LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica
URI Permanente desta comunidade
O Laboratório de Pesquisa em Cirurgia Torácica é ligado ao Departamento de Cardiopneumologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP).
Linhas de pesquisa: alterações anatômicas, patológicas e fisiológicas do sistema respiratório no tratamento cirúrgico das pneumopatias avançadas; bases anatômicas e resultados do tratamento cirúrgico do tromboembolismo pulmonar, emprego da cirurgia minimamente invasiva e vídeo-assistida e simpatectomia cervicotorácica e lombar; estudo anatômico e funcional das ressecções e reconstruções da parede torácica; bases anatômicas e fisiológicas das intervenções no processo de remodelamento ventricular na insuficiência miocárdica.
Site oficial: http://limhc.fm.usp.br/portal/lim61-laboratorio-de-pesquisa-em-cirurgia-toracica/
Linhas de pesquisa: alterações anatômicas, patológicas e fisiológicas do sistema respiratório no tratamento cirúrgico das pneumopatias avançadas; bases anatômicas e resultados do tratamento cirúrgico do tromboembolismo pulmonar, emprego da cirurgia minimamente invasiva e vídeo-assistida e simpatectomia cervicotorácica e lombar; estudo anatômico e funcional das ressecções e reconstruções da parede torácica; bases anatômicas e fisiológicas das intervenções no processo de remodelamento ventricular na insuficiência miocárdica.
Site oficial: http://limhc.fm.usp.br/portal/lim61-laboratorio-de-pesquisa-em-cirurgia-toracica/
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- LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica
- LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica
- LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica
Submissões Recentes
Abruzzini procedure for the treatment of bronchopleural fistulas: surgical technique description using intraoperative recording
(2023) GREGóRIO, P. H. Peitl; CHIRICHELA, I. A.; ULLOA, P. J.; MARIANI, A. W.; PêGO-FERNANDES, P. M.
Despite all improvements in thoracic surgery over the last decades, chronic bronchopleural fistulas still pose a challenging disease to treat. The Abruzzini technique is often considered one of the last viable options to manage this undesirable complication. Unfortunately, surgical trainees are not regularly exposed to this procedure during their training since it is not routinely performed. Moreover, available educational resources are particularly restricted to text descriptions or illustrations. Those factors lead to insufficient training of this technique, which is fundamental to the thoracic surgery practice. In this article, we present a step-by-step description of the Abruzzini technique using an intraoperative video recorded with a rigid endoscope. This device allows improved teaching and guidance for every trainee in the operating room and grants further review for educational purposes after the surgery. The media used in the present description was collected from a surgery performed to treat a large right bronchopleural fistula, which was a result of a lung resection secondary to aspergilloma. In this case, an approach through the pleural cavity would not be feasible due to several previous surgeries, so a transsternal approach was planned. The bronchus was successfully closed and the patient did not present any signs of recurrence, with over 1 year of follow-up.
Effect of paclitaxel and methotrexate associated with cholesterol-rich nanoemulsions on ischemiareperfusion injury after unilateral lung transplantation in rats
(2023) BATTOCHIO, Angela; TAVARES, Elaine; CORREIA, Aristides; ALMEIDA, Francine; CARVALHO, Priscila; GUIDO, Maria; PEGO-FERNANDES, Paulo; MARANHAO, Raul; PAZETTI, Rogerio
Robot-assisted thoracoscopic surgery resection of a ground-glass nodule in the right middle lobe
(2023) MINAMOTO, Fabio Eiti Nishibe; MENDES, Guilherme Falleiros; CAMPOS, Jose Ribas Milanez de; GARCIA, Rodrigo Gobbo; TERR, Ricardo Mingarini
Practice patterns and trends in surgical treatment for chronic lung infections: a survey from the Brazilian Society of Thoracic Surgery
(2023) MARIANI, Alessandro Wasum; D'AMBROSIO, Paula Duarte; ROCHA JUNIOR, Eserval; NETO, Antero Gomes; FORTUNATO, Sergio Tadeu Lima; TERRA, Ricardo Mingarini; PEGO-FERNANDES, Paulo Manuel
