Airtightness of lung parenchyma without a closing suture after atypical resection using the Nd:YAG Laser LIMAX® 120
Identifieur interne : 000273 ( Pmc/Curation ); précédent : 000272; suivant : 000274Airtightness of lung parenchyma without a closing suture after atypical resection using the Nd:YAG Laser LIMAX® 120
Auteurs : Andreas Kirschbaum [Allemagne] ; Thorsten Steinfeldt [Allemagne] ; Andreas Gockel [Allemagne] ; Pietro Di Fazio [Allemagne] ; Karl Quint [Allemagne] ; Detlef K. Bartsch [Allemagne]Source :
- Interactive Cardiovascular and Thoracic Surgery [ 1569-9293 ] ; 2013.
Abstract
Lung metastases can be non-anatomically resected with a Nd:YAG Laser. It is recommended that the resected lung surface be sealed by slowly resorbable sutures. However, the lung tissue may be restricted by the sutures once it is re-ventilated. Thus, it was analysed whether the lung parenchyma is airtight after laser resection without suturing the defect.
The pulmonary artery of unimpaired paracardial lung lobes of freshly slaughtered pigs (mean weight 46 g) was cannulated and rinsed out via a hypotonic saline–heparin solution (5000 IE) until the perfusate was clear of body fluid. The lobular bronchus was connected to an airtight ventilation tube (Fa. VYGON 520 3.5 oral tube) and ventilated pressure-controlled (PEEP + 5 cm H2O,
All group 1 lobes tested airtight under pressure-controlled ventilation. The mean burst pressure was 34.4 mbar (SD ± 3.2 mbar). Six lobes of group 2 were also completely airtight. The remaining two lobes, however, revealed a serious parenchymal leak (score 3). This was caused by the cross-opening of a segmental bronchus, although the surrounding lung parenchyma was also airtight. The mean burst pressure of these lobes was 31.7 mbar (SD ± 4.08 mbar). There was no significant difference between the two groups (
Peripheral lung defects after Nd:YAG Laser resection might not be sutured, since the laser-induced vaporization of the lung parenchyma seems to be initially airtight. These experimental data warrant confirmation in a controlled clinical study.
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DOI: 10.1093/icvts/ivt420
PubMed: 24087831
PubMed Central: 3867037
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Airtightness of lung parenchyma without a closing suture after atypical resection using the Nd:YAG Laser LIMAX<sup>®</sup> 120</title><author><name sortKey="Kirschbaum, Andreas" sort="Kirschbaum, Andreas" uniqKey="Kirschbaum A" first="Andreas" last="Kirschbaum">Andreas Kirschbaum</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Visceral, Thoracic- and Vascular Surgery</addr-line>,<institution>Philipps University Marburg</institution>,<addr-line>Marburg</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Steinfeldt, Thorsten" sort="Steinfeldt, Thorsten" uniqKey="Steinfeldt T" first="Thorsten" last="Steinfeldt">Thorsten Steinfeldt</name><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Department of Anaesthesiology</addr-line>,<institution>Philipps University Marburg</institution>,<addr-line>Marburg</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Gockel, Andreas" sort="Gockel, Andreas" uniqKey="Gockel A" first="Andreas" last="Gockel">Andreas Gockel</name><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Department of Anaesthesiology</addr-line>,<institution>Philipps University Marburg</institution>,<addr-line>Marburg</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Di Fazio, Pietro" sort="Di Fazio, Pietro" uniqKey="Di Fazio P" first="Pietro" last="Di Fazio">Pietro Di Fazio</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Visceral, Thoracic- and Vascular Surgery</addr-line>,<institution>Philipps University Marburg</institution>,<addr-line>Marburg</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Quint, Karl" sort="Quint, Karl" uniqKey="Quint K" first="Karl" last="Quint">Karl Quint</name><affiliation wicri:level="1"><nlm:aff id="af3"><institution>Institute of Pathology, University Hospital