Frontiers of minimally invasive thoracic surgery:
Gespeichert in:
Format: | Buch |
---|---|
Sprache: | English |
Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2008
|
Schriftenreihe: | Thoracic surgery clinics
18,3 |
Schlagworte: | |
Online-Zugang: | Inhaltsverzeichnis |
Beschreibung: | VIII, S. 236 - 332 Ill. graph. Darst. |
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adam_text | FRONTIERS OF MINIMALLY INVASIVE THORACIC SURGERY
CONTENTS
Preface xi
Gaetano Rocco
Retraction xiii
The Variability of Practice in Minimally Invasive Thoracic Surgery
for Pulmonary Resections 235
Gaetano Rocco, Eveline Internullo, Stephen D. Cassivi,
Dirk Van Raemdonck, and Mark K. Ferguson
Although minimally invasive thoracic surgery (MITS), under various denominations, is
currently the accepted approach to the management of several thoracic diseases, its use
for the treatment of lung cancer and infectious conditions of surgical interest is still
debated, both from a philosophic and a technical point of view. The concept of
minimally invasive pulmonary resections still provokes several controversies as to the
terminology, the indications, and the techniques used by different surgeons. The issue of
the variability of practice in this field of MITS is addressed through an analysis of the
most recent literature and the results of an international survey that was originated and
devised by the European Society of Thoracic Surgeons and supported by CTSnet.
VATS Lobectomy is Better than Open Thoracotomy: What is the Evidence
for Short-Term Outcomes? 249
Eric L. Grogan and David R. Jones
Lung cancer remains the leading cause of cancer death in the United States, with more
than 200,000 new cases each year and 160,000 deaths. Surgical resection with an
anatomic resection (typically a lobectomy) remains standard care for patients who have
stage I and stage II non-small cell lung cancer. In the past 15 years, video-assisted
thoracic surgery (VATS) has been used with increasing frequency worldwide to perform
anatomic resections for lung cancer. This article reviews the current VATS lobectomy
series and studies published since 2000 that compare VATS to open lobectomy.
Long-Term Outcomes of Thoracoscopic Lobectomy 259
Thomas A. D Amico
Thoracoscopic lobectomy is associated with superior outcomes, as measured by many
important quality of life variables, as opposed to thoracotomy by lobectomy. Despite
these proved advantages, concern has existed regarding the long-term outcomes of
thoracoscopic lobectomy, which has limited its use. Review of the available literature
VOLUME 18 • NUMBER 3 • AUGUST 2008 v
suggests that the long-term outcomes of thoracoscopic lobectomy are at least equivalent
to, and may be superior to, conventional approaches.
Video-Assisted Thoracic Surgery Lobectomy: Centers of Excellence
or Excellence of Centers? 263
Cynthia S. Chin and Scott J. Swanson
Currently, an anatomic lobectomy or segmentectomy and complete mediastinal lymph
node dissection can be achieved through two to four small incisions, without rib
spreading, using videoscopic visualization. This article discusses the assimilation of this
technique, video-assisted thoracic surgery lobectomy, into the practice of a thoracic
surgeon and attempts to answer the question: How do we, as professionals, assure
quality (defined as a proper oncologic surgery) and safety while introducing this new
technology?
Minimally Invasive Open Surgery Approach for the Surgical Resection
of Thoracic Malignancies 269
Hisao Asamura
This article describes minimally invasive open surgery for resection of intrapulmonary
malignancies. This approach compensates for the weak points of video-assisted thoracic
surgery while remaining minimally invasive. Overall, it is respected as a technically
feasible alternative to conventional lobectomy by way of open thoracotomy with an
acceptable range of morbidity or mortality.
Complications and Learning Curves for Video-Assisted Thoracic
Surgery Lobectomy 275
Robert J. McKenna Jr
Launching new techniques into a medical practice involves the educational process to
train surgeons about the new technique, a learning curve for surgeons as they introduce
the new procedure to their patients, and comparison of the complications for the new
and older techniques. This article addresses these issues, as well as the introduction of
these new techniques into the practice of thoracic surgery.
The VATS Lobectomist: Analysis of Costs and Alterations
in the Traditional Surgical Working Pattern in the Modern Surgical Unit 281
William S. Walker and Gianluca Casali
Analysis of cost issues in video-assisted thoracic surgery (VATS) lobectomy is
complicated by social and health care system factors. Overall, VATS lobectomy costs
are similar to open lobectomy. Operating room costs are noticeably increased but are
more than offset by reduced inpatient stay with consequent generation of bed days for
other cases. VATS lobectomy is one of a series of minimally invasive tools available to
surgeons. With appropriate skills and resourcing, VATS resections could account for
30% of the lobectomies undertaken in most units.
