vats bullectomy
TRANSCRIPT
VATS BULLECTOMY
Initial shillong Experience Dr L.M.DarlongAsst Prof SurgeryNEIGRIHMS [email protected]
VATS
• Video Assisted Thoracoscopic Surgery
• Jacobeus in 1910 ( Thoracoscopy )
• 1992 - VATS
Bullous lung disease
• Expansion of alveolar spaces• Heavy smoking• Symptomatic• Pressure effect – compress
normal functioning lung tissues , Pneumothorax
• Asymptomatic – incidental finding
Surgical indications
• Progressive respiratory insufficiency
• Recurring pneumothorax• persistent pneumothorax• Hemoptysis• Chest pain• Bulla infection
Aims of surgery
• Reduce pressure effect - Lung Parenchyma - Diaphragm - Mediastinum
• V/Q ratio Optimization
• Dead space reduction
Surgical Techniques
• Ressect bulla – Stappled - Endoloop
• Prevent recurrence – - Pleurodesis
• Preserve functioning lung tissue
Indications Diagnostic
• Pleura
• Lung parenchyma
• Mediastinum
Therapeutic• Pleurodesis/
Empyema• Mediastinal mass• Bullous lung disease• Lobectomy/ wedge
ex / pneumonectomy
• Esophagus • Thymectomy• Ectopic parathyroid• Cardiac surgery• Spine surgery
Contraindications
Inability to tolerate single lung ventilation
Case 1
• 32 yrs male , smoker • Sudden onset chest pain, dyspnoea• Cxr – Lt pneumothorax • Post ICD drainage persistant
pnx,air leak• HRCT chest – Lt apical subpleural
blebs with C/L apical bulla• 2 stage VATS done
Case 2
• 42 yrs male , smoker• Progressive dyspnoea Grd II• Chest pain• Cxr – Rt apical bulla• HRCT Chest – Rt apical bulla,
multiple septation
Imaging
Shillong ExperienceCase Age
/ sex
Indication Intraop Vats procedure
OT time (mins)
Postop compli
cation
Duration of chest drain (days )
Postop stay (days )
Follow-up (months )
1 32/M Chest pain, dyspnoea pnx
Persistent pnx air leak
Left apical bullae
Stappled bullectomy
Mech pld
150 4 5 5
2 32/M Contra lateral bulla
Rt apical bullae
Stappled bullectomy
Mech pld
120 Catheter related prepuce edema
3 4 4
3 42/M Chest pain , apical bulla
Rt apical bulla with sub pleural blebs
Stappled bullectomy Endoloop ligation.
180 3 5 5
NO BLOOD TRANSFUSION
VATS - WHY Access procedure
Benefits•Postop Pain•Postop stay•Acceptance•Cosmetic
•Cost benefit
Cellular level•Cytokine activation
•Immune function
•Long term benefits
Instrumentation
Author No of cases
O.T time(mins)
Indications PostopComplication
Chest drainRemoval (days)
PostopHospital Stay (days)
Followup(mths)
Akio w.etal
16 Dyspnoea(10)Spontaneous pneumothorax(6)Infection(1)
Air leak(3-62 days)
36
Teriyashi etal
50 147.8(bulla)45.9(bleb)
Giant bulla(6)Spontaneous pneumothorax(44)
5.2(bulla)1.2(bleb)
11.3(bulla)4.7(bleb)
H.P.Liu etal
79 70
(40-110)
Symptomatic Bullous emphysema
Subcutaneous emphysema(3)-3.8%Air leak>10 days(7)-8.9%Localized empyema(2)Wound infection(3)
6(4-16)
9.6(5-26)
21(5-37)
Gian franco etal
29 Spontaneous pneumothorax(23)Choice(6)
Reoperation for persistent air leak(2)Respiratory failure(2)-6.9%
5(3-14)
6(3-16)
16(1-36)
Tiziano etal
25 107=25
Complication of bulla(9)Dyspnoea(12)Asymptomatic giant bulla(4)
Air leak>7 days(12)-48%
8=4.13 11=5.76
Review of literature
Recurrence
• 3 – 10 % overall recurrence in lit
• 1.8 % with Apical bullectomy
• 23 % with no excision
• Recurrences more -No bleb / bullae
Conclusion
• Short term results – good• Acceptance higher• Superior in terms of
– Low Morbidity– Low invasiveness– Cosmetic
• Similar recurrence
Thank you