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Minithoracotomy combined with mechanically stapled bronchial and vascular ligation for anatomical lung resection.
Ann Thorac Surg. 2004 Jun; 77(6):1904-9; discussion 1909-10.AT

Abstract

BACKGROUND

The most appropriate approach to anatomic pulmonary resection has been debated with the advance of minimally invasive techniques and especially the common use of mechanical staplers. Video assisted surgery and muscle-sparing thoracotomy are established options of surgical approach for lung resection. We utilize a combined technique of vertical muscle sparing minithoracotomy and mechanical closure of the hilum structures to accomplish lung resection.

METHODS

From December 1995 through January 2002, 713 patients (mean age, 65 +/- 11, 44.6% male) underwent anatomic pulmonary resection including 64 pneumonectomies, 514 lobectomies, and 135 formal segmental resections. Pulmonary resection was approached though a direct access, vertical, minithoracotomy (< 10 cm), and vascular ligation was performed with port-access endostapling instrumentation. Full mediastinal lymph node sampling was performed for primary lung cancer.

RESULTS

The average operative time was 55 minutes for lobectomy-formal segmentectomy and 62 minutes for pneumonectomy. An average of 3.6 staple applications were utilized to ligate the pulmonary vasculature (n = 2548 for 713 patients). Operative vascular complications included 5 minor intimal fractures, 1 posterior segmental arterial avulsion, and 1 staple misfiring for an adverse event rate during stapler application of 0.27%. Only one conversion to standard thoracotomy was necessary to control bleeding from the pulmonary vein. There were no intraoperative deaths.

CONCLUSIONS

Vertical minithoracotomy is a safe and expedited approach for anatomic lung resection. Direct visualization for dissection and effective pulmonary hilum mechanical closure with staplers were demonstrated. This approach is a reasonable option when a complete video-assisted surgery seems to be hazardous and a full open thoracotomy could represent an additional morbidity.

Authors+Show Affiliations

Section of Cardiothoracic Surgery, West Virginia University School of Medicine and Morgantown West Virginia Hospital, Morgantown, West Virginia 26506-9238, USA. mszwerc@hsc.wvu.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15172234

Citation

Szwerc, Michael F., et al. "Minithoracotomy Combined With Mechanically Stapled Bronchial and Vascular Ligation for Anatomical Lung Resection." The Annals of Thoracic Surgery, vol. 77, no. 6, 2004, pp. 1904-9; discussion 1909-10.
Szwerc MF, Landreneau RJ, Santos RS, et al. Minithoracotomy combined with mechanically stapled bronchial and vascular ligation for anatomical lung resection. Ann Thorac Surg. 2004;77(6):1904-9; discussion 1909-10.
Szwerc, M. F., Landreneau, R. J., Santos, R. S., Keenan, R. J., & Murray, G. F. (2004). Minithoracotomy combined with mechanically stapled bronchial and vascular ligation for anatomical lung resection. The Annals of Thoracic Surgery, 77(6), 1904-9; discussion 1909-10.
Szwerc MF, et al. Minithoracotomy Combined With Mechanically Stapled Bronchial and Vascular Ligation for Anatomical Lung Resection. Ann Thorac Surg. 2004;77(6):1904-9; discussion 1909-10. PubMed PMID: 15172234.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Minithoracotomy combined with mechanically stapled bronchial and vascular ligation for anatomical lung resection. AU - Szwerc,Michael F, AU - Landreneau,Rodney J, AU - Santos,Ricardo S, AU - Keenan,Robert J, AU - Murray,Gordon F, PY - 2003/12/01/accepted PY - 2004/6/3/pubmed PY - 2004/6/30/medline PY - 2004/6/3/entrez SP - 1904-9; discussion 1909-10 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 77 IS - 6 N2 - BACKGROUND: The most appropriate approach to anatomic pulmonary resection has been debated with the advance of minimally invasive techniques and especially the common use of mechanical staplers. Video assisted surgery and muscle-sparing thoracotomy are established options of surgical approach for lung resection. We utilize a combined technique of vertical muscle sparing minithoracotomy and mechanical closure of the hilum structures to accomplish lung resection. METHODS: From December 1995 through January 2002, 713 patients (mean age, 65 +/- 11, 44.6% male) underwent anatomic pulmonary resection including 64 pneumonectomies, 514 lobectomies, and 135 formal segmental resections. Pulmonary resection was approached though a direct access, vertical, minithoracotomy (< 10 cm), and vascular ligation was performed with port-access endostapling instrumentation. Full mediastinal lymph node sampling was performed for primary lung cancer. RESULTS: The average operative time was 55 minutes for lobectomy-formal segmentectomy and 62 minutes for pneumonectomy. An average of 3.6 staple applications were utilized to ligate the pulmonary vasculature (n = 2548 for 713 patients). Operative vascular complications included 5 minor intimal fractures, 1 posterior segmental arterial avulsion, and 1 staple misfiring for an adverse event rate during stapler application of 0.27%. Only one conversion to standard thoracotomy was necessary to control bleeding from the pulmonary vein. There were no intraoperative deaths. CONCLUSIONS: Vertical minithoracotomy is a safe and expedited approach for anatomic lung resection. Direct visualization for dissection and effective pulmonary hilum mechanical closure with staplers were demonstrated. This approach is a reasonable option when a complete video-assisted surgery seems to be hazardous and a full open thoracotomy could represent an additional morbidity. SN - 0003-4975 UR - https://www.unboundmedicine.com/medline/citation/15172234/Minithoracotomy_combined_with_mechanically_stapled_bronchial_and_vascular_ligation_for_anatomical_lung_resection_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003497503024901 DB - PRIME DP - Unbound Medicine ER -