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Title: | Pathophysiological mechanism of post-lobectomy air leaks |
Authors: | Casha, Aaron R. Bertolaccini, Luca Camilleri, Liberato Manche, Alexander Gauci, Marilyn Melikyan, Gor Gatt, Ruben Dudek, Krzysztof Solli, Piergiorgio Grima, Joseph N. |
Keywords: | Biomechanics Temporal lobectomy Chest -- Surgery Chest -- Endoscopic surgery |
Issue Date: | 2018 |
Publisher: | Pioneer Bioscience Publishing Company |
Citation: | Casha, A. R., Bertolaccini, L., Camilleri, L., Manche, A., Gauci, M., Melikyan, G., ... & Grima, J. N. (2018). Pathophysiological mechanism of post-lobectomy air leaks. Journal of Thoracic Disease, 10(6), 3689. |
Abstract: | Background: Air leak post-lobectomy continues to remain a significant clinical problem, with upper lobectomy associated with higher air leak rates. This paper investigated the pathophysiological role of pleural stress in the development of post-lobectomy air leak. Methods: Preoperative characteristics and postoperative data from 367 consecutive video assisted thoracic surgery (VATS) lobectomy resections from one centre were collected prospectively between January 2014 and March 2017. Computer modelling of a lung model using finite element analysis (FEA) was used to calculate pleural stress in differing areas of the lung. Results: Air leak following upper lobectomy was significantly higher than after middle or lower lobectomy (6.3% versus 2.5%, P=0.044), resulting in a significant six-day increase in mean hospital stay, P=0.004. The computer simulation model of the lung showed that an apical bullet shape was subject to eightyfold higher stress than the base of the lung model. Conclusions: After upper lobectomy, the bullet shape of the apex of the exposed lower lobe was associated with high pleural stress, and a reduction in mechanical support by the chest wall to the visceral pleura due to initial post-op lack of chest wall confluence. It is suggested that such higher stress in the lower lobe apex explains the higher parenchymal air leak post-upper lobectomy. The pleural stress model also accounts for the higher incidence of right-sided prolonged air leak post-resection. |
URI: | https://www.um.edu.mt/library/oar/handle/123456789/55965 |
Appears in Collections: | Scholarly Works - FacSciSOR |
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File | Description | Size | Format | |
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Pathophysiological_mechanism_of_post_lobectomy_air_leaks.pdf | 707.65 kB | Adobe PDF | View/Open |
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