2020 SCIENCELINE

Journal of Life Science and Biomedicine

J Life Sci Biomed, 10 (2): 10-16, 2020

ISSN 2251-9939

DOI: https://dx.doi.org/10.29252/scil.2020.jlsb2

Comparative analysis of the videothoracoscopic

interventions results

Otabek Djurayevich ESHONKHODJAEV¹^, Ravshan Aliyevich IBADOV¹, Ulugbek Nasirovich BOBAYEV²

and Bakhodir Abdimusayevich ISMAILOV¹

¹Republican Specialized Scientific and Practical Medical Center of Surgery named after Academician V.Vakhidov, Tashkent, Uzbekistan

²Andijan State Medical Institute, Andijan, Uzbekistan

Corresponding author’s Email: dr.sardor.ibragimov@gmail.com

ABSTRACT

Original Article

Aim. This study was done to determine the feasibility and effectiveness of the proposed

method of thoracoscopic hemostasis and aerostasis. Methods. The study included 85

patients operated for bullous lung disease, closed chest injury and penetrating chest

wounds in the Lung and Mediastinum surgery department of the Republican Specialized

Scientific and Practical Medical Center of Surgery named after Academician V.Vakhidov for

the period from 2015 to 2019. Total of 33 patients made up the main group: thoracoscopy

using the proposed technique and 52 patients for the comparison group: thoracoscopic

aerostasis was performed using known methods. In 21 (40.4%) cases of comparison group, we

performed video-assisted thoracoscopic (VATS) excision and suturing with pleurodesis; in 14

(26.9%) cases – VATS with stitching of a lung wound. VATS excision and flashing of bullae of

PII: S225199392000002-10

Rec. 05 January 2020

Rev. 15 March 2020

Pub. 25 March 2020

the lung using a stapler was performed in 19.2% (10 of 52) cases of the comparison group and Keywords

24.2% in the main group, where all VATS were supplemented with Geprotsel gel application.

Results. Using the Geprotsel in VATS interventions allowed to reduce the necessity of lung

tissue stitching from 67.7% to 27.3%, respectively, to limit excision in 36.4% of patients, to

achieve complete tightness after hardware stitching (χ²- 17.304; Df=3; p<0.001), which

generally leveled the risk of postoperative pneumonia and impaired hemostasis.

Recommendation. We suggest that applying Geprotsel gel during VATS for lung tissue

damages allows to reduce the application of additional sutures, improve the efficiency of

minimally invasive operations with a decrease in the frequency of postoperative disorders of

aero- and hemostasis.

Lung Pathology,

Video-Assisted

Thoracoscopy,

Geprotsel,

Hemostasis,

Aerostasis

INTRODUCTION

The number of complications in thoracoscopic lung surgery associated with the development of postoperative

intrapleural bleeding and leakage of the pulmonary parenchyma, as well as with a violation of the tightness of

the sutured bronchus stump, remains significant and does not have a noticeable downward trend [1]. Under

conditions of persistent pneumothorax, prerequisites are created for the development of infectious

complications, the formation of a persistent residual cavity, which, in turn, may require repeated interventions

or prolonged drainage [2].

Some studies showed that air leakage occurs immediately after surgery in 28-60% of patients who

undergo conventional lung resections, including lobectomy and smaller resections [3]. On the 1^stday after

surgery, air leakage is observed in 26-48% of patients; on the 2nd day, air leakage is present in 22-24% of cases;

on the 4th day - in 8% of cases [4]. The National Emphysema Treatment Trial assumes that air leakage occurs at

some point in the postoperative period in 90% of patients undergoing bilateral procedures with both

thoracotomy and thoracoscopy, with average air leak duration of 7 days, and 12% of patients had a constant air

leak even 30 days after surgery [5, 6].

To achieve adequate hemoaerostasis - reliable sealing of the resection line - various methods of

strengthening the wound surfaces of the lung are used in clinical practice: laser exposure, plasma factors,

ultrasound, electrical coagulation, applying synthetic and biological adhesives to the surgical wound,

application of adhesive collagen plates and synthetic materials [7, 8].

This study aimed to determine the feasibility and effectiveness of the proposed method of thoracoscopic

hemostasis and aerostasis.

Citation: Eshonkhodjaev OD, Ibadov RA, Bobayev UN and Ismailov BA. Comparative analysis of the videothoracoscopic interventions results. J Life Sci Biomed,

2020; 10(2): 10-16. DOI: https://dx.doi.org/10.29252/scil.2020.jlsb2

MATERIAL AND METHODS

The study included 85 patients operated in the Lung and Mediastinum surgery department of the Republican

Specialized Scientific and Practical Medical Center of Surgery named after Academician V.Vakhidov (Tashkent,

Uzbekistan) for the period from 2015 to 2019. Total of 33 patients of whom made up the main group

(thoracoscopy using the proposed technique) and 52 patients considered as the comparison group

(thoracoscopic aerostasis was performed using known methods).

