Unplanned Procedures During Thoracoscopic Segmentectomies.

Gossot, Dominique; Lutz, Jon Andri; Grigoroiu, Madalina; Brian, Emmanuel; Seguin-Givelet, Agathe (2017). Unplanned Procedures During Thoracoscopic Segmentectomies. Annals of thoracic surgery, 104(5), pp. 1710-1717. Elsevier 10.1016/j.athoracsur.2017.05.081

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BACKGROUND Thoracoscopic sublobar resections (TSLRs) are gaining popularity, but are challenging. However, despite technical difficulties, the reported rate of adverse events, complications, and unplanned procedures is low. To understand this paradox, we have studied our series of TSLRs. METHODS We reviewed our prospective and intention-to-treat database on videothoracoscopic anatomical resections and extracted all planned thoracoscopic segmentectomies from January 2007 to July 2016. Intraoperative and postoperative data were analyzed. Unplanned procedures were defined as a conversion into thoracotomy or an unplanned additional pulmonary resection. RESULTS During the study period 284 thoracoscopic anatomical segmentectomies were performed in 280 patients. There were 124 men and 156 women with a mean age of 64 years (range, 18 to 86 years). Indication for segmentectomy was a proven or suspected non-small cell lung carcinoma in 184 patients, suspected metastasis in 51 patients, and benign lesion in 49 patients. In total, 23 patients had an unplanned procedure (8%). There were 10 unplanned thoracotomies (9 conversions and 1 reoperation; 3.1%) mainly for vascular injuries, and 15 unplanned additional resections (5.1%) distributed among oncological reasons (n = 7), per operative technical issues (n = 6) and postoperative adverse events (lingular ischemia, n = 2). Considering only the 235 patients operated on for cancer, the unplanned additional pulmonary resection rate for an oncological reason was 3%. CONCLUSIONS Although lower than for thoracoscopic lobectomies, the rate of unplanned procedure during TSLRs is of concern. It could most likely be reduced by technical refinements, such as a better preoperative planning.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Thoracic Surgery

UniBE Contributor:

Lutz, Jon Andri

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0003-4975

Publisher:

Elsevier

Language:

English

Submitter:

Thomas Michael Marti

Date Deposited:

14 Mar 2018 17:34

Last Modified:

22 Oct 2019 17:15

Publisher DOI:

10.1016/j.athoracsur.2017.05.081

PubMed ID:

28969898

BORIS DOI:

10.7892/boris.109989

URI:

https://boris.unibe.ch/id/eprint/109989

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