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Low-voltage coagulation, polyglycolic acid sheets, and fibrin glue to control air leaks in lung surgery

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Abstract

Objective

We evaluated the efficacy of low-voltage coagulation (LVC) with polyglycolic acid (PGA) sheets (Neoveil, GUNZE Ltd., Japan) and fibrin glue to control intraoperative alveolar air leaks after lung surgery.

Methods

We included 176 patients with non-small cell lung cancer who underwent thoracoscopic lobectomies. When alveolar air leak was confirmed after lung resection, we applied LVC system to the pleural defect followed by layers of PGA sheets and fibrin glue (n = 40). We then analyzed postoperative air leaks (rate of occurrence and duration time).

Results

73% of patients (29/40 cases) experienced no postoperative air leaks. Although 11 patients experienced air leaks after surgery, there were no prolonged air leaks (>7 days) (resolution time, 3.5 ± 1.4 days; range, 2–6 days). Two patients required drainage for late-onset air leaks, but their conditions improved without further treatment. There were no further adverse events.

Conclusions

The use of LVC with PGA sheets and fibrin glue following pulmonary resection efficiently prevented both intraoperative air leaks and prolonged air leaks after lung surgery.

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References

  1. Brunelli A, Varela G, Refai M, Jimenez MF, Pompili C, Sabbatini A, et al. A scoring system to predict the risk of prolonged air leak after lobectomy. Ann Thorac Surg. 2010;90:204–9.

    Article  PubMed  Google Scholar 

  2. Filosso PL, Ruffini E, Sandri A, Lausi PO, Giobbe R, Oliaro A. Efficacy and safety of human fibrinogen-thrombin patch (TachoSil®) in the treatment of postoperative air leakage in patients submitted to redo surgery for lung malignancies: a randomized trial. Interact Cardiovasc Thorac Surg. 2013;16:661–6.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Belda-Sanchis J, Serra-Mitjans M, Iglesias Sentis M, Rami R. Surgical sealant for preventing air leaks after pulmonary resections in patients with lung cancer. Cochrane Database Syst Rev. 2010. doi:10.1002/14651858.CD003051.pub3.

  4. Anegg U, Rychlik R, Smolle-Juttner F. Do the benefits of shorter hospital stay associated with the use of fleece-bound sealing outweigh the cost of the materials? Interact Cardiovasc Thorac Surg. 2008;7:292–6. (discussion 26).

    Article  PubMed  Google Scholar 

  5. Rivera C, Bernard A, Falcoz PE, Thomas P, Schmidt A, Benard S, et al. Characterization and prediction of prolonged air leak after pulmonary resection: a nationwide study setting up the index of prolonged air leak. Ann Thorac Surg. 2011;92:1062–8. (discussion 68).

    Article  PubMed  Google Scholar 

  6. Orsini B, Baste JM, Gossot D, Berthet JP, Assouad J, Dahan M, et al. Index of prolonged air leak score validation in case of video-assisted thoracoscopic surgery anatomical lung resection: results of a nationwide study based on the French national thoracic database, EPITHOR. Eur J Cardiothorac Surg. 2015;48:608–11.

    Article  PubMed  Google Scholar 

  7. Fleisher AG, Evans KG, Nelems B, Finley RJ. Effect of routine fibrin glue use on the duration of air leaks after lobectomy. Ann Thorac Surg. 1990;49:133–4.

    Article  CAS  PubMed  Google Scholar 

  8. Wong K, Goldstraw P. Effect of fibrin glue in the reduction of postthoracotomy alveolar air leak. Ann Thorac Surg. 1997;64:979–81.

    Article  CAS  PubMed  Google Scholar 

  9. McCarthy PM, Trastek VF, Bell DG, Buttermann GR, Piehler JM, Payne WS, et al. The effectiveness of fibrin glue sealant for reducing experimental pulmonary air leak. Ann Thorac Surg. 1988;45:203–5.

    Article  CAS  PubMed  Google Scholar 

  10. Fabian T, Federico JA, Ponn RB. Fibrin glue in pulmonary resection: a prospective, randomized, blinded study. Ann Thorac Surg. 2003;75:1587–92.

    Article  PubMed  Google Scholar 

  11. Matar AF, Hill JG, Duncan W, Orfanakis N, Law I. Use of biological glue to control pulmonary air leaks. Thorax. 1990;45:670–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Itano H. The optimal technique for combined application of fibrin sealant and bioabsorbable felt against alveolar air leakage. Eur J Cardiothorac Surg. 2008;33:457–60.

    Article  PubMed  Google Scholar 

  13. Pedersen TB, Honge JL, Pilegaard HK, Hasenkam JM. Comparative study of lung sealants in a porcine ex vivo model. Ann Thorac Surg. 2012;94:234–40.

    Article  PubMed  Google Scholar 

  14. Gika M, Kawamura M, Izumi Y, Kobayashi K. The short-term efficacy of fibrin glue combined with absorptive sheet material in visceral pleural defect repair. Interact Cardiovasc Thorac Surg. 2007;6:12–5.

