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PubMed1982

The third manpower study of thoracic surgery: 1980 report of the Ad Hoc Committee on Manpower of The American Association for Thoracic Surgery and The Society of Thoracic Surgeons.

An ad hoc committee was appointed by The Society of Thoracic Surgeons (STS) in 1977 in order to determine the available manpower and workload of thoracic surgeons in 1976. This committee conducted a survey of the professional activities and geographic location of all known surgeons certified by the American Board of Thoracic Surgery (ABTS) at that time. A summary of this study indicated the available and projected thoracic surgery manpower. The report also determined the present and projected health care needs of the population of the United States through 1993. Because thoracic surgery needs to continue to meet the health care needs of the United States in an appropriate yet economical fashion, the STS and The American Association for Thoracic Surgery (AATS) undertook a joint review to determine again the available manpower and its workload in calendar year 1980. In addition, this study compared its findings with the 1976 report in order to detect changes in the workload and need for thoracic surgical services. A questionnaire was mailed to 3,584 certified thoracic surgeons. There were 2,675 responses. The material was sent to the Academic Computer Services at George Washington University Medical Center for tabulation and data processing. This report summarizes the results of this survey. It also compares these data with those obtained in the 1976 study and, based on this information, attempts to project the thoracic surgery manpower needs in the next decade by using several hypothetical models.

Forecasting↗
PubMedDate not supplied

The current role of video-assisted thoracic surgery (VATS) in the overall practice of thoracic surgery. A review of 207 cases.

From December 1991 to June 1995, video-assisted thoracic surgery (VATS) was performed on 207 patients at the Medical Center of Delaware with minimal complications and no mortality. A definitive diagnosis was made in all patients. Results with VATS procedures appear to be comparable to those with the standard open technique. Operating time was comparable to that with the open technique. Length of stay and pain and suffering were dramatically reduced compared with the open technique. We now consider VATS to be the preferred procedure in the following conditions: 1. Undiagnosed pulmonary infiltrate in the non-ventilator-dependent patient. 2. Indeterminate pulmonary nodule. 3. Undiagnosed disease of the pleural space. 4. Recurrent or persistent pneumothorax. 5. Mediastinal or pericardial cystic tumors. 6. Thoracic sympathectomy. 7. Selected patients requiring esophagocardiomyotomy. The utilization of VATS for resection of a pulmonary mass in patients with compromised pulmonary status (i.e., FEV < 1) is being studied.

Aged↗
PubMed1996

Dissemination of malignant tumors after video-assisted thoracic surgery: a report of twenty-one cases. The Video-Assisted Thoracic Surgery Study Group.

Video-assisted thoracic surgical techniques are widely used for biopsy and resection of thoracic tumors, but studies of long-term outcomes have not been reported. Dissemination of tumor by these techniques is a potential hazard. Therefore we surveyed the surgical members of the Video-Assisted Thoracic Surgery Study Group to determine whether tumor implants thought to be directly related to video-assisted techniques had occurred. Surgeons reported 21 cases. The sites of recurrence were the incision (n = 14), pulmonary staple line (n = 2), pleura (n = 2), both staple line and incision (n = 1), both pleura and incision (n = 1), and both pleura and staple line (n = 1). Review of these cases illustrates the pitfalls of present video-assisted techniques for malignant tumors of the thorax.

Adult↗
PubMed1992

Effects of surgical site and inspired gas warming devices on body temperature during lower abdominal and thoracic surgery.

To evaluate the effects of surgical site and inspired gas warming and humidifying devices on body temperature, we studied rectal, tympanic membrane, and esophageal temperature changes in 48 patients. The patients were divided into 4 groups (n = 12), according to surgical site, lower abdominal surgery and thoracic surgery, and according to the warming device used, heat and moisture exchanger (ThermoVent 600) and heated humidifier (Cascade 1). The heated humidifier was controlled to warm inspired gases to about 35 degrees C. All body temperatures fell significantly during surgery. There was no difference in the tympanic membrane and esophageal temperature declines between the two surgical sites, but the decline in rectal temperature was larger in the lower abdominal surgery than in the thoracic surgery. At the end of surgery, all temperatures returned to the value before surgery, and the rectal and tympanic membrane temperatures even exceeded them. There was no difference between the effects of the ThermoVent 600 and Cascade 1. These results suggest that rectal temperature is influenced by the ambient temperature during lower abdominal surgery and that warming and humidifying devices for inspired gases do not prevent, but can restore the decline in body temperature during lower abdominal and thoracic surgery. The heated humidifier showed no advantage over the heat and moisture exchanger in our study.

