19 results on '"Petersen, René Horsleben"'
Search Results
2. Predictors of reoperation after lung volume reduction surgery
- Author
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Lund, Alberte, Soldath, Patrick, Nodin, Erika, Hansen, Henrik Jessen, Perch, Michael, Jensen, Kristine, Hornbech, Kåre, Kalhauge, Anna, Mortensen, Jann, and Petersen, René Horsleben
- Abstract
Objectives: Lung volume reduction surgery (LVRS) has proven an effective treatment for emphysema, by decreasing hyperinflation and improving lung function, activity level and reducing dyspnoea. However, postoperative air leak is an important complication, often leading to reoperation. Methods: Consecutive single-centre unilateral VATS LVRS performed from 2017 to 2022 were included. Typically, 3–5 minor resections were made using vascular magazines without buttressing. Data were obtained from an institutional database and analysed. Multivariable logistic regression was used to identify predictors of reoperation. Number and location of injuries were registered. Results: In total, 191 patients were included, 25 were reoperated (13%). In 21 patients, the indication for reoperation was substantial air leak, 3 patients bleeding and 1 patient empyema. Length of stay (LOS) was 21 (11–33) vs. 5 days (3–11), respectively. Only 3 injuries were in the stapler line, 13 within < 2cm and 15 injuries were in another site. Multivariable logistic regression analysis showed that decreasing DLCO increased risk of reoperation, OR 1.1 (1.03, 1.18, P= 0.005). Resections in only one lobe, compared to resections in multiple lobes, were also a risk factor OR 3.10 (1.17, 9.32, P= 0.03). Patients undergoing reoperation had significantly increased 30-day mortality, OR 5.52 (1.03, 26.69, P= 0.02). Conclusions: Our incidence of reoperation after LVRS was 13% leading to prolonged LOS and increased 30-day mortality. Low DLCO and resections in a single lobe were significant predictors of reoperation. The air leak was usually not localized in the stapler line. Graphical abstract: Key question: What characterizes reoperations after lung volume reduction surgeries?
- Published
- 2024
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3. Postoperative outcomes in patients with diabetes after enhanced recovery thoracoscopic lobectomy
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Huang, Lin, Petersen, René Horsleben, and Kehlet, Henrik
- Abstract
Background: Diabetes is considered a general surgical risk factor, but with few data from enhanced recovery (ERAS) otherwise known to improve outcome. Therefore, this study aimed to investigate postoperative outcomes of patients with diabetes who underwent video-assisted thoracoscopic surgery (VATS) lobectomy in an established ERAS setting. Methods: We retrospectively analysed outcome data (hospital stay (LOS), readmissions, and mortality) from a prospective database with consecutive unselected ERAS VATS lobectomies from 2012 to 2022. Complete follow-up was secured by the registration system in East Denmark. Results: We included 3164 patients of which 323 had diabetes, including 186 treated with insulin and antidiabetic medicine, 35 with insulin only and 102 with antidiabetic medicine only. The median LOS was 3 days, stable over the study period. There were no differences in terms of LOS, postoperative complications, readmissions or 30 days alive and out of hospital. Patients with diabetes had significantly higher 30- and 90-day mortality rates compared to those without diabetes (p< .001), but also had higher preoperative comorbidity. Preoperative HbA1c levels did not correlate with postoperative outcomes. Conclusion: In an ERAS setting, diabetes may not increase the risk for prolonged LOS, complications, and readmissions after VATS lobectomy, however with higher 30- and 90-day mortality probably related to more preoperative comorbidities.
