Treatment of Non-small Cell Lung Cancer by Single-direction Four-hole Complete Video-assisted Thoracoscopic Lobectomy HUANG Jia, ZHAO Xiao-jing, LIN Hao, TAN Qiang, DING Zheng-ping, LUO Qing-quan. (Shanghai Lung Tumor Clinical Medical Center, Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, P. R. China) Corresponding author：LUO Qing-quan, Email：luoqingquan@hotmail. com Abstract： Objective To explore the feasibility and safety of single-direction four-hole video-assisted thoracoscopic lobectomy in the treatment of non-small cell lung cancer (NSCLC). Methods Between January 2007 and December 2010, 428 patients with NSCLC were surgically treated by single-direction complete video-assisted thoracoscopic lobectomy in Shanghai Chest Hospital. There were 186 males and 242 females; aged 33 to 78 years. All the patients were diagnosed as primary NSCLC at early clinical stage. Among the 428 patients, 134 patients underwent right upper lobectomy, 48 patients underwent right middle lobectomy, 98 patients underwent right lower lobectomy, 4 patients underwent right middle and lower lobectomy, 72 patients underwent left upper lobectomy, and 72 patients underwent left lower lobectomy. All the 428 patients were divided into two groups according to their surgical approach：a three-hole group (300 patients) and a four-hole group (128 patients).The clinical results of the two groups were analyzed. Results A total of 412 patients underwent complete video-assisted thoracoscopic lobectomy, and 16 patients (3.7%) underwent conversion to open surgery. The average operation time was 132.1 (120-180) min, average length of incision was 3.7 (3-5) cm, and average blood loss was 150.0 (50-800) ml. There was no statistical difference in extubation time, intraoperative blood loss, and postoperative hospital stay between the two groups. But the operation time of the four-hole group is significantly shorter than that of the three-hole group （P＜0.05）. The 16 patients who underwent conversion to open surgery received intraoperative blood transfusion. Five patients died of severe pulmonary infection, pulmonary embolism, and acute cerebral infarction. Fifty two patients had squamous cancer, 340 patients had adenocarcinoma, 20 patients had adenosquamous carcinoma, 8 patients had poorly differentiated carcinoma, 6 patients had big cell lung cancer, and 2 patients had carcinoid. Postoperative persistent lung air leak occurred in 4 patients, thoracic empyema in 2 patients, pulmonary infection in 4 patients, arrhythmia in 26 patients, pulmonary embolism in 2 patients, chylothorax in 2 patients, and acute cerebral infarction in 2 patients. The overall 3-year survival rate was 83.6%（358/428）. Conclusion Single-direction four-hole complete video-assisted thoracoscopic lobectomy is feasible, safe and consistent with the operation standard in the surgical treatment for NSCLC patient. It is also helpful to reduce the operation time and facilitate lymph node dissection. Key words： Video-assisted thoracoscopic surgery； Lobectomy； Single-direction； Four-hole； Non-small cell lung cancer
Objective To investigate the clinical value of using videoassisted thoracoscopic lobectomy（VATS lobectomy） to treat primary nonsmall cell lung cancer(NSCLC) so that the videoassisted thoracoscopic surgery(VATS) can be better used in clinic. Methods From September 2007 to December 2008, seventysix NSCLC patients were collected. Thirtyseven patients underwent VATS lobectomy(VATS group), 21 male and 16 female with an average age of 60.4 years. Among them 20 underwent videoassisted minithoracotomy lobectomy, and 17 underwent total thoracoscopic lobectomy. Thirtynine patients underwent conventional thoractomy(conventional thoracotomy group), 32 male and 7 female with an average age of 58.7 years. Perioperative clinical and laboratory parameters of the two groups were compared. Results There was no severe complication and perioperative mortality in both groups. There were statistical significances between VATS group and conventional thoracotomy group in incision length (7.6±1.9 cm vs. 28.5±3.6 cm, t=-31.390,P=0.000), postoperative dosage of dolantin(160±125 mg vs.232±101 mg，t=-2.789,P=0.007), postoperative chest tube time(chest tube output＞100ml,4.8±2.5 d vs. 8.1±3.2 d，t=-4.944,P=0.000） and postoperative hospitalization time(12.1±3.0 d vs. 15.7±4.7 d，t=-3.945,P=0.000). There was no statistical significance between two groups in operation time（t=1.732，P=0.087）, intraoperative blood loss（t=-1.645，P=0.105） and the number of