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.
Abstract： Objective To evaluate video-assisted thoracic surgery（VATS）and minimal incision thoracotomy（MIT）lobectomy for early stage non-small cell lung cancer patients and the impact upon postoperative quality of life（QOL）. Methods A prospective randomized controlled trial was conducted. From January 1, 2008 to December 10, 2011, the qualified patients with early stage NSCLC were recruited and randomized to VATS group （57 patients）and MIT group（49 patients）, totally 106 patients，57 males and 49 females, aged 57.60 years. The quality of life was assessed using Lung Cancer Symptom Scale （LCSS） before operation and at 1,3,6,9,12 months after operation. Results There were no significant differences between the 2 groups in age, sex, the location of tumor, tumor pathologic stage, pathological types, postoperative complications, tumor size, operative time, operative bleeding and air leak days. There were no symptoms after operation at the VATS group worse than the leve before operation. Five major symptoms, including appetit（1.04±0.71 vs.2.00±0.83, F=6.357，P=0.021）, fatigue （4.55±1.17 vs.10.19±2.10, F=4.721，P=0.043）, dyspnea（2.18±0.86 vs.10.26±2.05, F=10.020，P=0.005）, normal activity（5.16±1.70 vs.17.60±3.17, F=12.319，P=0.002）at the MIT group were deteriorated significantly at 1 month after the operation （P＜0.05）. Conclusion The VATS will lead to better quality of life for the patients with early stage NSCLC after surgery and lead to a smooth postoperative recovery.
Objective To assess the safety and clinical outcomes of segmentectomy in one- or two-staged video-assisted thoracoscopic surgery (VATS) for bilateral lung cancer. MethodsWe retrospectively enrolled 100 patients who underwent VATS segmentectomy for bilateral lung cancer at the Department of Thoracic Surgery of Peking Union Medical College Hospital from December 2013 to May 2022. We divided the patients into two groups: a one-stage group (52 patients), including 17 males and 35 females with a mean age of 55.17±11.09 years, and a two-stage group (48 patients), including 16 males and 32 females with a mean age of 59.88±11.48 years. We analyzed multiple intraoperative variables and postoperative outcomes. Results All 100 patients successfully completed bilateral VATS, and at least unilateral lung received anatomical segmentectomy. Patients in the one-stage group were younger (P=0.040), had lower rate of comorbidities (P=0.030), were less likely to have a family history of lung cancer (P=0.018), and had a shorter interval between diagnosis and surgery (P=0.000) compared with patients in the two-stage group. Wedge resection on the opposite side was more common in the one-stage group (P=0.000), while lobectomy was more common in the two-stage group. The time to emerge from anesthesia in the one-stage group was longer than that in the first and second operations of the two-stage group (P=0.000, P=0.002). Duration of surgery and anesthesia were similar between two groups (P>0.05). Total number of lymph node stations for sampling and dissection (P=0.041) and lymph nodes involved (P=0.026) were less in the one-stage group. Intraoperative airway management was similar between two groups (P>0.05). The one-stage group was associated with lower activities of daily living (ADL) scores. Conclusion Segmentectomy is safe in one- or two-staged VATS for bilateral lung cancer, including contralateral sublobectomy and lobectomy. Duration of surgery and perioperative complications are similar between two groups, but the one-stage group is associated with lower ADL scores. On the basis of comprehensive consideration in psychological factors, physical conditions and personal wishes of patients, one-staged sequential bilateral VATS can be the first choice.
ObjectiveTo investigate the effect of changing of body posture on video-assisted thoracoscopic surgery for pulmonary bullae.
MethodsFrom January 2011 to October 2012, 28 patients with pulmonary bullae including 21 males and 7 females were admitted to our department. The median age of these patients was 18 years old, ranging from 16 to 61. All patients were divided into two groups:video-assisted pulmonary bullae resection with changing of body posture (n=14) and without changing of body posture (n=14). Surgery time, blood loss during operation, drainage, duration of drainage, length of stay in hospital, incidence of complications and recurrence rate were observed and compared between the two groups.
ResultsSurgery time in the non-change group was shorter than that in the change group (P<0.05). Blood loss during operation in the non-change group was less than that in the change group (P<0.05). There were no significant difference in drainage, duration of drainage, length of stay in hospital and recurrence rate between the two groups (P>0.05). No complications occurred.
ConclusionFor patients with bilateral bullae having tolerated cardiopulmonary function and not-heavy pleural adhesions, non-changing of body posture is safe and effective, not only to avoid a second surgery, but also to avoid turning over and second surgical disinfection, which is more beneficial to the patients.
