Safety analysis of thulium laser in thoracoscopic pulmonary wedge resection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Xiao , SUN Chun , YANG Mengcheng ,  LIU Lei

Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, P.R.China;

Corresponding?author：

LIU Lei, Email: mtv12@sina.com

Keywords：

Thoracoscopic wedge resection; thulium laser; safety

DOI：

10.7507/1007-4848.201903043

Video：

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Objective To explore the feasibility and safety of 2 μm thulium laser in thoracoscopic wedge resection. Methods The clinical data of 137 patients who underwent thoracoscopic wedge resection with thulium laser (as a thulium laser group, 64 patients, including 22 males, 42 females, average age of 58.39±10.40 years) and staplers (as a stapler group, 73 patients, including 33 males, 40 females, average age of 60.79±10.96 years) in thoracic Department of Xuanwu Hospital between April 2016 and August 2018 were retrospectively analyzed. In the study, the intraoperative blood loss, the operative time, chest tube duration, daily amount of fluid leak, hospital stay and hospitalization costs were compared between two groups. Results The intraoperative blood loss of the thulium laser group (16.05±23.67 mL) was significantly shorter or lower than that of the stapler group (28.56±32.09 mL) (P=0.011). Besides, the post operation hospital stay and hospitalization costs of the thulium laser group (4.72±2.49 d, 37 127.33±9 302.14 yuan) were also significantly shorter or lower than those of the stapler group (5.67±2.02 d, 49 545.76±13 831.93 yuan) (P=0.015, P=0.000). Furthermore, no statistical difference was found between the thulium laser group and the stapler group in the operative time (116.38±41.91 min vs. 108.36±47.25 min), total hospital stay (10.13±2.98 d vs. 11.05±3.26 d), daily amount of fluid leak (138.38±72.23 mL vs. 152.7±77.54 mL), chest tube duration (2.89±2.34 d vs. 3.52±1.48 d) and the frequency of postoperative fever (0.89±1.55 times vs. 1.23±1.70 times). Conclusion Applying 2 μm thulium laser to thorascopic wedge resection is safe and feasible. Besides, 2 μm thulium laser can achieve a similar result to that of the standard technique by using staplers.

Citation： ZHANG Xiao, SUN Chun, YANG Mengcheng, LIU Lei. Safety analysis of thulium laser in thoracoscopic pulmonary wedge resection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(10): 988-991. doi: 10.7507/1007-4848.201903043 Copy

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2.	李秋澤, 魏松洋. 三種術式治療早期肺癌的近期療效比較. 吉林醫學, 2018, 39(1): 87-89.
3.	Marulli G, Droghetti A, Di Chiara F, et al. A prospective randomized trial comparing stapler and laser techniques for interlobar fissure completion during pulmonary lobectomy. Lasers Med Sci, 2013, 28(2): 505-511.
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11.	Gilbert S, Maghera S, Seely AJ, et al. Identifying patients at higher risk of prolonged air leak after lung resection. Ann Thorac Surg, 2016, 102(5): 1674-1679.
12.	劉海波, 林鋼, 張詩杰, 等. 電刀切割和機械切割在全胸腔鏡肺段切除術段間平面分離中應用的對照研究. 中國肺癌雜志, 2017, 20(1): 41-46.
13.	Rolle A, Pereszlenyi A, Koch R, et al. Is surgery for multiple lung metastases reasonable? A total of 328 consecutive patients with multiple-laser metastasectomies with a new 1318-nm Nd:YAG laser. J Thorac Cardiovasc Surg, 2006, 131(6): 1236-1242.
14.	張毅, 王若天, 錢坤, 等. 銩激光在胸腔鏡下肺結節切除手術中的應用. 中華胸心血管外科雜志, 2017, 33(6): 360-362.
15.	Gesierich W, Reichenberger F, Fertl A, et al. Endobronchial therapy with a thulium fiber laser (1940 nm). J Thorac Cardiovasc Surg, 2014, 147(6): 1827-1832.
16.	Kirschbaum A, H?chsmann N, Steinfeldt T, et al. Investigations of initial airtightness after non-anatomic resection of lung parenchyma using a thulium-doped laser with different optical fibres. Lasers Med Sci, 2016, 31(6): 1097-1103.
17.	Yamashita S, Tokuishi K, Moroga T, et al. Totally thoracoscopic surgery and troubleshooting for bleeding in non-small cell lung cancer. Ann Thorac Surg, 2013, 95(3): 994-999.
18.	張治, 袁方良, 黃建峰, 等. 全胸腔鏡下肺葉切除手術中轉開胸原因分析. 中國腫瘤外科雜志, 2013, 5(3): 141-144.
19.	蔡慶勇, 梁貴友, 曾寬, 等. 電視胸腔鏡肺葉切除術中并發癥的分析與對策. 中國腫瘤臨床, 2014, 41(10): 643-646.
20.	許世寧, 王鋒. 全胸腔鏡肺葉切除術中血管損傷致出血處理措施. 現代儀器與醫療, 2015, 21, (2): 88-89.

