Short-term efficacy of surgical treatment for multiple pulmonary nodules: A retrospective study in a single center / 中国胸心血管外科临床杂志

@#Objective To summarize and analyze the clinical diagnosis, surgical treatment and prognosis of multiple pulmonary nodules (MPNs). Methods The clinical data of lung cancer patients who received surgical treatment in our hospital from 2018 to 2020 were collected. The short-term efficacy of surgical treatment for MPNs was analyzed. Results A total of 97 patients were enrolled, including 30 males and 67 females with an average age of 56.1±10.0 years at onset ill. There were 62 patients with double lesions, 22 patients with three lesions, 4 patients with four lesions, and 9 patients with more than four lesions. A total of 213 lesions were surgically treated, including 88 pure ground-glass nodules, 81 partially solid nodules, and 7 solid nodules. There were 87 simultaneous surgeries and 10 staged surgeries, with an average operation interval of 5.2 months. The pathological combination type included adenocarcinoma-adenocarcinoma in 96 (99.0%) patients, squamous cell carcinoma-squamous cell carcinoma in 1 (1.0%) patient, and no lymph node metastasis was found. The 2-year disease-free survival (DFS) rate was 92.1%, and the overall survival (OS) rate was 100.0%. Univariate analysis showed that high-risk lesion size>2 cm (P=0.316), residual lesions (P=0.782) and pathological combination type (P=0.913) had statistical effect on the 2-year DFS rate. Conclusion MPNs are mainly diagnosed with multiple primary lung cancers, and the pathological combination is mostly adenocarcinoma-adenocarcinoma combination. Imaging examination is of great help to the surgical approach selection, diagnosis and differential diagnosis of MPNs. During the operation, maximal preservation of lung function and complete resection of high-risk nodules should be taken as the principle, and the prognosis is satisfactory.

Clinical efficacy of da Vinci robotic and thoracoscopic transxiphoid approach in the treatment of anterior mediastinal tumors: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective To compare the safety and efficacy of the da Vinci robot and thoracoscopic subxiphoid approach for the treatment of anterior mediastinal tumors. Methods The clinical data of patients who underwent anterior mediastinal tumor resection through the subxiphoid approach admitted to the same medical group in the Department of Thoracic Surgery of the First Hospital of Lanzhou University between June 2020 and April 2022 were retrospectively analyzed. According to the surgery approach, the patients were divided into a robot-assisted thoracoscopic surgery (RATS) group and a video-assisted thoracoscopic surgery (VATS) group. The perioperative data and the incidence of postoperative complications were compared between the two groups. Results A total of 79 patients were enrolled. There were 41 patients in the RATS group, including 13 males and 28 females, with an average age of 45.61±14.99 years. There were 38 patients in the VATS group, including 14 males and 24 females, with an average age of 47.84±15.05 years. All patients completed the surgery successfully. Hospitalization cost and operative time were higher or longer in the RATS group than those in the VATS group, and the difference was statistically significant (P<0.05). Intraoperative bleeding, postoperative hospital stay, postoperative water and food intake time, postoperative off-bed activity time, white blood cell count, neutrophil percentage and visual analogue scale (VAS) score on the first postoperative day, white blood cell count and neutrophil percentage on the third postoperative day, duration of analgesic pump use, the number of voluntary compressions of the analgesic pump, and mediastinal drainage volume were all superior to those in the VATS group (P<0.05). The differences in VAS scores on the third postoperative day, duration of drainage tube retention and postoperative complication rates were not statistically different between the two groups (P>0.05). Conclusion RATS subxiphoid anterior mediastinum tumor resection is a safe and feasible surgical method with less injury and higher safety, which is conducive to rapid postoperative recovery and has wide clinical application prospects.