Background: Chronic lung infections represent a diversity of clinical entities that combined respond to significant public health, particularly in developing countries. However, there is no data regarding the practice patterns, surgeons' preferences, and technological usage, especially among Brazilian surgeons, in the setting of the surgical treatment of chronic lung infections. We, therefore, surveyed Brazilian thoracic surgeons from the Brazilian Society of Thoracic Surgery (SBCT) about practice patterns and trends in surgical treatment for chronic lung infections. Methods: A cross-sectional anonymous survey of all thoracic surgeons from the Brazilian Society was conducted in 2019. As the study was purely descriptive no further statistical evaluation was performed. Results: The responsive rate was 34% (259/766) from 23 of the 26 states in Brazil. A total of 141 (54.4%) participants reported their institution as a surgical reference for chronic infection lung disease, only 13.1% of surgeons have a high-volume service (more than 11 cases operated annually). The majority (76.2%) of respondents performed 1-5 surgical resection to treat tuberculosis (TB) sequelae, but only 62 (30.1%) had performed more than one resection to treat active TB. Chronic lung infection (76%) and hemoptysis (66%) were the most common symptoms as surgical indications. A proportion of 42.2% of the respondents do not have and/or perform routine drug sensitivity tests. In addition, 19.3% of respondents were not familiar with the recommendations of surgery in the treatment of pulmonary TB. Video-assisted thoracoscopic surgery (VATS) is available for 80% of respondents, while robotic surgery is for only 10%. Most (86%) surgeons have access to surgical staplers. Among the structural resources, respiratory isolation beds in the intensive care unit (ICU) (80%) and ward (79%) are frequently available resources. However, less than 12% of surgeons have in their institution a specific operating room for sputum-positive patients. Conclusions: Lung resection for chronic infectious disease is an essential area of activity for thoracic surgeons in Brazil, which occurs mainly in the public sphere, with no concentration of cases per surgeon or institution. The lack of adequate resources in many centers justifies the creation of reference centers for improving care for these patients.
A semi-automated microscopic image analysis method for scoring Ki-67 nuclear immunostaining
(2023) FERNEZLIAN, S. M.; BALDAVIRA, C. M.; SOUZA, M. L. F. de; FARHAT, C.; VILHENA, A. F. de; PEREIRA, J. C. N.; CAMPOS, J. R. M. de; TAKAGAKI, T.; BALANCIN, M. L.; AB'SABER, A. M.; CAPELOZZI, V. L.
Nuclear proliferation marker MIB-1 (Ki-67) immunohistochemistry (IHC) is used to examine tumor cell proliferation. However, the diagnostic or prognostic value of the Ki-67 nuclear staining intensity and location, defined as nuclear gradient (NG), has not been assessed. This study examined the potential association between Ki-67 NG and cell cycle phases and its effect on the prognosis of pulmonary typical carcinoid (PTC) tumors. We propose a method for classifying the NG of Ki-67 during the cell cycle and compare the results between PTC, pulmonary adenocarcinoma (PAD), and breast ductal carcinoma (BDC). A literature review and objective analysis of IHC-stained paraffin sections were used to determine the Ki-67 labeling index and composed a stratification of the NG into NG1, NG2, and NG3/4 categories. A semi-automated image analysis protocol was established to determine the Ki-67 NG in PTC, PAD, and BDC. High intraobserver consistency and moderate interobserver agreement were achieved in the determination of Ki-67 NG in tumor specimens. NG1 and NG2 were lower in PTC than in PAD and BDC. Cox multivariate analysis of PTC after adjusting for age and number of metastatic lymph nodes showed that Ki-67 NG1 and NG2 significantly predicted clinical outcomes. The semi-automated method for quantification of Ki-67 nuclear immunostaining proposed in this study could become a valuable diagnostic and prognostic tool in PTC.
