Skip to main content
Top
Published in: World Journal of Surgery 5/2021

01-05-2021 | Pleurodesis | Original Scientific Report

The Correlation Between Fissureless Technique and Prolonged Air Leak for Patients Undergoing Video-Assisted Right Upper Lobectomy

Authors: Kotaro Murakami, Sachio Maehara, Yoshihisa Shimada, Yojiro Makino, Masaru Hagiwara, Masatoshi Kakihana, Naohiro Kajiwara, Tatsuo Ohira, Norihiko Ikeda

Published in: World Journal of Surgery | Issue 5/2021

Login to get access

Abstract

Purpose

We aimed to assess the clinical usefulness of the fissureless technique, which avoided dissection of the lung parenchyma over the pulmonary artery, in preventing prolonged air leak after video-assisted thoracic surgery right upper lobectomy (VATS RUL).

Methods

Perioperative outcomes, including the frequency of prolonged air leak after fissureless technique or traditional fissure dissection technique, which dissected the lung parenchyma through the fissure, were compared in patients who underwent VATS RUL (n = 213) between January 2016 and March 2020. We adopted our fissural grade to evaluate the degree of fused fissure ranging from II (light incomplete fissure) to IV (severe incomplete fissure), which covered all fissural grades in 213 patients.

Results

Fifty-four and 159 patients underwent fissureless and traditional techniques, respectively. Significant differences in the incidence of prolonged air leak (p = 0.037), time to air leak cessation (p = 0.047), and duration of chest tube placement (p = 0.017) were observed between fissureless and traditional technique groups. On multivariable analysis, traditional technique (p = 0.005), and greater fissural grade (III vs II, p = 0.020; IV vs II, p = 0.001) were significantly associated with prolonged air leak.

