Thoracic Surgeon Stephen Broderick discusses techniques to prevent air leaks during thoracic surgery.
Share Fast Facts
Air leaks after lung cancer surgery are a major limitation in a patient’s recovery. What techniques are used to prevent this from happening? Click to Tweet
mm. Yeah. Mhm. Yeah, air leaks after lung cancer surgery are a major limitation in patients recovery. Uh the presence of a postoperative air leak, which is air that's actually leaking through sutra lines in the lung or potentially damage that was done to the long as part of the dissection for surgery uh requires us to leave a drainage tube in uh to allow that air to be evacuated from the pleural space. Uh That results in longer hospital stays, uh more discomfort for patients and overall a slower recovery. There are various definitions of what it means to have a prolonged air leak. Generally, we think that an air leak that goes on beyond five days is a prolonged leak. However, it would be terrific if we could have much shorter durations of air leaks uh say no air leak at all or leaks that only lasts a day or two. And allow us to have patients discharged from the hospital sooner. The prevalence of prolonged air leaks, depending on what you read in the literature is anywhere from from 10 to 25% of patients. Um and we know that those air leaks not only prolonged length of stay but significantly contribute to in hospital costs. So patients who are required to stay in the hospital longer, that's a higher cost of care as a result of that air leak. So, um we do employ certain strategies to reduce the risk of an air leak or reduce the likelihood of a postoperative air leak in the operating room. I think that that begins with identifying patients who are at high risk for leaks and those are patients in whom we have a poorer overall quality of the lung predominantly, patients who have emphysema, significant amounts of emphysema where there is less uh robust lung tissue and the lung tissue it takes longer to heal. And when we divide lung tissue for the most part, we use uh staples, titanium stapling devices and if there's just less quality, lower quality lung tissue, those staple lines have less lung to co opt in and more air leaks through those staples. So, uh in my practice, I try to be very careful before surgery to identify patients who are at risk for air leaks. And if they are at risk to take strategies or employ strategies in the operating room to reduce the likelihood of the leak. So what are those strategies? One is to avoid working in what we call the fishers, or the divisions between the different lobes of the lung, particularly when we're doing our most common lung cancer operation, which is an anatomical lumpectomy. If we can avoid working in the lung tissue itself and sort of start from the bottom of the pulmonary highland and work up or the top of the highland and work down or front to back as opposed to digging into the lung tissue. We can reduce the risk of leaks. The other is to employ silence. We don't routinely do this. There has been no good evidence to show that the routine application of silence reduces the risk of a postoperative air leak. However, in patients who we think are at high risk, or patients in whom were able to see an air leak at the end of a pulmonary resection. We will apply sealants to those future lines or to any raw surface in the lung to reduce the chance of a leak or to shorten the duration of the leak post operatively. If patients do have leaks, there are certain strategies that we can employ and how we manage the the sort of settings on the chest tube in order to reduce the duration or the impact of those leaks. And sometimes we even will if, if suitable for a patient, apply a valve to the end of the chest tube so that patients can be uh more easily ambulance did and and readily discharged from the hospital even while they still have a chest to place mm.
Facebook
Twitter
YouTube
LinkedIn
Instagram
E-News
BROADCASTMED