Robotic surgery training
(2023) ARAUJO, Pedro Henrique Xavier Nabuco de; PEGO-FERNANDES, Paulo Manuel
Exploration of a novel prognostic model based on nomogram in non-small cell lung cancer patients with distant organ metastasis: implications for immunotherapy
(2023) WANG, Min; ZHANG, Yong; LIU, Mingchuan; WANG, Yuanyong; NIU, Xiaona; QIU, Dan; XI, Hangtian; ZHOU, Ying; CHANG, Ning; XU, Tianqi; XING, Liangliang; YAMAUCHI, Yoshikane; TERRA, Ricardo Mingarini; TANE, Shinya; MOON, Mi Hyoung; YAN, Xiaolong; ZHAO, Feng; ZHANG, Jian
Background: Evidence for the effects of immunotherapy in non-small cell lung cancer (NSCLC) patients with distant organ metastasis is insufficient, and the predictive efficacy of established markers in tissue and blood is elusive. Our study aimed to determine the prognostic factors and develop a survival prognosis model for these patients.Methods: A total of 100 advanced NSCLC patients with distant organ metastases, who received single or combination immune checkpoint inhibitors (ICIs) in Xijing Hospital between June 2018 and June 2021, were enrolled for retrospective analysis. The major clinicopathological parameters were collected, and associated survival outcomes were followed up by telephone or inpatient follow-up for nearly 3 years to assess prognoses. The survival prognosis model was established based on univariate and multivariate Cox regression analyses to determine the candidate prognostic factors.Results: From the start of immunotherapy to the last follow-up, 77 patients progressed and 42 patients died, with a median follow-up of 18 months [95% confidence interval (CI): 15-19.9]. The median progression-free survival (PFS) and overall survival (OS) were 8 months (95% CI: 5.6-10.4) and 21 months (95% CI: 8.9-33.1), respectively. Multivariate Cox proportional hazards analysis showed Eastern Cooperative Oncology Group performance status (ECOG PS), body mass index (BMI), age-adjusted Charlson comorbidity index (ACCI), lactate dehydrogenase (LDH), and absolute neutrophil count (ANC) were correlated significantly with OS. Based on these five predictive factors, a nomogram and corresponding dynamic web page were constructed with a concordance index (C-index) of 0.81 and a 95% CI of 0.778-0.842. Additionally, the calibration plot and time-receiver operating characteristic (ROC) curve validated the precision of the model at 6-, 12-, and 18-month area under the curves (AUCs) reached 0.934, 0.829, and 0.846, respectively. According to the critical point of the model, patients were further divided into a high-risk total point score (TPS) >258, middle-risk (204< TPS 5258), and low-risk group (TPS 5204), and significant OS differences were observed among the three subgroups (median OS: 4.8 vs. 13.0 vs. 32.9 months).Conclusions: A feasible and practical model based on clinical characteristics has been developed to predict the prognosis of NSCLC patients with distant organ metastasis undergoing immunotherapy.
Use of OctopusTM Tissue Stabilizer for Minimal Manipulation Approach of Bronchial Anastomosis in Lung Transplant
(2023) RAZUK FILHO, Mauro; SANTOS, Samuel Lucas dos; REIS, Flavio Pola dos; ABDALLA, Luis Gustavo; FERNADES, Lucas Matos; PEGO-FERNANDES, Paulo Manuel
Bronchial anastomotic complications are a cause of grave concern for surgeons that perform lung transplantations. There are several risk factors that may lead to this complication, being inadequate surgical technique one of them, specifically regarding adequate exposure and manipulation of the bronchial stump and anastomosis. Here we report the use of OctopusTM Tissue Stabilizer as a mean to allow for a better exposure of the stump and facilitate a ""no-touch"" approach towards anastomosis. Systematic application of devices that facilitate the employment of the correct surgical techniques can have an effect in reducing the incidence of bronchial anastomotic complications.
Endovascular repair of ascending aorta pseudoaneurysm post-extracorporeal membrane oxygenation cannulation during pulmonary transplant
(2023) KANAMORI, Lucas Ruiter; MULATTI, Grace Carvajal; BARROS, Taina Curado Gomes de; ABDALLA, Luis Gustavo; BIHAN, David Costa de Souza Le; LUCCIA, Nelson De
We demonstrated an endovascular technique excluding an ascending aorta pseudoaneurysm using an aortic extension. A 32-year-old woman, 3 years after lung transplantation with extracorporeal membrane oxygenation presented with an ascending aortic pseudoaneurysm. Vascular surgery was consulted after open repair was deemed high risk. An aortic extension stent graft was placed in a hybrid operating room with the aid of intraoperative transesophageal echocardi-ography. Ascending aorta pseudoaneurysms are complex and life-threatening complications. Traditional repair involves high surgical and anesthetic risks whereas endovascular treatment is technically feasible.
Thoracic Surgery
(2022) TERRA, R. M.; JúNIOR, E. R.
Neoplasms originating in chest organs are important not only for their incidence but also for the complexity of their treatment. Given the presence of vital structures such as heart, lung, and great vessels, multidisciplinary treatment is often necessary. Lung cancer is a major concern given its high incidence and lethality, besides being the neoplasm with the significant relation to thromboembolic events. Mediastinal tumors originating in the thymus gland and germinative cell tumors require special attention from the vascular surgeon since their treatment is sometimes composed of complex vascular reconstructions or endovascular therapy beyond the technical knowledge of the thoracic surgeon. Primary pulmonary artery sarcoma, although rare, is an important differential diagnosis for pulmonary thromboembolism and requires adequate surgical treatment for a better prognosis. In this chapter, we review these thoracic neoplasms and their vascular implications. © Springer Nature Switzerland AG 2022.