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Pleurodesis with Thulium Cyber Laser versus talc poudrage: a comparative experimental study

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Abstract

Sclerosing fluids to achieve pleurodesis could be hardly replaced for bed-side procedures, but other devices may be successfully applied during thoracoscopy. Thulium Cyber Laser was experimented for this purpose and compared to talc poudrage. Twenty pigs underwent operative videothoracoscopy (VATS). Ten models were subjected to double-port VATS and parietal pleura photoevaporation using Thulium Cyber Laser™ (TCL) 150 W 2010 nm on the posterior third of three ribs; the pleural surface was homogeneously treated inside the target perimeter. The remaining ten pigs underwent uniportal thoracoscopy; talc poudrage was performed using the current clinical practice dosage (1 g/18 kg) with accurate talc powder spread over the whole pleural surface. All models were followed up for 60 days. Pleurodesis firmness was graded on a three-tier scale (none-moderate-firm) and site-matching topographical expectancy was evaluated. TCL produced pleurodesis in all models: 7/10 were firm and 3/10 moderate. Talc poudrage pleurodesis was firm in 4/10 and moderate in 6/10. Pleural adhesions were found exclusively in the treated area after laser treatment, while talc created a wide spectrum of effects, most commonly anarchic jagged adhesions obliterating less than 50 % of the pleural cavity (7/10), mostly declivous. The pathologist found more aggressive inflammation (sometimes severe) in the talc group. Expected localized pleurodesis was always registered in laser group (10/10), while talc poudrage was found poorly effective if consistent pleurodesis is expected in an apico-dorsal position (2/10). Laser pleurodesis appears more homogeneous, qualitatively not inferior, and topographically more predictable than talc pleurodesis. Parietal photoevaporation seems effective and the localized pleurodesis is reproducible.

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References

  1. Light RW (2013) Pleural diseases, 6th edn. Lippincott, Williams and Wilkins, Baltimore

    Google Scholar 

  2. Light RW (2013) New agents for pleurodesis. Curr Respir Care Rep 2:88–92

    Article  Google Scholar 

  3. Marcheix B, Renaud C, Lamarche Y, Mugniot A, Benouaich V, Berjaud J, Dahan M (2007) Videothoracoscopic silver nitrate pleurodesis for primary spontaneous pneumothorax: an alternative to pleurectomy and pleural abrasion? Eur J Cardiothorac Surg 31(6):1106–1109

    Article  PubMed  Google Scholar 

  4. Bresticker MA, Oba J, LoCicero J 3rd, Greene R (1993) Optimal pleurodesis: a comparison study. Ann Thorac Surg 55:364–366

    Article  CAS  PubMed  Google Scholar 

  5. Light RW (2000) Talc should not be used for pleurodesis. Am J Respir Crit Care Med 162(6):2024–2026

    Article  CAS  PubMed  Google Scholar 

  6. Gossot D, Galetta D, Stern JB, Debrosse D, Caliandro R, Girard P, Grunenwald D (2004) Results of thoracoscopic pleural abrasion for primary spontaneous pneumothorax. Surg Endosc 18(3):466–471

    Article  CAS  PubMed  Google Scholar 

  7. Duarte FJ (2008) Tunable laser applications. CRC Press, Boca Raton, p214. ISBN 1-4200-6009-0.

  8. Maskell N, British Thoracic Society Pleural Disease Guideline Group (2010) British Thoracic Society Pleural Disease Guidelines—2010 update. Thorax 65(8):667–669

    Article  PubMed  Google Scholar 

  9. Bufalari A, De Monte V, Pecoriello R, Donati L, Ceccarelli S, Cagini L, Ragusa M, Vannucci J (2015) Experimental left pneumonectomy in pigs: procedure and management. J Surg Res 198(1):208–216

    Article  PubMed  Google Scholar 

  10. Gary Lee YC, Melkerneker D, Thompson PJ, Light RW, Lane KB (2002) Transforming growth factor beta induces vascular endothelial growth factor elaboration from pleural mesothelial cells in vivo and in vitro. Am J Respir Crit Care Med 165(1):88–94

    Article  CAS  PubMed  Google Scholar 

  11. Kuschel TJ, Gruszka A, Hermanns-Sachweh B, Elyakoubi J, Sachweh JS VJS, Vhhw J, Sa JF, Schnoering H (2013) Prevention of postoperative pericardial adhesions with TachoSil. Ann Thorac Surg 95(1):183–188

    Article  PubMed  Google Scholar 

  12. Neumann PJ, Weinstein MC (2010) Legislating against use of cost-effectiveness information. N Engl J Med 363(16):1495–1497