    Article  PubMed  Google Scholar 

  15. Kawai H, Harada K, Ohta H, Tokushima T, Oka S. Prevention of alveolar air leakage after video-assisted thoracic surgery: comparison of the efficacy of methods involving the use of fibrin glue. Thorac Cardiovasc Surg. 2012;60:351–5.

    Article  PubMed  Google Scholar 

  16. Albes JM, Krettek C, Hausen B, Rohde R, Haverich A, Borst HG. Biophysical properties of the gelatin-resorcin-formaldehyde/glutaraldehyde adhesive. Ann Thorac Surg. 1993;56:910–5.

    Article  CAS  PubMed  Google Scholar 

  17. Hirokawa F, Hayashi M, Miyamoto Y, Iwamoto M, Tsunematsu I, Asakuma M, et al. A novel method using the VIO soft-coagulation system for liver resection. Surgery. 2011;149:438–44.

    Article  PubMed  Google Scholar 

  18. Sakuragi T, Ohma H, Ohteki H. Efficacy of SOFT COAG for intraoperative bleeding in thoracic surgery. Interact Cardiovasc Thorac Surg. 2009;9:767–8.

    Article  PubMed  Google Scholar 

  19. Uchiyama A, Miyoshi K, Nakamura K. VIO soft-coagulation system for major pulmonary resections: results in 68 patients with primary lung cancer. Gen Thorac Cardiovasc Surg. 2011;59:175–8.

    Article  PubMed  Google Scholar 

  20. Toyazaki T, Tomioka Y, Chiba N, Ueda Y, Sakaguchi Y, Gotoh M, et al. Thoracoscopic partial resection without using a stapler (complete republication). Gen Thorac Cardiovasc Surg. 2017;65:449–54.

    Article  PubMed  Google Scholar 

  21. Ikegami T, Maeda T, Kayashima H, Oki E, Yoshizumi T, Sakaguchi Y, et al. Soft coagulation, polyglycolic acid felt, and fibrin glue for prevention of pancreatic fistula after distal pancreatectomy. Surg Today. 2011;41:1224–7.

    Article  CAS  PubMed  Google Scholar 

  22. Porte HL, Jany T, Akkad R, Conti M, Gillet PA, Guidat A, et al. Randomized controlled trial of a synthetic sealant for preventing alveolar air leaks after lobectomy. Ann Thorac Surg. 2001;71:1618–22.

    Article  CAS  PubMed  Google Scholar 

  23. Wain JC, Kaiser LR, Johnstone DW, Yang SC, Wright CD, Friedberg JS, et al. Trial of a novel synthetic sealant in preventing air leaks after lung resection. Ann Thorac Surg. 2001;71:1623–8. (discussion 28–9).

    Article  CAS  PubMed  Google Scholar 

  24. Ikeda T, Sasaki M, Yamada N, Takamori A, Tanabe S, Okada A, et al. Controlling air leaks using free pericardial fat pads as surgical sealant in pulmonary resection. Ann Thorac Surg. 2015;99:1170–5.

    Article  PubMed  Google Scholar 

  25. Shintani Y, Inoue M, Funaki S, Kawamura T, Minami M, Okumura M. Clinical usefulness of free subcutaneous fat pad for reduction of intraoperative air leakage during thoracoscopic pulmonary resection in lung cancer cases. Surg Endosc. 2015;29:2910–3.

    Article  PubMed  Google Scholar 

  26. Murakami J, Ueda K, Tanaka T, Kobayashi T, Kunihiro Y, Hamano K. The validation of a no-drain policy after thoracoscopic major lung resection. Ann Thorac Surg. 2017;104:1005–11.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan

    Norikazu Kawai, Takeshi Kawaguchi, Motoaki Yasukawa, Takashi Tojo & Shigeki Taniguchi

  2. Queensland Eye Institute, South Brisbane, Australia

    Shuko Suzuki

Authors
  1. Norikazu Kawai
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  2. Takeshi Kawaguchi
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  3. Shuko Suzuki
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  4. Motoaki Yasukawa
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  5. Takashi Tojo
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  6. Shigeki Taniguchi
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Corresponding author

Correspondence to Norikazu Kawai.

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Conflict of interest

The Thoracic and Cardiovascular Surgery unit at Nara Medical University has no financial interest in the materials or methods used, nor any financial relationship with any of the manufacturers mentioned in this report. The authors declare no conflict of interest.

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Kawai, N., Kawaguchi, T., Suzuki, S. et al. Low-voltage coagulation, polyglycolic acid sheets, and fibrin glue to control air leaks in lung surgery. Gen Thorac Cardiovasc Surg 65, 705–709 (2017). https://doi.org/10.1007/s11748-017-0829-2

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  • DOI: https://doi.org/10.1007/s11748-017-0829-2

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