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Objective:To investigate the safety and feasibility of Ivor-Lewis procedure under uniportal video-assisted thoracoscopy(VATS) for esophageal cancer and Siewert type I esophago-gastric junction carcinoma.Methods:The patients with middle-lower segment esophageal cancer or Siewert type I esophago-gastric junction carcinoma received minimally invasive esophagectomy between October 2020 and June 2021, and the clinical data was collected and analyzed.Results:26 patients received Ivor-Lewis procedure underwent uniportal VATS, while 45 patients underwent McKeown surgery under multiport VATS. The average operation time of patients in the two groups were(265±110)min and (235±94)min, and the average intraoperative blood loss were(80±57)ml and(105±60)ml. The mean number of lymph nodes removed in the surgery were (19.3±2.9) and 18.6±2.7 respectively in two groups, and the mean length of hospital stay was(7.5±3.5)days and(8.3±2.7)days. The incidence of perioperative complications were not significantly different in two groups. The VAS score of patients received Ivor-Lewis procedure underwent uniportal VATS was lower than that of patients received McKeown surgery in ostoperative day 1, day 3, day 7 and 1 month. The difference was statistically significant in two groups( P<0.05). Conclusion:The Ivor-Lewis procedure under uniportal VATS for esophageal cancer and Siewert type I esophago-gastric junction carcinoma has the advantage of less postoperative pain, and the procedure is feasible in clinical practice.
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@#Objective To explore the feasibility of early chest tube removal following single-direction uniportal video-assisted thoracoscopic surgery (S-UVATS) anatomical lobectomy. Methods The clinical data of consecutive VATS lobectomy by different surgeons in Xuzhou Central Hospital between May 2019 and February 2022 were retrospectively reviewed. Finally, the data of 1 084 patients were selected for analysis, including 538 males and 546 females, with a mean age of 61.0±10.1 years. These patients were divided into a S-UVATS group with 558 patients and a conventional group (C-UVATS) with 526 patients according to the surgical procedures. The perioperative parameters such as operation time, blood loss were recorded. In addition, we assessed the amount of residual pleural effusion and the probability of secondary thoracentesis when taking 300 mL/d and 450 mL/d as the threshold of chest tube removal. Results Tumor-negative surgical margin was achieved without mortality in this cohort. As compared with the C-UVATS group, patients in the S-UVATS group demonstrated significantly shorter operation time (P<0.001), less blood loss (P=0.002), lower rate of conversion to multiple-port VATS or thoracotomy (P=0.003), but more stations and numbers of dissected lymph nodes as well as less suture staplers (P<0.001). Moreover, patients in the S-UVATS demonstrated shorter chest tube duration, less total volume of thoracic drainage and shorter postoperative hospital stay, with statistical differences (P<0.001). After excluding patients of chylothorax and prolonged air leaks>7 d, subgroup analysis was performed. First, assuming that 300 mL/d was the threshold for chest tube removal, as compared with the C-UVATS group, patients in the S-UVATS group would report less residual pleural effusion and less necessitating second thoracentesis with residual pleural effusion>500 mL (P<0.05). Second, assuming that 450 mL/d was the threshold for chest tube removal, as compared with the C-UVATS group, the S-UVATS group would also report less residual pleural effusion and less necessitating second thoracentesis with residual pleural effusion>500 mL (P<0.05). Further multivariable logistic regression analysis indicated that S-UVATS was significantly negatively related to drainage volume>1 000 mL (P<0.05); whereas combined lobectomy, longer operation time, more blood loss and air leakage were independent risk factors correlated with drainage volume>1 000 mL following UVATS lobectomy (P<0.05). Conclusion The short-term efficacy of S-UVATS lobectomy is significantly better than that of the conventional group, indicating shorter operation time and less chest drainage. However, early chest tube removal with a high threshold of thoracic drainage volume probably increases the risk of secondary thoracentesis due to residual pleural effusion.
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@#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.
