An Effective Alternative For Hilar Dissection And Lymphadenectomy During Vats Lobectomy: The Transcollation Technology
Cecilia Menna, Claudio Andreetti, Anna Maria Ciccone, Antonio D'Andrilli, Giulio Maurizi, Camilla Vanni, Alberto Baccarini, Erino Angelo Rendina, Mohsen Ibrahim.
Sant'Andrea Hospital, Rome, Italy.
BACKGROUND: Hilar dissection and mediastinal lymphadenectomy in video-assisted thoracoscopic surgery (VATS) major lung resections can represent difficult issues and cause post-operative complications. The aim of the study was to retrospectively evaluate the effectiveness of Transcollation technology (TT) in reducing blood loss and improving the postoperative outcome in patients who underwent VATS lobectomy.
METHODS: Between November 2015 and October 2017, TT was used to perform hilar dissection and mediastinal lymphadenectomy in 24 patients (TT Group) who underwent VATS lobectomy. Conventional electrocoagulation was used in 29 patients (EC Group). Operative time, daily drainage amount at 24, 48 and 72 h, pre- and postoperative haemoglobin levels, need for blood transfusion, intra- and postoperative air leaks and duration of chest tube placement and hospital stay were analyzed.
RESULTS: No adverse events related to the TT system occurred, including reoperation for bleeding. The mean operating time was 75.2 ± 25.8 min in the TT Group versus 98.1 ± 33.3 min in the EC Group (P = 0.023). The mean postoperative haemoglobin level was 11.7 ± 2.2 g/dl versus the preoperative level of 13.2 ± 2.7 g/dl in the TT Group (P = 0.177) and 9.4 ± 2.3 vs 13.4 ± 2.6 g/dl in the EC Group (P = 0.006). Only 1 patients (4.2%) received postoperative blood transfusion in the EC Group vs no patients in the TT Group (P = 0.091). Intraoperative and postoperative (24 h) air leak rates were 8.3% (n = 2) and 12.5% (n = 3) in the TT Group vs 17.2% (n = 5) and 20.7% (n = 6) in the EC Group (P = 0.001), respectively. The mean duration of chest tube placement was shorter in the TT Group (4.6 ± 0.5 vs 6.9 ± 1.2 days, P = 0.018), as well as the mean hospital stay (4.3 ± 1.8 vs 6.5 ± 0.2 days, P = 0.007).
CONCLUSIONS: The use of TT seems to reduce haemorrhage occurrence and postoperative hospital stay after VATS lobectomy.
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