#thoracotomy

In this article, we will discuss Clamshell Thoracotomy (Case report). So, let’s get started. Schwannomas (neurilemmomas) are benign tumors arising from the Schwann cells of the neural sheath. They are typically well-encapsulated lesions and in the chest they are most commonly seen within the posterior mediastinum, often originating along the intercostal nerves. Several operative approaches have…

This past September, I caught a cold and went to an urgent care center to see if I actually had COVID. Test was negative, but the doctor said I had bronchitis. No big deal, right? I used to get that type of stuff all of the time when I was young. About a week later, I went in to work and had to leave about an hour later since I felt like I couldn’t breathe. I had progressively been getting worse so I assumed I had COVID and that last test wasn’t right. I went to a different urgent care, and I was immediately put on oxygen. They did a COVID test (negative) and an X-ray. The X-ray showed that my entire left lung was whited out, and said they needed to call an ambulance to take me to the hospital (only 6 miles away 🙄). While at the hospital, they put in a chest tube. The doctor had told me that they didn’t get many people needing chest tubes and I would probably be sent to a bigger hospital. That was pretty much the last thing I remember before waking up in a hospital in Tulsa, OK....6 days later.

I was so confused and still highly medicated, and started begging for them to call my mom. I also was convinced that she had sent me there for punishment, and that they had taken me into outer space to do it. I hurt everywhere, didn’t understand why there were so many manchines, etc. My mom got there and explained what she could. I had been life flighted and put on life support. I went septic and had a thoracotomy to drain and clean out that lung. I had 3 chest tubes at that point. I had lost most function of my hand. I was on life support for 6 days and was told that they didn’t think I was going to survive that first night.

I spent 20 days in, was sent home, then came back 4 days later because I couldn’t breathe. I was admitted and spent another 14 days. At least I got to spend time with my daughter on her birthday when I was home those short 4 days. Altogether during those 34 days, I had a thoracotomy, thoracentisis, 6 chest tubes, a JP tube (draining from my stomach), 256 X-rays, 1 MRI, and 30 something CTs. They diagnosed me with Necrotizing Pneumonia, Necrotizing Pancreatitis, and they found a large pseudocyst. The pseudocyst went from behind my liver, up through a hole in my diaphragm, and was pushing up against my esophagus. I was sent home with IV antibiotics and I’m now on a 24 hour one while still going to work and taking care of my kids.

Which brings us to today. I started coughing up blood on January 2. Its been a constant, all day, bright red blood anywhere from the size of a quarter to a handful if I have a coughing fit. I spent this month going back and forth to see 4 of my doctors. I had a couple of CTs, xrays, labs, and a bronchoscopy. The doctors all said everything looks great and is getting better, but my left lobe is what is causing the blood. They believe it was just damaged too much during the previous stay.

I’m ready to get this over with. I’m also dreading the pain. They will go through my same scar that goes from under my armpit, around to about an inch away from my spine. It is still very tender. I’m not looking forward to the discomfort of the tubes, the box I have to carry around, the walks you have to take while in pain, the feel of the tubes being yanked out, etc. With how sick I was, I was told it would take at least a year of recovery. I’m just hoping this is my last surgery.

Anyways, wish me luck!

Ashley

An American high-tech company has developed an automatic rib retractor that limits the patient's post-operative pain and improves tissue regeneration. High torque maxon motors ensure smooth movement of the device. 

As incredible as this sounds to you, some of the instruments used in invasive surgery today were developed in the 1930s and have not been fundamentally improved since. In most cases, these tools are suitable for the intended task, even if the healing takes a long time. This is true in particular during thorax operations, such as cardiac or pulmonary operations, for example.

Two methods are currently used to open the rib cage wide enough for the doctor to operate inside: thoracotomy (incision of the rib cage) and sternotomy (rectilinear incision of the sternum). A thoracotomy surgical instrument set provides access to the inside of the rib cage through an incision made between two ribs. 

In a sternotomy, on the other hand, the surgeon makes a straight incision in the breastbone to open the rib cage. In both cases, the surgeon separates the ribs or both parts of the sternum using a device consisting of a rack equipped with a crank and a positioning pawl. But the separation of the ribs requires significant forces.

The development team at the American company Physcient discovered that the force required to spread the ribs is roughly equivalent to the patient's weight. Therefore, the use of a retractor can mean broken bones, trapped nerves, distended joints and sprains, all of which can lead to lasting post-operative injury. Physcient (Durham, North Carolina) has developed techniques that dramatically reduce injuries caused by the spreading of the rib cage

Chuck Pell, co-founder with Hugh Crenshaw of Physcient, explains: “Our goal was to solve two main problems. On the one hand, our retractor should not exceed the dimensions of the other devices used in the operating room. On the other hand, it had to withstand extremely frequent sterilizations. ”

"Physcient's Assuage ™ Smart Retractor ™ was developed to solve a long-known problem using new technologies, without changing the work of surgeons." Pell adds, “We both studied biomechanics. We therefore try to translate our knowledge of the movement of living creatures into technical devices. We have recently taken an interest in surgical instruments.

Surgery still uses today many instruments manufactured before biomechanics acquired its letters of nobility. " According to the National Heart, Lung, and Blood Institute, more than half a million heart operations take place each year. If we add another hundred thousand pulmonary interventions, the need for better adapted surgical instruments is obvious. 

The number of rib fractures is steadily increasing due to the obsolete construction of rib retractors and the increasing number of operations.

Crenshaw and Pell found that the forces applied by rib spreaders have received little research; they therefore formed a team to measure the effects of retractors and develop a technology intended to reduce the injuries they cause. Bones are flexible and can undergo significant curvatures before breaking. But this parameter depends on the speed at which the spreader moves.

If a rib experiences a sharp bend - as often happens with a crank spreader - it can break. It is because the extension of bone fibers can only take place very gradually. The sensors integrated into the Assuage ™ automatic rib spreader make it very easy to detect any instability in the fibers.

This information is then fed back to the instrument, which immediately responds to conditions found in the tissue. This motor feedback control circuit must be extremely precise and absolutely reliable in order to be able to be used in medical devices.

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Open Thoracotomy (Viewer Discretion Advised)

VIEWER DISCRETION ADVISED:  This video is very graphic.  An open thoracotomy is performed on a motorcycle accident victim who was initially talking at the scene and became unresponsive and lost his vital signs in the ambulance minutes away from the hospital.  A heroic attempt was made to save his life.  Unfortunately, despite return of spontaneous circulation the patient died in the operating room.

Having people fuck with your ribs is the worst and don't let anyone tell you different.