A prospective randomized trial comparing stapler and laser techniques for interlobar fissure completion during pulmonary lobectomy.
Identifieur interne : 000371 ( PubMed/Corpus ); précédent : 000370; suivant : 000372A prospective randomized trial comparing stapler and laser techniques for interlobar fissure completion during pulmonary lobectomy.
Auteurs : Giuseppe Marulli ; Andrea Droghetti ; Francesco Di Chiara ; Francesca Calabrese ; Alessandro Rebusso ; Egle Perissinotto ; Giovanni Muriana ; Federico ReaSource :
- Lasers in medical science [ 1435-604X ] ; 2013.
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
Links to Exploration step
pubmed:22526973Le document en format XML
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F" first="Francesca" last="Calabrese">Francesca Calabrese</name></author><author><name sortKey="Rebusso, Alessandro" sort="Rebusso, Alessandro" uniqKey="Rebusso A" first="Alessandro" last="Rebusso">Alessandro Rebusso</name></author><author><name sortKey="Perissinotto, Egle" sort="Perissinotto, Egle" uniqKey="Perissinotto E" first="Egle" last="Perissinotto">Egle Perissinotto</name></author><author><name sortKey="Muriana, Giovanni" sort="Muriana, Giovanni" uniqKey="Muriana G" first="Giovanni" last="Muriana">Giovanni Muriana</name></author><author><name sortKey="Rea, Federico" sort="Rea, Federico" uniqKey="Rea F" first="Federico" last="Rea">Federico Rea</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2013">2013</date><idno type="doi">10.1007/s10103-012-1097-0</idno><idno type="RBID">pubmed:22526973</idno><idno type="pmid">22526973</idno><idno type="wicri:Area/PubMed/Corpus">000371</idno><idno type="wicri:explorRef" wicri:stream="PubMed" 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sortKey="Calabrese, Francesca" sort="Calabrese, Francesca" uniqKey="Calabrese F" first="Francesca" last="Calabrese">Francesca Calabrese</name></author><author><name sortKey="Rebusso, Alessandro" sort="Rebusso, Alessandro" uniqKey="Rebusso A" first="Alessandro" last="Rebusso">Alessandro Rebusso</name></author><author><name sortKey="Perissinotto, Egle" sort="Perissinotto, Egle" uniqKey="Perissinotto E" first="Egle" last="Perissinotto">Egle Perissinotto</name></author><author><name sortKey="Muriana, Giovanni" sort="Muriana, Giovanni" uniqKey="Muriana G" first="Giovanni" last="Muriana">Giovanni Muriana</name></author><author><name sortKey="Rea, Federico" sort="Rea, Federico" uniqKey="Rea F" first="Federico" last="Rea">Federico Rea</name></author></analytic><series><title level="j">Lasers in medical science</title><idno type="eISSN">1435-604X</idno><imprint><date when="2013" type="published">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Chest Tubes</term><term>Female</term><term>Humans</term><term>Laser Therapy (economics)</term><term>Laser Therapy (instrumentation)</term><term>Laser Therapy (methods)</term><term>Length of Stay (economics)</term><term>Male</term><term>Middle Aged</term><term>Pneumonectomy (economics)</term><term>Pneumonectomy (methods)</term><term>Postoperative Complications (etiology)</term><term>Postoperative Complications (prevention & control)</term><term>Prospective Studies</term><term>Surgical Stapling (economics)</term><term>Surgical Stapling (methods)</term><term>Thulium</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" type="chemical" xml:lang="en"><term>Thulium</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Laser Therapy</term><term>Length of Stay</term><term>Pneumonectomy</term><term>Surgical Stapling</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Postoperative Complications</term></keywords><keywords scheme="MESH" qualifier="instrumentation" xml:lang="en"><term>Laser Therapy</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Laser Therapy</term><term>Pneumonectomy</term><term>Surgical Stapling</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Postoperative Complications</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Chest Tubes</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Prospective Studies</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><pubmed><MedlineCitation Owner="NLM" Status="MEDLINE"><PMID Version="1">22526973</PMID><DateCreated><Year>2013</Year><Month>03</Month><Day>04</Day></DateCreated><DateCompleted><Year>2013</Year><Month>12</Month><Day>10</Day></DateCompleted><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1435-604X</ISSN><JournalIssue CitedMedium="Internet"><Volume>28</Volume><Issue>2</Issue><PubDate><Year>2013</Year><Month>Feb</Month></PubDate></JournalIssue><Title>Lasers in medical science</Title><ISOAbbreviation>Lasers Med Sci</ISOAbbreviation></Journal><ArticleTitle>A prospective randomized trial comparing stapler and laser techniques for interlobar fissure completion during pulmonary lobectomy.