The study included patients with the following nosologies: bullous lung disease was diagnosed in 62.4% of

cases, closed chest injury - 21.2%, penetrating chest wounds - 16.5% of cases.

Surgery was performed as the main treatment. Video-assisted thoracoscopic (VATS) excision and suturing

with pleurodesis was performed in most cases of comparison group (40.4%; 21 out of 52). The next most frequent

surgical intervention was VATS with stitching of a lung wound (26.9%; 14 out of 52). VATS excision and flashing of

bullae of the lung using a stapler was performed in 19.2% (10 of 52) cases of the comparison group and 24.2% in the

main group, where all VATS were supplemented with Geprotsel gel application. The following operations were

also performed in the main group: VATS excision of bullae of the lung with application of Geprotsel gel [9] (24.2%),

VATS with application of Geprocel gel on the wound of the lung (21.2%)

Ethical approval

The review board and ethics committee of RSCS named after acad. V.Vakhidov approved the study

protocol and informed consents were taken from all the participants.

Statistical analysis

The obtained results were subjected to the statistical processing with the using the standard package of

Microsoft Excel 2010 software by the method of variation statistics with the estimation of indexes’ values

(M±m).

RESULTS AND DISCUSSION

The most frequent complications of VATS were hemostasis and aerostasis disorders and, as a result,

recondensing hemothorax and pneumothorax. Comparative analysis of complications frequency after VATS in

comparison groups is presented in Table 1. Thus, at the comparative analysis of the complications frequency

after VATS it was noted that only 3 (5.8%) patients of the control group had a recurrence of bleeding, while one

of them had a recurrence of hemothorax (1.9%). Violations of aerostasis were registered in one (3.0%) case in the

main group patient and in 6 (11.5%) patients from the comparison group. Pneumothorax relapse was only

reported in one (1.9%) patient from the comparison group.

Exudative pleuritis was also observed only in 3 (5.8%) patients from the comparison group. Thus, the

frequency of complicated course in the control group significantly exceeded these parameters in the main

group (9 vs. 1) with the difference reliability (criterion χ²) - 3,964; Df=1; P=0.047.

Table 1. The comparative analysis of complications rate after VATS

Main group

Comparison group

Complication

abs.

Impaired hemostasis

Impaired aerostasis

Pneumothorax relapse

Hemothorax relapse

Exudative pleuritis

0.0%

3.0%

0.0%

3.0%

5.8%

11.5%

1.9%

5.8%

17.3%

Total number of patients with complications

Criterion χ²3,964; Df=1; P=0.047

Out of 31 patients with bulla in the comparison group, a bulla rupture less than 5 cm occurred in 21

patients and 10 patients with bulla were over 5 cm in size. At the same time, pneumonia after aerostasis was

noted in 4 (12.9%), 2 (9.5%) with bull less than 5 cm and 2 (20.0%) with bull more than 5 cm. In the main group of

this type of complication in 22 patients (8 patients with bulla more than 5 cm and 14 patients with bulla less

Citation: Eshonkhodjaev OD, Ibadov RA, Bobayev UN and Ismailov BA. Comparative analysis of the videothoracoscopic interventions results. J Life Sci Biomed,

2020; 10(2): 10-16. DOI: https://dx.doi.org/10.29252/scil.2020.jlsb2

than 5 cm) with bull disease was not noted (criterion χ²- 3.918; Df=1; P=0.048). Hemostasis disorder was noted

in only one (10%) patient from the comparison group with a bulla size greater than 5 cm.

When considering the technical aspects of HTS performance at the break of the bulla (Figure 1), it was

noted that the use of gel composite material allowed in 36.4% of cases in the main group to limit the bulla

excision without piercing the wound surface, while in the comparison group in 67.7% of cases the bulla excision

was necessarily complemented by piercing the wound surface. Sealed hardware piercing was practically

comparable in the comparison groups and was required in 8 (36.4%) cases in the main group and in 8 (25.8%)

comparison groups. Additional sewing after the mechanical stitching was performed in two (6.5%) patients

from the comparison group.

The next comparative analysis in the compared groups depending on the reason for which VATS

interventions were performed was the analysis of treatment results in case of lung injury (Figure 2). So, from 11

patients of the main group after VATS, in one case (9.1%) there was a pneumonia and there were no cases of

hemostasis disturbance, whereas, from 21 patients of the comparison group in 2 cases there was a pneumonia

(9.5%) and in 2 cases (9.5%) hemostasis disturbance.