lymph node dissection（t=-0.088，P=0.930）. The total hospitalization expenses in VATS group were higher than that in conventional thoracotomy group, but there was no statistical significance（t=1.303，P=0.197）. The serum levels of glucose at 1st day after operation（7.2±1.2 mmol/L vs. 8.4±2.2 mmol/L, t=5.603,P=0.000）and the total count of white blood cell (12.7±3.8×10.9/L vs. 15.1±5.9×10.9/L,t=5.082,P=0.004) in VATS group were significantly lower than that in conventional thoracotomy group. The prealbumin(PA) level in VATS group was significantly higher than that in conventional thoracotomy group（215.0±45.5 mg/L vs.147.3+50.8 mg/L,t=-7.931,P=0.000). Conclusion VATS lobectomy could clean lymph node completely. Its advantages include less postoperative trauma, lower acute phase response, mild pain, rapid recovery, shorter hospitalization time and less economic burden. It could be an operation approach for early NSCLC patients who have been strictly selected.
Abstract： Objective To find out goodness and weakness by comparing totally thoracoscopic surgery （TTS）and median sternotomy （MS）with cardiopulmonary bypass for pediatric open heart operation. Methods One hundred and fortyseven patients with ventricular septal defect(VSD) and atrial septal defect(ASD) were randomly divided into two groups according to operative methods, TTS group: patients were operated by totally thoracoscopy; MS group: patients were operated by median sternotomy with cardiopulmonary bypass. The clinical records from two groups were compared on operative effect, complications, hospitalization, ventilation time,variations of main data of blood routine test, drainage of pleura cavity, blood loss and transfusion, and pulmonary function. Results There were no death in two groups. There was VSD residual leak the same day after operation which was cured by TTS in one patient of TTS group. There was one case which bleeding was stopped by second operation in MS group. Followup visit were made to 41 patients for 3 months, no heart murmur was detected. The ultrasonic cardiography (UCG) showed that correcting of VSD and ASD were good and had no residual leak. The hospitalization,aortic clampping time, ventilation time and variations of main data of blood routine test, drainage of pleura cavity, blood transfusion and blood loss in TTS group had no significant difference to those in MS group (Pgt;0.05). Operating times was longer in TTS group than that in MS group, while stays in the intensive care unit were shorter in TTS group than that in MS group (Plt;0.01). Preoperative and 3 months postoperative pulmonary function of both teams had no statistically significant difference in two groups (Pgt;0.05). Conclusion TTS is a safe and effective method to pediatric VSD and ASD as MS is.
ObjectiveTo compare the perioperative efficacy and safety of robot-assisted thoracoscopic surgery (RATS) and uniportal video-assisted thoracoscopic surgery (UVATS) in the lobectomy for early lung adenocarcinoma.MethodsClinical data of 70 early lung adenocarcinoma patients, receiving RATS or UVATS lobectomy by the same surgical team in our hospital from November 2018 to May 2020 were retrospectively analyzed. There were 24 males and 46 females with an average age of 59.3±8.9 years. According to different surgical methods, the patients were divided into a RATS group (31 patients) and a UVATS group (39 patients). The operation time, intraoperative blood loss, postoperative hospital stay, indwelling time, drainage volume, number of lymph node dissected, stations of lymph node dissected and perioperative complications were compared between the two groups.ResultsThere was no conversion to thoracotomy or perioperative death in both groups. There was no significant difference in intraoperative blood loss, postoperative hospital stay, indwelling time of thoracic drainage tube, thoracic drainage volume or stations of lymph node dissected between the two groups (P>0.05). There was no significant difference in the incidence of pulmonary infection, persistent lung leakage, chylothorax, arrhythmia or overall complications between the two groups (P>0.05). The operation time of the RATS group was longer than that of the UVATS group (195.8±52.8 min vs. 154.0±43.1 min, P=0.001). The number of lymph node dissected in the RATS group was more than that of the UVATS group (P=0.016).ConclusionBoth RATS and UVATS are safe and feasible in the treatment of lung cancer. The number of lymph nodes removed by RATS is significantly more than that of UVATS.
