Center for Thoracic Surgery and Center for Minimally Invasive Surgery, Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy.
J Cardiothorac Surg. 2021 Mar 20;16(1):40. doi: 10.1186/s13019-021-01421-1.
This study aims to compare safety and impact of monopolar electrocautery and ultrasonic dissector (Harmonic ACE Plus®) on postoperative short-term outcomes after video-assisted thoracoscopic (VATS) lobectomy and lymphadenectomy for lung cancer.
We analyzed the prospectively collected data of 140 consecutive patients [59% male; median age: 71(IQR:62-76) years] undergoing VATS lobectomy and lymphadenectomy in our institution between October 2016 and November 2019. Patients were divided in two groups based on device used: monopolar electric hook in 79 cases (Group A); ultrasonic dissector in 61(Group B). Energy instrument-related intraoperative accidents, hemothorax/chylothorax incidence, total pleural effusion volume at 48 postoperative hours and chest tube duration were compared between groups. Multivariable analysis was performed to test energy device as possible independent risk factor either for increased pleural effusion volume or for prolonged chest tube duration.
No intraoperative accidents due to energy device occurred. No hemothorax was recorded. Postoperative chylothorax incidence was slightly higher in Group A (2.5% vs 0%; p-value = 0.21). Total pleural effusion volume at 48 h was significantly higher in Group B: 400 (285-500) vs 255 (150-459) ml (p-value = 0.005). Chest tube duration was similar in the two groups: 5 (3-9) vs 5 (3-8) days (p-value = 0.77). At multivariable analysis the energy device used was not associated with increased pleural effusion volume (p-value = 0.43) nor with prolonged chest tube duration (p-value = 0.28).
Monopolar electrocautery and Harmonic ACE Plus® were safe and had a similar impact on short-term outcomes after VATS lobectomy and lymphadenectomy, suggesting that energy devices choice could be left to surgeon's preference.
本研究旨在比较单极电凝和超声刀（Harmonic ACE Plus®）在电视辅助胸腔镜（VATS）肺叶切除和淋巴结清扫术后短期结果方面的安全性和影响。
我们分析了 2016 年 10 月至 2019 年 11 月期间在我们机构接受 VATS 肺叶切除和淋巴结清扫术的 140 例连续患者的前瞻性收集数据[59%为男性；中位年龄：71（IQR：62-76）岁]。根据使用的设备将患者分为两组：79 例使用单极电钩（A 组）；61 例使用超声刀（B 组）。比较两组之间与能量器械相关的术中事故、血胸/乳糜胸发生率、术后 48 小时总胸腔积液量和胸腔引流管持续时间。多变量分析用于测试能量设备是否为胸腔积液量增加或胸腔引流管持续时间延长的可能独立危险因素。
没有因能量设备引起的术中事故。未记录血胸。A 组术后乳糜胸发生率略高（2.5%比 0%；p 值=0.21）。B 组术后 48 小时胸腔总积液量明显较高：400（285-500）比 255（150-459）ml（p 值=0.005）。两组胸腔引流管持续时间相似：5（3-9）比 5（3-8）天（p 值=0.77）。多变量分析显示，使用的能量设备与胸腔积液量增加无关（p 值=0.43），也与胸腔引流管持续时间延长无关（p 值=0.28）。
单极电凝和 Harmonic ACE Plus®在 VATS 肺叶切除和淋巴结清扫术后的短期结果方面是安全且具有相似影响的，这表明能量设备的选择可以留给外科医生的偏好。