χ²- 17,304; Df=3; P<0.001

80%

67.7%

60%

36.4%

40%

20%

27.3%

25.8%

6.5%

0.0%

Bull chipping without The need for stitching

piercing the wound

surface

Sealed hardware

suturing

Additional suturing

after mechanical

seaming

tissue after excision of

the bull

Main group

Comparison group

Figure 1. Technical aspects of VATS Interventions for pulmonary rupture

19.0%

χ²- 0,543; Df=1; P=0.462

20%

15%

9.5%

9.1%

10%

0.0%

Pneumorea

Impaired hemostasis

Main group Comparison group

Total

Figure 2. The frequency of complications after VATS interventions for lung injury

Citation: Eshonkhodjaev OD, Ibadov RA, Bobayev UN and Ismailov BA. Comparative analysis of the videothoracoscopic interventions results. J Life Sci Biomed,

2020; 10(2): 10-16. DOI: https://dx.doi.org/10.29252/scil.2020.jlsb2

When considering the technical aspects of VATS in the lung injury (Figure 3), it was noted that in 36.4% of

cases in the main group the use of gel composite material allowed achieving good results without piercing the

wound surface, while in the comparison group in 33.3% of patients the effectiveness of hemostasis and

aerostasis was achieved by electrocoagulation. Hermetic suturing of the lung wound was practically

comparable in the comparison groups and was required in 6 (54.5%) cases in the main group and in 10 (47,6%)

cases in the comparison group. Additional suturing after mechanical suturing was performed in one (9.1%)

patient from the main group and in 4 (19.0%) patients from the comparison group.

One of the evaluation criteria that determine not only the effectiveness of manipulations with VTS

interventions, but also the quality of life of the patient is the duration of drainage of the pleural cavity and

drainage.

Table 2 shows the duration of pleural cavity drainage in comparable groups. Thus, during two days the

pleural cavity drainage was required in 31 (93.9%) patients of the main group and in 42 (80.8%) patients from the

comparison group. The pleural cavity drainage was required for three days in 1 (3.0%) patient from the main

group and in 1 (1.9%) patient from the comparison group. From 4 to 5 days and from 6 to 7 days drainage was

observed only in the comparison group patients: 4 (7.7%) and 3 (5.8%) patients, respectively. Drainage was

prescribed for 2 (3.8%) patients from the comparison group.

Summary results of VATS interventions in comparison groups are presented in Fig. 4. As can be seen from

the diagram, complications were noted in only 3.0% of patients in the main group versus 17.3% in patients from

the comparison group; pleural puncture (1.9%) and thoracoscopy for hemothorax (1.9%) were required only in

patients of the comparison group. Only patients (3.8%) from the comparison group were also discharged with

drainage.

χ²- 11,830; Df=3; P=0.008

80%

54.5%

60%

47.6%

36.4%

33.3%

40%

19.0%

20%

9.1%

0.0%

Aero- and hemostasis

after gel application

The need for

coagulation

Hermetic closure of a Additional sutures

lung wound

after suturing a lung

wound

Main group

Comparison group

Figure 3. Technical aspects of VATS interventions for lung injury

Table 2. Duration of pleural cavity drainage

Main group

Comparison group

Drainage dates

abs.

2 days

93.9%

3.0%

80.8%

1.9%

3 days

4-5 days

3.0%

7.7%

6-7 days

0.0%

5.8%

3.8%

Discharged with drainage

Total

0.0%

100.0%

Citation: Eshonkhodjaev OD, Ibadov RA, Bobayev UN and Ismailov BA. Comparative analysis of the videothoracoscopic interventions results. J Life Sci Biomed,

2020; 10(2): 10-16. DOI: https://dx.doi.org/10.29252/scil.2020.jlsb2

25%

20%

15%

10%

19.2%

17.3%

6.1%

3.8%

3.0%

1.9%

0.0%

Complications

Long-term

drainage of the

pleural cavity

Discharged with

drainage

Hemothorax

retoracoscopy

Puncture of the

pleural cavity in

case of exudative

pleuritis

Main group

Comparison group

Figure 4. Results of VATS interventions

CONCLUSION

The use of Geprocel gel during VATS interventions reduced the need for flashing of lung tissue after excision

from 67.7% to 27.3%, respectively, limited to excision in 36.4% of patients, to achieve complete tightness after

hardware flashing (χ²- 17.304; Df=3; p<0.001), which generally ensured the risk of postoperative pneumorrhea

and hemostasis, reducing the overall frequency of all complications from 16.1% to 0% (χ²- 3.918; Df=1; p=0.048).