Robotically Assisted Lobectomy: Learning Curve and Complications 289
Franca M.A. Melfi and Alfredo Mussi
The past two decades have witnessed a revolutionary transition in surgical technique
and technology with the development of minimally invasive approaches. Many
advantages were obtained by using video-assisted thoracoscopic surgery: less surgical
trauma and pain, shorter hospital stay, and satisfactory cosmetic results. Limitations still
vi CONTENTS
remain, however, because of impaired vision, restricted instrument-maneuverability,
unstable camera platform, and poor ergonomics for the surgeon. Some of the more
prominent limitations involve the technical and mechanical nature of the equipment.
This article describes technical aspects, learning curve, and complications in the field of
robotic lobectomy.
Cost Comparison of Robotic, Video-assisted Thoracic Surgery
and Thoracotomy Approaches to Pulmonary Lobectomy 297
Bernard J. Park and Raja M. Flores
The financial impact of employing minimally invasive techniques for lobectomy
compared with traditional open thoracotomy was assessed. A retrospective review
was conducted using ICD9 codes for thoracotomy, video-assisted thoracic surgery
(VATS), and robotic VATS lobectomy to determine total average costs associated with the
resultant hospital stay. The difference in total average costs was calculated for each
group. Robotic VATS lobectomy had higher associated costs than VATS only, primarily
attributed to increased costs of the first hospital day, but was still less costly than
thoracotomy. The average cost of VATS is substantially less than thoracotomy primarily
because of a decreased length of stay. The cost of robotic assistance for VATS is still less
than thoracotomy, but greater than VATS alone.
Does Minimally Invasive Thoracic Surgery Warrant Fast Tracking
of Thoracic Surgical Patients? 301
Robert J. Cerfolio and Ayesha S. Bryant
This article evaluates the advantages of fast-tracking the patient who has undergone
video-assisted thoracoscopic surgery instead of open thoracotomy. Key issues such as
chest tube and air leak management, pain medicine protocols, psychologic advantages,
and hospital length of stay are examined. It concludes that teaching, philosophy, and
doctor and patient attitude may be more important than the type of surgery performed.
Uniportal Video-Assisted Thoracic Surgery for Diagnosis
and Treatment of Intrathoracic Conditions 305
Michele Salati, Alessandro Brunelli, and Gaetano Rocco
The effort to reduce the invasiveness of thoracic surgery is increasing in this specialty.
In this context, preliminary evidence has shown that uniportal video-assisted thoracic
surgery represents a valuable option to perform different diagnostic and curative
procedures. This article addresses the topic of uniportal video-assisted thoracic surgery
as the least invasive such approach that may be used to diagnose and treat several
intrathoracic conditions.
Awake Operative Videothoracoscopic Pulmonary Resections 311
Eugenio Pompeo and Tommaso C. Mineo
General anesthesia with one-lung ventilation is considered mandatory for video¬
thoracoscopic pulmonary resection but has some adverse effects, which can contribute to
the overall procedure-related morbidity. This finding has led to the concept of a more
physiologic and globally less-invasive approach, entailing awake thoracoscopic
pulmonary resection under sole epidural anesthesia. Indications, although still
investigational, include resection of undetermined solitary pulmonary nodules,
pulmonary metastases, and non-small cell lung cancer in high-risk patients. Preliminary
results have been highly satisfactory, showing that this modality is feasible, safe, and
effective. Furthermore, some evidence seems to show that this patient-friendly approach
could be more cost-effective, allow a more rapid recovery, and require reduced
hospitalization. Further investigation and larger prospective studies will eventually
CONTENTS vii
confirm the real effectiveness and proper indications of awake videothoracoscopic
pulmonary resections.
Outpatient Thoracic Surgery 321
Laureano Molins, Juan J. Fibla, Jose M. Mier, and Ana Sierra
Although there has been a significant increase in ambulatory surgery activity, there is
still great potential for an increase in outpatient thoracic surgery. Video-assisted
mediastinoscopy, lung biopsy, and bilateral thoracic sympathectomy can be accom¬
plished safely in a significant percentage as ambulatory patients. The impact of the
economical benefit of an outpatient thoracic surgical program over the conventional
hospitalization depends on the previous department s policy on hospital stay. Further
experience is needed to increase the substitution index and expand the outpatient
thoracic surgical program to other procedures.
Index 329
viii CONTENTS
|
adam_txt |
FRONTIERS OF MINIMALLY INVASIVE THORACIC SURGERY
CONTENTS
Preface xi
Gaetano Rocco
Retraction xiii
The Variability of Practice in Minimally Invasive Thoracic Surgery
for Pulmonary Resections 235
Gaetano Rocco, Eveline Internullo, Stephen D. Cassivi,
Dirk Van Raemdonck, and Mark K. Ferguson
Although minimally invasive thoracic surgery (MITS), under various denominations, is
currently the accepted approach to the management of several thoracic diseases, its use
for the treatment of lung cancer and infectious conditions of surgical interest is still
debated, both from a philosophic and a technical point of view. The concept of
minimally invasive pulmonary resections still provokes several controversies as to the
terminology, the indications, and the techniques used by different surgeons. The issue of
the variability of practice in this field of MITS is addressed through an analysis of the
most recent literature and the results of an international survey that was originated and
devised by the European Society of Thoracic Surgeons and supported by CTSnet.
