Ligature thermo-fusion de l'artère pulmonaire dans les lobectomies par thoracoscopie. « From bedside to bench and back to bedside. » Étude prospective internationale, multicentrique, de phase 2 portant sur l'utilisation de l'énergie ultrasonique lors de la ligature de l'artère pulmonaire durant une lobectomie par thoracoscopie et l'analyse coût – efficacité

 

Moishe Liberman

Centre de recherche du Centre hospitalier de l'Université de Montréal

 

Domaine : cancer  (techniques, mesures et systèmes)

Programme chercheurs-boursiers-cliniciens - Senior

Concours 2017-2018

Lobectomy is the primary treatment strategy for operable early stage lung cancer. Video Assisted Thoracoscopic Surgery (VATS) anatomical lung resection (lobectomy) provides an effective minimally invasive treatment strategy for stage I and II lung cancer. VATS lobectomy is associated with significantly less postoperative complications, decreased length of stay, earlier return to pre-operative baseline and increased tolerance for adjuvant chemotherapy compared to lobectomy using standard chest incisions (thoracotomy).

Although VATS lobectomy has been proven to be effective, it is not devoid of complications. These complications, when related to major bleeding from pulmonary arterial (PA) branches, can be catastrophic. Currently, a minority of anatomical pulmonary resections are being performed by VATS. We believe that if we can decrease the manipulation on the PA branches, we can make these procedures safe and therefore more commonly utilized for lung resection.

VATS lobectomy is currently being performed using endoscopic staplers for PA branch ligation and separation. Ultrasonic devices transform electrical energy to mechanical energy through a piezoelectric crystal located at the tip of the instrument. These devices have a low profile, are easier to manipulate and are theoretically safer when applied to small, short vessels compared to endostaplers. Our laboratory has shown that these devices are safe in both animal and human studies.

The proposed research program consists of a prospective, multi-institutional Phase 2 trial and an economic cost-effectiveness analysis for the use of energy in VATS lobectomy compared to traditional techniques.  Our group has already completed and is in the progress of completing 7 related studies on this specific application of technology and technique. A total of 15 sites have been chosen in Canada, the US and Europe and 150 patients will undergo this technique in the study. Funding has been secured for this study from Johnson and Johnson.