Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Mini-thoracostomy with vacuum-assisted closure: a minimally invasive alternative to open-window thoracostomy

Minipleurostomia com curativo a vácuo: uma opção minimamente invasiva a pleurostomia

Alessandro Wasum Mariani1,a, João Bruno Ribeiro Machado Lisboa1,b, Guilherme de Abreu Rodrigues1,c, Ester Moraes Avila2,d, Ricardo Mingarini Terra1,e, Paulo Manuel Pêgo-Fernandes1,f

J Bras Pneumol.2018;44(3):227-230

Abstract PDF PT PDF EN Portuguese Text

Thoracostomy is a common treatment option for patients with stage III pleural empyema who do not tolerate pulmonary decortication. However, thoracostomy is considered mutilating because it involves a thoracic stoma, the closure of which can take years or require further surgery. A new, minimally invasive technique that uses the vacuum-assisted closure has been proposed as an alternative to thoracostomy. This study aims to analyze the safety and effectiveness of mini-thoracostomy with vacuum-assisted closure in an initial sample of patients.

 


Keywords: Infection; Empyema, pleural; Negative-pressure wound therapy; Thoracostomy.

 


Ex vivo experimental model: split lung block technique

Modelo experimental ex vivo com bloco pulmonar dividido

Alessandro Wasum Mariani, Israel Lopes de Medeiros, Paulo Manuel Pêgo-Fernandes, Flávio Guimarães Fernandes, Fernando do Valle Unterpertinger, Lucas Matos Fernandes, Mauro Canzian, Fábio Biscegli Jatene

J Bras Pneumol.2011;37(6):791-795

Abstract PDF PT PDF EN Portuguese Text

Since they were first established, ex vivo models of lung reconditioning have been evaluated extensively. When rejected donor lungs are used, the great variability among the cases can hinder the progress of such studies. In order to avoid this problem, we developed a technique that consists of separating the lung block into right and left blocks and subsequently reconnecting those two blocks. This technique allows us to have one study lung and one control lung.

 


Keywords: Lung transplantation; Transplantation conditioning; Organ preservation; Organ preservation solutions.

 


Ex vivo lung perfusion: initial Brazilian experience

Perfusão pulmonar ex vivo: experiência nacional inicial

Paulo Manuel Pêgo-Fernandes, Israel Lopes de Medeiros, Alessandro Wasum Mariani, Flávio Guimarães Fernandes, Fernando do Valle Unterpertinger, Marcos Naoyuki Samano, Eduardo de Campos Werebe, Fábio Biscegli Jatene

J Bras Pneumol.2009;35(11):1107-1111

Abstract PDF PT PDF EN Portuguese Text

In the last 20 years, lung transplantation has become the standard treatment for patients with end-stage lung disease. However, less than 20% of the donor lungs available for transplant are actually usable. This disparity between the growing number of recipients and the small number of donors has resulted in increased mortality among lung transplant candidates on waiting lists. Strategies such as the utilization of organs from marginal donors have proven ineffective in increasing the number of transplants. In 2000, a new method for reconditioning human lungs that had been previously rejected for transplantation was developed in Sweden. We describe our initial experience with ex vivo lung perfusion.

 


Keywords: Lung transplantation; Organ preservation; Organ preservation solutions; Thoracic surgery.

 


Ex vivo lung reconditioning: a new era for lung transplantation

Recondicionamento pulmonar ex vivo: uma nova era para o transplante pulmonar

Alessandro Wasum Mariani, Paulo Manuel Pêgo-Fernandes, Luis Gustavo Abdalla, Fabio Biscegli Jatene

J Bras Pneumol.2012;38(6):776-785

Abstract PDF PT PDF EN Portuguese Text

Lung transplantation has come to be viewed as the best treatment option for various end-stage lung diseases. The low number of viable donors continues to be a major obstacle to increasing the number of lung transplants, resulting in high mortality among patients on the waiting list. Unlike transplantation of other solid organs, lung transplantation is primarily limited not by the absolute number of donors but by the viability of the donor lungs, which can be damaged by brain death and by treatments given in the ICU. There are various proposals of ways to increase the number of lung donors: intensification of donation campaigns, use of non-heart-beating donors, living lobar lung transplantation, and adoption of more flexible criteria for donors. However, the proposal that has attracted the most attention from lung transplant groups is ex vivo lung perfusion, especially due to the prospect of reconditioning previously discarded lungs. This system consists of perfusion and ventilation of the isolated heart-lung block using a modified cardiopulmonary bypass circuit. Various authors have been studying this technique due to the satisfactory results obtained and the prospect of an increase in the number of organs suitable for transplantation. Researchers in Sweden, Canada, Austria, England, Spain, and Brazil have extensive experience with the method and have introduced modifications to it. The objective of this article was to review the development of, state of the art in, and future prospects for the ex vivo model of lung perfusion and reconditioning.

 


Keywords: Lung transplantation; Transplantation conditioning; Perfusion; Organ preservation.

 


Applications for a hybrid operating room in thoracic surgery: from multidisciplinary procedures to ­­image-guided video-assisted thoracoscopic surgery

Usos da sala híbrida em cirurgia torácica: de procedimentos multidisciplinares à cirurgia toracoscópica videoassistida guiada por imagem

Ricardo Mingarini Terra1,2, Juliano Ribeiro Andrade2, Alessandro Wasum Mariani1,2, Rodrigo Gobbo Garcia2, Jose Ernesto Succi2,3, Andrey Soares2,4, Paulo Marcelo Zimmer2

J Bras Pneumol.2016;42(5):387-390

Abstract PDF PT PDF EN Portuguese Text

The concept of a hybrid operating room represents the union of a high-complexity surgical apparatus with state-of-the-art radiological tools (ultrasound, CT, fluoroscopy, or magnetic resonance imaging), in order to perform highly effective, minimally invasive procedures. Although the use of a hybrid operating room is well established in specialties such as neurosurgery and cardiovascular surgery, it has rarely been explored in thoracic surgery. Our objective was to discuss the possible applications of this technology in thoracic surgery, through the reporting of three cases.

 


Keywords: Thoracic surgery, video-assisted; Bronchoscopy; Thoracoscopy; Radiology, interventional.

 


 

 


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