Surgery has played an important role in treating non-small cell lung cancer (NSCLC). Resection is usually the first choice for NSCLC patients in stage Ⅰ and stage Ⅱ, and it is also an important part of the comprehensive treatment for the stage ⅢA patients. Standard surgery of NSCLC includes resection of the primary tumor lesion and swee-ping of ipsilateral lymph nodes and mediastinal lymph nodes. The goal of treatment for lung cancer in early stage aims to decrease the rate of recurrence and mortality. In recent years, video-assisted thoracoscopic surgery and da Vinci robotic minimal invasive surgery have made gratifying achievements, especially for small peripheral lung nodules surgery. For patients with NSCLC at stage ⅢA, the central focus of research is about identifying patients who will benefit in the surgery combining with chemotherapy and radiotherapy, therefore to choose the appropriate surgery.
ObjectiveTo determine if comfort level was associated with chest tube size(16F or 28F) among lung cancer patients with video-assisted thoracoscopic surgery (VATS) lobectomy.
MethodsWe performed VATS lobectomy for 163 patients with lung cancer in our hospital between February and May 2014. There were 70 males 93 females. The patients were allocated into two groups including a 28F group and a 16F group. There were 75 patients at age of 53.18±14.73 years with insertion of one chest drain of 28F in the 28F group. And there were 88 patients at age of 56.62±12.62 years with insertion of one chest drain of 16F in the 16F group. Heart rate and variation of pulse, breathing rate and variation of breathing rate, pain scores, comfort level, and activities daily living (ADL) of the two groups were compared.
ResultsThere was no significant difference in the patient characteristics and operation data between the two groups. There were statistical differences in variation of heart rates on the 1st day, 2nd day, and 3rd day after operation between the 16Fgroup and the 28F group (9.67±3.33 times/min vs.18.54±5.33 times/min, P=0.037; 7.89±2.88 times/min vs. 19.01±4.67 times/min, P=0.045; 7.67±3.01 times/min vs. 20.88±5.34 times/min, P=0.021). The percentage patients of mild pain in the 16F group (77.65%) was higher than that in the 28F group (49.78%, P=0.023) with a statistical difference. The independent ambulation and comfort level in the 16F group(67.05%, 67.05%) were significant higher than those in the 28F group (45.78%,55.11%, P=0.023, P=0.026).
ConclusionOur findings suggest that drainage via a small-bore chest tube provides meaningful postoperative comfort level in the patients with VATS lobectomy.
ObjectiveTo evaluate the safety, efficacy, and cost-effectiveness of different uses of oxidized regenerated cellulose (ORC) in video-assisted thoracoscopic surgery (VATS) for lung cancer resection to provide a reference for the selection, clinical use, and rational utilization of absorbable hemostatic materials. MethodsA retrospective analysis of relevant data from inpatients who underwent VATS for lung cancer resection at a tertiary hospital from July 2019 to January 2020 and from July 2020 to December 2020 was conducted. Patients were divided into two groups based on the use of ORC: 1) combined use group (ORC and collagen sponge) and 2) sole-use group (ORC). Safety, efficacy, and economic outcome indicators were compared between the two groups. ResultsThe main analysis included a total of 904 patients, with 466 in the combined use group and 438 in the sole-use group. Compared to the combined use group, the sole-use group had a significantly longer hospital stay, used fewer hemostatic drugs, had a lower average cost of hemostatic materials, and a lower median total hospitalization cost (P<0.05). No statistically significant difference was found between the two groups in terms of intraoperative blood loss volume, massive blood loss rate, perioperative transfusion rate, reoperation rate, postoperative 48-hour drainage volume, bloody drainage fluid rate, or postoperative laboratory test indicators. ConclusionThere was no significant difference in the safety or efficacy of VATS for lung cancer resection between the sole use of ORC and the combined use of ORC, but the sole use of ORC was associated with a lower cost of hemostatic materials and a lower total hospitalization cost. The sole use of hemostatic gauze in VATS for lung cancer resection may be a more cost-effective choice.
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.
With the continuous development of living standards, medical imageology, pathology and the technique of cell biology, the morbidity of double primary lung cancer (DPLC) grows rapidly in recent years. The thoracic surgeons have constantly improved its standard of diagnosis and treatment. At the present, union diagnosis of multiple indexes, defining clinical stage based on a single leision, and the early surgery have been accepted by most of the thoracic surgeons. The video-assisted thoracoscopic surgery (VATS), for its advantage of small trauma, has been accepted by thoracic surgeons and been widely used now. It's a promising treatment for DPLC and other chest diseases. In addition, it has been proved that there was no statistical diffence in prognosis between the simple radiotherapy and surgical treatment. The traditional concept of thoracic surgery is facing severe challenges. Therefore, we review the clinical diagnosis and treatment progress of DPLC as follows.
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.