    Article  PubMed  Google Scholar 

  13. Marulli G, Droghetti A, Di Chiara F, Calabrese F, Rebusso A, Perissinotto E, Muriana G, Rea F (2013) A prospective randomized trial comparing stapler and laser techniques for interlobar fissure completion during pulmonary lobectomy. Lasers Med Sci 28(2):505–511

    Article  PubMed  Google Scholar 

  14. Sepehripour AH, Nasir A, Shah R (2012) Does mechanical pleurodesis result in better outcomes than chemical pleurodesis for recurrent primary spontaneous pneumothorax? Interact Cardiovasc Thorac Surg 14(3):307–311

    Article  PubMed  Google Scholar 

  15. Bobbio A, Ampollini L, Internullo E, Caporale D, Cattelani L, Bettati S, Carbognani P, Rusca M (2006) Thoracoscopic parietal pleural argon beam coagulation versus pleural abrasion in the treatment of primary spontaneous pneumothorax. Eur J Cardiothorac Surg 29(1):6–8

    Article  PubMed  Google Scholar 

  16. Torre M, Grassi M, Nerli FP, Maioli M, Belloni PA (1994) Nd-YAG laser pleurodesis via thoracoscopy. Endoscopic therapy in spontaneous pneumothorax Nd-YAG laser pleurodesis. Chest 106(2):338–341

    Article  CAS  PubMed  Google Scholar 

  17. Daddi N, Vannucci J, Maggio C, Giontella A, Bravi I, Marziani F, Capozzi R, Ragusa M, Bufalari A, Puma F (2011) Efficacy of tigecycline pleurodesis: a comparative experimental study. J Surg Res 169(2):e109–e118

    Article  CAS  PubMed  Google Scholar 

  18. Vannucci J, Droghetti A, Bufalari A, De Monte V, Bellezza G, Bianconi F, Pecoriello R, Daddi N, Moriconi F, Puma F (2016) Effectiveness and predictability of pleurodesis with the Tachosil® surgical patch compared with talc poudrage: an experimental study. Eur J Cardiothorac Surg doi:10.1093/ejcts/ezw118 [Epub ahead of print].

  19. Lang-Lazdunski L, Chapuis O, Bonnet PM, Pons F, Jancovici R (2003) Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax: long-term results. Ann Thorac Surg 75(3):960–965

    Article  PubMed  Google Scholar 

  20. Argote-Greene LM, Chang MY, Sugarbaker DJ (2005) Extrapleural pneumonectomy for malignant pleural mesothelioma. MMCTS (0628), mmcts-2004. doi: 10.1510/mmcts.2004.000133

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Acknowledgments

The study was supported by a free donation from Quanta System S.p.A. Solbiate Olona, VA, Italy. The authors acknowledge the invaluable work of all our fellows and the outstanding participation of Tiziana Zambon. Special thanks to all technical assistants especially Mariano Rosati for his devotion for animal care.

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    Authors and Affiliations

    1. Thoracic Surgery Division, Carlo Poma Hospital, via Lago Paiolo n°10, 46100, Mantova, Italy

      Andrea Droghetti, Maria Caterina Bottoli & Michele Giovanardi

    2. Thoracic Surgery Unit, University of Perugia Medical School, Perugia, Italy

      Jacopo Vannucci & Francesco Puma

    3. Department of Veterinary Medicine, University of Perugia, Perugia, Italy

      Antonello Bufalari, Valentina De Monte & Franco Moriconi

    4. Institute of Pathological Anatomy and Histology, University of Perugia Medical School, Perugia, Italy

      Guido Bellezza

    5. Thoracic Surgery Division, University of Padova, Padova, Italy

      Giuseppe Marulli

    6. Medical Oncology Division, Santa Maria della Misericordia Hospital, Perugia, Italy

      Verena De Angelis

    7. Thoracic Surgery, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy

      Niccolò Daddi

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    1. Andrea Droghetti
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    2. Jacopo Vannucci
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    3. Antonello Bufalari
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    4. Guido Bellezza
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    5. Valentina De Monte
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    6. Giuseppe Marulli
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    7. Maria Caterina Bottoli
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    12. Francesco Puma
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    Correspondence to Andrea Droghetti.

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    Authors declare no conflict of interest.

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    Andrea Droghetti and Jacopo Vannucci contributed equally to this work.

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    Droghetti, A., Vannucci, J., Bufalari, A. et al. Pleurodesis with Thulium Cyber Laser versus talc poudrage: a comparative experimental study. Lasers Med Sci 31, 1407–1413 (2016). https://doi.org/10.1007/s10103-016-2002-z

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    • DOI: https://doi.org/10.1007/s10103-016-2002-z

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