VATS Lobectomy is Better than Open Thoracotomy: What is the Evidence
for Short-Term Outcomes? 249
Eric L. Grogan and David R. Jones
Lung cancer remains the leading cause of cancer death in the United States, with more
than 200,000 new cases each year and 160,000 deaths. Surgical resection with an
anatomic resection (typically a lobectomy) remains standard care for patients who have
stage I and stage II non-small cell lung cancer. In the past 15 years, video-assisted
thoracic surgery (VATS) has been used with increasing frequency worldwide to perform
anatomic resections for lung cancer. This article reviews the current VATS lobectomy
series and studies published since 2000 that compare VATS to open lobectomy.
Long-Term Outcomes of Thoracoscopic Lobectomy 259
Thomas A. D'Amico
Thoracoscopic lobectomy is associated with superior outcomes, as measured by many
important quality of life variables, as opposed to thoracotomy by lobectomy. Despite
these proved advantages, concern has existed regarding the long-term outcomes of
thoracoscopic lobectomy, which has limited its use. Review of the available literature
VOLUME 18 • NUMBER 3 • AUGUST 2008 v
suggests that the long-term outcomes of thoracoscopic lobectomy are at least equivalent
to, and may be superior to, conventional approaches.
Video-Assisted Thoracic Surgery Lobectomy: Centers of Excellence
or Excellence of Centers? 263
Cynthia S. Chin and Scott J. Swanson
Currently, an anatomic lobectomy or segmentectomy and complete mediastinal lymph
node dissection can be achieved through two to four small incisions, without rib
spreading, using videoscopic visualization. This article discusses the assimilation of this
technique, video-assisted thoracic surgery lobectomy, into the practice of a thoracic
surgeon and attempts to answer the question: How do we, as professionals, assure
quality (defined as a proper oncologic surgery) and safety while introducing this new
technology?
Minimally Invasive Open Surgery Approach for the Surgical Resection
of Thoracic Malignancies 269
Hisao Asamura
This article describes minimally invasive open surgery for resection of intrapulmonary
malignancies. This approach compensates for the weak points of video-assisted thoracic
surgery while remaining minimally invasive. Overall, it is respected as a technically
feasible alternative to conventional lobectomy by way of open thoracotomy with an
acceptable range of morbidity or mortality.
Complications and Learning Curves for Video-Assisted Thoracic
Surgery Lobectomy 275
Robert J. McKenna Jr
Launching new techniques into a medical practice involves the educational process to
train surgeons about the new technique, a learning curve for surgeons as they introduce
the new procedure to their patients, and comparison of the complications for the new
and older techniques. This article addresses these issues, as well as the introduction of
these new techniques into the practice of thoracic surgery.
The VATS Lobectomist: Analysis of Costs and Alterations
in the Traditional Surgical Working Pattern in the Modern Surgical Unit 281
William S. Walker and Gianluca Casali
Analysis of cost issues in video-assisted thoracic surgery (VATS) lobectomy is
complicated by social and health care system factors. Overall, VATS lobectomy costs
are similar to open lobectomy. Operating room costs are noticeably increased but are
more than offset by reduced inpatient stay with consequent generation of bed days for
other cases. VATS lobectomy is one of a series of minimally invasive tools available to
surgeons. With appropriate skills and resourcing, VATS resections could account for
30% of the lobectomies undertaken in most units.
Robotically Assisted Lobectomy: Learning Curve and Complications 289
Franca M.A. Melfi and Alfredo Mussi
The past two decades have witnessed a revolutionary transition in surgical technique
and technology with the development of minimally invasive approaches. Many
advantages were obtained by using video-assisted thoracoscopic surgery: less surgical
trauma and pain, shorter hospital stay, and satisfactory cosmetic results. Limitations still
vi CONTENTS
remain, however, because of impaired vision, restricted instrument-maneuverability,
unstable camera platform, and poor ergonomics for the surgeon. Some of the more
prominent limitations involve the technical and mechanical nature of the equipment.
This article describes technical aspects, learning curve, and complications in the field of
robotic lobectomy.
