MUSCLE SPARING THORACOTOMY

Prof. Abdulsalam Y Taha

School of MedicineUniversity of Sulaimani

Iraq

https://sulaimaniu.academia.edu/AbdulsalamTaha

INTRODUCTION Thoracic Surgery in Sulaimani Teaching

Hospital was began in 2003 Thoracic Surgeons in 2009: 3 The standard technique: Posterolateral

thoracotomy. Occasionally: partial muscle sparing

thoracotomy.

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OUR PROJECT To introduce and popularize MUSCLE

SPARING THORACOTOMY. WHY? Good impact on patient care. Realistic. Team of Surgeons & Anaesthetists.

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MUSCLE SPARING THORACOTOMY

MUSCLE SPARING THORACOTOMY

FEATURES:● Small.● No muscle cutt ing.● No impairment of shoulder or arm mobil i ty.● Less painful.● Less postop Resp complications.● Shorter hospital stay.● Better cosmetic result.● Preserved Latissimus dorsi m.□ Limited Exposure.

TECHNIQUES OF ONE LUNG VENTILSTION

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VASCULAR & BRONCHIAL STAPLERS

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STAPLED STRUCTURES

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POSTEROLATERAL THORACOTOMY

FEATURES:1. Big2. Muscle cutting3. Time consuming4. Severely painful5. Impaired arm & shoulder movement6. Bad cosmetic result7. Longer hospital stay8. Increased cost9. No lattisimus dorsi available for flap in future.10. Postop scolioses in children.11. Excellent exposure.

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STAKEHOLDERS Powerful but less

interested Administration.

Powerful & Interested

SURGEONS.+_ ANAESTHETISTS.

+_ Manufacturing Co. + Little Interest &

Power Nursing Staff.

Interested but less powerful

Patients.+

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PLAN OF IMPLEMENTATION Time table: 3 months. Communication with stakeholders:

surgeons, anaesthetists, administrator & companies.. different messages.

Equipments to be requested & made ready in reasonable time.

Training: surgeons & anaesthetists. Audit.

Surgeons Familiar with the technique. welcome it.

Share their experience. Unfamiliar with it: motivated to do it. Training: observing a colleague or

visiting a specialized centre. Selecting uncomplicated case to start

with..

Anaesthetists The short supply of equipments should

be solved. Meanwhile: consolidating the

experience of the trained..DLT for every adult pt.

Training the junior anaesthetists. Motivating them: training course

abroad.

ADMINISTRATION & Companies

In view of anticipated improvement in patient's care & cost saving; should be interested.

Role: to get the equipments & training opportunities..

Co.. Best deals to provide the best products for best prices & training of staff.

THREATS Reluctant training.. Motivation. Equipments may not be ready in time.. Complications: bleeding. Patient's

safety should not be compromised. Whenever

exposure is inadequate, never hesitate to extend the incision.

CONCLUSIONS To be well exposed, it is half the success of a

surgical procedure. With adequate deflation of underlying lung,

most thoracic procedures can be performed safely through a limited incision.

Muscle sparing thoracotomy is easy to perform with appropriate attention to chest wall anatomy.

Evidence from Literature

1. M Ashour. Modified muscle sparing posterolateral thoracotomy. Thorax 1990; 45: 935-938.

2. Posterior ( auscultatory triangle) Muscle sparing thoracotomy.

3. A. J. Jawad. Experience with modified posterolateral muscle-sparing thoracotomy in neonates, infants, and children.Paediatric Surgery International. Volume 12, Numbers 5-6/ July, 1997.

4. Nicolas Dürrleman and Gilbert Massard. Posterolateral thoracotomy. MMCTS (August 10, 2006).

TAKE HOME MESSAGE

BIG SURGEONS NOT

NECESSARLY DO

BIG INCISIONS.