From one incision to one port: The surgical technique and the evolution of segmentectomy in patients with pulmonary tuberculosis.
OBJECTIVES:We retrospectively reviewed the evolution of segmentectomy for pulmonary tuberculosis (TB) and the feasibility of multi- and single-incision video-assisted thoracoscopic segmentectomy. METHODS:Of 348 patients undergoing surgery for TB, the medical records of 121 patients undergoing segmen...
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doaj-5139259b51df42328f5405ea93bddadd2020-11-25T01:14:57ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01135e019728310.1371/journal.pone.0197283From one incision to one port: The surgical technique and the evolution of segmentectomy in patients with pulmonary tuberculosis.Yau-Lin TsengChao-Chun ChangYing-Yuan ChenYi-Sheng LiuLili ChengJia-Ming ChangMing-Ho WuYi-Ting YenOBJECTIVES:We retrospectively reviewed the evolution of segmentectomy for pulmonary tuberculosis (TB) and the feasibility of multi- and single-incision video-assisted thoracoscopic segmentectomy. METHODS:Of 348 patients undergoing surgery for TB, the medical records of 121 patients undergoing segmentectomy between January 1996 and November 2015 were reviewed. Clinical information and computed tomography (CT) image characteristics were investigated and analyzed. RESULTS:Eighteen patients underwent direct or intended thoracotomy. Sixty-four underwent video-assisted thoracoscopic segmentectomy (VATS), including 53 multi-incision thoracoscopic segmentectomy (MITS), and 11 single-incision thoracoscopic segmentectomy (SITS). Thirty-nine were converted to thoracotomy. The intended thoracotomy group had more operative blood loss (p = 0.005) and hospital stay (p = 0.001) than the VATS group although the VATS group had higher grade of cavity (p = 0.007). The intended thoracotomy group did not differ from converted thoracotomy in operative time, blood loss, or hospital stay, and the grade of pleural thickening was higher in the converted thoracotomy group (p = 0.001). The converted thoracotomy group had more operative blood loss, hospital stay, and complication rate than the MITS group (p = 0.001, p<0.001, and p = 0.009, respectively). The MITS group had lower pleural thickening, peribronchial lymph node calcification, cavity, and tuberculoma grading than the converted thoracotomy group (p<0.001, p = 0.001, 0.001, and 0.017, respectively). The SITS group had lower grading in pleural thickening, peribronchial lymph node calcification, and aspergilloma grading than the converted thoracotomy group (p = 0.002, 0.010, and 0.031, respectively). Four patients in the intended thoracotomy group and seven in the converted thoracotomy group had complications compared with three patients in the MITS and two in the SITS group. Risk factors of conversion were pleural thickening and peribronchial lymph node calcification. CONCLUSION:Although segmentectomy is technically challenging in patients with pulmonary TB, it could be safely performed using MITS or SITS and should be attempted in selected patients. Its efficacy for medical treatment failure needs investigation.http://europepmc.org/articles/PMC5953493?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yau-Lin Tseng Chao-Chun Chang Ying-Yuan Chen Yi-Sheng Liu Lili Cheng Jia-Ming Chang Ming-Ho Wu Yi-Ting Yen |
spellingShingle |
Yau-Lin Tseng Chao-Chun Chang Ying-Yuan Chen Yi-Sheng Liu Lili Cheng Jia-Ming Chang Ming-Ho Wu Yi-Ting Yen From one incision to one port: The surgical technique and the evolution of segmentectomy in patients with pulmonary tuberculosis. PLoS ONE |
author_facet |
Yau-Lin Tseng Chao-Chun Chang Ying-Yuan Chen Yi-Sheng Liu Lili Cheng Jia-Ming Chang Ming-Ho Wu Yi-Ting Yen |
author_sort |
Yau-Lin Tseng |
title |
From one incision to one port: The surgical technique and the evolution of segmentectomy in patients with pulmonary tuberculosis. |
title_short |
From one incision to one port: The surgical technique and the evolution of segmentectomy in patients with pulmonary tuberculosis. |
title_full |
From one incision to one port: The surgical technique and the evolution of segmentectomy in patients with pulmonary tuberculosis. |
title_fullStr |
From one incision to one port: The surgical technique and the evolution of segmentectomy in patients with pulmonary tuberculosis. |
title_full_unstemmed |
From one incision to one port: The surgical technique and the evolution of segmentectomy in patients with pulmonary tuberculosis. |
title_sort |
from one incision to one port: the surgical technique and the evolution of segmentectomy in patients with pulmonary tuberculosis. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2018-01-01 |
description |
OBJECTIVES:We retrospectively reviewed the evolution of segmentectomy for pulmonary tuberculosis (TB) and the feasibility of multi- and single-incision video-assisted thoracoscopic segmentectomy. METHODS:Of 348 patients undergoing surgery for TB, the medical records of 121 patients undergoing segmentectomy between January 1996 and November 2015 were reviewed. Clinical information and computed tomography (CT) image characteristics were investigated and analyzed. RESULTS:Eighteen patients underwent direct or intended thoracotomy. Sixty-four underwent video-assisted thoracoscopic segmentectomy (VATS), including 53 multi-incision thoracoscopic segmentectomy (MITS), and 11 single-incision thoracoscopic segmentectomy (SITS). Thirty-nine were converted to thoracotomy. The intended thoracotomy group had more operative blood loss (p = 0.005) and hospital stay (p = 0.001) than the VATS group although the VATS group had higher grade of cavity (p = 0.007). The intended thoracotomy group did not differ from converted thoracotomy in operative time, blood loss, or hospital stay, and the grade of pleural thickening was higher in the converted thoracotomy group (p = 0.001). The converted thoracotomy group had more operative blood loss, hospital stay, and complication rate than the MITS group (p = 0.001, p<0.001, and p = 0.009, respectively). The MITS group had lower pleural thickening, peribronchial lymph node calcification, cavity, and tuberculoma grading than the converted thoracotomy group (p<0.001, p = 0.001, 0.001, and 0.017, respectively). The SITS group had lower grading in pleural thickening, peribronchial lymph node calcification, and aspergilloma grading than the converted thoracotomy group (p = 0.002, 0.010, and 0.031, respectively). Four patients in the intended thoracotomy group and seven in the converted thoracotomy group had complications compared with three patients in the MITS and two in the SITS group. Risk factors of conversion were pleural thickening and peribronchial lymph node calcification. CONCLUSION:Although segmentectomy is technically challenging in patients with pulmonary TB, it could be safely performed using MITS or SITS and should be attempted in selected patients. Its efficacy for medical treatment failure needs investigation. |
url |
http://europepmc.org/articles/PMC5953493?pdf=render |
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