ObjectiveTo explore the clinical efficacy of thoracoscopy-assisted modified Nuss procedure for pectus excavatum (PE) in children.MethodsThe clinical data of patients with PE who underwent thoracoscopy-assisted modified Nuss procedure from October 2013 to October 2020 in Daping Hospital were retrospectively analyzed.ResultsA total of 86 patients were collected, including 79 males and 7 females with a mean age of 14.03±3.36 years. The operations were performed successfully in all patients without intraoperative cardiac vascular injury or perioperative death. The mean operation time was 87.30±33.45 min, bleeding volume was 19.94±14.60 mL, and the postoperative hospitalization stay time was 6.89±2.59 d. Early postoperative complications included 2 patients of pneumothorax, 2 patients of wound fat liquefaction and infection, 2 patients of bar flipping and displacement. One patient had bar displacement 1 year after the surgery. The total complication rate was 8.14%. All patients were followed up for 3-42 months. The bars were taken out about 36 months after the surgery. According to the evaluation criteria of orthopedic effect, 68 (79.07%) patients were excellent, 10 (11.63%) patients were good, 5 (5.81%) patients were moderate and 3 (3.49%) patients were poor.ConclusionMinimally invasive and individualized shaping via the Nuss procedure for PE children is safe and convenient, with satisfied effect. It is worthy of popularization in the clinic.
Objective
To explore the safety and feasibility of spontaneous breathing anesthesia combined with tubeless uniportal thoracoscopy in pulmonary bullae surgery.
Methods
Totally 112 patients with pulmonary bullae in the Affiliated Hospital of Inner Mongolia Medical University from March 2015 to May 2017 were enrolled. According to the random number chosen by computer, the patients were randomly divided into two groups: a tubeless group (spontaneous breathing anesthesia combined with tubeless uniportalthoracoscopy) and a control group (uniportal thoracoscopy by general anesthesia with tracheal intubation) . There were 49 males and 7 females with an average age of 25.5±6.5 years in the tubeless group, and 50 males and 6 females with an average age of 23.5±4.5 years in the control group. The difference of the lowest intraoperative arterial oxygen saturation (SaO2), SaO2 at postoperative one hour, operation time, postoperative awakening time, hospital stay, hospitalization cost and postoperative pain score were analyzed.
Results
There was no significant difference between the two groups in the operation time, the lowest SaO2, SaO2 at one hour after the operation and the partial pressure of carbon dioxide (PaCO2). The awakening time and duration of postoperative hospital stay in the tubeless group was shorter than those in the control group (P=0.000). The cost of hospitalization in the tubeless group was less than that in the control group (P=0.000). The discomfort caused by urinary tract and visual analogue score (VAS) in the tubeless group were better than those in the control group.
Conclusion
It is safe and feasible to use spontaneous breathing anesthesia combined with tubeless uniportal thoracoscopy in pulmonary bullae resection.
Objective To compare the effects of preserving and releasing the inferior pulmonary ligament (IPL) during thoracoscopic right upper lobe apical segment resection for non-small cell lung cancer patients, and to explore appropriate management methods for intraoperative IPL. MethodsAccording to the prospective and open principle, the patients with non-small cell lung cancer who underwent thoracoscopic right upper lobe apical segment resection in the Cardiothoracic Surgery Department of Ningbo Second Hospital from January 2020 to November 2022 were selected and divided into two groups: a release group (receiving IPL release during thoracoscopic right upper lobe apical segment resection) and a retention group (receiving the same right upper lobe apical segment resection, but retaining IPL during operation). The clinical data of the two groups were compared. ResultsA total of 70 patients were included in this study, including 33 males and 37 females, aged 35-76 years. There were 35 patients in the release group with an average age of (57.02±9.25) years; 35 patients in the retention group with an average age of (56.81±9.94) years. The surgical time in the release group was statistically longer than that in the retention group (P=0.017). There was no statistical difference between the two groups in terms of intraoperative bleeding, duration of postoperative air leakage, time to achieve lung recruitment, drainage flow rate of the chest tube, retention time of the chest tube, incidence of postoperative complications, postoperative hospitalization days, or residual cavity rate one month after the surgery (P>0.05). ConclusionCompared to releasing IPL during thoracoscopic right upper lobe apical segment resection, preserving IPL can simplify surgical procedures, shorten surgical time and reduce trauma, and does not increase postoperative adverse effects. This further reflects the concept of minimally invasive surgery and can be applied to clinical practice.
Objective
To analyze the safety and effectiveness of ultrasound-guided thoracoscopic atrial septal defect (ASD) closure.
