PURPOSE: We report two new surgical techniques in emphysematous with concurrent resectable lung cancer to reduce hospital stay and improve quality of life.
METHODS: Between January 2005 and September 2005 we performed 28 lung volume reductions to as many ipsilateral major resections. Twenty-six patients (mean age: 67 + 7 years) had primary NSCLCs and 2 colorectal metastases. FEV1 baseline was 0.90 + 0.3 L and RV was 5.1 + 0.7 L.The bullectomy was separated from cancer resection in 6 cases: 4 lobectomies, 1 bilobectomy and 1 wedge resection for metastases. We performed in partnership stapler to the stratum of collagen for the bullectomy, both for open surgery than for videothoracoscopy.The intraparenchimal caverns were approached in 20 lobectomies and 2 bilobectomies through a short muscle sparing thoracotomy and opened after disinfection. First the fibrin glue was instilled and manufactured a patch with stratum of collagen to close the bulla without tailoring. The manoeuvre can be performed also with an elastic synthetic sealant, always combining it to the usual stratum of collagen.
RESULTS: There were only 2 postoperative transient cardiac arrhythmias. Median hospital stay was 8 days (range: 5-16).The two procedures were without a final increase of the costs of management neither for duration neither for the postoperative hospitalization. In fact, to forehead of few about 10.00 € the cure of the bulla/caverna can be performed strengthening the mechanical suture with reabsorbable material as the patches of collagen and maintaining the initial elasticity of the pulmonary parenchima to term application.
CONCLUSION: The costs of the described methods are reduced and lower to any other employee for such pathologies with excellent results in the care of the same diseases.
CLINICAL IMPLICATIONS: The careful employment of adhesive, sealant and biomatherials has generally modified surgical procedures already consolidated even if sometimes not enough to the pathologies to be treated and it has widened the indications of it allowing what first with difficulty or technical artifices today it can be simplified.
DISCLOSURE: Cosimo Lequaglie, None.