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- 2024
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4. Readmission after enhanced recovery video-assisted thoracoscopic surgery wedge resection
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Huang, Lin, Kehlet, Henrik, and Petersen, René Horsleben
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Background: Despite the implementation of Enhanced Recovery After Surgery (ERAS) programs, surgical stress continues to influence postoperative rehabilitation, including the period after discharge. However, there is a lack of data available beyond the point of discharge following video-assisted thoracoscopic surgery (VATS) wedge resection. Therefore, the objective of this study is to investigate incidence and risk factors for readmissions after ERAS VATS wedge resection. Methods: A retrospective analysis was performed on data from prospectively collected consecutive VATS wedge resections from June 2019 to June 2022. We evaluated main reasons related to wedge resection leading to 90-day readmission, early (occurring within 0–30 days postoperatively) and late readmission (occurring within 31–90 days postoperatively). To identify predictors for these readmissions, we utilized a logistic regression model for both univariable and multivariable analyses. Results: A total of 850 patients (non-small cell lung cancer 21.5%, metastasis 44.7%, benign 31.9%, and other lung cancers 1.9%) were included for the final analysis. Median length of stay was 1 day (IQR 1–2). During the postoperative 90 days, 86 patients (10.1%) were readmitted mostly due to pneumonia and pneumothorax. Among the cohort, 66 patients (7.8%) had early readmissions primarily due to pneumothorax and pneumonia, while 27 patients (3.2%) experienced late readmissions mainly due to pneumonia, with 7 (0.8%) patients experiencing both early and late readmissions. Multivariable analysis demonstrated that male gender, pulmonary complications, and neurological complications were associated with readmission. Conclusions: Readmission after VATS wedge resection remains significant despite an optimal ERAS program, with pneumonia and pneumothorax as the dominant reasons. Early readmission was primarily associated with pneumothorax and pneumonia, while late readmission correlated mainly with pneumonia.
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- 2024
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5. Assessing VATS competence based on simulated lobectomies of all five lung lobes
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Haidari, Tamim Ahmad, primary, Bjerrum, Flemming, additional, Christensen, Thomas Decker, additional, Vad, Henrik, additional, Møller, Lars Borgbjerg, additional, Hansen, Henrik Jessen, additional, Konge, Lars, additional, and Petersen, René Horsleben, additional
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- 2022
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6. Simulation-based VATS resection of the five lung lobes: a technical skills test
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Haidari, Tamim Ahmad, primary, Bjerrum, Flemming, additional, Hansen, Henrik Jessen, additional, Konge, Lars, additional, and Petersen, René Horsleben, additional
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- 2021
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7. Simulation-based VATS resection of the five lung lobes: a technical skills test
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Haidari, Tamim Ahmad, Bjerrum, Flemming, Hansen, Henrik Jessen, Konge, Lars, and Petersen, René Horsleben
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Background: Video-Assisted Thoracoscopic Surgery (VATS) lobectomy is an advanced procedure and to maximize patient safety it is important to ensure the competency of thoracic surgeons before performing the procedure. The objective of this study was to investigate validity evidence for a virtual reality simulator-based test including multiple lobes of the lungs. Method: VATS experts from the department of Cardiothoracic Surgery at Rigshospitalet, Copenhagen, Denmark, worked with Surgical Science (Gothenburg, Sweden) to develop VATS lobectomy modules for the LapSim
® virtual reality simulator covering all five lobes of the lungs. Participants with varying experience in VATS were recruited and classified as either novice, intermediate, or experienced surgeons. Each participant performed VATS lobectomy on the simulator for three different randomly chosen lobes. Nine predefined simulator metrics were automatically recorded on the simulator. Results: Twenty-two novice, ten intermediate, and nine experienced surgeons performed the test resulting in a total of 123 lobectomies. Analysis of Variances (ANOVA) found significant differences between the three groups for parameters: blood loss (p< 0.001), procedure time (p< 0.001), and total instrument path length (p= 0.03). These three metrics demonstrated high internal consistency and significant test–retest reliability was found between each of them. Relevant pass/fail levels were established for each of the three metrics, 541 ml, 30 min, and 71 m, respectively. Conclusion: This study provides validity evidence for a simulator-based test of VATS lobectomy competence including multiple lobes of the lungs. The test can be used to ensure basic competence at the end of a simulation-based training program for thoracic surgery trainees.- Published
- 2022
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8. Evaluating competency in video-assisted thoracoscopic surgery (VATS) lobectomy performance using a novel assessment tool and virtual reality simulation
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Jensen, Katrine, primary, Hansen, Henrik Jessen, additional, Petersen, René Horsleben, additional, Neckelmann, Kirsten, additional, Vad, Henrik, additional, Møller, Lars Borgbjerg, additional, Pedersen, Jesper Holst, additional, and Konge, Lars, additional