Methods
We prospectively collected the clinical data of 12 patients with ASD treated by ultrasound-guided thoracoscopic ASD closure in Fuwai Hospital from January to September 2017. The characteristics of the patients' ASD and operation, operation safety and effectiveness, postoperative complications and follow-up results were analyzed.
Results
Among the 12 patients, 10 were successfully treated with ultrasound-guided thoracoscopic ASD closure. Two patients switched to ASD repair under thoracoscopy-assisted cardiopulmonary bypass. The size of the ASD was 17-40 (27.22±8.97) mm and the size of the occluder was 36 (30-42) mm. The average postoperative length of hospital stay was 6 days. There were no complications such as arrhythmia, bleeding and pericardial effusion after operation. The average follow-up was 6 (3-10) months after the operation. During the follow-up, no Ⅲ-degree conduction block, occluder dislocation, residual shunt or cardiac pericardial effusion was found.
Conclusion
Ultrasound-guided thoracoscopic ASD closure is a minimally invasive, safe and effective treatment. This technique provides a new minimally invasive surgical option for patients with large defect diameter and poor edge condition.
ObjectiveTo compare the clinical efficacy of video-assisted thoracoscopy and thoracotomy for the treatment of encapsulated tuberculous pleurisy.
MethodsWe retrospectively analyzed the clinical data of 99 patients who had underwent surgery for encapsulated tuberculous pleurisy within 3 months of disease onset in our hospital from January through December 2013. Based on the surgical mode, patients were assigned to a video-assisted thoracoscopy group, including 49 patients (35 males and 14 females, a mean age of 26.78±9.36 years), to receive video-assisted thoracoscopic pleurectomy; or a thoracotomy group, including 50 patients (31 males and 19 females, a mean age of 31.84±11.08 years), to receive conventional thoracotomic pleurectomy. The first 43 patients in the video-assisted thoracoscopy group received thoracic catheter drainage, with the drainage volume of 659.08±969.29 ml; the first 48 patients in the thoracotomy group received thoracic catheter drainage, with the drainage volume of 919.03±129.97 ml. The clinical effects were compared between the two groups.
ResultsAll the patients in the video-assisted thoracoscopy group completed thoracoscopy without conversion to thoracotomy. The surgery duration and postoperative intubation time were shorter in the video-assisted thoracoscopy group than those in the thoracotomy group (surgery duration:103.00±53.04 min vs. 127.06±51.60 min, P<0.01; postoperative intubation time 3.02±0.83 d vs. 3.94±1.25 d, P<0.01). At the end of 6 months of follow-up, the forced expiratory volume in one second (FEV1>) was 2.83±0.64 L in the thoracos-copy group and 2.25±0.64 L in the thoracotomy group (P<0.01); forced vital capacity (FVC) was 3.02±0.72 L in the thora-coscopy group and 2.57±0.79 L in the thoracotomy group (P<0.05); and maximal voluntary ventilation (MVV) was 93.90± 15.86 L in the thoracoscopy group and 80.34±17.06 L in the thoracotomy group (P<0.01).
ConclusionThoracoscopic surgery is feasible for patients with encapsulated pleurisy within 3 months of onset. Furthermore video-assisted thoraco-scopy will be superior to thoracotomy.
ObjectiveTo investigate the safety, feasibility and advantages of subxiphoid uni-portal thoracoscopic thymectomy.MethodsClinical data of 65 patients undergoing subxiphoid uni-portal thoracoscopic thymectomy in our hospital from September 2018 to March 2019 were retrospectively analyzed. They were treated as a subxiphoid surgery group, including 36 males and 29 females, aged 49.5 (29-71) years. The incision with the length of about 3 cm was located approximately 1 cm under the xiphoid process. From January 2016 to December 2017, 65 patients received intercostal uni-portal thoracoscopic thymectomy, who were treated as a control group, including 38 males and 27 females, aged 48.9 (33-67) years. All patients who were clinically diagnosed with thymic tumor before surgery were treated with total thymectomy. After surgery, expectoration and analgesia were used.ResultsThere was no statistically significant difference in general clinical data, lesion size, intraoperative blood loss, postoperative catheterization time, postoperative hospital stay and postoperative pathology between the two groups. All operations were successfully completed, and the patients in both groups recovered uneventfully after surgery. Visual analogue scale scores on the 1st, 3rd, 7th and 30th day after surgery in the subxiphoid surgery group were lower than those in the control group.ConclusionThe subxiphoid uni-portal thoracoscopic approach can achieve total thymectomy with less trauma and faster postoperative recovery.
