At present, several possibilities of postoperative analgesia have been known in the case of thoracotomy. Most frequent is the bolus administration of various analgetic drugs, continuous analgetic infusions, or, now more preferred the epidural application of analgetic drugs. The authors compared two groups of patients subjected to intrathoracic surgery and hospitalized at the Ist Surgical Clinic in Olomouc. The first group (23 patients) was given analgetics by the classical method (bolus administration), to the second group (15 patients) epidural morphine was applied. No significant differences were found between the both groups. Postoperative complications (e.g. atelectasis) did not occur in any group of patients, values of blood gas according to Astrup were within normal limits. The day of the operation was subjectively better tolerated in the second group but there were some insignificant complications related to morphine administration (vomiting, urine retention) even in 60% of cases.

• MeSH
• analgetika aplikace a dávkování   terapeutické užití   MeSH
• dospělí MeSH
• epidurální analgezie MeSH
• injekce intravenózní MeSH
• lidé středního věku MeSH
• lidé MeSH
• mezižeberní svaly chirurgie   MeSH
• pooperační bolest farmakoterapie   MeSH
• senioři MeSH
• torakotomie * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• srovnávací studie MeSH
• Názvy látek
• analgetika MeSH

BACKGROUND: Pulmonary hernia is a rare condition characterized by the protrusion of lung tissue through a chest wall defect. Trauma and thoracic surgery are the most common causes of acquired lung hernias. We present an unusual case of (sequential) bilateral lung herniation with parenchymal infarction after bilateral lobar lung transplantation. CASE PRESENTATION: A 50-year-old female, wait-listed as high-urgency candidate, with a body mass index (BMI) of 29 kg/m2 underwent a bilateral lobar lung transplantation for pulmonary fibrosis through a clamshell thoracotomy approach. Due to a size mismatch, stapler resection of the segment 3 and the middle lobe of the right lung, as well as an upper left lobectomy was required. The chest was closed with 3 braided non-absorbable pericostal sutures on each side. Sternal osteosynthesis was performed with a titanium sternal splint along with 7 self-tapping screws with a length of 18 mm. On the posttransplant day (PTD) 18, patient's clinical condition deteriorated. Physical examination didn't reveal any palpable subcutaneous chest resistance. However, a computed tomography (CT) scan showed a herniation of the segment 6 of the right lung. During acute surgical revision, perioperative finding revealed posterior pericostal suture failure. Therefore, a stapler resection was performed due to the infarction of the herniated segment. On the PTD 36, herniation of the left lung parenchyma was detected by acute CT scan. The protruding vital parenchyma was surgically repositioned without necessity of resection. Two posterior pericostal sutures were broken, and distal part of sternal splint detached. Thoracotomy was closed using 5 braided non-absorbable sutures. Sternum was re-osteosynthesized with the STRATOS™ system. After 3 months of intensive postoperative care, the patient was transferred to the rehabilitation department. She was discharged on the PTD 99. After 20 months of follow-up, lung function remains stable without the need for oxygen support. CONCLUSION: Clamshell incision remains ultimate approach in thoracic surgery. However, pulmonary herniation after clamshell thoracotomy is a rare complication and may manifest as acute respiratory distress syndrome with an inflammatory response. In these cases, CT scan should be always considered, even if no palpable pathology of chest is present.