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BACKGROUND@#At present, an ultrafine chest tube combined with a traditional thick tube were often used after pulmonary uniportal video-assisted thoracoscopic surgery (U-VATS). However, the thick tube was often placed in the incision, which increased the risk of poor wound healing and postoperative pain. The aim of this study is to investigate the feasibility and safety of using two ultrafine chest tubes (10 F pigtail tube) for drainage after pulmonary U-VATS.@*METHODS@#The medical records of patients who underwent pulmonary U-VATS during June 2018 and June 2020 in the department of cardiothoracic surgery of the second affiliated hospital of Soochow university were retrospectively reviewed to compare two different drainage strategies, receiving two 10 F pigtail tubes as chest tube (group A) or one 10 F pigtail tube as lower chest tube combined with one 24 F tube as upper chest tube (group B).@*RESULTS@#106 patients in group A receiving two 10 F pigtail tubes during June 2019 and June 2020 and 183 patients in group B receiving one 10 F pigtail tube as lower chest tube combined with one 24 F tube as upper chest tube during June 2018 and June 2019 were included. There was no significant difference between two groups in terms of the postoperative thoracic drainage (mL) (1st: 199.54±126.56 vs 203.59±139.32, P=0.84; 2nd: 340.30±205.47 vs 349.74±230.92, P=0.76; 3rd: 435.19±311.51 vs 451.37±317.03, P=0.70; 4th: 492.58±377.33 vs 512.57±382.94, P=0.69; Total: 604.57±547.24 vs 614.64±546.08, P=0.88), drainage time (d) (upper chest tube: 2.54±2.20 vs 3.40±2.07, P=0.21; lower chest tube: (2.24±2.43 vs 3.82±2.12, P=0.10), postoperative hospital stays (d) (6.87±3.17 vs 7.06±3.21, P=0.63), poor wound healing (0 vs 3.28%, P=0.09), replacement of lower chest tube (0.94% vs 2.19%, P=0.66) and the VAS1 (3.00±0.24 vs 2.99±0.15, P=0.63). Notably, there were significant differences between two groups in terms of the VAS₂ (2.28±0.63 vs 2.92±0.59, P<0.01) and VAS₃ (2.50±1.58 vs 2.79±1.53, P=0.02), as well as the frequency of using additional analgesics (25.47% vs 38.25%, P=0.03) and replacement of the upper chest tube (0 vs 4.37%, P=0.03).@*CONCLUSIONS@#It's feasible and safe to use two 10 F pigtail tubes for drainage after pulmonary U-VATS, which can achieve less postoperative pain and lower frequency of replacement of the upper chest tube on some specific patients.
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@#Objective To investigate the effectiveness of sublobar resection and lobectomy via uniportal video-assisted thoracoscopic surgery (U-VATS) for lung metastases from colorectal cancer. Methods Retrospective research was conducted on 42 colorectal cancer patients with lung metastases who underwent U-VATS sublobar resection and lobectomy at the Tongji Hospital, Huazhong University of Science and Technology between April 2016 and May 2019, including 24 males and 18 females with an average age of 58.0±9.9 years. Among them 17 patients received U-VATS sublobar resection and 25 patients received lobectomy. The operation time, intraoperative blood loss, postoperative pulmonary infection, drainage tube indwelling time, drainage volume on the first day after surgery, postoperative hospital stay were analyzed between the two groups, and the relationship between the prognosis and clinical characteristics of the two groups was compared. Results Sublobar resection patients had less lung metastases (P=0.043) and shorter operation time (P=0.023) compared with the lobectomy patients. There was no significant difference between the lobectomy and sublobar resection groups in intraoperative blood loss (P=0.169), rate of postoperative infection (P=0.982), postoperative drainage duration (P=0.265), drainage volume on the first day after surgery (P=0.402) and postoperative hospital stay (P=0.612). The progression-free survival of the two groups was 25.19 months and 23.63 months (P=0.721), and their overall survival was 29.09 months and 30.64 months (P=0.554). Conclusion Considering guantity and locations of lung metastases, U-VATS sublobar resection can achieve a similar prognosis to lobectomy for lung metastases from colorectal cancer. Further efficacy of this surgical strategy remains to be proved by longer follow-up.
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@#Objective To 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. Methods Clinical 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. Results There 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). Conclusion Both 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.
