Staged unilateral lung volume reduction surgery: From mini-invasive to minimalist treatment strategies
| Autor: | Mario Dauri, Eugenio Pompeo, Benedetto Cristino, Gianluigi Sergiacomi, Paola Rogliani, Eleonora Fabbi |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Lung volume reduction surgery (LVRS) Sedation chronic obstructive pulmonary disease (COPD) emphysema nonintubated anesthesia thoracoscopy video-assisted thoracic surgery (VATS) Settore MED/21 - Chirurgia Toracica Review Article 030204 cardiovascular system & hematology Lung volume reduction surgery 03 medical and health sciences Mini invasive surgery 0302 clinical medicine Thoracoscopy medicine In patient Surgical approach medicine.diagnostic_test business.industry Surgery 030228 respiratory system Treatment strategy medicine.symptom business Target control |
| Popis: | Lung volume reduction surgery (LVRS) entailing unilateral or bilateral non-anatomical resection of severely damaged emphysematous tissue carried out by thoracoscopic or open surgical approaches, under general anesthesia with single-lung ventilation, has resulted in significant and long-lasting clinical and functional benefit. Unfortunately, the morbidity rates reported by simultaneous bilateral resectional LVRS has led to raise criticism regarding its cost-effectiveness and has stimulated in recent years the development of less invasive bronchoscopic and surgical non-resectional methods of treatment that are preferentially performed in a staged unilateral fashion. We had previously proposed an innovative LVRS modality, which did not entail any resection of lung tissue and was electively carried out according to a staged unilateral strategy by a multiport thoracoscopic access, through thoracic epidural anesthesia in conscious, spontaneously ventilating patients (awake LVRS). The awake LVRS resulted in significant clinical benefit paralleling that achieved by the resectional method with lower morbidity rates and shorter hospital stay. Moreover, the awake LVRS proved also suitable to be employed in stringently selected patients to perform redo procedures following previous successful bilateral LVRS. More recently, in order to minimize the global surgery- and anesthesia-related traumas, we have modified our original non-resectional method by adopting a single thoracoscopic access as well as an anesthesia protocol entailing use of a simple intercostal block with target control sedation, to realize an ultra-minimally invasive or minimalist LVRS. Hence, a deeper investigation of the pros and cons of staged unilateral LVRS strategies as well as of the novel surgical non-resectional and redo LVRS is warranted in order to verify, the optimal strategies of treatment, which will prove to reduce the typical LVRS-related morbidity while assuring the most durable benefit in patients with advanced emphysema. |
| Databáze: | OpenAIRE |
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