Erlangen</institution>,<addr-line>Erlangen</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Bartsch, Detlef K" sort="Bartsch, Detlef K" uniqKey="Bartsch D" first="Detlef K." last="Bartsch">Detlef K. Bartsch</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Visceral, Thoracic- and Vascular Surgery</addr-line>,<institution>Philipps University Marburg</institution>,<addr-line>Marburg</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24087831</idno><idno type="pmc">3867037</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867037</idno><idno type="RBID">PMC:3867037</idno><idno type="doi">10.1093/icvts/ivt420</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">000273</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000273</idno><idno type="wicri:Area/Pmc/Curation">000273</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000273</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Airtightness of lung parenchyma without a closing suture after atypical resection using the Nd:YAG Laser LIMAX<sup>®</sup> 120</title><author><name sortKey="Kirschbaum, Andreas" sort="Kirschbaum, Andreas" uniqKey="Kirschbaum A" first="Andreas" last="Kirschbaum">Andreas Kirschbaum</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Visceral, Thoracic- and Vascular Surgery</addr-line>,<institution>Philipps University Marburg</institution>,<addr-line>Marburg</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Steinfeldt, Thorsten" sort="Steinfeldt, Thorsten" uniqKey="Steinfeldt T" first="Thorsten" last="Steinfeldt">Thorsten Steinfeldt</name><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Department of Anaesthesiology</addr-line>,<institution>Philipps University Marburg</institution>,<addr-line>Marburg</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Gockel, Andreas" sort="Gockel, Andreas" uniqKey="Gockel A" first="Andreas" last="Gockel">Andreas Gockel</name><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Department of Anaesthesiology</addr-line>,<institution>Philipps University Marburg</institution>,<addr-line>Marburg</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Di Fazio, Pietro" sort="Di Fazio, Pietro" uniqKey="Di Fazio P" first="Pietro" last="Di Fazio">Pietro Di Fazio</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Visceral, Thoracic- and Vascular Surgery</addr-line>,<institution>Philipps University Marburg</institution>,<addr-line>Marburg</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Quint, Karl" sort="Quint, Karl" uniqKey="Quint K" first="Karl" last="Quint">Karl Quint</name><affiliation wicri:level="1"><nlm:aff id="af3"><institution>Institute of Pathology, University Hospital Erlangen</institution>,<addr-line>Erlangen</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Bartsch, Detlef K" sort="Bartsch, Detlef K" uniqKey="Bartsch D" first="Detlef K." last="Bartsch">Detlef K. Bartsch</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Visceral, Thoracic- and Vascular Surgery</addr-line>,<institution>Philipps University Marburg</institution>,<addr-line>Marburg</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">Interactive Cardiovascular and Thoracic Surgery</title><idno type="ISSN">1569-9293</idno><idno type="eISSN">1569-9285</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>OBJECTIVES</title><p>Lung metastases can be non-anatomically resected with a Nd:YAG Laser. It is recommended that the resected lung surface be sealed by slowly resorbable sutures. However, the lung tissue may be restricted by the sutures once it is re-ventilated. Thus, it was analysed whether the lung parenchyma is airtight after laser resection without suturing the defect.