Perioperative Outcomes Of Uniportal Vats Segmentectomy For Pulmonary Tuberculosis
Makhmud Mortada, Grigorii Kudriashov, Armen Avetisyan, Piotr Yablonskii.
St. Petersburg State Research Institute of Phthisiopulmonology, Saint Petersburg, Russia, Saint Petersburg, Russian Federation.
BACKGROUND. It is known that, compared with open surgery, video-assisted thoracoscopic surgery (VATS) is associated with less perioperative morbidity, less pain and shorter hospitalization. However, аccording to the literature, VATS anatomical segmenectomy for pulmonary tuberculosis (TB) accompanied by high conversion rate and severe postoperative complications. METHODS. Between Jule 2016 and December 2017 there were 108 patients included in retrospective cohort study. All patients were underwent anatomical segmentectomy for localized cavitary pulmonary TB according to National guidelines and WHO consensus statement. Patients were divided into two groups: open segmentectomy (lateral muscle sparing thoracotomy) (n=48), uniportal VATS (uVATS) segmentectomy (n=60). There was no significant difference in anthropometric and social characteristics, the presence of comorbidities, lung function, drug-resistance TB between the groups. There were 58% of patients in uVATS-group and 37,5% in thoracotomy-group with drug resistance tuberculosis (p=0,11). All intraoperative and postoperative data were evaluated: ultimate surgical approach, operative time, blood loss, length of hospital stay, drainage treatment time, pain level, complications. Pain level was indirectly evaluated by the dose of the necessary opioid analgesics in the postoperative period. Postoperative complications were registered by Ottawa Thoracic Morbidity & Mortality Classification System. RESULTS. The mean operative time was lower in thoracotomy group (152 min vs 182 min, p=0.01). There was a trend toward lower intraoperative blood loss is uVATS group (62 ml vs 75 ml, p=0.06). There were five cases (8%) with non-emergent conversion to open surgery due to perivascular fibrosis and a potentially higher risk of intraoperative complications. The use of opioid analgesics in the postoperative period is less in the uVATS group (p = 0.01). Table 1 shows the postoperative complications in both groups. There were 21% and 35% major complications after thoracotomy and VATS segmenectomy, respectively (p<0.05). No significant difference was found in length of stay, duration of chest tube drainage. "LEGEND: Table 1. Postoperative complications in both groups."
CONCLUSIONS. Uniportal VATS anatomical segmenectomy for localized cavitary pulmonary tuberculosis associated with acceptable perioperative outcomes due to less morbidity rate and pain level, providing the benefits of minimally invasive and maximally parenchymal-sparing surgery.
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