Thoracic surgery clinics
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There is scant evidence on the management of chest tubes after surgery for pneumothorax. Most of the current knowledge is extrapolated from studies performed on subjects with lung cancer. ⋯ Moreover, the role of regulated suction, which seems to provide some benefit in reducing pneumothorax recurrence after bullectomy and pleurodesis, is discussed. Finally, a personal view on the management of chest tubes after surgery for pneumothorax is provided.
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Chest drain placement is one of the most common surgical procedures performed in routine clinical practice. Despite the many benefits, chest tube insertion is not always a harmless procedure, and potential significant morbidity and mortality may exist. The aim of this article was to highlight the correct chest tube placement procedure and to focus on errors and clinical complications following its incorrect insertion into the chest.
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Thoracic surgery clinics · Feb 2017
ReviewSuction or Nonsuction: How to Manage a Chest Tube After Pulmonary Resection.
Despite several randomized trials and meta-analyses, the dilemma as to whether to apply suction after subtotal pulmonary resection has not been solved. The combination of a poorly understood pathophysiology of the air leak phenomenon and the inadequate quality of the published randomized trials is actually preventing thoracic surgeons from abandoning an empirical management of chest drains. Even digital systems do not seem to have made the difference so far. Based on the evidence of the literature, the authors propose a new air leak predictor score (ALPS) as a contributing step toward appropriateness in using intraoperative sealants, opting for an external suction and managing and chest tubes.
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Thoracic surgery clinics · Aug 2016
ReviewManagement of Stage IIIA (N2) Non-Small Cell Lung Cancer.
There is no consensus as to the optimal management of IIIA (N2) non-small cell lung cancer, nor for the role of surgery in treating this disease stage. Clinical trial evidence struggles to keep up with technology advancement and the evolution of expert opinion. Despite advances in chemotherapeutic regimens, methods of delivery for radiation, and less invasive surgical techniques, survival for patients with stage IIIA-N2 malignancies remains poor. Further developments in both will stimulate and maintain controversy in the field for years to come.
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Thoracic surgery clinics · May 2016
ReviewAdvances in Uniportal Video-Assisted Thoracoscopic Surgery: Pushing the Envelope.
Uniportal video-assisted thoracic surgery (VATS) represents a radical change in the approach to lung resection compared with conventional VATS. Because the placement of the surgical instruments and the camera is done through the same incision, uniportal VATS can pose a challenge for both the surgeon and the assistant. ⋯ We can expect more developments of subcostal or embryonic natural orifice translumenal endoscopic surgery access, improvements in 3D image systems, single-port robotics, and wireless cameras. The advances in digital technology may facilitate the adoption of the uniportal VATS technique.