Conclusions

Fissureless technique during VATS RUL can be a superior alternative to the traditional technique to prevent prolonged air leak in treating incomplete fissures.
Literature
1.
go back to reference Laursen LØ, Petersen RH, Hansen HJ, Jensen TK, Ravn J, Konge L (2016) Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy. Eur J Cardiothorac Surg 49:870–875CrossRef Laursen LØ, Petersen RH, Hansen HJ, Jensen TK, Ravn J, Konge L (2016) Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy. Eur J Cardiothorac Surg 49:870–875CrossRef
2.
go back to reference Allen MS, Darling GE, Pechet TT, Mitchell JD, Herndon JE 2nd, Landreneau RJ et al (2006) Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 81:1013–1019CrossRef Allen MS, Darling GE, Pechet TT, Mitchell JD, Herndon JE 2nd, Landreneau RJ et al (2006) Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 81:1013–1019CrossRef
3.
go back to reference Brunelli A, Varela G, Refai M, Jimenez MF, Pompili C, Sabbatini A et al (2010) A scoring system to predict the risk of prolonged air leak after lobectomy. Ann Thorac Surg 90:204–209CrossRef Brunelli A, Varela G, Refai M, Jimenez MF, Pompili C, Sabbatini A et al (2010) A scoring system to predict the risk of prolonged air leak after lobectomy. Ann Thorac Surg 90:204–209CrossRef
4.
go back to reference Ng T, Ryder BA, Machan JT, Cioffi WG (2010) Decreasing the incidence of prolonged air leak after right upper lobectomy with the anterior fissureless technique. J Thorac Cardiovasc Surg 139:1007–1011CrossRef Ng T, Ryder BA, Machan JT, Cioffi WG (2010) Decreasing the incidence of prolonged air leak after right upper lobectomy with the anterior fissureless technique. J Thorac Cardiovasc Surg 139:1007–1011CrossRef
5.
go back to reference Abolhoda A, Liu D, Brooks A, Burt M (1998) Prolonged air leak following radical upper lobectomy: an analysis of incidence and possible risk factors. Chest 113:1507–1510CrossRef Abolhoda A, Liu D, Brooks A, Burt M (1998) Prolonged air leak following radical upper lobectomy: an analysis of incidence and possible risk factors. Chest 113:1507–1510CrossRef
6.
go back to reference Temes RT, Willms CD, Endara SA, Wernly JA (1998) Fissureless lobectomy. Ann Thorac Surg 65:282–284CrossRef Temes RT, Willms CD, Endara SA, Wernly JA (1998) Fissureless lobectomy. Ann Thorac Surg 65:282–284CrossRef
7.
go back to reference Gómez-Caro A, Calvo MJ, Lanzas JT, Chau R, Cascales P, Parrilla P (2007) The approach of fused fissures with fissureless technique decreases the incidence of persistent air leak after lobectomy. Eur J Cardiothorac Surg 31:203–208CrossRef Gómez-Caro A, Calvo MJ, Lanzas JT, Chau R, Cascales P, Parrilla P (2007) The approach of fused fissures with fissureless technique decreases the incidence of persistent air leak after lobectomy. Eur J Cardiothorac Surg 31:203–208CrossRef
8.
go back to reference Refai M, Brunelli A, Salati M, Pompili C, Xiumè F, Sabbatini A (2011) Efficacy of anterior fissureless technique for right upper lobectomies: a case-matched analysis. Eur J Cardiothorac Surg 39:1043–1046CrossRef Refai M, Brunelli A, Salati M, Pompili C, Xiumè F, Sabbatini A (2011) Efficacy of anterior fissureless technique for right upper lobectomies: a case-matched analysis. Eur J Cardiothorac Surg 39:1043–1046CrossRef
9.
go back to reference Qiu T, Shen Y, Wang D, Wang Z, Wei Y (2013) Clinical outcomes of fissureless technique to practice lobectomy with fused fissure for lung cancer. Zhongguo Fei Ai Za Zhi 16:148–152PubMed Qiu T, Shen Y, Wang D, Wang Z, Wei Y (2013) Clinical outcomes of fissureless technique to practice lobectomy with fused fissure for lung cancer. Zhongguo Fei Ai Za Zhi 16:148–152PubMed
10.
go back to reference Stamenovic D, Bostanci K, Messerschmidt A, Jahn T, Schneider T (2016) Fissureless fissure-last video-assisted thoracoscopic lobectomy for all lung lobes: a better alternative to decrease the incidence of prolonged air leak? Eur J Cardiothorac Surg 50:118–123CrossRef Stamenovic D, Bostanci K, Messerschmidt A, Jahn T, Schneider T (2016) Fissureless fissure-last video-assisted thoracoscopic lobectomy for all lung lobes: a better alternative to decrease the incidence of prolonged air leak? Eur J Cardiothorac Surg 50:118–123CrossRef
11.