Continuous vital signs monitoring using wireless wearable devices in patients after video-assisted thoracoscopic surgery for lung cancer: A prospective self-control study / 中国胸心血管外科临床杂志

@#Objective To explore the reliability and safety of continuous monitoring of vital signs in patients using wireless wearable monitoring devices after video-assisted thoracoscopic surgery (VATS) for lung cancer. Methods The patients undergoing VATS for lung cancer in West China Hospital, Sichuan University from May to August 2023 were prospectively enrolled. Both wireless wearable and traditional wired devices were used to monitor the vital signs of patients after surgery. Spearman correlation analysis, paired sample t test and ratio Bland-Altman method were used to test the correlation, difference and consistency of monitoring data measured by the two devices. The effective monitoring rate of the wireless wearable device within 12 hours was calculated to test the reliability of its continuous monitoring. Results A total of 20 patients were enrolled, including 15 females and 5 males with an average age of 46.20±11.52 years. Data collected by the two monitoring devices were significantly correlated (P<0.001). Respiratory rate and blood oxygen saturation data collected by the two devices showed no statistical difference (P>0.05), while heart rate measured by wireless wearable device was slightly lower (=−0.307±1.073, P<0.001), and the blood pressure (=1.259±5.354, P<0.001) and body temperature(=0.115±0.231, P<0.001) were slightly higher. The mean ratios of heart rate, respiratory rate, blood oxygen saturation, blood pressure and body temperature collected by the two devices were 0.996, 1.004, 1.000, 1.014, and 1.003, respectively. The 95% limits of agreement (LoA) and 95% confidence interval of 95%LoA of each indicator were within the clinically acceptable limit. The effective monitoring rate of each vital signs within 12 hours was above 98%. Conclusion The wireless wearable device has a high accuracy and reliability for continuous monitoring vital signs of patients after VATS for lung cancer, which provides a security guarantee for subsequent large-scale clinical application and further research.

Diagnosis and treatment of 131 adult patients with bronchopulmonary sequestration: A retrospective analysis / 中国胸心血管外科临床杂志

@#Objective    To explore the safety and feasibility of uni-portal video-assisted thoracic surgery (VATS) for the treatment of bronchopulmonary sequestration (BPS). Methods    The clinical data of BPS patients with surgical resection in Shanghai Pulmonary Hospital from February 2010 to June 2021 were reviewed. The patients were divided into a VATS group and a thoracotomy group according to the operation method. The operation time, intraoperative blood loss, hospital stay and postoperative complication rate were compared between the two groups. The VATS group was subdivided into a uni-portal VATS group and a multi-portal VATS group for subgroup analysis. Results    Finally 131 patients were enrolled, including 62 males and 69 females with an average age of 39.3±13.2 years. There were 103 patients in the VATS group and 28 patients in the thoracotomy group. A total of 104 patients were diagnosed with left lower BPS, 26 with right lower BPS and 1 with bilateral lower BPS. The main symptom was cough (88 patients, 67.2%). There were 119 patients diagnosed by thoracic enhanced CT before operation. Compared with the thoracotomy group, the operation time was not statistically different (P=0.717), but the blood loss was less, the rate of postoperative complication was lower and hospital stay was shorter in the VATS group (P<0.05). The rate of conversion to open surgery in the uni-portal VATS group and multi-portal VATS group was 11.8% and 13.5%, respectively. Meanwhile, patients in the uni-portal VATS group had shorter operation time and postoperative hospital stay, less blood loss and lower postoperative complication rate than those in the multi-portal VATS group (P<0.05). Conclusion     In order to improve the rate of diagnosis, the lung enhanced CT scan should be selected as an optimal noninvasive method in adult suspected patients (especially those with solid cystic and solid lesions in the lower lobe). Uni-portal VATS is a safe and feasible method for BPS which can be widely promoted.