• Klíčová slova
• Clamshell thoracotomy, Lung hernia, Lung transplantation,
• MeSH
• hernie * etiologie   diagnóza   MeSH
• infarkt * etiologie   chirurgie   diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• plíce * krevní zásobení   chirurgie   diagnostické zobrazování   MeSH
• plicní nemoci * etiologie   chirurgie   MeSH
• počítačová rentgenová tomografie MeSH
• pooperační komplikace * etiologie   chirurgie   MeSH
• torakotomie * škodlivé účinky   metody   MeSH
• transplantace plic * škodlivé účinky   metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Operations in the pleural cavity are connected with circulatory changes in pulmonary circulation and general changes of hemodynamics. These changes are influenced by the position of patient's body on the operation table and by the introduction of artificial pneumothorax. Thoracoscopy is an advanced surgical approach in thoracic surgery, but its hemodynamic effect is still not known. The aim of the present study was to compare the hemodynamic response to surgeries carried out by open (thoracotomy - TT) and closed (thoracoscopy - TS) surgical approach. Thirty-eight patients have been monitored throughout the operation--from the introduction of anesthesia to completing the surgery. Monitored parameters were systolic blood pressure (BPs), diastolic blood pressure (BPd), O2 saturation (SaO2), systolic blood pressure in pulmonary artery (BPPAs), diastolic blood pressure in pulmonary artery (BPPAd), wedge pressure (P(W)), central venous pressure in right atrium (CVP), cardiac output (CO) and total peripheral resistance (TPR). No significant difference has been found in hemodynamic response between TT and TS groups. Significant changes of hemodynamic parameters occurring during the whole surgical procedure were detected in both technical approaches. The most prominent changes were found after the position of patients was changed to the hip position (significantly decreased BPs, BPd, MAP, SaO2 and BPPAs) and 5 min after the pneumothorax was established (restoration of the cardiac output to the initial value and significant decrease of the TPR). It can be concluded that the thoracoscopy causes almost identical hemodynamic changes like the thoracotomy.

• MeSH
• časové faktory MeSH
• centrální žilní tlak MeSH
• cévní rezistence MeSH
• dospělí MeSH
• hemodynamika * MeSH
• léčebný pneumotorax MeSH
• lidé středního věku MeSH
• lidé MeSH
• minutový srdeční výdej MeSH
• mladý dospělý MeSH
• peroperační monitorování MeSH
• plicní oběh * MeSH
• plicní tlak v zaklínění MeSH
• polohování pacienta MeSH
• prospektivní studie MeSH
• senioři MeSH
• torakoskopie * MeSH
• torakotomie * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

• Klíčová slova
• TUBERCULOSIS, SPINAL/surgery *,
• MeSH
• lidé MeSH
• neurochirurgické výkony * MeSH
• páteř * MeSH
• torakotomie * MeSH
• tuberkulóza páteře chirurgie   MeSH
• tuberkulóza * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

In 1969 to 1989 in the Research Institute of Tuberculosis and Respiratory Diseases in Prague a total of 3583 thoracotomies were performed. Of these during the postoperative period 29 patients were re-operated on account of continuing haemorrhage into the pleural cavity. This is approximately 0.8% of all thoracotomies. Sixteen patients had to be re-operated within 12 hours after operation, 12 patients were re-operated later than 12 hours after operation but within 24 hours, one patient was re-operated later than 24 hours after operation. The cause of haemothorax was in the first place capillary haemorrhage from a lacerated pleura, in the second place haemorrhage from a severe intercostal artery at the very site of the thoracotomy. Other causes of haemorrhage such as haemorrhage from the bronchial artery and its branches are not frequent. None of the patients had to be re-operated on account of haemorrhage from the major arteries of the pulmonary hilus. Administration of small doses of heparin before and after operation did not influence the number of re-operations on account of haemothorax.

• MeSH
• hemotorax etiologie   MeSH
• lidé MeSH
• torakotomie škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

