| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Eur J Cardiothorac Surg 2007;32:397-398. doi:10.1016/j.ejcts.2007.05.006
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
Letters to the Editor |
Division of Thoracic Surgery, University of Modena and Reggio Emilia, Italy
Received 9 May 2007; accepted 11 May 2007.
* Corresponding author. Address: Division of Thoracic Surgery, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41100 Modena, Italy. Tel.: +39 0594222257; fax: +39 056360159. (Email: morandi.uliano{at}unimo.it).
Key Words: Talc pleurodesis • Thoracoscopy
We thank Dr Margaritora and colleagues [1] for their comments and questions.
Once the superiority of videothoracoscopic talc poudrage demonstrated, the question of how many thoracoscopic accesses are needed to deliver talc can be interesting.
It is commonly accepted that reducing the number and size of thoracoscopic ports leads to a less invasive operation, in terms of esthetical results, postoperative pain, and recovery. These minimally invasive techniques have been especially applied in the treatment of palmar hyperhidrosis. In a study comparing uniportal and three-port videothoracoscopy for spontaneous pneumothorax, a lower incidence of postoperative pain and paraesthesia has been reported for the uniportal technique [2].
There are no studies specifically addressing the question of the number of VATS accesses for talc poudrage. Boutin and colleagues [3], in their series of 360 medical thoracoscopies, reported that pain was almost invariably present during the first 24 h after the operation. In one of the largest series (547 patients), both the single port and three-port approaches were used: only 2% of patients developed postoperative pain but specific data were not reported [4]. The only Phase III study comparing talc poudrage and talc slurry did not address the question [5].
In our study, 58.3% patients (42/72) underwent a single access VATS (group 1A), the remaining had a two-port procedure (group 2A). Our policy was to place a second thoracoport of 7 mm whenever biopsies or pleurolysis were needed; through this access, we introduced the small-bore catheter in every patient. In case of no additional manoeuvres apart from fluid aspiration and talc insufflation, a single 7-mm trocar with a 5-mm thoracoscope was used. We did not find a significant difference between the two groups about morbidity, incidence of postoperative pain (34% in 1A, 37% in 2A), duration of narcotics administration (beyond 48 h in 22% and 17%, respectively, in 1A and 2A), and length of postoperative hospital stay; operative time was longer for 2A, but this reflects the more complex type of operation and the need to wait for intraoperative frozen examination when diagnosis was not previously established (mean time 27 min, range 20–45 for 1A; mean time 47 min, range 25–75 for 2A; p = 0.034).
In agreement with Margaritora and colleagues, we support the need of a minimal invasive approach in these compromised patients. However, we do not believe that a two-port VATS, using 7-mm trocars, represents a more invasive procedure than the single-access technique. In our experience, pain, morbidity, and recovery were similar and there are no esthetical indications in these patients. We believe that single-access VATS remains the procedure of choice for simple talc instillation, but when endoscopic manoeuvres are needed, a two-port approach may make the procedure easier, faster, and more complete.
Otherwise, we agree with the common opinion that pain and discomfort after talc pleurodesis are basically due to chest drains and to the inflammation caused by talc itself; our policy to place a small-bore catheter to control the pleural fluid reaccumulation, allowing early drain removal and patient recovery, is based on this remark.
References
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