Clinical application of Mimics software system to three-dimensional reconstruction to guide thoracoscopic anatomic pulmonary segmentectomy / 中国胸心血管外科临床杂志

@#Objective    To investigate the clinical effect of 3D computed tomography bronchial bronchography and angiography (3D-CTBA) and guidance of thoracoscopic anatomic pulmonary segmentectomy by Mimics software system. Methods    A retrospective analysis was performed on patients who underwent thoracoscopic segmentectomy in the Department of Thoracic Surgery of Affiliated People's Hospital of Jiangsu University from June 2020 to December 2022. The patients who underwent preoperative 3D-CTBA using Materiaise's interactive medical image control system (Mimics) were selected as an observation group, and the patients who did not receive 3D-CTBA were selected as a control group. The relevant clinical indicators were compared between the two groups. Results    A total of 59 patients were included, including 29 males and 30 females, aged 25-79 years. There were 37 patients in the observation group, and 22 patients in the control group. The operation time (163.0±48.7 min vs. 188.8±43.0 min, P=0.044), intraoperative blood loss [10.0 (10.0, 20.0) mL vs. 20.0 (20.0, 35.0) mL, P<0.001], and preoperative puncture localization rate (5.4% vs. 31.8%, P=0.019) in the observation group were better than those in the control group. There was no statistically significant difference in the thoracic tube placement time, thoracic fluid drainage volume, number of intraoperative closure nail bin, postoperative hospital stay, or postoperative air leakage incidence (P>0.05) between the two groups. Conclusion    For patients who need to undergo anatomical pulmonary segmentectomy, using Mimics software to produce 3D-CTBA before surgery can help accurately identify pulmonary arteriovenous anatomy, reduce surgical time and intraoperative blood loss, help to determine the location of nodules and reduce invasive localization before surgery, and alleviate patients' pain, which is worthy of clinical promotion.

Desbridamiento retroperitoneal video asistido: una nueva técnica quirúrgica para una vieja patología, la pancreatitis aguda severa presentación de caso clínico / Video-assisted retroperitoneal debridement: a new surgical technique for an old pathology, severe acute pancreatitis clinical case presentation

INTRODUCCIÓN: el desbridamiento retroperitoneal video asistido (DRVA) es una técnica mínimamente invasiva usada para el tratamiento de la necrosis pancreática infectada (NPI). MATERIAL Y MÉTODO: reporte de caso. RESULTADOS: se presenta un caso de pancreatitis aguda severa tratada con DRVA en una paciente femenina de 43 años, con un cuadro clínico de 5 días de evolución caracterizado por dolor abdominal espasmódico en hipocondrio derecho, de moderada intensidad, irradiado a epigastrio y en cinturón a ambos flancos. La paciente recibió atención privada en dos centros previos al ingreso al nuestro. Al ingreso, en el laboratorio, presenta leucocitosis y desvió izquierdo, amilasémia y lipasémia altas. Se realizaron tomografías contrastadas y punciones guiadas por TAC y DRVA cuando se evidencia necrosis amurallada. Se describe la técnica quirúrgica. Súbitamente la paciente presenta insuficiencia respiratoria y datos compatibles con tromboembolia pulmonar y fallece. CONCLUSIÓN: bajo la visión de terapia escalonada, el desbridamiento retroperitoneal video asistido va ganando adeptos en el manejo de la Pancreatitis Aguda Severa

BACKGROUND: video-assisted retroperitoneal debridement (VARD) is a minimally invasive technique used for the treatment of infected necrotizing pancreatitis. MATERIAL AND METHODS: case report. RESULTS: a case of severe necrotizing pancreatitis is presented in a 43 years old female patient, with 5 days clinical evolution with spasmodic abdominal pain in epigastrium and right hypochondrium of moderate intensity, irradiated to both flanks in belt. The patient received private care in two centers upon the admission in our hospital. In the laboratory at the admission, she showed leukocytosis and left deviation, high level in amylase and lipase. Contrasted enhanced tomography and guided punctures were realized and VARD were considered when evidence of wall of necrosis was observed in scanner. The surgical technique is described. Suddenly the patient presented acute respiratory failure with massive pulmonary thromboembolism and died. CONCLUSION: under the step-up approach vision, the video-assisted retroperitoneal debridement is gaining popularity in the management of the acute necrotizing pancreatitis

Explaining Skeletal System Anatomy with Classical Method, Video Assisted Method and 3D Imaging Techniques and Comparison of Learning Levels Between Methods

