Effect of Artificial Pneumothorax on Operating Time for Video Assisted Thoracoscopic (VATS) Thymectomy
DOI:
https://doi.org/10.51253/pafmj.v75i4.12643Keywords:
Artificial Pneumothorax, Operative Time, One-Lung Ventilation, Thymectomy, VATSAbstract
Objective: To evaluate the effect of artificial pneumothorax on operating time for Video Assisted Thoracoscopic (VATS) Thymectomy
Study Design: Quasi-experimental study
Duration and Place of Study: Department of Thoracic Surgery, Combined Military Hospital Multan, Pakistan from Mar 2022 to Apr 2024.
Methodology: One hundred and ten patients aged between 18-65 years with different Thymic pathologies were included in this study. Patients were divided randomly into two groups; Group-O and Group-P. Group-O was subjected to one lung ventilation without artificial pneumothorax whereas Group-P was subjected to one lung ventilation with artificial pneumothorax. The operating time was noted from the time of incision till closure of the skin.
. There were 62(56.36%) females and 48 (43.64%) males. The overall mean operating time was 132.34±13.23 minutes. The mean operating time was significantly less 126.04±12.65 minutes in artificial pneumothorax than the group without artificial pneumothorax 138.41±10.78 minutes with very significant p-value (p<0.001).
Conclusion: The use of artificial pneumothorax for VATS thymectomy is associated with a notable decrease in the operating time without an increase in postoperative complications.
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References
1. Wei B, Cerfolio R. Robotic thymectomy. J Vis Surg 2016; 2: 136 https://doi.org/10.21037/jovs.2016.07.17
2. Al-Githmi IS, Alotaibi A, Habeebullah A, Bajunaid W, Jar S, Alharbi NA, et al. Postoperative Pulmonary Complications in Patients Undergoing Elective Thoracotomy Versus Thoracoscopic Surgeries. Cureus 2023; 15(9): e45367.
https://doi.org/10.7759/cureus.45367
3. Marulli G, Comacchio GM, Rea F. Robotic thymectomy. J Vis Surg 2017; 3: 68.
https://doi.org/10.21037/jovs.2017.05.01
4. O'Sullivan KE, Kreaden US, Hebert AE, Eaton D, Redmond KC. A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy. Ann Cardiothorac Surg 2019; 8(2): 174-193.
https://doi.org/10.21037/acs.2019.02.04
5. Shen C, Li J, Li J, Che G. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for treatment of patients with thymoma: A systematic review and meta-analysis. Thorac Cancer 2022; 13(2): 151-161.
https://doi.org/10.1111/1759-7714.14234
6. Tomescu D, Grigorescu B, Nitulescu R, Tomulescu V, Popescu I, Tulbure D et al. Hemodynamic changes induced by positive pressure capnothorax during thoracoscopic thymectomy. Chirurgia 2007; 102(3): 263-270.
7. Witt L, Osthaus WA, Schröder T, Teich N, Dingemann C, Kübler J, et al. Single-lung ventilation with carbon dioxide hemipneumothorax: hemodynamic and respiratory effects in piglets. Paediatr Anaesth 2012; 22(8): 793-798.
https://doi.org/10.1111/j.1460-9592.2011.03766.x
8. Jones DR, Graeber GM, Tanguilig GG, Hobbs G, Murray GF. Effects of insufflation on hemodynamics during thoracoscopy. Ann Thorac Surg 1993; 55(6): 1379-1382.
https://doi.org/10.1016/0003-4975(93)91074-w
9. Brock H, Rieger R, Gabriel C, Pölz W, Moosbauer W, Necek S. Haemodynamic changes during thoracoscopic surgery the effects of one-lung ventilation compared with carbon dioxide insufflation. Anaesthesia 2000; 55(1): 10-16.
https://doi.org/10.1046/j.1365-2044.2000.01123.x
10. Qi K, Wang B, Wang B, Zhang LB, Chu XY. Video-assisted thoracoscopic surgery thymectomy versus open thymectomy in patients with myasthenia gravis: a meta-analysis. Acta Chir Belg 2016; 116(5): 282-288.
https://doi.org/10.1080/00015458.2016.1176419
11. Raja SM, Guptill JT, McConnell A, Al-Khalidi HR, Hartwig MG, Klapper JA, et al. Perioperative Outcomes of Thymectomy in Myasthenia Gravis: A Thoracic Surgery Database Analysis. Ann Thorac Surg 2022; 113(3): 904-910.
https://doi.org/10.1016/j.athoracsur.2021.06.071
12. Zhang M, Wang H, Pan X, Wu W, Zhang H. Thoracoscopic resection of bulky thymoma assisted with artificial pneumothorax: A report of 19 consecutive cases. Oncol Lett 2016; 11(5): 3061-3063.
https://doi.org/10.3892/ol.2016.4326
13. Cerfolio RJ, Bryant AS, Sheils TM, Bass CS, Bartolucci AA. Video-assisted thoracoscopic surgery using single-lumen endotracheal tube anesthesia. Chest 2004; 126(1): 281-285.
https://doi.org/10.1378/chest.126.1.281
14. Cai L, Li Y, Sun L, Yang XW, Wang WB, Feng F, et al. Better perioperative outcomes in thoracoscopic-esophagectomy with two-lung ventilation in semi-prone position. J Thorac Dis 2017; 9(1): 117-122.
https://doi.org/10.21037/jtd.2017.01.27
15. Zhao M, Jiang T, Li M, Yang X, Dai X, Shen Y, et al. Video-assisted thoracoscopic total thymectomy: two-lung ventilation with artificial pneumothorax. Minim Invasive Ther Allied Technol 2020; 29(6): 380-384.
https://doi.org/10.1080/13645706.2019.1660681
16. Gross DJ, Zangbar B, Muthu N, Chang EH, Badami A, Stein L,et al. Saving the split: the benefits of VATS thymectomy. J Thorac Dis 2019; 11(4): 1428-1432.
https://doi.org/10.21037/jtd.2019.03.51
17. Buentzel J, Straube C, Heinz J, Roever C, Beham A, Emmert A, et al. Thymectomy via open surgery or robotic video assisted thoracic surgery: Can a recommendation already be made? Medicine 2017; 96(24): e7161.
https://doi.org/10.1097/MD.0000000000007161
18. Ren Y, Yan H, Ge H, Peng J, Zheng H, Zhang P. CO2 artificial pneumothorax on coagulation and fibrinolysis during thoracoscopic esophagectomy. Medicine 2021; 100(2): e23784.
https://doi.org/10.1097/MD.0000000000023784
19. Ren Y, Zhu X, Yan H, Chen L, Mao Q. Cardiorespiratory impact of intrathoracic pressure overshoot during artificial carbon dioxide pneumothorax: a randomized controlled study. BMC Anesthesiol 2022; 22(1): 76.
https://doi.org/10.1186/s12871-022-01621-9
20. Lin M, Shen Y, Wang H, Fang Y, Qian C, Xu S, et al. A comparison between two lung ventilation with CO2 artificial pneumothorax and one lung ventilation during thoracic phase of minimally invasive esophagectomy. J Thorac Dis 2018; 10(3): 1912-1918. https://doi.org/10.21037/jtd.2018.01.150
21. Wolfe GI, Kaminski HJ, Aban IB, Minisman G, Kuo HC, Marx A, et al. Randomized Trial of Thymectomy in Myasthenia Gravis. N Engl J Med 2016; 375(6): 511-522.
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