OBJECTIVE: We sought to demonstrate the applicability of video-assisted multivessel revascularization through a left anterior small thoracotomy approach with the use of the Symmetry Aortic Connector System (St Jude Medical Anastomotic Technology Group, Inc, St Paul, Minn) as an alternative to the standard median sternotomy approach and to evaluate predischarge angiographically documented graft patency. METHODS: From October 2001 through February 2002, a total of 15 patients with triple-vessel disease were operated on through a left anterior small thoracotomy approach with video-assisted port-access construction of proximal aorta-to-saphenous vein anastomoses with the Symmetry Aortic Connector System and cardiopulmonary bypass with femoral cannulation and without cardioplegic arrest. There were 9 male and 6 female subjects with a mean age of 68.3 +/- 3.6 years and an average ejection fraction of 55.8% +/- 19.6%. Subject inclusion criteria consisted of female sex (initially but not throughout the study), coronary artery reoperations, and sternal bone disease. Subject exclusion criteria consisted of an age younger than 65 years, extensive atheromatous plaques in the ascending aorta, and aortoiliac occlusive disease. All but 1 patient underwent angiographic patency evaluation before discharge. RESULTS: Fifteen operations were performed successfully without any deaths. Twenty-nine sutureless proximal anastomoses were performed, with an average of 3.13 +/- 0.62 distal anastomoses per patient. Eleven (73%) patients underwent a fast track protocol with extubation in the operating room. We did not observe any instances of low cardiac output syndrome, stroke, renal insufficiency, wound complication, or perioperative myocardial infarction. A single episode of atrial fibrillation occurred in this group. Angiographic assessment of 44 bypass grafts and target arteries was performed, and 86% of those examined were widely patent (FitzGibbon score A). CONCLUSIONS: We have demonstrated a potential advantage of the sutureless Symmetry Aortic Connector System as a suitable approach that affords minimal access. Video-assisted multivessel revascularization through a left anterior small thoracotomy approach with an automated mechanical anastomosis device is particularly useful in patients undergoing coronary artery bypass reoperations or those at risk of poor sternal healing or infection. This approach seems to be a safe alternative to standard median sternotomy.

• MeSH
• anastomóza chirurgická přístrojové vybavení   metody   MeSH
• aorta chirurgie   MeSH
• hrudní chirurgie video-asistovaná * MeSH
• koronární bypass přístrojové vybavení   metody   MeSH
• lidé MeSH
• senioři MeSH
• torakotomie * MeSH
• vena saphena transplantace   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Lung cancer poses a significant challenge with high mortality rates. Minimally invasive surgical approaches, including the uniportal thoracoscopic technique, offer potential benefits in terms of recovery and patient compliance. This study focuses on evaluating the radicality of mediastinal lymphadenectomy during uniportal thoracoscopic lung resection, specifically assessing the reachability of established lymphatic stations. METHODS: A comparative study was conducted at the University Hospital Ostrava from January 2015 to July 2022, focusing on the evaluation of radicality in mediastinal lymphadenectomy across three patient subgroups: uniportal thoracoscopic approach, multiportal thoracoscopic approach, and thoracotomy approach. The study implemented the routine identification and excision of 8 lymph node stations from the respective hemithorax to assess the radicality of lymph node harvesting. RESULTS: A total of 428 patients were enrolled and evaluated. No significant differences were observed in the number of lymph nodes removed between the subgroups. The mean number of lymph nodes removed was 6.50 in the left hemithorax and 6.49 in the right hemithorax. The 30-day postoperative morbidity rate for the entire patient population was 27.3%, with 17.5% experiencing minor complications and 6.5% experiencing major complications. Statistically significant differences were observed in major complications between the uniportal approach and the thoracotomy approach (3.5% vs 12.0%, p = 0.002). The overall mortality rate in the study population was 3%, with a statistically significant difference in mortality between the uniportal and multiportal approaches (1.0% vs 6.4%, p = 0.020). CONCLUSIONS: The uniportal approach demonstrated comparable accessibility and lymph node yield to multiportal and thoracotomy techniques. It is equivalent to established methods in terms of postoperative complications, with fewer major complications compared to thoracotomy. While our study indicates a potential for lower mortality following uniportal lung resection in comparison to multiportal lung resection, and demonstrates comparable outcomes to thoracotomy, it is important to approach these findings cautiously and refrain from drawing definitive conclusions.

• Klíčová slova
• Lung cancer, Lung resection, Mediastinal lymphadenectomy, Morbidity, Mortality, Uniportal thoracoscopy,
• MeSH
• hrudní chirurgie video-asistovaná metody   MeSH
• lidé MeSH
• lymfadenektomie metody   MeSH
• nádory plic * chirurgie   patologie   MeSH
• plíce patologie   MeSH
• pneumektomie škodlivé účinky   metody   MeSH
• retrospektivní studie MeSH
• torakotomie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