1. 董淑敏, 邵仲凡, 潘引鵬, 等. 全胸腔鏡下肺楔形切除術治療肺部疾病的臨床分析. 中華腔鏡外科雜志(電子版), 2015, (1): 54-58.
2. 李秋澤, 魏松洋. 三種術式治療早期肺癌的近期療效比較. 吉林醫學, 2018, 39(1): 87-89.
3. Marulli G, Droghetti A, Di Chiara F, et al. A prospective randomized trial comparing stapler and laser techniques for interlobar fissure completion during pulmonary lobectomy. Lasers Med Sci, 2013, 28(2): 505-511.
4. Brunelli A, Monteverde M, Borri A, et al. Predictors of prolonged air leak after pulmonary lobectomy. Ann Thorac Surg, 2004, 77(4): 0-1210.
5. Sakata KK, Reisenauer JS, Kern RM, et al. Persistent air leak - review. Respir Med, 2018, 137: 213-218.
6. Liang S, Ivanovic J, Gilbert S, et al. Quantifying the incidence and impact of postoperative prolonged alveolar air leak after pulmonary resection. J Thorac Cardiovas Surg, 2013, 145(4): 948-954.
7. Petrella F, Borri A, Brambilla D, et al. Efficacy and safety of innoseal for air leak after pulmonary resection: a case-control study. J Surgical Res, 2016, 206(1): 22-26.
8. Drahush N, Miller AD, Smith JS, et al. Standardized approach to prolonged air leak reduction after pulmonary resection. Ann Thorac Surg, 2016, 101(6): 2097-2101.
9. Park JB, Hwang JJ, Lee WS, et al. Postoperative chest tube placement after thoracoscopic wedge resection of lung for primary spontaneous pneumothorax: is it mandatory? J Thorac Dis, 2018, 10(8): 4812-4818.
10. Deng B, Qian K, Zhou JH, et al. Optimization of chest tube management to expedite rehabilitation of lung cancer patients after video-assisted thoracic surgery: A meta-analysis and systematic review. World J Surg, 2017, 41(8): 2039-2045.
11. Gilbert S, Maghera S, Seely AJ, et al. Identifying patients at higher risk of prolonged air leak after lung resection. Ann Thorac Surg, 2016, 102(5): 1674-1679.
12. 劉海波, 林鋼, 張詩杰, 等. 電刀切割和機械切割在全胸腔鏡肺段切除術段間平面分離中應用的對照研究. 中國肺癌雜志, 2017, 20(1): 41-46.
13. Rolle A, Pereszlenyi A, Koch R, et al. Is surgery for multiple lung metastases reasonable? A total of 328 consecutive patients with multiple-laser metastasectomies with a new 1318-nm Nd:YAG laser. J Thorac Cardiovasc Surg, 2006, 131(6): 1236-1242.
14. 張毅, 王若天, 錢坤, 等. 銩激光在胸腔鏡下肺結節切除手術中的應用. 中華胸心血管外科雜志, 2017, 33(6): 360-362.
15. Gesierich W, Reichenberger F, Fertl A, et al. Endobronchial therapy with a thulium fiber laser (1940 nm). J Thorac Cardiovasc Surg, 2014, 147(6): 1827-1832.
16. Kirschbaum A, H?chsmann N, Steinfeldt T, et al. Investigations of initial airtightness after non-anatomic resection of lung parenchyma using a thulium-doped laser with different optical fibres. Lasers Med Sci, 2016, 31(6): 1097-1103.
17. Yamashita S, Tokuishi K, Moroga T, et al. Totally thoracoscopic surgery and troubleshooting for bleeding in non-small cell lung cancer. Ann Thorac Surg, 2013, 95(3): 994-999.
18. 張治, 袁方良, 黃建峰, 等. 全胸腔鏡下肺葉切除手術中轉開胸原因分析. 中國腫瘤外科雜志, 2013, 5(3): 141-144.
19. 蔡慶勇, 梁貴友, 曾寬, 等. 電視胸腔鏡肺葉切除術中并發癥的分析與對策. 中國腫瘤臨床, 2014, 41(10): 643-646.
20. 許世寧, 王鋒. 全胸腔鏡肺葉切除術中血管損傷致出血處理措施. 現代儀器與醫療, 2015, 21, (2): 88-89.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Safety analysis of thulium laser in thoracoscopic pulmonary wedge resection

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