記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1172/jci.insight.192981

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

Abstract

OBJECTIVES

We evaluated intimal damage at the histological level resulting from various clamp techniques in human pulmonary artery specimens obtained after lobectomy.

METHODS

We prospectively analysed patients who underwent anatomical lung resection at two centres between April 2021 and March 2025. The double-loop technique (DLT), DeBakey vascular clamp (3rd and 4th notches), Fogarty vascular clamp (2nd notch), endovascular clips (gold and silver), and vessel loop technique (VLT) were evaluated. Pulmonary artery specimens with an external diameter ≥10 mm were included. We measured the burst pressure and evaluated the intimal damage in the human pulmonary artery by using the modified Zhang’s score (MZS; 0 − 5).

RESULTS

Thirty-six patients were enrolled, and 70 pulmonary artery samples were obtained. DeBakey 3rd exerted a significantly higher burst pressure than did DLT (P = 0.022). No significant difference was found between DLT and VLT (P = 0.453). A burst pressure ≥30 mmHg was achieved in all DLT cases. None of the samples clamped with DLT and VLT exhibited MZS 3 − 5. The rate of MZS ≥2 with DeBakey 3rd, Fogarty 2nd, gold and silver clips, and VLT was statistically comparable to that for DLT, whereas DeBakey 4th resulted in significantly higher MZS values than did DLT (P = 0.029).

CONCLUSIONS

The DLT is a feasible and safe for thoracoscopic clamping. Additionally, DLT, VLT, and gold clip are appropriate for clamping the peripheral pulmonary artery. For DeBakey vascular clamp, notch selection should be carefully tailored to the vessel diameter.

DOI： 10.1093/ejcts/ezaf232

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

Abstract

Lung hernia is a rare complication of minimally invasive surgery (MIS). Suture-based rib approximation to restore costal margin continuity during MIS-related lung hernia repair has not been reported. We present three cases of repair using suture-based rib approximation for MIS-related lung hernias. Between 2016 and 2025, our department performed four MIS-related lung hernia repairs. Three followed minimally invasive cardiac surgery (MICS), and one followed video-assisted thoracoscopic surgery (VATS). We excluded the MICS case requiring third-rib resection during MICS and Gore-Tex patch for repair. All MICS-related hernias occurred at the right fourth intercostal space; the VATS-related hernia occurred at the left fourth intercostal space. In all three cases, hernial defects were repaired with sutures placed across the intercostal space between the upper and lower ribs. No perioperative mortality, morbidity, or recurrence occurred. Suture-based rib approximation demonstrated favorable outcomes. Further case accumulation is necessary to identify risk factors and establish optimal techniques.

DOI： 10.1093/jscr/rjaf518

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

Abstract

<p></p> OBJECTIVES

We analysed our clinical experience using silk sutures [the double-loop technique (DLT)] or DeBakey type vascular clamp (DeBakey clamp) for pulmonary artery (PA) troubles during anatomical lung resection to validate its practicality and safety.

METHODS

We retrospectively reviewed the records of patients who underwent either of the above clamping techniques during anatomical lung resection at our hospital between April 2007 and August 2022. We measured the PA diameter at the occlusion site on computed tomography images acquired within 1 year pre- and postoperatively. The difference between pre- and postoperative diameters of the occlusion sites was calculated as the change in the PA diameter. We zoned the occlusion site of the PA to adjust for variation. PA deformation was evaluated as an adverse event caused by clamping.

RESULTS

Ultimately, 27 and 26 patients who underwent the DLT and DeBakey clamp, respectively, were included. No additional injury due to the clamp procedure was found in either group. For zone R1/L1, defined as the main PA, the median changes in the PA diameter were 0.02 (–0.7 to 0.27) mm for the DLT and 0.36 (–0.28 to 0.89) mm for the DeBakey clamp. No significant differences were observed between the 2 groups (P = 0.106). Furthermore, no aneurysms, dissections, or stenoses were found in either group.

CONCLUSIONS

The DLT and DeBakey clamp had only minimal effects on the occlusion site of the PA. The DLT is a practical thoracoscopic technique for PA bleeding when primary haemostasis has been achieved.

その他リンク： https://academic.oup.com/ejcts/article-pdf/65/3/ezae034/56886996/ezae034.pdf

DOI： 10.1093/ejcts/ezae034

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

Abstract

<p></p> OBJECTIVES

The double-loop technique has been used in our clinical settings for pulmonary arterioplasty and/or injured artery repair during thoracoscopic anatomical lung resection. We evaluated the pressure resistance capacity and intimal load to determine the effectiveness and safety of the double-loop technique.

METHODS

The double-loop technique, DeBakey clamp, Fogarty clamp, endovascular clips and vessel loop technique were evaluated. During an experimental study, a polyvinyl alcohol main pulmonary artery model, manometer and in-deflation device were used to measure the burst pressure. The maximum clamp pressure was measured using a pressure-measuring film. Each measurement was performed 10 times. During the histological study, we measured the burst pressure and evaluated the intimal damage of the human pulmonary artery associated with the double-loop technique and DeBakey clamp.

RESULTS

The experimental burst pressure (mmHg) and maximum clamp pressure (MPa) between the double-loop technique and DeBakey at the third notch were not significantly different (24.6 ± 2.8 and 21.8 ± 2.8, P = 0.094; 1.54 ± 0.12 and 1.49 ± 0.12, P = 0.954). During the histological study, the burst pressures of the double-loop technique and DeBakey at the third notch were also not significantly different (P = 0.754). Furthermore, the double-loop technique resulted in only intimal deformation in each five samples.

CONCLUSIONS

The double-loop technique is feasible for thoracoscopic anatomical lung resection because it has similar pressure resistance capacity and intimal load as DeBakey at the 3rd notch.

その他リンク： https://academic.oup.com/icvts/article-pdf/37/3/ivad119/51548260/ivad119.pdf

DOI： 10.1093/icvts/ivad119

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開催年月日： 2025年5月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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