Back to 2024 Display ePosters
Usefulness Of Artificial Pneumothorax During Totally Thoracoscopic Atrial Fibrillation Surgery
Shunsuke Sato, M.D., Takashi Azami, Ph.D, Kyoxo Inoue, Ph.D, Jun Fujisue, M.D.;
Yodogawa Chiristian Hospital, Osaka, Japan
BACKGROUND: During totally thoracoscopic left atrial appendage closure and surgical ablation in patients with atrial fibrillation, it is sometimes difficult to obtain a clear thoracoscopic view, especially in patients with large hearts or elevated diaphragms. We report the development of a technique using an artificial pneumothorax.
METHODS: Seventy-one consecutive patients who underwent port wound only, off-pump, right and left pulmonary vein isolation, and left atrial appendage closure at our hospital were divided into two groups according to the use of artificial pneumothorax. Twenty-four patients who did not use artificial pneumothorax were designated as group C, and 47 patients who used artificial pneumothorax were designated as group A. The artificial pneumothorax was used from April 2022, and all patients before that date were in group C, and all patients after that date were in group A. Procedure: The surgery was performed in the supine position with ports from the bilateral lateral thoracic areas, using one-lung ventilation, respectively. A total of four ports were used, one each of 12 mm, 11 mm, 10 mm, and 5 mm. When artificial pneumothorax was used, ports with check valves were used except for the camera port. The positive pressure for the artificial pneumothorax was 5-8 mmHg. Bilateral pulmonary vein isolation was performed in all patients using the radiofrequency ablation device. En bloc left pulmonary vein and appendage isolation was added in 37 patients, 52% (group C, 6 patients, 25%; group A, 31 patients, 66%, p=0.0009). For left atrial appendage closure, 54 patients (76%) underwent resection with anastomotic device, and 17 patients (24%) underwent closure with left atrial appendage clip.
RESULTS: Operation time was 198±77 minutes in group C and 108±26 minutes in group A, Group A was predominantly shorter (p<0.0001) . The variance between the two groups was also predominantly different (F=9.050, p<0.0001). There were no hospital deaths or major complications.
CONCLUSIONS:After the introduction of artificial pneumothorax, the surgical field is no longer difficult to secure, and the variability in operative time has decreased and become consistently shorter.
Back to 2024 Display ePosters
