HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hiroshi Date Permission Requests Google Scholar Articles by Hirami, Y. Articles by Date, H. PubMed Articles by Hirami, Y. Articles by Date, H. Related Collections Lung - cancer Trachea and bronchi

Letters to the Editor

Reply to Kamiyoshihara and Ibe

Department of Cancer and Thoracic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama University, Okayama, Japan

Received 25 March 2008; accepted 26 March 2008.

^_* Corresponding author. Address: Department of Thoracic and Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama 701-0192, Japan. Tel.: +81 86 462 1111; fax: +81 86 464 1189. (Email: yhirami{at}med.kawasaki-m.ac.jp).

Key Words: Bronchopleural fistula • Lymphadenectomy • Electric scalpel

Thank you for your interest in our article [1].

We think that the authors principally have agreed with the essential content of our article, and that the purpose of their letter is to kindly refer to minor details to clarify our description.

In response to the first question, we perform lymphadenectomy using an electric scalpel by cauterizing and cutting the connective tissues (blend mode). We used the term ‘sharp’ to distinguish our procedure from those using mainly a cauterizing mode involving ultrasonic devices or ones taking the tissue out mainly by force. If the authors feel that sharp dissection can only be done with scissors, we apologize for confusing the authors.

As to the second question, needless to say, a surgeon should handle tissue protectively. However, undesirable complications sometimes occur in general. We dared to use this description to evoke special attention to lymphadenectomy around the airway. We basically conduct a subcarinal lymph node dissection down to the bronchus intermedius level. As a result, the force of traction for acquiring a view may be applied to the frail bronchus intermedius membrane that may receive unrecognized burning with the electric scalpel.

This complication occurred within a recent 2-year period, so we must reflect on what was the cause [2]. One reasonable suggestion is ‘the usage of scissors and clips for lymph node dissection whenever possible, or ultrasonic devices’ to avoid this complication. However, this suggestion is only ‘ based on experience’, not the conclusion from the outcome of a prospective study. However we still appreciate their comments. Because we believe that the electric scalpel is a convenient tool with further possible uses and many surgeons use the electric scalpel for lymphadenectomy without serious complications, we welcome comments from experts that include ‘how to do it’ or objective pros and cons for lymphadenectomy using the electric scalpel.

References

1. Kamiyoshihara M, Ibe T. Does the electric scalpel facilitate bronchial tissue damage?. Eur J Cardiothorac Surg 2008;34:223.[Free Full Text]
2. Hirami Y, Toyooka S, Sano Y, Date H. Postoperative perforation in the bronchus intermedius membrane after a primary lung cancer resection. Eur J Cardiothorac Surg 2008;33:130-132.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hiroshi Date Permission Requests Google Scholar Articles by Hirami, Y. Articles by Date, H. PubMed Articles by Hirami, Y. Articles by Date, H. Related Collections Lung - cancer Trachea and bronchi