vs. average off-site: ICC = 0.84). Average total DOPSknee scores were significantly correlated with the average global rating scores on-site and off-site ( r = 0.47 and 0.75) and in cross-over conditions ( r = 0.54 and 0.71). The cut-off score for the DOPSkneewas determined to be 14 points, and the construct validity analysis of both on-site and off-site evaluations from the average DOPSknee total scores demonstrated that the average global rating scores of the students who passed were significantly higher ( p 0.05). Conclusions: The clinimetric properties of the DOPSknee protocol revealed generally good results for on-site validity and reliability in assessing student performance and a need to be interpreted and applied with care off-site. The average measures may help improve the results from the two evaluators.
Publisher: Wiley
Date: 30-08-2007
DOI: 10.1111/J.1445-2197.2007.04257.X
Abstract: Surgical resection (SR) is the most effective strategy in the management of patient with lung abscess who have failed medical treatment. Surgical drainage (SD) of lung abscess is an alternative in high-risk patients. There are limited findings in comparing the two procedures. The aim of this study was to compare surgical outcomes in patients who underwent SR versus SD. We retrospectively reviewed 61 patients receiving surgical intervention for lung abscess in our hospital from 1994 to 2002. The patients were ided into two groups according to different surgical procedure. They are patients who received SR (lobectomy, pneumonectomy or wedge resection) and patients who underwent SD (pneumonotomy) of lung abscess. There were 33 patients enrolled in SD and 28 patients in the SR for lung abscess. There was no significant difference between the two groups in number of risk factors or size or location of abscess. The operation time and blood loss seemed to be less in SD, although they did not reach statistic difference. Postoperative major complications were more frequent for SD than for SR (36.3 vs 32.1%, P = 0.038). The mortality rate and total complication rate were similar. When surgery is indicated for lung abscess, SR is the preferred procedure. Whenever there are great difficulties during SR or patients are unable to tolerate major pulmonary resection, SD can be an alternative choice. The techniques were relatively easy and effective. The surgical outcomes in short term was favourable and can be comparable to that of standard SR.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.JTCVS.2018.06.088
Abstract: The efficacy and safety of intraoperative computed tomography (IOCT)-guided lung tumor localization and resection performed in a hybrid operating room (OR) compared with the conventional 2-stage preoperative CT (POCT)-guided approach for the treatment of small and deep solitary pulmonary nodules (SPNs) remains unknown. We compared IOCT-guided (IOCT group) and POCT-guided (POCT group) thoracoscopic resections in 64 consecutive patients with SPNs. The main outcome measures included efficacy, safety, and radiation exposure. The IOCT (n = 34) and POCT (n = 30) groups had a similar SPN depth-to-size ratio. All SPNs were successfully localized and removed using a minimally invasive approach. There were no significant intergroup differences in localization procedural time (mean, 17.68 [IOCT] vs 19.63 minutes [POCT] P = .257) and radiation exposure (median, 3.65 [IOCT] vs 6.88 mSv [POCT] P = .506). The use of a hybrid operating room (OR) for tumor localization significantly reduced the patient time at risk (ie, the interval from completion of localization to skin incision mean, 215.83 [POCT] vs 13.06 minutes [IOCT] P < .001). However, the IOCT-guided approach significantly increased the time under general anesthesia (mean, 120.61 [POCT] vs 163.1 minutes [IOCT] P < .001) and the total OR utilization time (mean, 168.68 [POCT] vs 227.41 minutes [IOCT] P < .001). Compared with the POCT-guided approach, the IOCT-guided approach decreased the time at risk, despite a significant increase in the global OR utilization time. Because no significant outcome differences were evident, the choice between the 2 approaches should be based on the most readily available approach at a surgeon's specific facility.
Publisher: Wiley
Date: 24-05-2010
DOI: 10.1002/JSO.21588
Abstract: Non-regional lymph node metastasis in intrathoracic esophageal cancer is classified as M1 lesion with poor prognosis following surgery alone. We studied the controversial question of whether chemoradiotherapy (CRT) improves survival of these patients. A cohort of patients with clinically overt nodal M1 disease, which could be encompassed by a tolerable radiation therapy port, was selected from the database of the Chang Gung Memorial Hospital. From 1994 to 2005, 54 nodal stage IV intrathoracic esophageal squamous cell carcinoma (SCC) patients received neoadjuvant CRT. Significant response occurred in 24 patients. Scheduled esophagectomy was performed in 26 patients. The 3-year overall survival (OS) and disease-free survival (DFS) for the whole group were 27% (median: 14.2 months) and 22% (median: 14.7 months), respectively. Multivariate analysis identified pretherapy lymph nodes classified as M1a and R0 resection after CRT as independent favorable prognosticators. Median survival reached 36.9 months in the pretherapy M1a subgroup as opposed to 12.5 months in the M1b subgroup (3-year-DFS: 40% vs. 10%, P = 0.0117). Scheduled surgery after CRT benefits only after R0 resection (3-year-DFS: 36%, median survival: 45 months). The group with incomplete resection had a high surgical risk and dismal survival compared to the non-surgery group (3-year-DFS: 0% vs. 9%, 9.5 vs. 10.5 months). Pretherapy M1a disease had a significantly better survival than nodal M1b disease after CRT in SCC. Aggressive surgical treatment after CRT is reserved for cases when complete resection is anticipated.
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End Date: End date not available
Funder: National Science Council
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