</ArticleTitle><Pagination><MedlinePgn>505-11</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1007/s10103-012-1097-0</ELocationID><Abstract><AbstractText>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.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Marulli</LastName><ForeName>Giuseppe</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Department of Cardiologic, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Via Giustiniani, 1, 35100, Padua, Italy. beppemarulli@libero.it</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Droghetti</LastName><ForeName>Andrea</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Di Chiara</LastName><ForeName>Francesco</ForeName><Initials>F</Initials></Author><Author ValidYN="Y"><LastName>Calabrese</LastName><ForeName>Francesca</ForeName><Initials>F</Initials></Author><Author ValidYN="Y"><LastName>Rebusso</LastName><ForeName>Alessandro</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Perissinotto</LastName><ForeName>Egle</ForeName><Initials>E</Initials></Author><Author ValidYN="Y"><LastName>Muriana</LastName><ForeName>Giovanni</ForeName><Initials>G</Initials></Author><Author ValidYN="Y"><LastName>Rea</LastName><ForeName>Federico</ForeName><Initials>F</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016449">Randomized Controlled Trial</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2012</Year><Month>04</Month><Day>24</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Lasers Med Sci</MedlineTA><NlmUniqueID>8611515</NlmUniqueID><ISSNLinking>0268-8921</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>8RKC5ATI4P</RegistryNumber><NameOfSubstance UI="D013932">Thulium</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName MajorTopicYN="N" UI="D000368">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D015505">Chest Tubes</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D005260">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D006801">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D053685">Laser Therapy</DescriptorName><QualifierName MajorTopicYN="N" UI="Q000191">economics</QualifierName><QualifierName MajorTopicYN="N" UI="Q000295">instrumentation</QualifierName><QualifierName MajorTopicYN="Y" UI="Q000379">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D007902">Length of Stay</DescriptorName><QualifierName MajorTopicYN="N" UI="Q000191">economics</QualifierName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D008297">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D008875">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D011013">Pneumonectomy</DescriptorName><QualifierName MajorTopicYN="N" UI="Q000191">economics</QualifierName><QualifierName MajorTopicYN="Y" UI="Q000379">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D011183">Postoperative Complications</DescriptorName><QualifierName MajorTopicYN="N" UI="Q000209">etiology</QualifierName><QualifierName MajorTopicYN="N" UI="Q000517">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D011446">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D017792">Surgical Stapling</DescriptorName><QualifierName MajorTopicYN="N" UI="Q000191">economics</QualifierName><QualifierName MajorTopicYN="Y" UI="Q000379">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D013932">Thulium</DescriptorName></MeshHeading><MeshHeading><DescriptorName MajorTopicYN="N" UI="D016896">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2011</Year><Month>11</Month><Day>7</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2012</Year><Month>4</Month><Day>9</Day></PubMedPubDate><PubMedPubDate PubStatus="aheadofprint"><Year>2012</Year><Month>4</Month><Day>24</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2012</Year><Month>4</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2012</Year><Month>4</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2013</Year><Month>12</Month><Day>16</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="doi">10.1007/s10103-012-1097-0</ArticleId><ArticleId IdType="pubmed">22526973</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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