In case of wound damage of the lung tissue application of the composite material in the form of gel in the

course of VATS interventions allows to improve the tightness of primary sutures from 71.4% to 85.7%,

respectively, to reduce the probability of additional sutures from 28.6% to 14.3%, and in general to improve

the efficiency of mini-invasive operations with a decrease in the frequency of postoperative manifestations of

air and hemostasis abnormalities from 19.0% to 9.1%. The developed of VATS-technique for aero- and

hemostasis abnormalities in case of pulmonary tissue injuries by means of local application of composite

material in the form of a gel by means of the suggested delivery device allowed to reduce the frequency of the

mentioned complications in the postoperative period from 17.3% to 3.0%, to reduce the necessity of prolonged

drainage of the pleural cavity from 19.2% to 6.1%, to level out the necessity of repeated mini-invasive

manipulations (3.8% in the comparison group) and, accordingly, to increase the share of patients without

complications.

DECLARATIONS

Acknowledgements

This work was supported by “Republican Specialized Scientific and Practical Medical Center of Surgery

named after Academician V.Vakhidov”, Uzbekistan.

Authors’ contributions

All authors contributed equally to this work.

Competing interests

The authors declare that they have no competing interests.

REFERENCES

1. Bharat A, Graf N, Mullen A, Kanter J, Andrei AC, Sporn PH, DeCamp MM, Sznajder JI. Pleural hypercarbia after lung

surgery

associated with

persistent

alveolopleural

fistulae.

Chest.

2016;

149(1):220-7.

DOI:

https://doi.org/10.1378/chest.15-1591 Google Scholar

Citation: Eshonkhodjaev OD, Ibadov RA, Bobayev UN and Ismailov BA. Comparative analysis of the videothoracoscopic interventions results. J Life Sci Biomed,

2020; 10(2): 10-16. DOI: https://dx.doi.org/10.29252/scil.2020.jlsb2

2. Hrachovinová I. Diagnostic strategies in disorders of hemostasis. Diagnostika poruch hemostázy. Vnitrni lekarstvi.

2018; 64(5):537–544. Google Scholar PMID: 30193524

3. Gilbert S, Maghera S, Seely AJ, Maziak DE, Shamji FM, Sundaresan SR, Villeneuve PJ. Identifying patients at higher risk

of prolonged air leak after lung resection. The Annals of thoracic surgery. 2016; 102(5):1674-9. DOI:

https://doi.org/10.1016/j.athoracsur.2016.05.035 Google Scholar

4. Murakami J, Ueda K, Tanaka T, Kobayashi T, Hamano K. Grading of emphysema is indispensable for predicting

prolonged air leak after lung lobectomy. The Annals of thoracic surgery. 2018; 105(4):1031-7. DOI:

https://doi.org/10.1016/j.athoracsur.2017.11.053 Google Scholar

5. Nishida T, Mikami I, Fujii Y. New technique to prevent prolonged air leak: use of ‘Tachosuture’technique. General

thoracic and cardiovascular surgery. 2017; 65(2):133-136. DOI: https://doi.org/10.1007/s11748-016-0733-1

Google

Scholar

6. Zhang Q, Qi C, Wang H, Xiao X, et al. Biocompatible and degradable Bletilla striata polysaccharide hemostasis sponges

constructed from natural medicinal herb Bletilla striata. Carbohydrate Polymers. 2019; 226:115304. DOI:

https://doi.org/10.1016/j.carbpol.2019.115304 Google Scholar

7. Assmann A, Vegh A, Ghasemi-Rad M, Bagherifard S, Cheng G, Sani ES, Ruiz-Esparza GU, Noshadi I, Lassaletta AD,

Gangadharan S, Tamayol A. A highly adhesive and naturally derived sealant. Biomaterials. 2017; 140:115-27. DOI:

https://doi.org/10.1016/j.biomaterials.2017.06.004 Google Scholar

8. Hamzah AA, Adnan AS, Rahman MN, Khan AH. Oxidized Cellulose (Surgicel) As a Surgical Hemostat in Liver Injury: A

Case Report and Litrature Review. International Journal of Surgical Research. 2013; 2(3):21-3. Google Scholar

9. Khudaybergenov ShN, Eshonkhodjaev OD, and Khalmuratova MK Geprotsel, biocompatible implant: comparative

estimation of its application results for providing airstasis and hemostasis in the lung surgery. Journal of Life Science

and Biomedicine. 2019; 9(2): 45-51; www.jlsb.science-line.com Google Scholar

Citation: Eshonkhodjaev OD, Ibadov RA, Bobayev UN and Ismailov BA. Comparative analysis of the videothoracoscopic interventions results. J Life Sci Biomed,

2020; 10(2): 10-16. DOI: https://dx.doi.org/10.29252/scil.2020.jlsb2