Journal Article↗
PubMed1999

Video-assisted thoracic surgery diagnosis of thoracic spinal tuberculosis.

Tuberculous spondylitis is rare in economically well-developed countries. MRI is the most sensitive radiologic method of diagnosis. CT-guided fine needle aspiration can be an appropriate method for obtaining samples for culture, with positive cultures in 25 to 89% of cases. However, it can take >6 weeks for specimens to grow, and it is essential to have adequate culture and sensitivity studies for the diagnosis and treatment of mycobacterial diseases. We propose a minimally invasive diagnostic approach that ensures that adequate surgical specimens are obtained prior to initiating treatment.

Adult↗
PubMed2001

Thoracic epidural anesthesia combined with general anesthesia: the preferred anesthetic technique for thoracic surgery.

UNLABELLED: Thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) as well as total-IV anesthesia (TIVA) are both established anesthetic managements for thoracic surgery. We compared them with respect to hypoxic pulmonary vasoconstriction, shunt fraction and oxygenation during one-lung ventilation. Fifty patients, ASA physical status II-III undergoing pulmonary resection were randomly allocated to two groups. In the TIVA group, anesthesia was maintained with propofol and fentanyl. In the TEA group, anesthesia was maintained with TEA (bupivacaine 0.5%) combined with low-dose concentration 0.3-0.5 vol% of isoflurane (end-tidal). Changing from two-lung ventilation to one-lung ventilation caused a significant increase in cardiac output (CO) in the TIVA group, whereas no change was observed in the TEA group. One-lung ventilation caused significant increases in shunt fraction in both groups which was associated per definition with a significant decrease in PaO(2) in both groups but PaO(2) remained significantly increased in the TEA group (P < 0.05). We conclude that both anesthetic regimens are safe intraoperatively. However, TEA in combination with GA did not impair arterial oxygenation to the same extent as TIVA, which might be a result of the changes in CO. Therefore, patients with preexisting cardiopulmonary disease and impaired oxygenation before one-lung ventilation might benefit from TEA combined with GA. IMPLICATIONS: Fifty patients underwent lung surgery through the opened chest wall requiring ventilation of only one lung. Patients were randomly assigned to receive either general anesthesia alone or in combination with regional anesthesia via a catheter in the back. Oxygen content in the blood and blood pressure was better maintained in the group receiving the combination of general with regional anesthesia.

Adult↗
PubMed2001

Acute phase responses following minimal access and conventional thoracic surgery.

OBJECTIVES: Major thoracic surgery is associated with trauma-related immunological changes. These may impair anti-tumour immunity. We hypothesize that the reduced operative trauma associated with a video-assisted thoracic surgery (VATS) approach may decrease acute phase responses and, consequently, lead to better preservation of immune function. This prospective randomized study compared the effects of conventional open thoracic surgery and VATS on acute phase responses in patients undergoing pulmonary lobectomy. METHODS: Acute phase indicators were analyzed in patients undergoing lobectomy for suspected bronchogenic carcinoma. Surgery was prospectively randomized to pulmonary lobectomy by VATS or limited postero-lateral thoracotomy. Blood was taken pre-operatively and at 4, 24, 48, 72, 120 and 168 h post-operatively for analysis of C-reactive protein (CRP; 41 patients: open, n=22; VATS, n=19) interleukin (IL)-6, tumour necrosis factor (TNF) receptors (TNF-sR55, TNF-sR75) and P-selectin (24 patients: open, n=12; VATS, n=12). Samples taken at 48 and 168 h were also analyzed for phagocyte reactive oxygen species (ROS) production (25 patients: open, n=16; VATS, n=19). RESULTS: Surgery increased acute phase responses. VATS was associated with lower CRP and IL-6 levels. In the open surgery group, significant increases in ROS in neutrophils (up to 36% greater than before surgery, n=12, P<0.02-0.05) were detected at 2 days after surgery, but in the VATS group, the increase after surgery (of up to 17%, n=18) did not reach significance. Similarly, monocyte ROS increases of up to 25% in the mean ROS in the open surgery group and of up to 17% in the VATS group were detected on days 2 and 7 after surgery. CONCLUSIONS: VATS pulmonary lobectomy is associated with reduced peri-operative changes in acute phase responses. This finding may have implications for peri-operative tumour immuno-surveillance in lung cancer patients.

