ObjectiveTo explore clinical outcomes of simutaneous video-assisted thoracoscopic surgery (VATS) for bilateral giant bullae (GB).
MethodsClinical data of 160 GB patients who received surgical treatment in the First Affiliated Hospital of Xinjiang Medical University from March 2011 to April 2013 were retrospectively analyzed. According to GB location and surgical strategies, all the patients were divided into 3 groups. In group A, there were 108 patients with spontaneous pneumothorax (SP) and unilateral GB who underwent unilateral GB resection with VATS, including 88 male and 20 female patients with their age of 31.36±16.14 years. In group B, there were 40 patients with SP and bilateral GB who underwent unilateral GB resection in the SP side with VATS, including 36 male and 4 female patients with their age of 37.63±18.84 years. In group C, there were 12 patients with SP and bilateral GB who underwent simultaneous bilateral GB resection with VATS, including 9 male and 3 female patients with their age of 32.58±16.06 years. Postoperative morbidity and SP recurrence rates were analyzed.
ResultsAll the operations were successfully performed, and patients were followed up for 20 months after discharge. In group A, postoperative complications included acute pulmonary edema in 1 patient, pleural adhesion in 11 patients, respiratory failure in 2 patients, and pulmonary air leak in 5 patients. During follow-up, SP recurred in 5 patients including 2 patients with SP recurrence at the same side and 3 patients with SP recurrence at the other side of thorax. In group B, postoperative complications included pleural adhesion in 4 patients, respiratory failure in 1 patient, and pulmonary air leak in 3 patients. During follow-up, SP recurred in 18 patients including 3 patients with SP recurrence at the same side and 15 patients with SP recurrence at the other side of thorax. In group C, postoperative complications included pleural adhesion in 2 patients and pulmonary air leak in 1 patient. During follow-up, SP recurred in 1 patient at the same side of thorax. SP recurrence rates of group A and C were significantly lower than that of group B (P=0.000 and P=0.031 respectively).
ConclusionSimultaneous VATS is safe, efficacious and reliable for the treatment of bilateral GB, and can effectively prevent SP recurrence at the other side of thorax.
Abstract： Objective To explore the method and effect of single utility port video-assisted thoracoscopic surgery （VATS） for the treatment of pulmonary diseases. Methods From Jan. 2008 to Jun. 2010, 158 patients with pulmonary diseases were treated by single working pore VATS in the Department of Thoracic Surgery of West China Hospital, Sichuan University. Their diseases included 6 kinds of different lesions, such as pneumothorax（inflammatory pseudotumor, hamartoma, lymphangiomyomatosis） , lung tuberculoma, and lung carcinoma. Seventy patients had definite diagnosis before their operation, and the others had their final diagnosis by intraoperative frozen section evaluation and postoperative pathology examination. All the resections were carried out by pure thoracoscopic procedures with two ports, one working pore and one observing pore. A 28-Fr chest tube was placed to the pleural apex. Limited lung resection was performed in 151 patients, single lobectomy in 7 patients, and simultaneous bilateral operation in 6 patients. Results For limited lung resection patients, the average operation time was 18 （5-60） min, and the average blood loss was 33 （5-95） ml. No patient needed intraoperative blood transfusion . Ten patients received an increased pore, including 6 patients with pleural cavity obliteration or abundant pleural adhesions, and 4 patients with intraoperative bleeding . The average postoperative length of stay was 2.5 （2-4） days, and the average medical cost was 17 884 （15 476-25 387） Yuan. For patients undergoing lobectomy and lymph node dissection, the average operation time was 128 （50-220） min, and the average blood loss was 180 （80-478） ml. No patient needed intraoperative blood transfusion. One patient received an increased pore. The average postoperative length of stay was 4.7 （4-7） days, and the average medical cost was 42 385 （38 965-57 695） Yuan. No perioperative death or severe complications were observed in present series. Conclusion Single utility port VATS is a safe and efficient procedure with good patient recovery. It is a method of choice for selected patients with pulmonary diseases.
Objective
To evaluate the validity of video-assisted thoracoscopic surgery (VATS) pneumonectomy in thoracic diseases treatment.
Methods
We retrospectively analyzed the clinical data of 34 consecutive patients who underwent VATS pneumonectomy in Xiangya Hospital Central South University between January 2013 and October 2015. There were 26 males and 8 females at age of 35–69 (53.8±7.7) years.
Results
VATS pneumonectomy was completed successfully in 32 patients (5.8% conversion rate). The average operation time was 182.5±52.4 min. The average blood loss was 217.1±1 834.8 ml. Chest tube drainage flow was 3–11 (6.0±1.7) days and postoperative hospital stay was 5–12 (7.6±1.8) days. Eleven patients got postoperative complications (34.3%), mainly pulmonary infections. The 32 patients were followed up for 10 (1–21) months. Two patients died of lung metastasis 16 or 17 months after the operation. One patient died of sudden cardiac arrest 3 months after operation. Bronchopleural fistula (BPF) happened in one patient after hospital discharge in 2 months.
Conclusion
VATS is feasible for pneumonectomy. However, further studies and follow-up are needed to verify the benefits of VATS pneumonectomy for lung cancer.
ObjectiveTo share the clinical experience of thoracoscopic unidirectional posterolateral basal segmentectomy via inferior pulmonary ligament.MethodsAll the patients were in the healthy lateral position, with endoscopy holes in the 8th intercostal space of the middle axillary line and 2-3 cm operation holes in the 5th intercostal space of the front axillary line. Anatomical segmentectomy of the posterolateral basal vein, bronchus and artery was performed through the inferior pulmonary ligament upward in turn. The clinical data of this group were analyzed retrospectively.ResultsFrom December 2015 to October 2018, 32 patients underwent thoracoscopic unidirectional posterolateral basal segmentectomy, including 8 males and 24 females, aged 13-71 (52.6±13.7) years. All patients successfully completed the operation, including 9 patients of left lower pulmonary posterolateral basal segmentectomy, 23 patients of right lower pulmonary posterolateral basal segmentectomy. The operation time was 80-295 (133.4 ±40.5) minutes, intraoperative bleeding volume was 20-300 (52.6±33.8) mL, drainage time was 2-14 (4.2±2.3) days, hospitalization time was 4-15 (6.9 ±2.4) days. No death occurred during hospitalization. Postoperative complications included atelectasis in 1 patient and persistent pulmonary leakage over 3 days (4 or 6 days respectively) in 2 patients , chylothorax in 1 patient. All of them recovered smoothly after non-operative treatments. Postoperative pathology showed that 29 patients of primary adenocarcinoma or atypical adenomatoid hyperplasia, including 5 patients of adenocarcinoma in situ, 9 patients of micro-invasive adenocarcinoma, 12 patients of invasive adenocarcinoma, 3 patients of atypical adenomatoid hyperplasia. One patient was of intestinal metastatic adenocarcinoma, 1 patient of inflammatory lesion and 1 patient of bronchiectasis. 3-21(9.6±4.6) lymph nodes were resected in the patients with primary pulmonary malignant tumors. And no metastasis was found.ConclusionThe operation of thoracoscopic unidirectional posterolateral basal segmentectomy via inferior pulmonary ligament is easy. There is no need to open intersegmental tissue. It can protect lung tissue better. The operative method is worthy of clinical promotion.
Abstract： Objective To investigate the application of a silicone guiding tube for endoscopic linear stapling device in complete video-assisted thoracoscopic lobectomy and segmentectomy，so as to improve the safety and efficiency of manipulating the endoscopic linear stapling device. Methods We retrospectively analyzed clinical data of 178 patients with peripheral non-small cell lung caner and 26 patients with benign lung lesions who underwent surgical resection in First Affiliated Hospital of Nanjing Medical University from October 2009 to December 2011. There were 85 males and 119 females with their average age of 62±11 years. A total of 172 patients underwent complete video-assisted thoracoscopic lobectomy and 32 patients underwent segmentectomy. We designed a silicone guiding tube to facilitate the use of endoscopic linear stapling device. With the help of the tube， a1l pulmonary arteries， veins， bronchus and interlobar fissure involved were managed with endoscopic linear stapling devices. Results Three patients （1.47%）underwent conversion to thoracotomy because of dense lymph node adhesion， and all other complete video-assisted thoracoscopic surgeries were successfully performed. There was no blood vessel injury， severe postoperative complications or perioperative death. The use rate of the tube was 95.6% （303/317）， 66.9% （115/172）， 22.7% （39/172） and 78.5% （255/325） in pulmonary arteries， veins， bronchus and interlobar fissure stapling for lobectomy respectively， and 94.4% （34/36）， 77.3% （17/22）， 25.0% （8/32）， 33.1% （45/136） in pulmonary arteries， veins， bronchus and interlobar fissure stapling for segmentectomy respectively. For lobectomy， a total of 986 staples were used with an average of 5.7 staples for each patient， the average operative time was 192.5±54.0 min and average intraoperative blood loss was 118.1±104.1 ml. For segmentectomy， a total of ?226 staples were used with an average of ?7.1 staples for each patient， the average operative time was 193.7±37.4 min and average intraoperative blood loss was 60.9±78.0 ml. Conclusion Using a silicone guiding tube can facilitate the application of endoscopic linear stapling device， shorten the learning curve of complete video-assisted thoracoscopic lobectomy and segmentectomy， and improve the safety， convenience and economical efficiency of endoscopic linear stapling device.
ObjectiveTo systematically review the efficacy and safety of single-port video-assisted thoracoscopic surgery (VATS) vs. multiple-port VATS in lobectomy for non-small cell lung cancer (NSCLC).MethodsThe PubMed, EMbase, the Cochrane Library, CBM, CNKI, Wanfang, VIP and Web of Science were searched to collect clinical studies about single- vs. multiple-port VATS for patients with NSCLC from inception to August 2018. The literatures were screened, data were extracted and the risk of bias of included studies was assessed independently by two reviewers. The meta-analysis with the collected data was performed by using RevMan 5.3 software.ResultsEleven studies (4 randomized controlled trials, 1 prospective cohort study and 6 retrospective cohort studies), including 1 574 patients. Among them, 779 patients were in the single-port group, and 795 in the multiple-port group. The results of meta-analysis showed that there was no significant difference between the two groups in the operation time (MD=3.60, 95%CI –8.59 to 15.79, P=0.56), the conversion rate (OR=1.06, 95%CI 0.54 to 2.06, P=0.87), the incidence of postoperative complications (OR=0.76, 95%CI 0.53 to 1.10, P=0.15), postoperative hospitalization time (MD=0.74, 95%CI –1.60 to 0.12, P=0.09), chest tube placement time (MD=0.63, 95%CI –1.28 to 0.02, P=0.06) or harvested lymph nodes (MD=–0.11, 95%CI –0.46 to 0.24, P=0.54). The intraoperative blood loss (MD=–17.12, 95%CI –31.16 to –3.08, P=0.02) was less in the single-port group than that in the multiple-port group. The visual analogue score (VAS) on postoperative first day (MD=–1.30, 95%CI –1.85 to –0.75, P<0.000 01) and on postoperative third day (MD=–0.82, 95%CI –1.00 to –0.65, P<0.000 01) were lower in the single-port group than those in the multiple-port group.ConclusionThe meta-analysis indicates that the efficacy of single-port VATS for NSCLC is equivalent to multiple-port VATS. However the intraoperative blood loss, the VAS scores on postoperative first and third days in the single-port group are better.
ObjectiveTo explore clinical strategies of early diagnosis and treatment of solitary pulmonary nodules (SPN), and define the importance of biological tumor markers, preoperative CT-guided localization with the combination of methylene blue and hookwire system, and video-assisted thoracoscopic surgery (VATS)for early diagnosis and treatment of SPN.
MethodsWe retrospectively analyzed clinical records of 70 SPN patients in Department of Thoracic Surgery of Taixing People's Hospital from January 2011 to February 2014. There were 33 male and 37 female patients with their age of 32-87 (59.74±2.04)years. Preoperatively, patients' medical history, heart, lung, liver and kidney function, sputum cytology and bronchoscopic biopsy results were combined with biological tumor markers to make a preliminary differential diagnosis between benign or malignant SPN and surgical risk evaluation. For SPN less than 1 cm or too small for accurate intraoperative localization, CT-guided localization with the combination of methylene blue and hookwire system was routinely performed half an hour before the operation. For SPN large enough for accurate intraoperative localization, wedge resection of SPN and surrounding lung tissue was directly performed with VATS. Intraoperative frozen-section examination of resected lung specimens was preformed. If the pathological diagnosis was malignant, conventional VATS lobectomy/segmentectomy and lymphadenectomy were performed. If the pathological diagnosis was benign, the operation was then completed. Long-term follow-up was performed for SPN patients, especially patients with early-stage lung cancer.
ResultsThere was no in-hospital death or postoperative bronchopleural fistula in this study. Postoperatively, there were 2 patients with pneumonia, 3 patients with pneumothorax and 1 patient with wound infection, who were all cured or improved after proper treatment. Among the 70 patients, 11 patients acquired pathological diagnosis via preoperative lung needle biopsy. Among the other 59 patients, 12 patients with eccentric SPN acquired pathological diagnosis via intraoperative biopsy, and 47 patients underwent SPN resection with VATS. Pathological diagnosis included adenocarcinoma in 19 patients, squamous cell carcinoma in 9 patients, bronchioloalveolar carcinoma in 3 patients, adenosquamous carcinoma in 2 patients, inflammatory pseudotumor in 11 patients, tuberculoma in 4 patients, granuloma in 5 patients, sclerosing hemangioma in 2 patients, lung metastasis from breast cancer in 1 patient, lung metastasis from colon cancer in 1 patient, lung metastasis from thyroid cancer in 1 patient, and lung metastasis from stomach cancer in 1 patient. All the 70 patients (100%)were followed up for a mean duration of 2-34 months, and there was no late death during follow-up. One patient with adenocarcinoma of the right upper lobe had cerebral metastasis 18 months after operation, and had been receiving radiotherapy. All the other patients had a good quality of life.
ConclusionAbove clinical strategies are accurate for early diagnosis and minimally invasive treatment of SPN with good postoperative recovery and short-term outcomes.
Objective To share the clinical experience of video-assisted thoracoscopic surgery (VATS) anatomic basal segmentectomy by single-direction method. Methods The clinical data of 352 patients who underwent VATS anatomic basal segmentectomy in West China Hospital between April 2015 and April 2021 were retrospectively reviewed, including 96 males and 256 females with a median age of 50 (range, 26-81) years. All basal segmentectomies were performed under thoracoscopy, through the interlobar fissure or inferior pulmonary ligament approach, and following the strategy of single-direction and the method of "stem-branch". ResultsAll patients underwent basal segmentectomy successfully (49 patients of uniportal procedure, 3 patients of biportal procedure and 300 patients of triportal procedure) without addition of incisions or conversion to thoracotomy and lobectomy. The median operation time was 118 (range, 45-340) min, median intraoperative blood loss was 20 (range, 5-500) mL, median drainage time was 2 (range, 1-22) d and median postoperative hospital stay was 4 (range, 2-24) d. The postoperative complications included pneumonia in 6 patients, prolonged drainage (air leakage duration＞5 d or drainage duration＞7 d) in 18 patients, cerebral infarction in 1 patient and other complications in 2 patients. All patients were treated well and discharged without main complaints. No perioperative death happened. ConclusionVATS anatomic basal segmentectomy is feasible and safe. It can be performed in a simple manner following the strategy of single-direction.
Recently, the frequency of lung disease appears higher and more precise than previously estimated. Small pulmonary nodules (SPNs) are frequently detected on high-resolution computed tomography (CT) scans. For the reason of high rate of false positives by fine needle aspirate biopsy, small lung nodules often can not be confirmed by monitor or palpation with forceps. How to precisely locate and mark the nodule before the surgery is one of the most important things for video-assisted thoracoscopic surgery (VATS). We reviews the methods of location the pulmonary nodules before the surgery and analyzes the advantages and disadvantages of various methods.
Objective
To evaluate the efficacy and safety of total thoracoscopic lobectomy for patients with stage Ⅰ/Ⅱ non-small cell lung cancer (NSCLC).
Methods
The clinical data of 138 NSCLC patients from January 2013 to June 2015 in Shaanxi People's Hospital were retrospectively analyzed. There were 88 males and 50 females with an average age of 57.4±8.8 years, ranging from 44 to 76 years. According to the operation methods, they were divided into a video-assisted thoracoscopic surgery (VATS) group (thoracoscopic lobectomy in 63 cases) and a thoracotomy group (conventional open chest surgery in 75 cases). The intra- and postoperative clinical data, surgical complications and pulmonary function were compared.
Results
There was no significant difference in the operation time, intraoperative lymph node dissection groups, intraoperative lymph node dissection number between two groups (P>0.05). The blood loss, postoperative drainage volume, duration of postoperative analgesia, Numeric Rating Scale for pain and hospital stay in the VATS group were significantly lower than those of the thoracotomy group (P<0.05). The pre- and postoperative FVC%pred and FEV1%pred in both groups were compared and there was no significant difference (P>0.05). However the postoperative FVC%pred and FEV1%pred in both groups significantly reduced compared with preoperative ones (P<0.05). Complication rate of thoracoscopic group was significantly less than that of the thoracotomy group (20.63%vs. 32.00%,χ2=3.974,P=0.046).
Conclusion
Thoracoscopic lobectomy for NSCLCⅠ/Ⅱpatients is reliable, and achieves rapid postoperative recovery as well as less complications.