Uniportal video-assisted thoracic surgery (UniVATS) is a significant approach of mini-invasive surgery for lung cancer. UniVATS was first used for treatment of lung cancer in 2010. The European consensus and the Chinese consensus were published in 2019 and 2020 respectively. The latest Chinese consensus included the definition of UniVATS, indications for lung cancer treatment, safety and feasibility, surgical skills, learning curve, short-term and long-term results, providing suggestions for the standardization of uniportal video-assisted thoracic surgery, which are essential to improve the quality of surgery and reduce the incidence of related complications. The Chinese consensus also summarized the current status of subxiphoid UniVATS and non-intubated UniVATS for lung cancer. Considering the technical difficulties and challenges, the application of both technologies in clinical treatment has certain limitation. This article aims to give an interpretation of the results of the Chinese consensus and the similarities and to compare the differences with the European consensus, and to provide a reference for the majority of thoracic surgery colleagues.
Objective To explore the advantages of postoperative chest drainage with 16F urinary catheter for video- assisted thoracoscopic surgery (VATS) lobectomy. Methods Data of 102 patients (October to December 2015) who under- went VATS lobectomy of lung disease with insertion of catheter (16 F urinary catheter or 28 F chest tube) were analyzed. The patients were divided into two groups including a 16F group (49 patients, with 16 F urinary catheter) and a 18F group (53 patients, with 18F chest drainage tube).The following post-operative data were evaluated: primary healing of tube inci- sion, chest X ray abnormalities (pneumothorax, pleural effusion, subcutaneous emphysema, and hematoma), drainage time, re-insert the drainage tube, and wound healing at the site of insertion. Results Both groups were similar in age, gender, co-morbidity and pathological evaluation of resected specimens. After adjustment, no statistically significant difference was found between the two groups in pulmonary complications (30.6% vs. 28.3%, P=0.102), subcutaneous emphysema (60.0% vs. 6.7%, P=0.011), required intervention (2.0% vs. 5.7%, P=0.048). The average total drainage volume in the 16F group (587.3±323.7 ml) was less than that of the 28 F group (824.1±444.3 ml, P=0.000). The rate of primary healing at the site of insertion in the 16 F group (100.0%) was higher than that in the 28F group (58.5%, P=0.014). A significant difference was found in the drainage time and post-operative length of stay between the two groups (54.2±28.6 h vs. 95.6±65.5 h，4.2±1.4 d vs. 6.5±3.0 d). Conclusion Since 16F urinary catheter has advantage in fast track rehabilitation and low risk of pulmonary complications, the use of 16F urinary catheter is appropriate after VATS pulmonary lobectomy.
