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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.
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