Acute-Phase Reaction↗
PubMed2005

[The role of video-thoracoscopy in thoracic surgery].

The widespread acceptance of minimal invasive techniques has revolutionized the practice of surgery including, thoracic surgery. Within a short period of time, video-assisted thoracic surgery (VATS) has become an acceptable approach to a wide range of thoracic procedures. The use of VATS as a diagnostic modality is now well established. For therapeutic procedures, VATS has also been generally accepted as the treatment for spontaneous pneumothorax, thoracic sympathectomy, treatment of loculated effusions and resection of simple mediastinal cysts and benign tumors. Its role in major procedures, e.g. anatomic lung resections and thymectomy, however, remain poorly defined at present although some of the existing intermediate results are encouraging. The technique continues to evolve, with further miniaturization to reduce access-induced trauma. No matter how attractive the new techniques may appear, carefully conducted clinical trials should precede the general acceptance and widespread use.

Aged↗
PubMed1994

[Antibiotic prophylaxis in thoracic surgery, pulmonary endoscopy, thoracic injuries and lung transplantation].

Effectiveness of prophylactic antibiotics is at present time well documented for many surgical procedures. In lung surgery, numerous randomized double-blinded studies have demonstrated the effectiveness of 1st or 2nd generation cephalosporins, administered over a short period of time, not exceeding 24 h. In the opposite, thoracic injuries do not seem to require prophylactic antibiotics, except penetrating injuries of the chest, which could benefit from a single antibiotic injection. In case of lung transplantation, infectious complications result from many factors, among which immunosuppression plays an important role. A prolonged antibiotherapy is routinely used by many transplantation teams, despite the lack of studies proving the effectiveness of this practice.

Anti-Bacterial Agents↗
PubMed2001

Sex differences in neurological outcomes and mortality after cardiac surgery: a society of thoracic surgery national database report.

BACKGROUND: The purpose of this study was to evaluate whether women undergoing cardiac surgery are more likely to suffer neurological complications than men and whether these complications could explain, at least in part, their higher perioperative mortality. METHODS AND RESULTS: The Society of Thoracic Surgery National Cardiac Surgery Database was examined for the years 1996 and 1997 to determine the frequency of new neurological events (stroke, transient ischemic attack, or coma) occurring after cardiac surgery. We reviewed clinical information on 416 347 patients (32% women) for whom complete neurological outcome data were available. New neurological events after surgery were higher for women than for men (3.8% versus 2.4%, P=0.001). For the whole group, the 30-day mortality was higher for women than for men (5.7% versus 3.5%, P=0.001), and among those patients who suffered a perioperative neurological event, mortality was also significantly higher for women than men (32% versus 28%, P=0.001). After adjustment for other risk factors (eg, age, history of hypertension and/or diabetes, duration of cardiopulmonary bypass, and other comorbid conditions) by multivariable logistic regression, female sex was independently associated with significantly higher risk of suffering new neurological events after cardiac surgery (OR 1.21, 95% CI 1.14 to 1.28, P=0.001). CONCLUSIONS: Women undergoing cardiac surgery are more likely than men to suffer new perioperative neurological events, and they have higher 30-day mortality when these complications occur. The higher incidence of perioperative neurological complications in women cannot be explained by currently known risk factors.

Adult↗