Cost Comparison of Robotic, Video-assisted Thoracic Surgery
and Thoracotomy Approaches to Pulmonary Lobectomy 297
Bernard J. Park and Raja M. Flores
The financial impact of employing minimally invasive techniques for lobectomy
compared with traditional open thoracotomy was assessed. A retrospective review
was conducted using ICD9 codes for thoracotomy, video-assisted thoracic surgery
(VATS), and robotic VATS lobectomy to determine total average costs associated with the
resultant hospital stay. The difference in total average costs was calculated for each
group. Robotic VATS lobectomy had higher associated costs than VATS only, primarily
attributed to increased costs of the first hospital day, but was still less costly than
thoracotomy. The average cost of VATS is substantially less than thoracotomy primarily
because of a decreased length of stay. The cost of robotic assistance for VATS is still less
than thoracotomy, but greater than VATS alone.
Does Minimally Invasive Thoracic Surgery Warrant Fast Tracking
of Thoracic Surgical Patients? 301
Robert J. Cerfolio and Ayesha S. Bryant
This article evaluates the advantages of fast-tracking the patient who has undergone
video-assisted thoracoscopic surgery instead of open thoracotomy. Key issues such as
chest tube and air leak management, pain medicine protocols, psychologic advantages,
and hospital length of stay are examined. It concludes that teaching, philosophy, and
doctor and patient attitude may be more important than the type of surgery performed.
Uniportal Video-Assisted Thoracic Surgery for Diagnosis
and Treatment of Intrathoracic Conditions 305
Michele Salati, Alessandro Brunelli, and Gaetano Rocco
The effort to reduce the invasiveness of thoracic surgery is increasing in this specialty.
In this context, preliminary evidence has shown that uniportal video-assisted thoracic
surgery represents a valuable option to perform different diagnostic and curative
procedures. This article addresses the topic of uniportal video-assisted thoracic surgery
as the least invasive such approach that may be used to diagnose and treat several
intrathoracic conditions.
Awake Operative Videothoracoscopic Pulmonary Resections 311
Eugenio Pompeo and Tommaso C. Mineo
General anesthesia with one-lung ventilation is considered mandatory for video¬
thoracoscopic pulmonary resection but has some adverse effects, which can contribute to
the overall procedure-related morbidity. This finding has led to the concept of a more
physiologic and globally less-invasive approach, entailing awake thoracoscopic
pulmonary resection under sole epidural anesthesia. Indications, although still
investigational, include resection of undetermined solitary pulmonary nodules,
pulmonary metastases, and non-small cell lung cancer in high-risk patients. Preliminary
results have been highly satisfactory, showing that this modality is feasible, safe, and
effective. Furthermore, some evidence seems to show that this patient-friendly approach
could be more cost-effective, allow a more rapid recovery, and require reduced
hospitalization. Further investigation and larger prospective studies will eventually
CONTENTS vii
confirm the real effectiveness and proper indications of awake videothoracoscopic
pulmonary resections.
Outpatient Thoracic Surgery 321
Laureano Molins, Juan J. Fibla, Jose M. Mier, and Ana Sierra
Although there has been a significant increase in ambulatory surgery activity, there is
still great potential for an increase in outpatient thoracic surgery. Video-assisted
mediastinoscopy, lung biopsy, and bilateral thoracic sympathectomy can be accom¬
plished safely in a significant percentage as ambulatory patients. The impact of the
economical benefit of an outpatient thoracic surgical program over the conventional
hospitalization depends on the previous department's policy on hospital stay. Further
experience is needed to increase the substitution index and expand the outpatient
thoracic surgical program to other procedures.
Index 329
viii CONTENTS |
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title | Frontiers of minimally invasive thoracic surgery |
title_auth | Frontiers of minimally invasive thoracic surgery |
title_exact_search | Frontiers of minimally invasive thoracic surgery |
title_exact_search_txtP | Frontiers of minimally invasive thoracic surgery |
title_full | Frontiers of minimally invasive thoracic surgery guest ed. Gaetano Rocco |
title_fullStr | Frontiers of minimally invasive thoracic surgery guest ed. Gaetano Rocco |
title_full_unstemmed | Frontiers of minimally invasive thoracic surgery guest ed. Gaetano Rocco |
title_short | Frontiers of minimally invasive thoracic surgery |
title_sort | frontiers of minimally invasive thoracic surgery |
topic | Chest Endoscopic surgery Surgical Procedures, Minimally Invasive Thoracic Surgical Procedures methods Thoracoscopy Brustkorb (DE-588)4069698-4 gnd Minimal-invasive Chirurgie (DE-588)4327907-7 gnd |
topic_facet | Chest Endoscopic surgery Surgical Procedures, Minimally Invasive Thoracic Surgical Procedures methods Thoracoscopy Brustkorb Minimal-invasive Chirurgie Aufsatzsammlung |
url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016764222&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
volume_link | (DE-604)BV019335438 |
work_keys_str_mv | AT roccogaetano frontiersofminimallyinvasivethoracicsurgery |