go back to reference Decaluwe H, Sokolow Y, Deryck F, Stanzi A, Depypere L, Moons J et al (2015) Thoracoscopic tunnel technique for anatomical lung resections: a “fissure first, hilum last” approach with staplers in the fissureless patient. Interact Cardiovasc Thorac Surg 21:2–7CrossRef Decaluwe H, Sokolow Y, Deryck F, Stanzi A, Depypere L, Moons J et al (2015) Thoracoscopic tunnel technique for anatomical lung resections: a “fissure first, hilum last” approach with staplers in the fissureless patient. Interact Cardiovasc Thorac Surg 21:2–7CrossRef
12.
go back to reference Igai H, Kamiyoshihara M, Yoshikawa R, Osawa F, Kawatani N, Ibe T et al (2016) The efficacy of thoracoscopic fissureless lobectomy in patients with dense fissures. J Thorac Dis 8:3691–3696CrossRef Igai H, Kamiyoshihara M, Yoshikawa R, Osawa F, Kawatani N, Ibe T et al (2016) The efficacy of thoracoscopic fissureless lobectomy in patients with dense fissures. J Thorac Dis 8:3691–3696CrossRef
13.
go back to reference Craig SR, Walker WS (1997) A proposed anatomical classification of the pulmonary fissures. J R Coll Surg Edinb 42:233–234PubMed Craig SR, Walker WS (1997) A proposed anatomical classification of the pulmonary fissures. J R Coll Surg Edinb 42:233–234PubMed
14.
go back to reference Li SJ, Zhou K, Wu YM, Wang MM, Shen C, Wang ZQ et al (2018) Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing video-assisted thoracoscopic lung cancer lobectomy. J Thorac Dis 10:416–431CrossRef Li SJ, Zhou K, Wu YM, Wang MM, Shen C, Wang ZQ et al (2018) Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing video-assisted thoracoscopic lung cancer lobectomy. J Thorac Dis 10:416–431CrossRef
15.
go back to reference Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRef Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRef
16.
go back to reference Anegg U, Lindenmann J, Matzi V, Mujkic D, Maier A, Fritz L et al (2006) AIRFIX®: the first digital postoperative chest tube airflowmetry- a novel method to quantify air leakage after lung resection. Eur J Cardiothorac Surg 29:867–872CrossRef Anegg U, Lindenmann J, Matzi V, Mujkic D, Maier A, Fritz L et al (2006) AIRFIX®: the first digital postoperative chest tube airflowmetry- a novel method to quantify air leakage after lung resection. Eur J Cardiothorac Surg 29:867–872CrossRef
17.
go back to reference Brunelli A, Monteverde M, Borri A, Salati M, Marasco RD, Fianchini A (2004) Predictors of prolonged air leak after pulmonary lobectomy. Ann Thorac Surg 77:1205–1210CrossRef Brunelli A, Monteverde M, Borri A, Salati M, Marasco RD, Fianchini A (2004) Predictors of prolonged air leak after pulmonary lobectomy. Ann Thorac Surg 77:1205–1210CrossRef
18.
go back to reference Attaar A, Tam V, Nason KS (2020) Risk factors for prolonged air leak after pulmonary resection: a systematic review and meta-analysis. Ann Surg 271:834–844CrossRef Attaar A, Tam V, Nason KS (2020) Risk factors for prolonged air leak after pulmonary resection: a systematic review and meta-analysis. Ann Surg 271:834–844CrossRef
19.
go back to reference Mayor JM, Lazarus DR, Casal RF, Omer S, Preventza O, Simpson K et al (2018) Air leak management program with digital drainage reduces length of stay after lobectomy. Ann Thorac Surg 106:1647–1653CrossRef Mayor JM, Lazarus DR, Casal RF, Omer S, Preventza O, Simpson K et al (2018) Air leak management program with digital drainage reduces length of stay after lobectomy. Ann Thorac Surg 106:1647–1653CrossRef
20.
go back to reference Lijkendijk M, Licht PB, Neckelmann K (2015) Electronic versus traditional chest tube drainage following lobectomy: a randomized trial. Eur J Cardiothorac Surg. 48:893–898 (discussion 8)CrossRef Lijkendijk M, Licht PB, Neckelmann K (2015) Electronic versus traditional chest tube drainage following lobectomy: a randomized trial. Eur J Cardiothorac Surg. 48:893–898 (discussion 8)CrossRef
Metadata
Title
The Correlation Between Fissureless Technique and Prolonged Air Leak for Patients Undergoing Video-Assisted Right Upper Lobectomy
Authors
Kotaro Murakami
Sachio Maehara
Yoshihisa Shimada
Yojiro Makino
Masaru Hagiwara
Masatoshi Kakihana
Naohiro Kajiwara
Tatsuo Ohira
Norihiko Ikeda
Publication date
01-05-2021
Publisher
Springer International Publishing
Keyword
Pleurodesis
Published in
World Journal of Surgery / Issue 5/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-020-05935-y

Other articles of this Issue 5/2021

World Journal of Surgery 5/2021 Go to the issue