SUMMARY: The aim of this research is to introduce the ideal lecture technique to the literature by explaining the anatomy of the skeletal system using the classical method, video-assisted method and 3D imaging techniques. The research was carried out with 180 students. The number of samples was determined by power analysis (a=0.05,b=0.20, effect size=0.25). Participants were pre-screened and divided into 4 groups with the closest group mean (group 1: control group: the group that did not take anatomy lessons, group 2: video-assisted anatomy education, group 3: 3D anatomy course, group 4: classical anatomy education group). The courses in the training groups were organised as 4 hours/day, 2 days/week for 5 weeks. At the end of the course, the students were re-examined and scaled to determine the difference in scores and self-efficacy between the groups. A one-way ANOVA test was performed because the data were normally distributed when comparing between groups. The mean scores were calculated as group 1=30.22±6.24, group 2=39.02±9.15, group 3=49.77±9.20 and group 4=59.28±8.95. In the post hoc comparison, in pairwise comparisons between all groups, the differences were highly significant (pgroup 3>group 2>group 1 (p<0.001). According to the results of this study, the laboratory method in skeletal anatomy teaching is the best alternative to 3D anatomy teaching.

El objetivo de esta investigación es introducir la técnica de lectura ideal en la literatura, explicando la anatomía del sistema esquelético, utilizando el método clásico, el método asistido por video y las técnicas de imágenes en 3D. La investigación se llevó a cabo con 180 estudiantes. El número de muestras se determinó mediante análisis de potencia (a=0,05, b=0,20, tamaño del efecto=0,25). Los participantes fueron preseleccionados y divididos en 4 grupos con la media de grupo más cercana (grupo 1: grupo de control: el grupo que no tomó lecciones de anatomía, grupo 2: educación de anatomía asistida por video, grupo 3: curso de anatomía 3D, grupo 4: grupo de educación en anatomía clásica). Los cursos en los grupos de formación se organizaron con 4 horas/día, 2 días/semana durante 5 semanas. Al final del curso, los estudiantes fueron reexaminados y escalados para determinar la diferencia en puntajes y autoeficacia entre los grupos. Se realizó una prueba de ANOVA de una vía debido a que los datos se distribuyeron normalmente al comparar entre grupos. Las puntuaciones medias se calcularon como grupo 1=30,22±6,24, grupo 2=39,02±9,15, grupo 3=49,77±9,20 y grupo 4=59,28±8,95. En la comparación post hoc, en comparaciones por pares entre todos los grupos, las diferencias fueron altamente significativas (pgrupo 3>grupo 2>grupo 1 (p<0,001). Según los resultados de este estudio, el método de laboratorio en la enseñanza de la anatomía esquelética es la mejor alternativa a la enseñanza de la anatomía en 3D.

Pleural empyema after COVID-19: A delayed presentation

Globally, the number of coronavirus disease-2019 (COVID-19) cases and deaths shows a declining trend since a peak in January 2022. For now, the pandemic phase looks to be ended, until a severe new variant may trigger another wave. At present, in India, small pockets of COVID-19 cases and post-COVID complications are still being reported. Therefore, physicians should remain vigilant about the atypical presentations and potential delayed or long-term complications of SARS-CoV-2 infection, even in individuals who had a mild COVID-19 infection. Here, we present the case of a 52-year-old male patient with a history of hypertension, who is a non-smoker and developed culture-negative pleural empyema 7 months after a mild COVID-19 infection. The patient was successfully treated with antibiotics and early video-assisted thoracoscopic surgery

