Grossi William, Masullo Gianluca, Londero Francesco, Morelli Angelo
Department of Cardiothoracic Surgery, Santa Maria della Misericordia Hospital, Udine, Italy.
J Vis Surg. 2018 Jan 15;4:12. doi: 10.21037/jovs.2017.12.07. eCollection 2018.
The object of our study is to show the causes leading to conversion, in order to observe the responsible variables and analyses if conversion influences the patient's outcome. Between January 2013 and December 2016, Udine Thoracic Department performed 180 video-assisted thoracoscopic surgery (VATS) lobectomies, and 24 cases were converted to thoracotomy due to an intra-operative complication such as arterial or venous bleeding, airway and other injuries. The VATS lobectomies' number increased over the three years: from 27 in 2013 to 55 in 2015 and 48 in 2016. While conversion's rate decreased from 33% in 2013 to 5.5% in 2015 and 10% in 2016. We performed a univariate and a multivariate analysis looking for the variables affecting the conversion rate. This was significantly related to intraoperative bleeding and airway injuries (P<0,001). Seventy-year older patients were not associated to a higher conversion rate, instead they showed an increased risk of post-operative complications (P<0,018, RR =1.8). We have focused our attention on all the variables leading to conversion and conditioning the patient's outcome in terms of post-operative complications and length of stay. The best strategy to face VATS complication is to prevent them. Young surgeons at the beginning of their learning curve should perform VATS lobectomies under close supervision of a skilled VATS surgeon. Moreover, conversion to open thoracotomy should be not considered a failure of VATS, but rather a procedure for patient's safety.
我们研究的目的是揭示导致中转开胸的原因，以便观察相关变量，并分析中转开胸是否会影响患者的预后。2013年1月至2016年12月期间，乌迪内胸外科进行了180例电视辅助胸腔镜手术（VATS）肺叶切除术，其中24例因术中出现动脉或静脉出血、气道及其他损伤等并发症而中转开胸。在这三年间，VATS肺叶切除术的数量有所增加：从2013年的27例增至2015年的55例以及2016年的48例。而中转开胸率则从2013年的33%降至2015年的5.5%以及2016年的10%。我们进行了单因素和多因素分析，以寻找影响中转开胸率的变量。这与术中出血和气道损伤显著相关（P<0.001）。70岁及以上的患者与较高的中转开胸率并无关联，相反，他们术后出现并发症的风险增加（P<0.018，RR =1.8）。我们关注了所有导致中转开胸并影响患者术后并发症和住院时间等预后的变量。应对VATS并发症的最佳策略是预防它们。处于学习曲线初期的年轻外科医生应在经验丰富的VATS外科医生的密切监督下进行VATS肺叶切除术。此外，中转开胸不应被视为VATS手术的失败，而应被视为保障患者安全的一种术式。