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ObjectiveTo explore the feasibility and clinical effect of subxiphoid uniportal video-assisted thoracoscopic surgery in the treatment of the anterior mediastinal tumors. MethodsThe clinical data of 38 patients, who underwent subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal tumor in Shanghai Pulmonary Hospital of Tongji University from Oct. 2014 to Aug. 2018, were retrospectively analyzed. Among them, 20 were males and 18 were females, the average age was (57.8±14.8) years, and the average diameter of anterior mediastinal tumors was (2.8±1.7) cm. The surgery was performed under video-assisted thoracoscope through an about 4 cm subxiphoid longitudinal incision. ResultsAll the 38 cases of subxiphoid uniportal video-assisted thoracoscopic surgery were performed successfully without conversion to thoracotomy or perioperative death. Except for one patient who received mechanical ventilatory support for 1 week because of worsened myasthenia gravis symptoms, there were no other complications. The operative time, volume of bleeding, volume of drainage on the operation day and hospital stay after surgery were 1-4 (1.9±0.8) h, 10-400 (87.5±68.7) mL, 50-650 (237.4±176.4) mL and 1-19 (4.1±2.9) d, respectively. Postoperative pathology showed 1 case of type A thymoma, 1 case of type B2 thymoma, 1 case of type B3 thymoma, 5 cases of type AB thymoma, 1 case of thymic squamous carcinoma, 6 cases of thymic hyperplasia, 16 cases of thymic cyst, 6 cases of simple thymus and fat and 1 case of bronchial cyst. The visual analogue scale scores on 1, 3 and 6 months after surgery were 3.8±2.2, 1.5±1.4 and 0.8±0.6, respectively. ConclusionSubxiphoid uniportal video-assisted thoracoscopic surgery is a safe, efficient, satisfactory procedure for early stage thymoma, benign anterior mediastinal tumors and some early stage anterior mediastinal malignant tumors, and it can effectively avert the intractable incision pain caused by intercostal nerve injury.
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ObjectiveTo explore the surgical technique and effectiveness of uniportal video-assisted thoracoscopic double-sleeve lobectomy and its clinical popularization value. MethodsThe clinical data of 19 consecutive patients (18 left-sided operations and 1 right-sided operation), who underwent uniportal video-assisted thoracoscopic double-sleeve lobectomy in Shanghai Pulmonary Hospital of Tongji University between Dec. 2016 and Jul. 2018, were included. Pre-, intra- and post-operative indicators were statistically analyzed, and the surgical patients were followed up. ResultsAmong 19 patients, there were 17 males and 2 females, with an average age of (62.3±6.6) years. The average operative time was (258.0±66.6) min, average operative blood loss was (210.0±157.8) mL, average bronchus anastomosis time was (26.0±5.8) min, average artery anastomosis time was (47.7±7.2) min, and average postoperative hospital stay was (7.6±4.5) d. Postoperative pathologic examination indicated that 15 cases had squamous cell carcinoma, 2 had adenocarcinoma, 1 had small cell carcinoma, and 1 had large cell carcinoma. TNM staging: 11 cases was IIIa and 8 was IIIb. Four patients suffered postoperative complications, including 1 case of thrombosis at the vascular anastomosis, 1 arrhythmia and 2 prolonged airleak. There were no bronchial anastomotic fistula and anastomotic stenosis, vascular anastomosis stenosis or operative death. The average followup time was (16.4±6.4) months and no tumor recurrence or metastasis was found during follow-up after operation. ConclusionUniportal video-assisted thoracoscopic double-sleeve lobectomy is a technique-demanding operation, which can be carried out in the thoracic centers with endoscopy proficiency. It is feasible for completely removing tumor, preserving lung function to the greatest extent, and reducing surgical trauma to achieve rapid recovery of patients.