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- 2018
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9. A novel assessment tool for evaluating competence in video-assisted thoracoscopic surgery lobectomy
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Jensen, Katrine, primary, Petersen, René Horsleben, additional, Hansen, Henrik Jessen, additional, Walker, William, additional, Pedersen, Jesper Holst, additional, and Konge, Lars, additional
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- 2018
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10. Using virtual reality simulation to assess competence in video-assisted thoracoscopic surgery (VATS) lobectomy
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Jensen, Katrine, primary, Bjerrum, Flemming, additional, Hansen, Henrik Jessen, additional, Petersen, René Horsleben, additional, Pedersen, Jesper Holst, additional, and Konge, Lars, additional
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- 2016
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11. Development and validation of a theoretical test of proficiency for video-assisted thoracoscopic surgery (VATS) lobectomy
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Savran, Mona Meral, primary, Hansen, Henrik Jessen, additional, Petersen, René Horsleben, additional, Walker, William, additional, Schmid, Thomas, additional, Bojsen, Signe Rolskov, additional, and Konge, Lars, additional
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- 2014
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12. Simulation-based training for thoracoscopic lobectomy: a randomized controlled trial
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Jensen, Katrine, primary, Ringsted, Charlotte, additional, Hansen, Henrik Jessen, additional, Petersen, René Horsleben, additional, and Konge, Lars, additional
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- 2014
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13. Reliable and valid assessment of performance in thoracoscopy
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Konge, Lars, primary, Lehnert, Per, additional, Hansen, Henrik Jessen, additional, Petersen, René Horsleben, additional, and Ringsted, Charlotte, additional
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- 2011
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14. Video-assisted thoracoscopic surgery (VATS) lobectomy using a standardized anterior approach
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Hansen, Henrik Jessen, primary, Petersen, René Horsleben, additional, and Christensen, Merete, additional
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- 2010
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15. Evaluating competency in video-assisted thoracoscopic surgery (VATS) lobectomy performance using a novel assessment tool and virtual reality simulation.
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Jensen K, Hansen HJ, Petersen RH, Neckelmann K, Vad H, Møller LB, Pedersen JH, and Konge L
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- Adult, Denmark, Female, Humans, Male, Pneumonectomy methods, Reproducibility of Results, Students, Medical, Young Adult, Clinical Competence, Pneumonectomy education, Simulation Training, Thoracic Surgery, Video-Assisted education, Virtual Reality
- Abstract
Background: Competency-based training has gained ground in surgical training and with it assessment tools to ensure that training objectives are met. Very few assessment tools are available for evaluating performance in thoracoscopic procedures. Video recordings would provide the possibility of blinded assessment and limited rater bias. This study aimed to provide validity evidence for a newly developed and dedicated tool for assessing competency in Video-Assisted Thoracoscopic Surgery (VATS) lobectomy., Methods: Participants with varying experience with VATS lobectomy were included from different countries. Video recordings from participants' performance of a VATS right upper lobe lobectomy on a virtual reality simulator were rated by three raters using a modified version of a newly developed VATS lobectomy assessment tool (the VATSAT) and analyzed in relation to the unitary framework (content, response process, internal structure, relation to other variables, and consequences of testing)., Results: Fifty-three participants performed two consecutive simulated VATS lobectomies on the virtual reality simulator, leaving a total of 106 videos. Content established in previously published studies. Response process Standardized data collection was ensured by using an instructional element, uniform data collection, a special rating program, and automatic generation of the results to a database. Raters were carefully instructed in using the VATSAT, and tryout ratings were carried out. Internal structure Inter-rater reliability was calculated as intra-class correlation coefficients, to 0.91 for average measures (p < 0.001). Test/re-test reliability was calculated as Pearson's r of 0.70 (p < 0.001). G-coefficient was calculated to be 0.79 with two procedures and three raters. By performing D-theory was found that either three procedures rated by two raters or five procedures rated by one rater were enough to reach an acceptable G-coefficient of ≥ 0.8. Relation to other variables Significant differences between groups were found (p < 0.001). The participants' VATS lobectomy experience correlated significantly to their VATSAT score (p = 0.016). Consequences of testing The pass/fail score was found to be 14.9 points by the contrasting groups' method, leaving five false positive (29%) and six false negatives (43%)., Conclusion: Validity evidence was provided for the VATSAT according to the unitary framework. The VATSAT provides supervisors and assessors with a procedure-specific assessment tool for evaluating VATS lobectomy performance and aids with the decision of when the trainee is ready for unsupervised performance.