Objective To explore the minimal invasiveness and practability of combined video-assisted thoracic surgery (VATS) with two trocars and endoscopic ultrasonography (EUS) in the treatment of esophageal leiomyoma. Methods Between February 2007 and February 2012, we retrospectively analysed the clinical data of 166 patients who underwent various surgeries for the treatment of esophageal leiomyoma. Among them, 62 received routine thoracotomy (group A), 49 accepted conventional VATS surgery with three trocars (group B), and 55 underwent combined VATS surgery with two trocars and EUS (group C). Then, we summarized the clinical indexes of patients in all the three groups for further comparative analysis. Results There was no significant difference among the three groups in age, gender, and lesion location, origin level and size (P > 0.05). There were significant differences between group A and C in blood loss, surgery time, intraoperative localization, postoperative incision pain, hospitalization expenses, length of hospital stay, fasting time, pulmonary infection, and the complications during the follow-up (P < 0.05). There were significant differences between group C and B in blood loss, surgery time, intraoperative localization, fasting time and pulmonary infection (P < 0.05). Conclusion Combined VATS surgery with two trocars and EUS is safe, minimally invasive, thorough with few complications, which is worthy of clinical promotion.
ObjectiveTo investigate the efficacy of total thoracoscopy (VATS) lobectomy and the thoracotomy for the treatment of benign lung disease. MethodsWe retrospectively analyzed the clinical data of 70 patients with benign lung diseases in the First People's Hospital of Qujing between January 2012 and September 2013. According to the surgical way, the patients were divided into two groups including a total VATS group involved in 35 patients with 25 males and 10 females, aged 18 to 71 years, mean age of 41.3±6.4 years and a thoracotomy group involved in 35 patients with 26 males and 9 females, aged 19 to 72 years, mean age of 42.4±5.6 years. Then we compared the efficacy of the two groups. ResultsThere was no statistical difference (P > 0.05) in operative time and postoperative survival rate comparison. While in the total VATS group, the total thoracoscopic incision length, bleeding volume or pain time, postoperative day time of analgesia, thoracic drainage volume, postoperative drainage tube pulling time and hospitalization time were all lower than those in the thoracotomy group with statistical differeces (P < 0.05). ConclusionThe thoracoscopic lobectomy for treatment of benign pulmonary lesions is superior to the conventional thoracotomy with much less bleeding and pain, more faster postoperative recovery and less impact on the patient's body. It's suitable for clinical application in normal hospital.
ObjectiveTo investigate the feasibility and clinical effect of controlled hypotension in 3 cm single-port video-assisted thoracoscopic surgery (VATS) for the lymph node group 7 dissection in the left lung resection. MethodsWe retrospectively analyzed the clinical data of 37 patients with lung cancer who underwent 3 cm single-port VATS from May 2015 to August 2015 in Tongji Hospital, and systolic blood pressure of 12 patients (7 males, 5 females, average age of 58.3 years, range 42-69 years) was controlled between 80-90 mm Hg by nitroglycerin or sodium nitroprusside while the pressure of 25 patients (14 males, 11 females, average age of 57.7 years, range 43-68 years) was not controlled when receiving lymph node group 7 dissection. ResultsControlled hypotension in lymphadenectomy achieved satisfactory results. The lymphadenectomy time of 12 patients with controlled hypotension (18.5±4.3 min on average, range 15.6-25.3 min) was shorter than that of 25 patients without controlled hypotension (24.3±5.1 min on average, range 18.2-29.8 min); the difference was statistically significant (P<0.05). ConclusionControlled hypotension is a simple and feasible method that increases the operating space, and reduces the difficulty of cleaning lymph nodes and the risk of bleeding.
The precise localization of pulmonary nodules has become an important technical key point in the treatment of pulmonary nodules by thoracoscopic surgery, which is a guarantee for safe margin and avoiding removal of too much normal lung parenchyma. With the development of medical technology and equipment, the methods of locating pulmonary nodules are also becoming less trauma and convenience. There are currently a number of methods applied to the preoperative or intraoperative localization of pulmonary nodules, including preoperative percutaneous puncture localization, preoperative transbronchial localization, intraoperative palpation localization, intraoperative ultrasound localization, and localization according to anatomy. The most appropriate localization method should be selected according to the location of the nodule, available equipment, and surgeon’s experience. According to the published literatures, we have sorted out a variety of different theories and methods of localization of pulmonary nodules in this article, summarizing their advantages and disadvantages for references.