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ObjectiveTo observe the therapeutic effect of subxiphoid uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy in the treatment of the early malignant lung tumors and localized benign lung lesions. MethodsA retrospective analysis was conducted on the clinical data of 220 patients with early malignant lung tumors or localized benign lung lesions undergoing subxiphoid uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy in the Shanghai Pulmonary Hospital of Tongji University between Sep. 2014 to Apr. 2017. Follow-up after operation was performed regularly to evaluate incision pain and surgical outcome. ResultsThe average age of 220 patients was (56.34±10.66) years, and 68 cases (30.91%) were males and 152 cases (69.09%) were females. The average operation time was (2.07±0.72) h, the average perioperative blood loss was (91.64±94.20) mL, and the average postoperative hospital stay was (4.64±9.97) d. A total of 14 patients underwent surgical conversion during the operation. Among them, 7 cases (3.18%, 7/220) had additional intercostal auxiliary hole during operation, 3 (1.36%, 3/220) were converted to subxiphoid uniportal video-assisted thoracoscopic lobectomy due to iatrogenic vascular or bronchial injury, and 4 cases (1.82%, 4/220) were converted to thoracotomy. The incidence of major complication (bleeding) was 0.45% (1/220). No patients suffered from bronchopleural fistula or developed incisional hernia. There were no perioperative deaths, with a postoperative 30 d survival rate of 100.00%. A total of 227 lesions were resected in 220 patients, 183 (80.62%) were malignant and the rest were benign or precancerous lesions. The median follow-up time was 30 months. No postoperative intractable incision pain occurred. Only 2 patients had itching of incision and surrounding skin, and 1 patient had hyposensation of incision and surrounding skin. No recurrence or metastasis occurred in patients with malignant tumors. ConclusionSubxiphoid uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy is an effective method for early malignant tumors and localized benign lesions. It can alleviate postoperative incision pain and has satisfactory therapeutic effects.
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ObjectiveTo explore the feasibility and safety of uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy in the treatment of benign and malignant small lung lesions. MethodsA retrospective analysis was conducted on the clinical data of 395 patients with small pulmonary lesions undergoing uniportal videoassisted thoracoscopic anatomic pulmonary segmentectomy by a single surgery group between Aug. 2013 and May 2017 in Shanghai Pulmonary Hospital of Tongji University. Among them, there were 139 males and 256 females, with a mean age of (56.25±10.53) years, and 193 left lung lesions and 202 right lung lesions. The double-lumen trachea cannula was performed under general anesthesia. Thoracoscopy and surgical instruments were inserted through a 4 cm single-hole incision in the 4th or 5th intercostal of anterior line axillary, and anatomical segmentectomy was performed. The perioperative data, postoperative pathology, intraoperative open thoracotomy transit, postoperative complications and long-term follow-up results were statistically analyzed. ResultsOf the 395 patients, 7 patients were converted to lobectomy, 3 to thoracotomy, 1 to basal pulmonary segmentectomy from posterior basal pulmonary segment, and all the other patients were successfully completed. There were no significant differences in the operation time, intraoperative blood loss, lesion diameter, number of lymph node samples, thoracic drainage at 24 h after operation, postoperative thoracic drainage tube insertion time or postoperative hospital stay between left and right lung lesions (all P>0.05). Postoperative pathology showed malignant lesions in 310 cases and benign lesions in 85 cases. Postoperative complications occurred in 11 cases (6 cases of left lung and 5 cases of right lung), including 2 cases of hemothorax, 6 cases of delayed leakage, and 3 cases of arrhythmia. There were no operative death. The average follow-up time was (40.06±2.86) months, ranging from 9 to 54 months. There were no long-term complications, no abnormal cardiopulmonary function and no recurrence or metastasis in patients with malignant tumors. Conclusion The uniportal video-assisted thoracoscopic anatomic pulmonary segmentectomy is safe and feasible, and can resect lesions accurately and minimally invasively. And thus it is worthy of clinical application.
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Recently, uniportal video-assisted thoracic surgery (VATS) has developed rapidly and has become the main theme of global surgical development. The specific, standardized and systematic training of this technology has become an important topic. Specific training in the uniportal VATS approach is crucial to ensure safety and radical treatment. Such training approach, including a direct interaction with experienced surgeons in high-volume centers, is crucial and represents an indispensable step. Another form of training that usually occurs after preceptorship is proctorship: an experienced mentor can be invited to a trainee's own center to provide specific on-site tutelage. Videos published online are commonly used as training material. Technology has allowed the use of different models of simulators for training. The most common model is the use of animal wet laboratory training. Other models, however, have been used mostrecently, such as the use of 3D and VR Technology, virtual reality simulators, and completely artificial models of the human thorax with synthetic lung, vessel, airway, and nodal tissues. A short-duration, high-volume, clinical immersion training, and a long term systematic training in high-volume centers are getting more and more attention. According to the evaluation of students' grading, a diversified training mode is adopted and the targeted training in accordance with different students helps to improve the training effect. We have done some work in systematic and standardized training of uniportal VATS in single center. We believe such training is feasible and absolutely necessary.
