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.
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.
ObjectiveTo explore the reliability and safety of continuous monitoring of vital signs in patients using wireless wearable monitoring devices after video-assisted thoracoscopic surgery (VATS) for lung cancer. MethodsThe patients undergoing VATS for lung cancer in West China Hospital, Sichuan University from May to August 2023 were prospectively enrolled. Both wireless wearable and traditional wired devices were used to monitor the vital signs of patients after surgery. Spearman correlation analysis, paired sample t test and ratio Bland-Altman method were used to test the correlation, difference and consistency of monitoring data measured by the two devices. The effective monitoring rate of the wireless wearable device within 12 hours was calculated to test the reliability of its continuous monitoring. ResultsA total of 20 patients were enrolled, including 15 females and 5 males with an average age of 46.20±11.52 years. Data collected by the two monitoring devices were significantly correlated (P<0.001). Respiratory rate and blood oxygen saturation data collected by the two devices showed no statistical difference (P>0.05), while heart rate measured by wireless wearable device was slightly lower (\begin{document}$ \bar{d} $\end{document}=?0.307±1.073, P<0.001), and the blood pressure (\begin{document}$ \bar{d} $\end{document}=1.259±5.354, P<0.001) and body temperature(\begin{document}$ \bar{d} $\end{document}=0.115±0.231, P<0.001) were slightly higher. The mean ratios of heart rate, respiratory rate, blood oxygen saturation, blood pressure and body temperature collected by the two devices were 0.996, 1.004, 1.000, 1.014, and 1.003, respectively. The 95% limits of agreement (LoA) and 95% confidence interval of 95%LoA of each indicator were within the clinically acceptable limit. The effective monitoring rate of each vital signs within 12 hours was above 98%. ConclusionThe wireless wearable device has a high accuracy and reliability for continuous monitoring vital signs of patients after VATS for lung cancer, which provides a security guarantee for subsequent large-scale clinical application and further research.
ObjectiveTo investigate the effects of closed thoracic drainage with single tube or double tubes after video-assisted thoracoscopic lung volume reduction surgery.MethodsRetrospective analysis was performed on 50 patients (39 males, 11 females) who underwent three-port thoracoscopic lung volume reduction surgery in our hospital from January 2013 to March 2019. Twenty-five patients with single indwelling tube after surgery were divided into the observation group and 25 patients with double indwelling tubes were divided into the control group.ResultsThere was no significant difference in pulmonary retension on day 3 after surgery, postoperative complications, the patency rate of drainage tube before extubation, retention time or postoperative hospital stay (P>0.05). Postoperative pain and total amount of nonsteroidal analgesics use in the observation group was less than those in the control group (P<0.05). ConclusionIt is safe and effective to perform closed thoracic drainage with single indwelling tube after video-assisted thoracoscopic lung volume reduction surgery, which can significantly reduce the incidence of related adverse drug reactions and facilitate rapid postoperative rehabilitation with a reduction of postoperative pain and the use of analgesic drugs.
Emphysema is a chronic progressive disease characterized by abnormal terminal bronchioles. Patients in end-stage have limited treatment. Lung volume reduction surgery(LVRS) is to remove the non-functional emphysematous lung tissue with the aim of palliating symptoms in selected patient with severe emphysema. It provides a new therapeutic method for emphysema. When LVRS is widely accepted after 1990s, a large number of institutions carried out the researches on surgical approaches, perioperative mortality, long-term efficacy and complications. Its targeted beneficial patients and surgical safety had been confirmed too. Bronchoscopic lung volume reduction (BLVR) successfully carried out on the basis of the development of LVRS and bronchoscopy. This article reviews the surgical approaches, safety and efficacy of LVRS and BLVR in patients with emphysema.
ObjectiveTo emphasize the important role of video-assisted thoracoscopic surgery (VATS) in treatment of mediastinal bronchogenic cysts (MBCs).MethodsWe retrospectively reviewed the clinical data of 112 patients (53 males and 59 females) of mediastinal bronchogenic cysts who underwent VATS in our institution between April 2001 and Aprial 2016. Median age was 4–75 (45.6±15.0) years. All patients underwent chest CT preoperatively. The patients were divided into two groups: an anterior mediastinum group, 47 patients; a middle and posterior mediastinum group, 65 patients including 35 patients in the middle mediastinum, 30 patients in the posterior mediastinum. The average diameter was 0.5–22.0 (3.50±2.33) cm. The average CT attenuation was 0–67 (35.5±15.3) Hu on unenhanced CT. We began each operation with the VATS technique.ResultsThe CT diagnostic accuracy for group middle and posterior mediastinum with CT value≤20 Hu was higher than others (61.5% vs. 13.1%, χ2=17.675, P<0.001). A total of 111 patients underwent VATS, only one patient converted to open thoracotomy. Cyst resection and thymectomy were conducted in 45 patients, cyst resection and extended thymectomy were conducted in 2 patients in the anterior mediastinum group. Simply cyst resection were performed in the middle and posterior mediastinum group (n=65). The average operative time was 40–360 (104.5±43.1) min. The average intraoperative blood loss was 5–600 (57.9±88.9) mL. The intraoperative complication rate was 3.6% and the incomplete resection rate was 6.3%. The main reason for these was severe adhesion between the cyst and mediastinal structure. No serious postoperative complication was found. Follow-up was done in 99 patients, and the mean follow-up time was 42 (12–191) months. There was no local recurrence.ConclusionVATS resection of MBCs is a safe and efficacious procedure, and minimally invasive and surgical resection should be performed as early as possible for MBCs.
