International Society For Minimally Invasive Cardiothoracic Surgery

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The Use Of Argon Plasma Energy For Thoracoscopic Pulmonary Matastasectomy: An Alternative Surgical Method
Savvas Lampridis, Sofoklis Mitsos, Davide Patrini, David R. Lawrence, Nikolaos Panagiotopoulos.
University College London Hospitals, London, United Kingdom.

BACKGROUND: Pulmonary metastasectomy is a commonly performed operation and tends to further increase as part of a concept for personalised treatment in advanced stages of cancer. Various surgical tools have been utilised to improve the resectability of pulmonary metastases while reducing the rate of complications: from electrosurgical instruments and mechanical staplers to Nd:YAG laser. More recently, pure argon plasma has provided an electrically neutral energy source for cutting and coagulating tissue with minimal depth of necrosis. These characteristics make argon plasma energy an appealing candidate for pulmonary metastasectomy, where the goal is complete excision of the lesion with simultaneous aerostasis, haemostasis and preservation of lung parenchyma. In this study, we assess the safety and efficacy of thoracoscopic pulmonary metastasectomy with argon plasma energy and we compare its clinical results with those observed by using more conventional surgical technologies.
METHODS: During a two-month period, five patients (three males and two females) aged between 67 and 85 years (mean age of 77 years) underwent uniportal video-assisted thoracoscopic surgery for pulmonary metastasectomy with the use of argon plasma energy. All patients had a medical history of colorectal carcinoma and presented with a solitary, less than 3cm in maximal diameter, peripherally located lung lesion with radiological features suspicious for metastasis.
RESULTS: In all cases, histopathological analysis of the lesion confirmed colorectal metastasis that was completely excised. The mean operative time was 22 minutes (range, 18 to 25). All surgeries were performed without complications, including bleeding and air leakage, thus allowing removal of the intercostal chest drain on the following day. All patients were discharged on the first postoperative day and were followed up for a mean period of 6 months (range, 4 to 8 months), during which no complications occurred.
CONCLUSIONS: The use of argon plasma energy for thoracoscopic excision of pulmonary metastases appears to be simple, safe and efficacious. When compared to more conventional surgical techniques, argon plasma energy represents a valid alternative method for pulmonary metastasectomy.

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