AIMS: (1) To compare the efficacy of bupivacaine/fentanyl and ropivacaine/fentanyl for postoperative pain control (2). To identify the predictors of acute post-operative pain at rest, during deep breathing and coughing. METHODS: The study was performed in patients aged 6-18 years after thoracic surgery. The subjects were randomized to the bupivacaine 0.125%/fentanyl 5.0 μg/mL (n=46) or ropivacaine 0.2%/fentanyl 5.0 μg/mL (n=48) group; analgesic mixtures were administered through epidural catheter. All the patients received paracetamol and non-steroidal anti-inflammatory drugs. The observation period after surgery lasted 72 h. Pain intensity was assessed at rest, during deep breathing and coughing and was based on the Numerical Rating Scale and the FLACC scale (range 0-10). If the pain was above 2/10, the analgesia was modified. RESULTS: Median pain scores at rest (0.4 vs. 0.5), during deep breathing (0.3 vs. 0.3) and coughing (0.6 vs. 0.6) were comparable in BF and RF group. The intensity of pain at rest was associated with the number of drains inserted into the thorax (β=0.39), the number of pain intensity measurements (β=0.36) and the number of nursing interventions undertaken to relieve pain (β=0.16). Pain intensity at rest determined the intensity of pain during deep breathing (β=0.60), which in turn decided on the severity of pain during coughing (β=0.80). The intensity of pain was increased by age. CONCLUSIONS: Thoracic epidural bupivacaine/fentanyl provided adequate pain relief and similar analgesia to ropivacaine/fentanyl. The effectiveness of analgesia depended on the number of pain measurements and interventions by nurses to relieve the pain. TRIAL REGISTRATION: ClinicalTrials.gov; Multimodal Analgesia in Children and Adolescents After the Ravitch Procedure and Thoracotomy; NCT03444636; https://clinicaltrials.gov/ct2/show/NCT03444636.

• Klíčová slova
• Ravitch procedure, adolescent, child, multimodal analgesia, postoperative pain, thoracic epidural catheter, thoracotomy,
• MeSH
• anestetika lokální terapeutické užití   MeSH
• bupivakain terapeutické užití   MeSH
• dítě MeSH
• fentanyl terapeutické užití   MeSH
• lidé MeSH
• management bolesti metody   MeSH
• mladiství MeSH
• opioidní analgetika terapeutické užití   MeSH
• pooperační bolest farmakoterapie   etiologie   MeSH
• prospektivní studie MeSH
• ropivakain terapeutické užití   MeSH
• torakotomie škodlivé účinky   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Názvy látek
• anestetika lokální MeSH
• bupivakain MeSH
• fentanyl MeSH
• opioidní analgetika MeSH
• ropivakain MeSH

Authors in the adduced work in the form of case report introduce a case of lung herniation as a rare complication after limited thoracotomy. Also on the strength of published literature they briefly discuss about the causes of genesis of lung hernia and the possibilities of their operative solution.

• MeSH
• hernie diagnostické zobrazování   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• operace kýly MeSH
• plicní nemoci diagnostické zobrazování   etiologie   chirurgie   MeSH
• radiografie MeSH
• torakotomie škodlivé účinky   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The purpose of this prospective study was to determine whether electrocautery as a means of creating thoracic wound result in increased wound infection rates. Seventy-three patients were randomized prospectively into two groups. Group A-coagulation, where the first half of the incision was done with scalpel and the second half with coagulation-fulgurate. Group B-cut mode, where half of incision was done with scalpel and half with blend cut mode. All wound complications were recorded and divided into infectious (grade 1: induration and erythema with no secretion, grade 2: grade 1 and serous secretion, grade 3: contaminated wound with pus formation) and non-infectious complications (haematoma with its evacuation). Scalpel and electrosurgical thoracotomy incision in elective surgery are similar in terms of early and late wound complications when used to perform anterolateral thoracotomy. Therefore, the choice of which method to use remains only a matter of surgeon preference.

• MeSH
• dospělí MeSH
• elektrochirurgie MeSH
• elektrokoagulace * přístrojové vybavení   metody   MeSH
• hojení ran MeSH
• infekce chirurgické rány MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• torakotomie škodlivé účinky   přístrojové vybavení   metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• klinické zkoušky MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH