ObjectiveTo systematically review the clinical effects and safety of thoracoscopy operation and thoracotomy for spontaneous pneumothorax.
MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 10, 2013), Web of Knowledge, CNKI, CBM, WanFang Data and VIP up to October 2013. Randomized controlled trials involving treatment outcomes of spontaneous pneumothorax using thoracoscopy compared with thoracotomy were included. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then RevMan 5.2 software was used for meta-analysis.
ResultsA total of 7 studies involving 481 patients were included. The results of meta-analysis showed that the operative time in the thoracoscopy goup was significantly longer than that in the thoracotomy group (MD=13.57, 95%CI 3.58 to 23.56, P=0.008). But there was no significant difference in recurrence rates (RR=3.16, 95%CI 0.84 to 11.94, P=0.09), total postoperative complications (RR=1.33, 95%CI 0.46 to 3.88, P=0.46), postoperative chest drainage time (MD=-0.00, 95%CI-0.64 to-0.63, P=0.99), and hospitalization time (MD=0.09, 95%CI-0.21 to 0.40, P=0.55).
ConclusionCompared with thoracotomy, thoracoscopy does not increase recurrence rates, postoperative complications, chest drainage time or hospitalization time, but it could prolong operation time in a certain extent.
Abstract： Objective To evaluate the safety and efficacy of total thoracoscopic anatomic pulmonary segmentectomy for the treatment of early-stage peripheral lung carcinoma, pulmonary metastases and benign pulmonary diseases. Methods We retrospectively analyzed 20 patients who received total thoracoscopic anatomic pulmonary segmentectomy in Zhongshan Hospital of Fudan University from March 2008 to November 2011. There were ten male and ten female patients with a mean age of 58.0（14-86）years. Three ports were used. The pulmonary artery and vein of the segment were dealt with Hem-o-lok or stapler. The bronchi of the segment were dealt with staplers. Staplers were used in peripheral lung of intersegmental plane. Results All the twenty patients underwent total thoracoscopic anatomic segmentectomy successfully without any conversion to thoracoctomy or lobectomy. No perioperative morbidity or mortality occurred. Postoperative pathological examinations showed lung cancer in 10 patients, pulmonary metastases in 3 patients and benign pulmonary diseases in 7 patients. The mean operative time was 133.0（90-240）min. The mean blood loss was 85.0（50-200）ml. The chest tubes were maintained in position for 3.2 （2-7） d. The mean postoperative hospitalization time was 6.7 （4-11）d. Conclusion Total thoracoscopic anatomic pulmonary segmentectomy is a feasible and safe technique to be used selectively for Ⅰa stage lung cancer, pulmonary metastases and benign pulmonary diseases that are not appropriate for wedge resection.
ObjectiveTo investigate the efficacy of preoperative nebulized indocyanine green (ICG)-assisted thoracoscopic anatomical lesion resection (TALR) in treating pediatric congenital pulmonary airway malformation (CPAM). MethodsA retrospective analysis was conducted on clinical data of 45 children with CPAM who underwent thoracoscopic surgery at the Third Affiliated Hospital of Zhengzhou University between June 2023 and March 2025. The patients were divided into an ICG group (preoperative nebulized ICG 0.5 mg/kg+TALR) and a non-ICG group (TALR under white light), with perioperative and postoperative recovery parameters compared between groups. ResultsA total of 45 children [22 males, 23 females; median age 7.4 (1.1-75.0) months] were enrolled. The ICG group (n=22) and non-ICG group (n=23) both achieved uneventful recoveries. Compared to the non-ICG group, the ICG group demonstrated significantly shorter surgical duration [91.3 (38.0, 144.0) min vs. 100.0 (50.0, 175.0) min, P=0.032], reduced intraoperative blood loss [3.0 (2.0, 10.0) mL vs. 5.0 (1.0, 10.0) mL, P=0.049], shorter postoperative drainage duration [2.7 (1.9, 3.9) d vs. 3.4 (1.8, 19.9) d, P=0.003], and shortened hospital stay [4.6 (2.9, 9.8) d vs. 5.0 (3.9, 21.5) d, P=0.013]. Residual lesions occurred in 2 patients from the non-ICG group but none in the ICG group. Intragroup comparisons revealed significant improvements in peak inspiratory flow ratio, tidal volume ratio, and normalized tidal volume per kilogram after surgery in both groups (P<0.05), though intergroup differences showed no statistical significance (P>0.05). ConclusionPreoperative nebulized ICG administration facilitates lesion identification in CPAM, reduces technical difficulty of TALR, enhances therapeutic outcomes, and provides valuable assistance for performing TALR procedures.
ObjectiveTo compare postoperative efficacy of thoracoscopic partial pneumonectomy with or without thoracic drainage tube postoperatively.MethodsThe PubMed, Wanfang database, CNKI and Web of Science from January 2000 to August 2020 were searched by computer to collect randomized controlled studies (RCT), cohort studies and case-control studies on the efficacy of chest drainage tube placement versus no placement after thoracoscopic partial pneumonectomy. Two reviewers independently screened articles and extracted data to evaluate the risk of literature bias. Meta-analysis was performed with RevMan software.ResultsA total of 15 articles were included, including 1 RCT and 14 cohort studies. A total of 1 524 patients were enrolled, including 819 patients in the test group (no postoperative chest drainage tube group) and 705 patients in the control group (postoperative chest drainage tube group). Compared with the control group, the length of hospital stay in the test group was shorter (MD=–1.3, 95%CI –1.23 to –0.17, P<0.000 01) and the incidence of postoperative pneumothorax was higher (RD=0.06, 95%CI 0.01 to 0.10, P=0.01). There was no significant difference between the two groups in operation time (MD=–2.37, 95%CI –7.04 to 2.30, P=0.32), the incidence of postoperative complications (RR=2.43, 95%CI 0.79 to 1.80, P=0.39), the reintervention rate of postoperative complications (RD=0.02, 95%CI=–0.00 to 0.04, P=0.05), postoperative subcutaneous emphysema (RD=0.02, 95%CI –0.01 to 0.06, P=0.20) and the incidence of postoperative pleural effusion (RD=0.04, 95%CI –0.00 to 0.09, P=0.10) .ConclusionCompared with the patients with chest drainage tube placement after thoracoscopic partial pneumonectomy (the control group), the test group can shorten the hospital stay. Although the incidence of postoperative pneumothorax is higher than that of the control group, the operation time, incidence of postoperative subcutaneous emphysema and in-hospital complications, and reintervention rate of in-hospital complications are not statistically significant between the two groups. Therefore no chest drainage tube may be placed after partial pneumonectomy.
Objective To explore the safety, effectiveness, and mid-term efficacy of total thoracoscopic mitral valvuloplasty (MVP) with chordal replacement (CR) and quadrangular resection (QR) for the treatment of mitral regurgitation (MR), and to provide reference for guiding the development and selection of clinical diagnosis and treatment methods for MR patients. Methods A prospective randomized controlled study was performed to collect patients with MR who underwent MVP at the Department of Cardiovascular Surgery, Leshan People's Hospital from January 2021 to March 2022. They were randomly divided into a CR group and a QR group by using a random number table, and were followed up for 12 months after the operation. The medical history, perioperative data and adverse cardiac endpoint events during the follow-up period were collected. The differences in surgical efficacy between the two groups were evaluated and compared, and the Kaplan-Meier method was used to compare the differences in survival rates between the two groups of patients. Results A total of 100 patients were enrolled. There were 46 patients in the CR group, including 27 males and 19 females with an average age of 49.50±9.23 years; there were 46 patients in the QR group, including 24 males and 22 females with an average age of 49.91±11.48 years. The aortic occlusion time in the CR group was longer than that in the QR group (P<0.05). Other surgical indicators, including total surgical time, extracorporeal circulation time, ventilator-assisted time, ICU hospitalization time, size of the valve ring, concomitant surgery during the same period, and the incidence of perioperative complications were not statistically different between the two groups (P>0.05). The left atrium diameter, left ventricular end-diastolic diameter, left ventricular end-diastolic volume, left ventricular end-systolic volume, and left ventricular ejection fraction (LVEF) of the two groups before discharge after the surgery were significantly improved compared to those before surgery (P<0.05). There was a statistical difference in LVEF between the two groups before discharge after the surgery (P<0.05). There was no statistical difference in clinical efficacy between the two groups (P>0.05). Kaplan-Meier analysis showed that the overall incidence of exemption from mild and above mitral regurgitation 12 months after the surgery in the CR group and QR group was 84.8% and 89.1%, respectively. According to the log-rank test, there was no statistical difference in the overall survival curve between the two groups (χ2=0.356, P=0.551). Conclusion CR and QR are both safe and effective methods for the treatment of simple posterior MR.
Objective
To explore the feasibility of single mediastinal drainage tube in treatment of esophageal carcinoma after thoracoscopic combined with laparoscopic surgery.
Methods
There were 90 esophagus cancer patients treated by surgery in our hospital between June 2015 and October 2016. The patients were allocated into two groups including a single-drainage tube group and a two-drainage tube group. There were 45 patients with 24 males and 21 females at age of 48-78 years in the two-drainage tube group and 45 patients with 23 males and 22 females at age of 45-84 years in the single-drainage tube group.The clinical effect of the two groups was compared.
Results
There was no statistical difference in gender and age, bleeding amount and surgical duration in operation, thoracic drainage amount, incidence of atelectasis, pneumothorax, and encapsulated effusion between the two groups(P<0.05).
Discussion
Single-drainage tube group displays less postoperative pain, faster recovery, and more convenient clinical care without complication.
