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Dures, from lobectomy to wedge resection. 7 , 9 one procedure might involve a 6-cm incision and one 12-mm port, whereas another might need 3 12-mm ports. By minimizing the invasiveness of lobectomy, could pain management be simplified further? Buy cheap viagra Experience tells us that the majority of patients rarely complain of wound pain after a vats lobectomy. generic viagra canada Thus, we postulated that an epidural catheter was unnecessary. viagra online canada Coincidentally, we encountered some cases in which epidural catheters could not be placed (e. Generic viagra online G. , patient refusal, abnormal coagulation profile, medicinal anticoagulation, and bony spinal abnormalities). canada mail viagra 4 , 5 in these patients, the postoperative course without tea was uneventful; therefore, it is apparent that vats lobectomy does not require tea. Consequently, we concluded that no randomized study was needed, and we decided to retrospectively investigate the requirement for an epidural catheter after vats lobectomy. Buy generic viagra online Patients and methods from january to december 2007, 30 consecutive patients who underwent vats lobectomy for various thoracic diseases were examined retrospectively. canada pharmacy viagra All patients who were scheduled to undergo vats lobectomy and consented to avoid epidural catheter placement were eligible for the study. Patients undergoing minor lung resection such as wedge resection and segmentectomy were excluded, as were any patients requiring rib spreading. Buy viagra cheap Each patient was informed that their clinical data may be used in studies, and consent was obtained on this basis. viagra for sale in canada We analyzed whether vats lobectomy under certain conditions can be completed without thoracic epidural analgesia. The patient was placed in the lateral decubitus position. A working port measuring 4␓7 cm in length was made in the 4th or 5th intercostal space. viagra canada drugs We usually decide the length of the utility access incision on the basis of the size of specimen to be removed and the operating technique, while adhering to the principle of not spreading the intercostal space or cutting intercostal muscle to a length (for the working port) equal to the skin incision. Additional 12-mm thoracic ports were made in the 7th intercostal space in the anterior axillary line or the 9th intercostal space in the posterior axillary l. canada viagra online generic viagra canada

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