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Minimally Invasive Thoracic Surgery Applicability In The Treatment Of Inflammatory And Infectious Pulmonary Diseases
Petrucio A. Sarmento1, Juliana P. Franceschini2, Ricardo S. Santos3.
1Universidade Federal da Paraíba, João Pessoa, Brazil, 2ProPulmão, São Paulo, Brazil, 3Hospital Cárdio Pulmonar, Salvador, Brazil.
BACKGROUND: The advent of video-assisted thoracic surgery (VATS) allowed a new approach of pulmonary infections, changing the post-operative scenario and improving the recovery process. The aim of this study was to describe a single center experience with the use of VATS for major pulmonary resections in patients with inflammatory/infectious disease.
METHODS: Between 2009 and 2019, 55 patients were identified. Inflammatory/infectious diseases included bronchiectasis, fungal ball, pulmonary destruction and multiresistant tuberculosis. The indication for VATS lobectomy or pneumonectomy was proposed by a multidisciplinary board for patients whom others clinical treatment options were tried without success. Resections were undertaken using an anterior three-port or four-port technique. Bronchial structures were transected using endoscopic staplers. Vascular structures were transected using endoscopic staplers or an energy device. Complete dissection of hilar lymph nodes was carried out.
RESULTS: Most patients were women (n=4; 74.5%) and presented severe illness, with borderline lung function. The most frequent comorbidity was Systemic Arterial Hypertension (9.1%) followed by Diabetes mellitus and Malnutrition (3.6 each one). Among patients requiring thoracic surgery, bronchiectasis was present in 37 patients, generally developed as post-infectious sequelae. Other etiologies included tuberculosos lung destruction, pulmonary sequestration, infected hydatid cyst, multi-resistant tuberculosis, pulmonary fungus ball and necrotizing pneumonia. Lobectomy was the most frequent procedure (n=46; 83.6%). Pneumonectomy was performed in six patients (10.9%). The mean surgery duration was 240 minutes, and the mean length of hospital stay was 4.3 days. Isolated stapled was used as the hilum approach in 53 patients (96.4%). The number and size of incisions are shown in table 1. Surgical complications included intraoperative vascular injury resulting in conversion to thoracotomy (5.5%), persistent pneumothorax in one patient (1.8%) and empyema in another patient (1.8%).
CONCLUSIONS: Most patients benefited from the procedure, with some surgical complication being observed in 5 patients. Our results are comparable to those reported by other authors and demonstrated the advantages of VATS in the treatment of pulmonary Inflammatory/infectious diseases.
| n=55 | |
| Number of incisions, n(%) | |
| 3 | 54 |
| 4 | 1 |
| Size of incision, n(%) | |
| ≤3cm | 27 |
| 4cm | 25 |
| 5cm | 3 |
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