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Humans , Lung Neoplasms , General Surgery , Surgeons , Education , Teaching , Thoracic Surgery, Video-Assisted , Education , MethodsABSTRACT
Objective To evaluate the feasibility of 3D thoracoscopic system in uniportal video-assisted thoracoscopic surgery (uniportal VATS) for the treatment of thoracic diseases. Methods 7 cases of thoracic diseases were accomplished with 3D thoracoscope from Nov 2015 to Dec 2015, including 3 cases of lobectomy, 2 cases of wedge resection of pulmonary tumor, 2 cases of mediastinal mass. Results All the operations were completed successfully, without conversion to open surgery. All the patient recovery successfully. The data of operative time, bleeding volume, postoperative chest tube drainage and hospital time and postoperative complications were counted. No complications and tumor recurrence or metastasis were observed during the followed 3 months. Conclusion 3D thoracoscopic system can be used in uniportal video-assisted thoracoscopic surgery (uniportal VATS) safely and provide high-definition and better sense of depth which facilitate the operation more precise and safer.
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Objective To compare the efficacy of uniportal VATS and single utility port VATS in treatment of spontaneous pneumothorax.Method From January 2013 to December 2015, we retrospectively collected clinical data of 53 patients with spontaneous pneumothorax who were treated with uniportal VATS, as study group; compared with control group: 53 patients received single utility port VATS in the same period. The clinical data was compared between the two groups, including the operation time, intraoperative blood loss, drainage time, postoperative extubation time, postoperative pain score, postoperative hospitalization and recurrence.Results All patients were successfully completed the operation, no death and serious complications occurred. There were no significant differences in intraoperative blood lose, duration of chest drainage, duration of hospital stay and incidence of serious postoperative complications between two groups (P > 0.05). Mean Visual Analogic Scale (VAS) score for 24 h post-operative pain was: (2.60 ± 0.71) for uniportal VATS and (3.38 ± 0.84) for single utility port VATS (P > 0.05), 72 h post-operative pain was: (1.30 ± 0.51) for uniportal VATS and (1.58 ± 0.62) for single utility port VATS (P > 0.05). Follow up 5 ~ 36 months, median follow up was 19 months. No recurrence occurred during follow up.Conclusions The study suggested that both surgical approaches to spontaneous pneumothorax are safe and effective. Significant differences were found for early post-operative pain between the two approaches, the uniportal way is better. It is worthy of clinical promoting.
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Objective To evaluate the clinical effect of Uniportal video -assisted thoracoscopic surgery and single utility port video-assisted thoracoscopic surgery for ⅠA stage non-small cell lung cancer .Methods A total of 81 patients with ⅠA stage non-small cell lung cancer was admitted to our hospital from January 2015 to November 2015 .The patients were divided into control group and observation group .51 patients of control group received single utility port video -assisted thoracoscopic surgery , while other 30 patients of observation group received Uniportal video -assisted thoracoscopic surgery .Results The incision length of observation group was(4.27 ±0.29) cm,operative time was (208.80 ±61.12) mins.The volume of blood intra -operation was (92.33 ±73.75)mL;the number of lymph nodes dissection was (15.62 ±5.12),post-operative drainage within 24 hours was(401.70 ±53.31)mL;drainage tube retention was (6.30 ±3.01)days;postoperative hospitalization time was(19.03 ±5.85)days.The incidence rate of postoperative complications was 13.33%.The incision length of control group was(3.86 ±0.23)cm.The operative time was(184.30 ±51.36)mins;The volume of blood intra-operation was(84.90 ±80.98)mL,the number of lymph nodes dissection was (15.84 ±5.66),post-operative drainage within 24 hours was(398.00 ±52.73)mL;drainage tube retention was(6.10 ±3.25)days;postoperative hospitalization time was(18.69 ±6.81) days;The incidence rate of postoperative complications was 25.49%, there were no significant difference between the two groups (P>0.05).VAS pain score of the observation group was(2.32 ±0.94)and it was(4.18 ±0.95)in control group,and observation group was significantly better than the control group(P<0.05).Conclusion Uniportal video -assisted thoracoscopic surgery has the benefit of less trauma and pain ,and it is worth using widely .