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- 2019
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16. Using virtual reality simulation to assess competence in video-assisted thoracoscopic surgery (VATS) lobectomy.
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Jensen K, Bjerrum F, Hansen HJ, Petersen RH, Pedersen JH, and Konge L
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- Adult, Computer Simulation, Educational Measurement, Female, Humans, Male, Reproducibility of Results, Virtual Reality, Clinical Competence standards, Competency-Based Education methods, Lung Neoplasms surgery, Pneumonectomy education, Pneumonectomy methods, Simulation Training methods, Surgery, Computer-Assisted education, Thoracic Surgery, Video-Assisted education, Thoracic Surgery, Video-Assisted methods
- Abstract
Background: The societies of thoracic surgery are working to incorporate simulation and competency-based assessment into specialty training. One challenge is the development of a simulation-based test, which can be used as an assessment tool. The study objective was to establish validity evidence for a virtual reality simulator test of a video-assisted thoracoscopic surgery (VATS) lobectomy of a right upper lobe., Methods: Participants with varying experience in VATS lobectomy were included. They were familiarized with a virtual reality simulator (LapSim
® ) and introduced to the steps of the procedure for a VATS right upper lobe lobectomy. The participants performed two VATS lobectomies on the simulator with a 5-min break between attempts. Nineteen pre-defined simulator metrics were recorded., Results: Fifty-three participants from nine different countries were included. High internal consistency was found for the metrics with Cronbach's alpha coefficient for standardized items of 0.91. Significant test-retest reliability was found for 15 of the metrics (p-values <0.05). Significant correlations between the metrics and the participants VATS lobectomy experience were identified for seven metrics (p-values <0.001), and 10 metrics showed significant differences between novices (0 VATS lobectomies performed) and experienced surgeons (>50 VATS lobectomies performed). A pass/fail level defined as approximately one standard deviation from the mean metric scores for experienced surgeons passed none of the novices (0 % false positives) and failed four of the experienced surgeons (29 % false negatives)., Conclusion: This study is the first to establish validity evidence for a VATS right upper lobe lobectomy virtual reality simulator test. Several simulator metrics demonstrated significant differences between novices and experienced surgeons and pass/fail criteria for the test were set with acceptable consequences. This test can be used as a first step in assessing thoracic surgery trainees' VATS lobectomy competency.- Published
- 2017
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17. Development and validation of a theoretical test of proficiency for video-assisted thoracoscopic surgery (VATS) lobectomy.
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Savran MM, Hansen HJ, Petersen RH, Walker W, Schmid T, Bojsen SR, and Konge L
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- Humans, Pneumonectomy methods, Reproducibility of Results, Surveys and Questionnaires, Clinical Competence, Lung Neoplasms surgery, Pneumonectomy standards, Thoracic Surgery, Video-Assisted
- Abstract
Background: Testing stimulates learning, improves long-term retention, and promotes technical performance. No purpose-orientated test of competence in the theoretical aspects of VATS lobectomy has previously been presented. The purpose of this study was, therefore, to develop and gather validity evidence for a theoretical test on VATS lobectomy consisting of multiple-choice questions., Methods: Four European VATS lobectomy experts were interviewed to explore their views on important theoretical VATS lobectomy knowledge (step 1). This information was used to construct the test items in compliance with existing guidelines for multiple-choice questions (step 2). The experts rated the relevance of the items to confirm content validity in a modified Delphi approach (step 3). Finally, the test was administered to physicians, who were categorised into different experience levels based on their experience in VATS procedures overall and in VATS lobectomies specifically. Their answers were used to achieve construct validity (step 4)., Results: Initially, 81 items were constructed and two Delphi iterations reduced the test to 50 items. Item analysis led to the exclusion of 19 items and the mean discrimination index of the 31 final items was 0.26. Cronbach's alpha for internal consistency was 0.75. The mean item difficulty was calculated to 0.63. According to performed VATS procedures, significantly different test performances were detected when comparing the group performances (p = 0.002) and the experts performed significantly better than the novices (p < 0.001) and intermediates (p = 0.01). In the category of performed VATS lobectomies, significant group performances were also found. In this category, the experts were also significantly better than the novices (p < 0.001), the trainees (p = 0.002), and the intermediates (p = 0.01)., Conclusions: This study led to the development of a theoretical test on VATS lobectomy consisting of multiple-choice questions. Both content and construct validity evidence were established.
