OBJECTIVES: Our goal was to report the results of the first consensus paper among international experts in uniportal video-assisted thoracoscopic surgery (UniVATS) lobectomy obtained through a Delphi process, the objective of which was to define and standardize the main procedural steps, optimize its indications and perioperative management and identify elements to assist in future training. METHODS: The 40 members of the working group were convened and organized on a voluntary basis by the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). An e-consensus finding exercise using the Delphi method was applied to require 75% agreement for reaching consensus on each question. Repeated iterations of anonymous voting continued for 3 rounds. RESULTS: Overall, 31 international experts from 18 countries completed all 3 rounds of questionnaires. Although a technical quorum was not achieved, most of the responders agreed that the maximum size of a UniVATS incision should be ≤4 cm. Agreement was reached on many points outlining the currently accepted definition of a UniVATS lobectomy, its indications and contraindications, perioperative clinical management and recommendations for training and future research directions. CONCLUSIONS: The UVIG Consensus Report stated that UniVATS offers a valid alternative to standard VATS techniques. Only longer follow-up and randomized controlled studies will predict whether UniVATS represents a valid alternative approach to multiport VATS for major lung resections or whether it should be performed only in selected cases and by selected centres. The next step for the ESTS UVIG is the establishment of a UniVATS section inside the ESTS databases.
- MeSH
- delfská metoda MeSH
- hrudní chirurgie video-asistovaná metody MeSH
- lidé MeSH
- pneumektomie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- konsensus - konference MeSH
- Geografické názvy
- Evropa MeSH
Účel prehľadu: Empyém hrudníka znamená hromadenie voľného hnisu v pleurálnej dutine. Príčina tohto stavu je často multifaktoriálna; môže ísť o priame šírenie infekcie, penetrujúce poranenie hrudníka alebo sekundárnu iatrogénnu príčinu po chirurgickom výkone v pleurálnej dutine. Súčasné vedenie liečby empyému je založené na miestnej empirickej praxi; konsenzus týkajúci sa optimálneho postupu liečby empyémov nebol doteraz vytvorený. V poslednom desaťročí je o chirurgickú liečbu empyému veľký záujem, ktorý viedol k vytvoreniu špecifických odporučení. Nové poznatky: Revolučnou metódou v chirurgickej liečbe pacientov s empyémom je videoasistovaná torakoskopia (VATS). K torakoskopickej liečbe empyému patrí VATS-débridement a dekortikácia. VATS-débridement sa používa na mnohých pracoviskách ako liečba voľby pri empyéme v skorom štádiu. Tento postup je však do istej miery sporný, nakoľko niektorí chirurgovia naďalej obhajujú úvodný pokus o drenáž hrudníka a antibiotickú obliteráciu hrudnej dutiny ako prvý krok v liečbe pred akýmkoľvek operačným výkonom. Razantnejším postupom je priamo pristúpiť k VATS-dekortikácii, ktorá je veľmi sľubnou metódou vo vedení liečby chronického empyému. Komplexnejšie, multifokálne ohraničené empyémy sa doteraz riešili výhradne komplexnými otvorenými chirurgickými postupmi, ako sú otvorená torakostómia alebo torakomyoplastika. Nedávno realizované štúdie však ukázali, že dekortikácia pomocou VATS prináša rovnocenné hodnoty miery vyliečenia ako otvorené postupy, ktoré sú navyše zaťažené vyššou morbiditou. Súhrn: Uvádzame súhrn najnovších postojov a výsledkov v torakoskopickej a otvorenej liečbe empyému hrudníka. Včas indikovaný VATS-débridement účinne rieši jednoduché parapneumonické výpotky. VATS-dekortikácia má vo vedení liečby ako chronických výpotkov, tak výpotkov v skorom štádiu rovnocennú účinnosť ako otvorená dekortikácia.
Thoracic empyema is the accumulation of frank pus within the pleural cavity. Its cause is often multifactorial and may include direct contiguous spread of infection, penetrating chest trauma or an iatrogenic cause secondary to surgical instrumentation of the pleural space. Current management of empyema is based on local empirical practice as there is no consensus on an optimal regimen. Over the past decade, surgical management of empyema has attracted great interest, leading to specific recommendations. RECENT FINDINGS: Video-assisted thoracoscopic surgery (VATS) has revolutionized surgical management of patients with empyema. Thoracoscopic management of empyema includes VATS debridement and decortication. VATS debridement has been employed by many centres as the primary treatment option for early-stage empyema. However, this is still contentious as some surgeons continue to advocate initial trials of chest tube drainage and antibiotic-mediated pleural space obliteration prior to any form of surgery. A more aggressive approach is to move directly to VATS decortication, which has shown great promise in the management of chronic empyema. More complex, mulitloculated empyemas would previously have been managed solely by complex open surgical procedures such as open window thoracostomy or thoracomyoplasty. However, recent studies have shown VATS decortication to produce equivalent resolution rates to the higher morbidity open approaches. SUMMARY: A summary of the most recent opinions and results in the thoracoscopic and open surgical management of thoracic empyema is outlined. Early VATS debridement effectively manages simple parapneumonic effusions. VATS decortication has equivalent efficacy to open decortication at managing both chronic and early-stage empyemas.