</p></sec><sec><title>METHODS</title><p>The pulmonary artery of unimpaired paracardial lung lobes of freshly slaughtered pigs (mean weight 46 g) was cannulated and rinsed out via a hypotonic saline–heparin solution (5000 IE) until the perfusate was clear of body fluid. The lobular bronchus was connected to an airtight ventilation tube (Fa. VYGON 520 3.5 oral tube) and ventilated pressure-controlled (PEEP + 5 cm H<sub>2</sub>O, <italic>P</italic><sub>1</sub> = 20 cm H<sub>2</sub>O, frequency = 10/min) via a respirator. All lobes were perfused with Ringer solution at 42°C at normothermia and normotonia. In group 1 (<italic>n</italic> = 8), an atypical peripheral parenchymal resection (average resected surface: 2 × 2 cm<sup>2</sup>) and in group 2 (<italic>n</italic> = 8), a deep atypical parenchymal resection (average resected surface: 4 × 4 cm<sup>2</sup>) were performed with the Nd:YAG Laser LIMAX® 120 (output power at 100 watts). After post-resection ventilation of 15 min, the resection surface was tested for airtightness and burst pressure.</p></sec><sec><title>RESULTS</title><p>All group 1 lobes tested airtight under pressure-controlled ventilation. The mean burst pressure was 34.4 mbar (SD ± 3.2 mbar). Six lobes of group 2 were also completely airtight. The remaining two lobes, however, revealed a serious parenchymal leak (score 3). This was caused by the cross-opening of a segmental bronchus, although the surrounding lung parenchyma was also airtight. The mean burst pressure of these lobes was 31.7 mbar (SD ± 4.08 mbar). There was no significant difference between the two groups (<italic>P</italic> = 0.12).</p></sec><sec><title>CONCLUSIONS</title><p>Peripheral lung defects after Nd:YAG Laser resection might not be sutured, since the laser-induced vaporization of the lung parenchyma seems to be initially airtight. These experimental data warrant confirmation in a controlled clinical study.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Interact Cardiovasc Thorac Surg</journal-id><journal-id journal-id-type="iso-abbrev">Interact Cardiovasc Thorac Surg</journal-id><journal-id journal-id-type="publisher-id">icvts</journal-id><journal-id journal-id-type="hwp">icvtsurg</journal-id><journal-title-group><journal-title>Interactive Cardiovascular and Thoracic Surgery</journal-title></journal-title-group><issn pub-type="ppub">1569-9293</issn><issn pub-type="epub">1569-9285</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24087831</article-id><article-id pub-id-type="pmc">3867037</article-id><article-id pub-id-type="doi">10.1093/icvts/ivt420</article-id><article-id pub-id-type="publisher-id">ivt420</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject><subj-group subj-group-type="heading"><subject>Thoracic</subject></subj-group></subj-group></article-categories><title-group><article-title>Airtightness of lung parenchyma without a closing suture after atypical resection using the Nd:YAG Laser LIMAX<sup>®</sup> 120</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kirschbaum</surname><given-names>Andreas</given-names></name><xref ref-type="aff" rid="af1">a</xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Steinfeldt</surname><given-names>Thorsten</given-names></name><xref ref-type="aff" rid="af2">b</xref></contrib><contrib contrib-type="author"><name><surname>Gockel</surname><given-names>Andreas</given-names></name><xref ref-type="aff" rid="af2">b</xref></contrib><contrib contrib-type="author"><name><surname>Di Fazio</surname><given-names>Pietro</given-names></name><xref ref-type="aff" rid="af1">a</xref></contrib><contrib contrib-type="author"><name><surname>Quint</surname><given-names>Karl</given-names></name><xref ref-type="aff" rid="af3">c</xref></contrib><contrib contrib-type="author"><name><surname>Bartsch</surname><given-names>Detlef K.</given-names></name><xref ref-type="aff" rid="af1">a</xref></contrib></contrib-group><aff id="af1"><label>a</label><addr-line>Department of Visceral, Thoracic- and Vascular Surgery</addr-line>,<institution>Philipps University Marburg</institution>,<addr-line>Marburg</addr-line>,<country>Germany</country></aff><aff id="af2"><label>b</label><addr-line>Department of Anaesthesiology</addr-line>,<institution>Philipps University Marburg</institution>,<addr-line>Marburg</addr-line>,<country>Germany</country></aff><aff id="af3"><label>c</label><institution>Institute of Pathology, University Hospital Erlangen</institution>,<addr-line>Erlangen</addr-line>,<country>Germany</country></aff><author-notes><corresp id="cor1"><label>*</label>Corresponding author. Department of Visceral, Thoracic- and Vascular Surgery, UKGM, Baldingerstrasse, 35033 Marburg, Germany. Tel: +49-6421-5861738; fax: +49-6421-5866593; e-mail: <email>akirschb@med.uni-marburg.de</email> (A. Kirschbaum).