Objective To investigate the current level of resourcefulness and its impact on work engagement among lung cancer patients who have returned to work after video-assisted thoracoscopic surgery (VATS) lung resection. Methods A sample of middle-aged and young lung cancer patients who underwent VATS lung resection at the Department of Thoracic Surgery, West China Hospital of Sichuan University, between March and September 2023 and had returned to work were selected as the study subjects. Data were collected using a general information questionnaire, the Resourcefulness Scale, and the Utrecht Work Engagement Scale (UWES). Univariate analysis and multiple stepwise regression analysis were used to examine the current status of patients’ resourcefulness upon returning to work and its influence on work engagement. Results A total of 219 patients were included in the study, comprising 60 males and 159 females, with a mean age of (43.18±7.55) years. The patients' score for resourcefulness in returning to work was (107.58±14.42) points, and the total score for work engagement was (64.80±12.72) points. A significant positive correlation was observed between the resourcefulness score and the work engagement score (P<0.001). Multiple stepwise regression analysis revealed that factors such as job nature, average monthly household income, postoperative complications, and individuals' level of resourcefulness all significantly influenced the degree of patients' work engagement (all P<0.05).Conclusion The resourcefulness level and work engagement of patients returning to work after VATS lung resection need to be improved.
Objective
To investigate the clinical outcomes of subxiphoid video-assisted thoracoscopic thymectomy for myasthenia gravis.
Methods
The clinical data of the 85 patients undergoing video-assisted thoracoscopic thymectomy for myasthenia gravis in Department of Cardiothoracic Surgery, Huashan Hospital affiliated to Fudan University between January 2014 and July 2016 were studied. Subxiphoid approach video-assisted thoracoscopic thymectomy (SXVT) and through traditional unilateral approach video-assisted thymectomy (TVAT) were compared. The clinical outcomes of SXVT and TVAT were compared.
Results
There was no surgical death and no statistical difference between the two groups in drainage time, postoperative volume of drainage, postoperative hospital stay and bleeding volume during operation (P>0.05). However, the acute chest pain after surgery, as well as the postoperative chest pain, and operative time were less in the the SXVT group than that in the TVAT group (P<0.05).
Conclusion
SXVT for myasthenia gravis is safe and executable. It can alleviate intercostal neuralgia and abnormal chest wall feeling. And it should be considered in the treatment of myasthenia gravis.
ObjectiveTo explore an effective and safe drainage method, by comparing open thoracic drainage and conventional thoracic drainage for lung cancer patients after thoracoscopic pneumonectomy.MethodsThe clinical data of 147 patients who underwent thoracoscopic pneumonectomy from January 2015 to March 2018 in our hospital were retrospectively analyzed, including 128 males and 19 females. Based on drainage methods, they were divided into an open drainage group (open group) and a conventional drainage group (regular group). The incidence of postoperative complications, chest tube duration, drainage volume at postoperative 3 days, postoperative hospital stay, hospitalization cost and quality of life were compared between the two groups.ResultsPostoperative complication rate was lower in the open group than that in the regular group (10.20% vs. 23.47%, P=0.04). The chest tube duration of the open group was longer compared with the regular group (5.57±2.36 d vs. 3.22±1.23 d, P<0.001). The drainage volume at postoperative 3 days was less in the regular group. In the open group, ambulation was earlier, thoracocentesis was less and re-intubation rate was lower (all P<0.001). The postoperative hospital stay in the regular group was significantly longer than that in the open group (8.37±2.56 d vs. 6.35±1.87 d, P<0.001) and hospitalization cost was significantly higher (66.2±5.4 thousand yuan vs. 59.6±7.3 thousand yuan, P<0.001). Besides, quality of life in 1 and 3 months after operation was significantly better than that in the open group (P<0.001).ConclusionCompared with the regular chest drainage, the effect of open thoracic drainage is better, which can help reduce postoperative complications, shorten the length of hospital stay, reduce the hospitalization cost and improve the quality of postoperative life. It is worthy of clinical promotion.
Magnetic anchoring and traction technique is one of the core technologies of magnetic surgery. With the "non-contact" traction force of the outer magnet on the inner magnet, we can drive the inner magnet and the gripper to multiple directions, and pull tissue or organ to required position in operations, so as to get a clearer surgical field of view. On the basis of the previous animal experiments, we applied magnetic anchoring and traction device in 3 human (males aged 63-71 years) thoracoscopic esophagectomies. Using the magnetic anchoring device, we could pull the esophagus dorsally or ventrally to assist in exposing the anatomical plane without special equipment or pleural puncture for retraction of the esophagus. The interference between operating instruments reduced. The mean blood loss in operation was 83 mL, the mean total operation time was 253 min and the mean length of hospital stay was 10 d. Postoperative follow-up showed that all 3 patients had good short-term prognosis. There was no swellling or pain in magnetic anchoring zone of chest wall.