Abstract: Objective To investigate the feasibility of videoassisted thoracoscopic surgery (VATS) ronchial sleeve lobectomy for lung cancer, and to describe this treatment method. Methods Between December 2010 and April 2011, three patients in our hospital underwent VATS bronchial sleeve lobectomy as treatment for right upper lobe nonsmall cell lung cancer. The patients were one female and two males, aged 61, 65, and 62 years. Surgical incisions were the same as for singledirection VATS right upper lobectomy. The right superior pulmonary vein was firstly transected, followed by the first branch of the pulmonary artery. Then, the lung fissure was transected and the mediastinal lymph nodes, including the subcarinal nodes, were also dissected to achieve sufficient exposure of the right main bronchus. The bronchus was transected via the utility incision, and the anastomosis was accomplished by continuous suture with 30 Prolene stitches. Another 0.5 cm port in the 7th intercostal space at the posterior axillary line was added in the third operation for handling of a pair of forceps to help hold the needle during anastomosis. A sealing test was performed to confirm that there was no leakage after completion of the anastomosis, and the stoma was covered with biological material. Bronchoscopy was performed to clear airway secretions and to confirm that there was no stenosis on postoperative day (POD) 1. Results The lobectomy and lymph node dissection was finished in 5158 minutes (averaging 54.7), and the time needed foranastomosis was 4055 minutes (averaging 45.7). Total blood loss was 55230 ml (averaging 155.0 ml). Number of dissected lymph nodes was 1821 (averaging 19.3). One patient was diagnosed with adenocarcinoma of the right upper lobe with metastatic hilar lymph node invasive to the right upper lobar bronchus. The other two patients were both diagnosed with centrally located squamous cell carcinoma of the right upper lobe, and all the patients achieved microscopically negative margins. There was no stenosis of the anastomosis stoma, and the postoperative course was uneventful. These patients were discharged on POD 810 (averaging 8.7 days), and they recovered well during the followup period, which lasted 2 to 6 months. [WTHZ]Conclusion [WTBZ]For experienced skillful thoracoscopic surgeons, VATS bronchial sleeve lobectomy is safe and feasible. Making the incisions of a singledirection VATS lobectomy with an additional miniport may be an ideal approach for this procedure.
ObjectiveTo investigate the feasibility and clinical outcomes of bilateral endoscopic thoracic sympathectomy (ETS) through single hole for palmar hyperhidrosis (PHH).
MethodsFrom August 2012 to April 2013, 19 PHH patients were admitted in the Department of Thoracic Surgery, The Third People's Hospital of Chengdu. There were 7 male and 12 female patients with their age of 24.7(15-33) years. All the patients underwent bilateral ETS through single hole under general anesthesia.
ResultsAll the operations were successfully performed. Average operation time was 28.4 minutes, and postoperative hospital stay was 1.6 days. Seventeen patients were followed up for 2 to 10 months. PHH symptoms all disappeared without Horner's syndrome or hemopneumothorax.
ConclusionBilateral ETS through single hole is a minimally invasive, reliable and safe procedure for PHH with low morbidity.
Cardiac surgery has a gradual change from traditional median sternotomy to minimally invasive surgery due to the appearance and application of peripheral extracorporeal circulation. There are great differences in the clinical practice of two different surgical methods in mitral valve operation. Minimally invasive thoracic surgery has the advantages of less trauma, less bleeding, faster recovery, beauty and so on. However, such surgery also has its weaknesses, such as longer learning curve, narrow operation space and high requirements of equipment. To compare the differences of early and long-term results in mitral valve operation between traditional median sternotomy and minimally invasive thoracic surgery is to better summarize and operate minimally invasive thoracic surgery for mitral valve surgery.
ObjectiveTo summarize the experience of totally thoracoscopic cardiac surgery for ventricular septal defect.MethodsClinical data of 449 patients undergoing totally thoracoscopic cardiac surgery for ventricular septal defect from May 2008 to December 2018 in Shanghai Yodak Cardiothoracic Hospital were analyzed retrospectively. There were 232 male and 217 female patients, aged from 3 to 55 years with a mean age of 17.3±11.2 years.ResultsAll the operations were completed successfully. Mean operative time was 2.4±0.3 h. The mean extracorporeal circulation time and aortic cross-clamp time was 64.2±11.6 min and 28.4±10.7 min, respectively. Mechanical ventilation time and intensive care unit stay was 6.9±3.8 h and 20.5±5.6 h, respectively. Postoperation drainage quantity was 213.1±117.2 mL. The hospital stay was 6.9±1.3 d. Intraoperative and postoperative complications occurred in 11 patients (2.4%), including 1 patient of intraoperative reoperation, 3 patients of reoperation for bleeding, 3 patients of the incision infection, 2 patients of small residual shunt, 1 patient of right femoral artery incision stenosis complicated by thromboembolism and 1 patient of right pleural cavity pneumothorax. The mean follow-up time was 72.2±33.9 months. During the period, there was no reoperation, but 2 patients of ventricular septal defect small residual shunt, 1 patient of mild-moderate mitral valve and 1 patient of mild-moderate aortic valve incompetence, respectively. During the period, heart function of the patients was NYHAⅠ-Ⅱ.ConclusionTotally thoracoscopic cardiac surgery for ventricular septal defect is a safe and effective treatment, with few serious complications, fast recovery for patients and good short to medium-term outcomes.