ObjectiveTo explore the learning curve of single pore video-assisted thoracoscopic surgery (VATS) for the treatment of pulmonary bullae. MethodsFrom July 2010 to October 2011, sixty consecutive patients with pulmo-nary bulla undergoing single pore VATS by the same group of surgeons in the Department of Thoracic and Cardiovascular Surgery, Songgang People's Hospital. According to the sequence of the operations, all the patients were divided into group A, B, and C with 20 patients in each group. Operation time, intraoperative blood loss, postoperative hospital stay and thoracic drainage duration were compared between the 3 groups to evaluate surgical outcomes in different stages. Operation time and postoperative hospital stay were the main indexes of the learning curve. ResultsThere was no statistical difference in age, gender or incidence of pneumothorax between the 3 groups (P > 0.05). Operation time of group A (42.7±9.4 minutes) was significantly longer than those of group B (21.3±6.7 minutes) and group C (20.8±7.5 minutes) (P < 0.01). Postoperative hospital stay of group A (10.6±2.2 days) was significantly longer than those of group B (7.6±1.2 days) and group C (7.4±1.2 days) (P < 0.05). There was no statistical difference in other indexes among the 3 groups (P > 0.05). ConclusionThe learning curve of single pore VATS for the treatment of pulmonary bullae is approximately 20 cases.
Objective To examine the application effectiveness of dual 8F ultrafine pigtail drainage tubes versus a single 28F large-bore chest tube in single-port thoracoscopic lobectomy/segmentectomy. Methods Clinical data of patients who underwent single-port video-assisted thoracoscopic lobectomy/segmentectomy within our medical group from January 2020 to August 2023 were retrospectively analyzed. They were categorized into two groups based on postoperative drainage methods: a dual 8F ultrafine pigtail tubes group and a single 28F large-bore chest tube group. Comparative analysis was performed on perioperative data for the two groups of patients. Results The dual 8F ultrafine pigtail tubes group comprised of 68 patients, with 41 females and 27 males, and an average age of (54.72±13.34) years, while the single 28F large-bore chest tube group comprised of 80 patients, with 40 females and 40 males, and an average age of (57.60±11.04) years. There were statistical differences between the two groups in terms of postoperative drainage volume on day 1, day 2, and day 3, total postoperative drainage volume, postoperative tube placement time, postoperative pain score at 48 hours, maximum postoperative pain score, postoperative hospital stay, postoperative complications related to drainage tubes, and emergency use of pain-relieving medication after surgery (P＜0.05). Conclusion After single-port thoracoscopic lobectomy/segmentectomy, the application of dual ultrafine 8F pigtail drainage tubes can lead to a reduction in postoperative drainage volume and shorten the duration of postoperative drainage tube placement and hospital stay, thereby decreasing postoperative pain and the frequency of emergency pain-relieving medication. Moreover, it lowers the incidence of drainage tube-related complications. In alignment with current enhanced recovery after surgery principles, this approach is advantageous for postoperative recovery.
Objective To explore the short-term surgical outcomes of the modified surgical procedure for uniportal thoracoscopic right middle lobectomy (RML). Methods In this modified approach, the incision was created at sixth or seventh intercostal space inferior to the subscapular angle. The surgeon stood on the opposite side of the operating table. The surgery was performed by serial division of the anterior oblique fissure, the vein, bronchus, artery, and horizontal fissure following the single-direction strategy. As for patients with malignant lesions, hilar and mediastinal lymph node dissection was performed. Clinical characteristics and early surgical outcomes were collected and analyzed. Results Fifty two patients were included in this study in the Department of Thoracic Surgery, West China Hospital, Sichuan University between January 2021 and June 2023. There were 20 males and 32 females at an average age of 48.0±10.5 years. No conversion or perioperative mortality was occurred. Mean surgical time was 68.1±16.8 min, mean blood loss was 16.5±4.9 mL, median chest tube duration was 2 (2-22) d and median postoperative hospital stay was 3 (3-24) d. There was no intraoperative or postoperative complication but one patient developed postoperative prolonged air leak (>5 d). Mean postoperative visual-analog scale on postoperative day 1, day 2 and day 3 was 1.5±0.8, 1.7±0.4, 0.8±0.7, respectively. Conclusion Trans-posterior-approach uniportal thoracoscopic single-direction RML is a safe, feasible, and effective procedure, which provides an appropriate direction and angle for dissection and stapling, solving the challenge of conventional uniportal RML lobectomy.