V-054 single-port video-assisted thoracoscopic pleurectomy by hydrostatic pleural dissection for pleurodesis

• Autor(a) principal: Araujo, Carlos Alberto Almeida de
• Data de Publicação: 2016
• Outros Autores: Carvalho, G.S.L., Pinheiro, L.D.P., Costa, M.G., Melo, L.V., Balieiro, Marcos Alexandre, Amorim, C.A., Dantas, J.L.C.M., Oliveira, A.A., Diniz, T.B.F.
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UFRN
• Texto Completo: https://repositorio.ufrn.br/handle/123456789/52527
• topic: pleurectomy; pneumothorax; epinephrine

Objectives: Pleurodesis plays an important role in treating spontaneous pneumothorax and recurrent pleural effusions. Conventional pleurectomy and talc pleurodesis achieve good results. Nevertheless, the former may be technically challenging and associated with bleeding, and the latter may result in respiratory distress. Considering the above, this study aims to demonstrate a technique that facilitates pleurectomy by subpleural epinephrine/saline solution infusion. Video description: The procedure was performed in 18 patients: 12 men and 6 women aged 16 to 68 years. Indications for surgery included: recurrent malignant pleural effusion, primary recurrent pneumothorax or secondary pneumothorax complicated by COPD. The technique consisted of a singleport pleuroscocopy to guide the percutaneous punctures and subpleural positioning of the needles, followed by infusion of diluted epinephrine in normothermic 0.9% saline in each intercostal space, separating the parietal pleura from the endothoracic fascia, creating a space which facilitates pleurectomy. The whole process was monitored by video, assuring space creation and safety. Cardiovascular parameters were monitored during and after the infusion. Pleurectomy was performed by VATS, through a singleport, using blunt instruments (Foster clamp and aspirator), followed by haemostasis review of all the dissected area. It is noteworthy that the removal of the parietal pleura is performed under direct video vision of the space between it and the endothoracic fascia, allowing local haemostasis when required. Finally a chest tube is placed under thoracoscopy. All patients had a good outcome without significant bleeding on chest tube drainage. Daily radiographic control was obtained until removal of the drain, usually on the second postoperative day, following lung expansion and a debt below 150 ml in the past 12 hours. No patient experienced significant cardiovascular changes during solution infusion. Conclusion: The authors conclude that the infusion facilitates pleurectomy and minimizes intraoperative and postoperative bleeding, allowing a safer and technically easier approach for pleurectomy and pleurodesis.