</corresp></author-notes><pub-date pub-type="ppub"><month>1</month><year>2014</year></pub-date><pub-date pub-type="epub"><day>30</day><month>9</month><year>2013</year></pub-date><volume>18</volume><issue>1</issue><fpage>92</fpage><lpage>95</lpage><history><date date-type="received"><day>26</day><month>4</month><year>2013</year></date><date date-type="rev-recd"><day>17</day><month>7</month><year>2013</year></date><date date-type="accepted"><day>19</day><month>8</month><year>2013</year></date></history><permissions><copyright-statement>© The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.</copyright-statement><copyright-year>2013</copyright-year></permissions><self-uri content-type="pdf" xlink:type="simple" xlink:href="ivt420.pdf"></self-uri><related-article id="d35e182" related-article-type="article-reference" ext-link-type="doi" xlink:href="10.1093/icvts/ivt475"></related-article><related-article id="d35e183" related-article-type="article-reference" ext-link-type="doi" xlink:href="10.1093/icvts/ivt521"></related-article><abstract><sec><title>OBJECTIVES</title><p>Lung metastases can be non-anatomically resected with a Nd:YAG Laser. It is recommended that the resected lung surface be sealed by slowly resorbable sutures. However, the lung tissue may be restricted by the sutures once it is re-ventilated. Thus, it was analysed whether the lung parenchyma is airtight after laser resection without suturing the defect.</p></sec><sec><title>METHODS</title><p>The pulmonary artery of unimpaired paracardial lung lobes of freshly slaughtered pigs (mean weight 46 g) was cannulated and rinsed out via a hypotonic saline–heparin solution (5000 IE) until the perfusate was clear of body fluid. The lobular bronchus was connected to an airtight ventilation tube (Fa. VYGON 520 3.5 oral tube) and ventilated pressure-controlled (PEEP + 5 cm H<sub>2</sub>O, <italic>P</italic><sub>1</sub> = 20 cm H<sub>2</sub>O, frequency = 10/min) via a respirator. All lobes were perfused with Ringer solution at 42°C at normothermia and normotonia. In group 1 (<italic>n</italic> = 8), an atypical peripheral parenchymal resection (average resected surface: 2 × 2 cm<sup>2</sup>) and in group 2 (<italic>n</italic> = 8), a deep atypical parenchymal resection (average resected surface: 4 × 4 cm<sup>2</sup>) were performed with the Nd:YAG Laser LIMAX® 120 (output power at 100 watts). After post-resection ventilation of 15 min, the resection surface was tested for airtightness and burst pressure.</p></sec><sec><title>RESULTS</title><p>All group 1 lobes tested airtight under pressure-controlled ventilation. The mean burst pressure was 34.4 mbar (SD ± 3.2 mbar). Six lobes of group 2 were also completely airtight. The remaining two lobes, however, revealed a serious parenchymal leak (score 3). This was caused by the cross-opening of a segmental bronchus, although the surrounding lung parenchyma was also airtight. The mean burst pressure of these lobes was 31.7 mbar (SD ± 4.08 mbar). There was no significant difference between the two groups (<italic>P</italic> = 0.12).</p></sec><sec><title>CONCLUSIONS</title><p>Peripheral lung defects after Nd:YAG Laser resection might not be sutured, since the laser-induced vaporization of the lung parenchyma seems to be initially airtight. These experimental data warrant confirmation in a controlled clinical study.</p></sec></abstract><kwd-group><kwd>Airtightness</kwd><kwd>Atypical lung parenchyma resection</kwd><kwd>Laser</kwd><kwd>Parenchyma closure</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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