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- 2015
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18. Reliable and valid assessment of performance in thoracoscopy.
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Konge L, Lehnert P, Hansen HJ, Petersen RH, and Ringsted C
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- Adult, Analysis of Variance, Female, Humans, Male, Middle Aged, Observer Variation, Thoracic Surgery, Video-Assisted standards, Clinical Competence standards, Competency-Based Education standards, Education, Medical, Graduate methods, General Surgery education, Thoracic Surgery, Video-Assisted education
- Abstract
Background: As we move toward competency-based education in medicine, we have lagged in developing competency-based evaluation methods. In the era of minimally invasive surgery, there is a need for a reliable and valid tool dedicated to measure competence in video-assisted thoracoscopic surgery. The purpose of this study is to create such an assessment tool, and to explore its reliability and validity., Methods: An expert group of physicians created an assessment tool consisting of 10 items rated on a five-point rating scale. The following factors were included: economy and confidence of movement, respect for tissue, precision of operative technique, creation and placement of ports, localization of pathologic tissue, use of staplers, retrieval of tissue in bag and placement of chest tube. Fifty consecutive thoracoscopic wedge resections were recorded and assessed blindly and independently by two experts using the tool., Results: Four residents, four fellows and five consultants performed 1-10 (median 4) operations each. The fellows performed significantly better than the residents (P = 0.03; effect size, ES = 0.72). The consultants scored 11% higher than the fellows, but this difference was not significant (P = 0.10, ES = 0.64). The inter-rater reliability was acceptable (Cronbach's alpha 0.71)., Conclusions: This tool for assessing performance in thoracoscopy is reliable and valid. It can provide unbiased feedback to trainees, and can be used to evaluate new teaching curricula, i.e. simulation-based training. Furthermore, it has potential to aid in certification of new thoracic surgeons.
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- 2012
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19. Video-assisted thoracoscopic surgery (VATS) lobectomy using a standardized anterior approach.
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Hansen HJ, Petersen RH, and Christensen M
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- Adenocarcinoma surgery, Blood Loss, Surgical, Comorbidity, Dissection methods, Electrocoagulation methods, Humans, Length of Stay statistics & numerical data, Lung Neoplasms secondary, Lung Neoplasms surgery, Lymph Node Excision methods, Middle Aged, Postoperative Complications epidemiology, Reoperation, Retrospective Studies, Surgical Stapling, Pneumonectomy methods, Thoracic Surgery, Video-Assisted methods
- Abstract
Background: Lobectomy using video-assisted thoracoscopic surgery (VATS) still is a controversial operation despite its many observed benefits. The controversy may be due to difficulties performing the procedure. This study addresses a standardized anterior approach facilitating the operation., Methods: This report describes 156 VATS lobectomies performed with a uniform anterior three-port technique. The surgeon and the assistant stand on the abdominal side of the patient, and the setup is independent of the lobe to be resected., Results: From 2005 to 2007, 156 VATS lobectomies and 13 conversions (7.7%) were performed with an anterior three-port technique. No mortality occurred among the VATS lobectomies during a 30-day period. The major comorbidity rate was 78%. The comorbidities included former thoracic surgery (9%) or a history of another cancer (22%), indicating potentially difficult surgery and a nonselected population. The majority (92%) of the patients had lung cancer. The major postoperative problem was air leakage, which usually prolongs the tube time and the in-hospital stay, but a "no-touch fissure" technique significantly reduced the median tube time to 4 days and the postoperative hospital stay to 5 days., Conclusions: This study shows that VATS lobectomies can be performed using a standardized anterior approach with low rates of conversion and morbidity. A "no-touch fissure" technique lowers the postoperative tube time, the in-hospital stay, and the number of patients with prolonged air leakage. A uniform anterior approach facilitates VATS lobectomy and makes this advanced procedure more easily adaptable by many surgeons familiar with an open anterior approach. The findings show that VATS lobectomy can be performed safely for a large proportion of lung cancer patients.
- Published
- 2011
- Full Text
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