A prospective randomized trial comparing stapler and laser techniques for interlobar fissure completion during pulmonary lobectomy.
Identifieur interne : 000568 ( Ncbi/Curation ); précédent : 000567; suivant : 000569A prospective randomized trial comparing stapler and laser techniques for interlobar fissure completion during pulmonary lobectomy.
Auteurs : Giuseppe Marulli [Italie] ; Andrea Droghetti ; Francesco Di Chiara ; Francesca Calabrese ; Alessandro Rebusso ; Egle Perissinotto ; Giovanni Muriana ; Federico ReaSource :
- Lasers in medical science [ 1435-604X ] ; 2013.
Descripteurs français
- KwdFr :
- Adulte d'âge moyen, Agrafage chirurgical (), Agrafage chirurgical (économie), Complications postopératoires (), Complications postopératoires (étiologie), Drains thoraciques, Durée du séjour (économie), Femelle, Humains, Mâle, Pneumonectomie (), Pneumonectomie (économie), Résultat thérapeutique, Sujet âgé, Thulium, Thérapie laser (), Thérapie laser (instrumentation), Thérapie laser (économie), Études prospectives.
- MESH :
- économie : Agrafage chirurgical, Durée du séjour, Pneumonectomie, Thérapie laser.
- étiologie : Complications postopératoires.
- Adulte d'âge moyen, Agrafage chirurgical, Complications postopératoires, Drains thoraciques, Femelle, Humains, Mâle, Pneumonectomie, Résultat thérapeutique, Sujet âgé, Thulium, Thérapie laser, Études prospectives.
English descriptors
- KwdEn :
- Aged, Chest Tubes, Female, Humans, Laser Therapy (economics), Laser Therapy (instrumentation), Laser Therapy (methods), Length of Stay (economics), Male, Middle Aged, Pneumonectomy (economics), Pneumonectomy (methods), Postoperative Complications (etiology), Postoperative Complications (prevention & control), Prospective Studies, Surgical Stapling (economics), Surgical Stapling (methods), Thulium, Treatment Outcome.
- MESH :
- chemical : Thulium.
- economics : Laser Therapy, Length of Stay, Pneumonectomy, Surgical Stapling.
- etiology : Postoperative Complications.
- instrumentation : Laser Therapy.
- methods : Laser Therapy, Pneumonectomy, Surgical Stapling.
- prevention & control : Postoperative Complications.
- Aged, Chest Tubes, Female, Humans, Male, Middle Aged, Prospective Studies, Treatment Outcome.
Abstract
Alveolar air leaks, often resulting from lung tissue traumatization during dissection of fissures, still remain a challenging problem in lung surgery. Several tools and techniques have been used to reduce air leakage, but none was judged ideal. This prospective, randomized trial was designed to evaluate the feasibility, safety, and effectiveness of completion of fissures during pulmonary lobectomy by using a laser system. A standard stapler technique was used for comparison; the primary goal was to reach at least a comparable result. Forty-four patients were enrolled, 22 were treated with standard technique by using staplers (S) and 22 underwent laser (L) dissection. Randomization to one of the two groups was intraoperative after evaluating the presence of incomplete fissure (grade 3-4 following Craig's classification). A Thulium laser 2010 nm (Cyber TM, Quanta System, Italy) was used at power of 40 W. Outcome primary measures were the evaluation and duration of intra- and postoperative air leaks, the rate of complications, and the hospital stay. Air leaks (2.1 ± 4.2 vs 3.6 ± 7.2 days; p = 0.98) and chest tube duration (6.4 ± 4.2 vs 7.5 ± 6.3 days, p = 0.44) were lower in L compared with S group even if these were not statistically significant. Complications (36.4 vs 77.3 %; p = 0.006), hospital stay (6.9 ± 3.8 vs 9.9 ± 6.9 days; p = 0.03), hospitalization costs (5,650 vs 8,147 euros; p = 0.01), and procedure costs (77 % of difference; p < 0.0001) were significantly lower for L group, while operative time was longer (197 ± 34 vs 158 ± 41 min; p = 0.004). The use of laser dissection to prevent postoperative air leaks is effective and comparable with stapler technique. Aero-haemostatic laser properties (by sealing of small blood vessels and checking air leaks) allow a safe application during pulmonary lobectomy in interlobar fissure completion avoiding stapler use.
DOI: 10.1007/s10103-012-1097-0
PubMed: 22526973
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pubmed:22526973Le document en format XML
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Several tools and techniques have been used to reduce air leakage, but none was judged ideal. This prospective, randomized trial was designed to evaluate the feasibility, safety, and effectiveness of completion of fissures during pulmonary lobectomy by using a laser system. A standard stapler technique was used for comparison; the primary goal was to reach at least a comparable result. Forty-four patients were enrolled, 22 were treated with standard technique by using staplers (S) and 22 underwent laser (L) dissection. Randomization to one of the two groups was intraoperative after evaluating the presence of incomplete fissure (grade 3-4 following Craig's classification). A Thulium laser 2010 nm (Cyber TM, Quanta System, Italy) was used at power of 40 W. Outcome primary measures were the evaluation and duration of intra- and postoperative air leaks, the rate of complications, and the hospital stay. Air leaks (2.1 ± 4.2 vs 3.6 ± 7.2 days; p = 0.98) and chest tube duration (6.4 ± 4.2 vs 7.5 ± 6.3 days, p = 0.44) were lower in L compared with S group even if these were not statistically significant. Complications (36.4 vs 77.3 %; p = 0.006), hospital stay (6.9 ± 3.8 vs 9.9 ± 6.9 days; p = 0.03), hospitalization costs (5,650 vs 8,147 euros; p = 0.01), and procedure costs (77 % of difference; p < 0.0001) were significantly lower for L group, while operative time was longer (197 ± 34 vs 158 ± 41 min; p = 0.004). The use of laser dissection to prevent postoperative air leaks is effective and comparable with stapler technique. Aero-haemostatic laser properties (by sealing of small blood vessels and checking air leaks) allow a safe application during pulmonary lobectomy in interlobar fissure completion avoiding stapler use.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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