Author of

• 10643

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  P1.07 - Poster Session 1 - Surgery (ID 184)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10659

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    P1.07-016 - Does the utilization of staplers for the interlobar fissures dissection really affect postoperative respiratory function? (ID 1334)

    09:30 - 09:30  |  Author(s): M. Yanada
    • Abstract

    Background
    We need to separate the interlobar fissures during pulmonary lobectomy / segmentectomy. Accordingly, we can select from among several different devices to separate the interlobar fissures. But it is difficult to determine which devices are most beneficial. On one hand, there is an opinion that it is not recommended to use staplers for the interlobar fissures dissection because of a reduction of pulmonary compliance. On the other hand, some surgeons feel that staples do not affect postoperative pulmonary function. The purpose here is to elucidate on whether the use of staplers for the interlobar fissures dissection affects postoperative respiratory function.

    Methods
    The study consisted of 41 patients who were examined for pulmonary function test before and after surgery. They had undergone a lobectomy / segmentectomy for lung cancer between April 2009 and April 2013 at Ayabe City Hospital. Video assisted thoracic surgery (VATS) was performed in all 41 patients. They were classified into 2 groups: the stapler group underwent the routine surgical procedure (ST group), and the other group did not have staplers applied; other devices were used (OD group). Postoperative respiratory function after pulmonary resection was analyzed mainly. We also analyzed other things between the ST group and the OD group (for example; gender, laterality, smoking, synechia, excision site, and the number of staplers). Postoperative respiratory function was analyzed by means of the ratio between predicted postoperative FEV1.0 (Forced Expiratory Volume in first second) and postoperative FEV1.0. The predicted postoperative FEV1.0 was calculated utilizing the methodology of Juhl B. et al（Acta Anaesthesiol Scand, 1975）.

    Results
    There were 25 men and 16 women with a mean age of 69.6 years old (51-83 years old). Forty-one patients underwent 39 lobectomies and 2 segmentectomy. All patients recovered and were discharged home. There was no operative mortality, and no hospital deaths. No significant difference of Postoperative respiratory function was observed between the ST group and the OD group (106.6±15.4 vs 105.1±20.7 %; p=0.833). However, Postoperative respiratory function of laterality was significantly lower for the right side than the left side (101.8±16.3 vs 114.9±12.1 %; p=0.012). Moreover, the operative time was significantly longer in the ST group compared with the OD group (275±74.8 vs 206±31.6 min; p=0.02). There was no statistically significant difference between the two groups regarding the postoperative hospitalization length (5.6±2.8 for ST vs 5.1±1.4 days for OD; P=0.639) and the duration of the chest tube placement (3.5±2.9 for ST vs 3±1.8 days for OD; P=0.67).

    Conclusion
    Persistent air leaks require prolonged chest tube drainage time, which increases the risk of pleuropulmonary infections, associated pain, and consequently longer hospital stays. Several tools and techniques have been used to prevent postoperative air leaks, but in this study, the utilization of staplers for the interlobar fissures dissection did not affect postoperative respiratory function when patients underwent lung resections.

• 12008

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  P2.25 - Poster Session 2 - Nurses (ID 249)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Nurses
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12009

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    P2.25-001 - Workflow improvement and results of standardization of thoracic surgery procedures among six hospitals (ID 1133)

    09:30 - 09:30  |  Author(s): M. Yanada
    • Abstract

    Background
    Five full-time doctors are sent to 5 affiliated hospitals from University Hospital of Kyoto Prefectural University of Medicine. To conduct a surgery in the affiliated hospitals, a doctor is sent from the university, for ensuring an efficient and secure medical care with limited members. Until now, each hospital performed surgeries in its own way. However, to perform safer and efficient surgery with a limited number of operating room nurses and thoracic surgeons, they need to work as one team. We report the standardization of thoracic surgery procedures.

    Methods
    First, to understand the current situation at each affiliated hospital, we survey all aspects of surgical procedures. Subsequently, we held 5 meetings among the group and standardized the surgical procedures. A thoracic surgeon and 3–4 operating room nurses from each hospital joined in the discussion. The topics of the discussion covered all aspects of surgery and methods from each hospital were analyzed and standardized. We have already standardized the thoracoscopy system and energy device in all hospitals. We also standardized the main surgical instruments and methods in these meetings. The content of the standardized main surgical procedure was thoroughly explained in a video distributed to each hospital in DVD format. We evaluated the frequency of use of the surgical instruments and excluded rarely used items. To increase the understanding on automatic suture instruments and energy device, the important usage points were shared in the meeting. Nurses were trained on the usage. In the 6[th] affiliated hospital meeting, a questionnaire was conducted to survey the awareness of this approach.

    Results
    The amount of time required from entering the operating room to starting the surgery was shortened from 62 to 55.5 minutes (average). The time required from the end of surgery to exiting the operating room was also shortened from 46.1 to 38.7 minutes (average). The difference among hospitals was successfully reduced. Because the main surgical instruments and methods were standardized, almost the same level of surgery could be performed in each hospital. Surgical instruments were reduced from 48.3 to 41.1 types (average). Total number of surgical instruments was successfully reduced from 91.8 to 73.5 items (average). In the questionnaire, all members referred to other hospitals devices, and they will attempt productions of their own device. All members confirmed improved understanding on thoracic surgery and 88% confirmed increased interest in thoracic surgery．

    Conclusion
    Standardization of the surgical procedures improved the workflow, enabled safe and efficient surgery among the affiliated hospitals, and increased awareness of the importance of workflow improvement. Change in awareness toward thoracic surgery was observed among participating members, suggesting that the present approach is highly useful.