Decortication of the Lung Thoracoscopic Decortication

Decortication of the Lung Thoracoscopic Decortication

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Robotic-Assisted Total Decortication of Right Lung for Fibrothorax

Monday, June 25, 2018

By

G. Jett

Jett GK. Robotic-Assisted Total Decortication of Right Lung for Fibrothorax. June 2018. doi:10.25373/ctsnet.6609419 .

This video describes robotic-assisted decortication for a recurrent pleural effusion secondary to fibrothorax. Technical aspects of the decortication are demonstrated, including port placement, robot docking, and closure.

Decortication is occasionally needed for an infected pleural space or recurrent pleural effusion caused by a trapped lung resulting from fibrothorax or malignant process (1). Outcomes of video-assisted thoracoscopic decortication have been shown to reduce complications and mortality (2), and conversion to open thoracotomy is more frequent with longer duration of the empyema or fibrothorax (3). Lung decortication, which re-expands the affected lung, has been shown to improve the quality of life in patients with trapped lungs following coronary artery bypass grafting (4).


References

  1. Rathinam S, Waller, DA. Pleurectomy decortication in the treatment of the “trapped lung” in benign and malignant pleural effusions. Thorac Surg Clin. 2013;23(1):51-61 .
  2. Tong BC, Hanna J, Toloza EM, et al. Outcomes of video-assisted thoracoscopic decortication. Ann Thorac Surg. 2010;89(1):220-225 .
  3. Landreneau RJ, Keenan RJ, Hazelrigg SR, Mack MJ, Naunheim KS. Thoracoscopy for empyema and hemothorax. Chest. 1996;109(1):18-24 .
  4. Celik S, Celik M, Aydemir B, Tunckaya C, Okay T, Dogusoy I. Long-term results of lung decortication in patients with trapped lung secondary to coronary artery bypass grafting. Ann Thorac Cardiovasc Surg. 2012;18(2):109-114 .

Dr Jeff is a proctor and speaker for Intuitive Surgical, Inc.

Comments

Submitted by
David Cooke
on
Interesting. Appears to be a very early fibrino-purulent empyema which may make robotic decortication likely successful.
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surgery

Decortication

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Decortication
ICD-9-CM 34.51 – 34.52
[ edit on Wikidata ]

Decortication is a medical procedure involving the surgical removal of the surface layer, membrane , or fibrous cover of an organ . The procedure is usually performed when the lung is covered by a thick, inelastic pleural peel restricting lung expansion. In a non-medical aspect, decortication is the removal of the bark, husk, or outer layer, or peel of an object. [1] It may also be done in the treatment of chronic laryngitis . It is the primary treatment for fibrothorax .

Procedure[ edit ]

Decortication is performed under general anaesthesia . It is a major thoracic operation that has traditionally required a full thoracotomy . Since the early ’90s this procedure has increasingly been performed using more minimally invasive thoracoscopy . All fibrous tissue is removed from the visceral pleural peel and pus is subsequently drained from the pleural space. [2]

Contraindications[ edit ]

Other than the overall health of the patients, there are no absolute contraindications. In some lung-disease patients, the lung will not expand after removal of the pleural peel, rendering the surgery futile. Other diseases that render decortication futile are narrowing of the large airway stenosis and uncontrolled pleural infection. With these conditions, the lung will not expand to fill the thorax space. A major surgery called a pleuropneumonectomy can be the only available option, but only if the patient has been worked up before the surgery. Pleuropneumonectomy is a major surgery with a very high mortality and high invasiveness [3] .

References[ edit ]

  1. ^ The American Heritage Dictionary of the English Language, Fourth Edition . Copyright © 2000 by Houghton Mifflin Company. Published by the Houghton Mifflin Company
  2. ^ Sharma, Dr. Sat (2006-06-23). “Pulmonary Empyema” . WebMD . Retrieved 2007-02-18.

  3. ^ “Decortication: Background, Indications, Contraindications” . 2018-03-21.
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      • Can Med Assoc J
      • v.89(25); 1963 Dec 21
      • PMC1922283
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      Can Med Assoc J. 1963 Dec 21; 89(25): 1260–1265.
      PMCID: PMC1922283
      PMID: 14098889

      Decortication of the Lung

      R. B. Lynn and J. L. Wellington
      Copyright and License information Disclaimer
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      Abstract

      Excision of an empyema sac and thickened pleura from the lung and chest wall has been performed for over 70 years. The most appropriate fields of application of this procedure are in treatment of tuberculous empyema, empyema complicating pneumonic processes (most frequently caused by staphylococcal infection), and clotted hemothorax following chest injury. The authors’ experience with 33 such decortications in the past five years is described, observations concerning the techniques, complications, and end results of the procedure are discussed, and illustrative case reports are presented.

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      Selected References

      These references are in PubMed. This may not be the complete list of references from this article.
      • GALE GL, DELARUE NC. Decortication in pleural and pulmonary tuberculosis. Can J Surg. 1962 Apr;5:172–179. [ PubMed ]

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