Lung Transplant Unit, Azienda Ospedaliero-Universitaria Senese, University of Siena, Siena, Italy.
Respiratory Diseases and Lung Transplant Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, 53100, Siena, Italy.
Surg Endosc. 2024 Aug;38(8):4753-4761. doi: 10.1007/s00464-024-11014-3. Epub 2024 Jul 10.
This study aims to compare three commonly used energy devices for dissection during Video-Assisted Thoracoscopic Surgery (VATS) lobectomy: monopolar hook, advanced bipolar, and ultrasonic device, in terms of duration of the surgical procedure and clinical intra- and post-operative outcomes.
In this prospective single-center study, 75 patients undergoing VATS lobectomy for non-small cell lung cancer between January 2022 and May 2023 were enrolled and divided into 3 groups based on the device used during the surgical procedure (Group 1: Ultrasonic Device, Group 2: Advanced Bipolar, Group 3: Monopolar Hook). The duration of the surgical procedure, daily pleural fluid production, post-operative pain, length of hospital stay, and occurrence of post-operative complications were compared for each group. In a subgroup of 20 patients (10 from Group 1 and 10 from Group 3), concentrations of inflammatory cytokines in pleural fluid at 3 h and 48 h post-surgery were analyzed.
Pleural fluid production on the first and second post-operative days was significantly lower in patients treated with the Ultrasonic device compared to the other two groups (p < 0.001). The duration of the surgical procedure was significantly shorter when using the Ultrasonic device (p < 0.001). There were no significant differences in length of hospital stay (p = 0.975), pain on the first and second post-operative days (p = 0.147 and p = 0.755, respectively), and blood hemoglobin levels on the first post-operative day (p = 0.709) and at discharge (p = 0.795). No differences were observed in terms of post-operative complications, although the incidence of post-operative cardiac arrhythmias was borderline significant (p = 0.096), with no cases of arrhythmias recorded in Group 1. IL-10 levels in pleural fluid of patients in Group 3 peaked at 3 h post-surgery, with a significant reduction at 48 h (p = 0.459).
The use of the ultrasonic device during VATS lobectomy may reduce pleural fluid production and shorten the duration of the surgical procedure compared to using a monopolar hook or advanced bipolar device. The choice of energy device may influence the local inflammatory response, although further studies are needed to confirm these results.
本研究旨在比较在电视辅助胸腔镜手术（VATS）肺叶切除术中常用的三种能量设备：单极钩、高级双极和超声刀，以评估手术时间和临床围手术期结局。
在这项前瞻性单中心研究中，纳入了 2022 年 1 月至 2023 年 5 月期间因非小细胞肺癌接受 VATS 肺叶切除术的 75 例患者，根据手术中使用的设备将其分为三组（第 1 组：超声刀，第 2 组：高级双极，第 3 组：单极钩）。比较了每组的手术时间、每日胸腔引流量、术后疼痛、住院时间和术后并发症的发生情况。在 20 例患者的亚组（每组 10 例）中，分析了术后 3 小时和 48 小时胸腔积液中炎症细胞因子的浓度。
与其他两组相比，使用超声刀的患者在术后第 1 天和第 2 天的胸腔引流量明显减少（p<0.001）。使用超声刀的手术时间明显缩短（p<0.001）。住院时间（p=0.975）、术后第 1 天和第 2 天的疼痛（p=0.147 和 p=0.755）以及术后第 1 天（p=0.709）和出院时（p=0.795）的血红蛋白水平均无显著差异。术后并发症方面无差异，但术后心律失常的发生率有临界显著差异（p=0.096），第 1 组无心律失常发生。第 3 组患者胸腔积液中的 IL-10 水平在术后 3 小时达到峰值，48 小时时显著降低（p=0.459）。
与使用单极钩或高级双极设备相比，在 VATS 肺叶切除术中使用超声刀可减少胸腔引流量并缩短手术时间。能量设备的选择可能会影响局部炎症反应，但需要进一步的研究来证实这些结果。