SUBXIPHOID UNIPORTAL VATS THYMECTOMY IN CASES OF MYASTHENIA GRAVIS:SINGLE CENTRE EXPERIENCE

Background: Thymectomy has been identified as Constructive and active strategy for patients with Myasthenia gravis and thymic masses which have been done classically by Open Sternotomy technique and nowadays new Minimally invasive approaches have also been introduced. In this paper , Subxiphoid Uniportal VATS(Video Assis Method : ted Thoracoscopic Surgery) Thymectomy through a single port technique by utilizing the Subxiphoid approach has been discussed. I have improvised my technique pertaining to the requirements and better recovery and better post operative outcome of the patient .This procedure is indicated for all anterior mediastinal masses and maybe extended to lung cancer.The patient was placed in supine position instead of classical lithotomy position .Carbon dioxide insufflation was not used which led to faster recovery after the surgery.After dissection and resection of thymus Bilateral pleural drain were placed which was removed usually on Post Operative day 4 or 5 and patients were discharged afterwards. Several benefits of this Results: approach were observed and documented including reduced postoperative pain, Early extubation, better post operative outcome, and better dissection . In the near future ,the Subxiphoid approach has the potential to become Conclusion: GOLD STANDARD for Thymectomy and various other conditions

Lobectomías pulmonares en Colombia: una caracterización demográfica y clínico-patológica / Pulmonary lobectomies in Colombia: a demographic and clinicopathological characterization

Introducción. La lobectomía pulmonar es uno de los procedimientos más frecuentes en la cirugía torácica en Colombia y a nivel mundial. El objetivo de este estudio fue proporcionar información sobre el comportamiento clínico de los individuos sometidos a este tipo de cirugías. Métodos. Estudio observacional retrospectivo en un Hospital Universitario de Cali, Colombia, que incluyó todos los pacientes sometidos a lobectomía pulmonar, por causas benignas o malignas, entre los años 2010 y 2020. La información se extrajo del registro institucional de cirugía de tórax, obteniendo datos demográficos, clínicos y patológicos. Resultados. Se evaluaron los registros clínicos de 207 individuos. El 55,5 % eran mujeres, la edad promedio fue 58 años y el 41 % tuvieron antecedente de tabaquismo. En el 51,6 % de los casos se diagnosticaron neoplasias, de las cuales el 47,8 % eran primarias de pulmón, siendo el adenocarcinoma el subtipo más común. Las enfermedades benignas no tumorales representaron el 48,3 % de los casos y la causa más frecuente fueron las infecciones, dentro de las que se incluyeron 17 casos de tuberculosis pulmonar. La técnica más frecuente fue la cirugía toracoscópica video asistida (82,6 %). Presentaron un porcentaje de reintervención del 5,8 %, 10,6 % de complicaciones severas y una mortalidad hospitalaria del 4,3 %. Conclusión. La población evaluada muestra una carga alta de comorbilidades y riesgo operatorio elevado; de forma consecuente, al compararla con otras series internacionales, se encontró un porcentaje mayor de complicaciones perioperatorias y mortalidad.

Introduction. The pulmonary lobectomies is one of the most common procedures in thoracic surgery in Colombia and worldwide. The objective of this study is to provide information on the clinical behavior of individuals who underwent this type of surgeries. Methods. Retrospective observational study at a University Hospital in Cali, Colombia, including all individuals who had pulmonary lobectomies, between the years 2010 to 2020 for benign and malignant causes. The information was extracted from the institutional registry of thoracic surgery, obtaining demographic, clinical and pathological data. Results. The clinical records of 207 individuals were evaluated, 55.5% were women, the average age was 58 years, and 41% had a history of smoking. Of these cases, 51.6% were diagnosed with neoplasms, of which 47.8% were primary lung neoplasms, with adenocarcinoma being the most common subtype. As for benign diseases, they represented 48.3% of the cases and the most frequent cause was infections, including 17 cases of pulmonary tuberculosis. The most frequent technique was video-assisted thoracoscopic surgery in 82.6%, with a reoperation rate of 5.8%, up to 10.6% of severe complications, a median hospital stay of 6 days, and a hospital mortality of 4.3%.Conclusion. The population evaluated shows a high burden of comorbidities and high operative risk; consequently, when compared with other international series, it shows a higher percentage of perioperative complications, hospital stay, and mortality.

Primary Spontaneous Pneumothorax: Surgery for the First Occurrence? An Early Experience from Nepal

Background: Primary spontaneous pneumothorax (PSP) is a common thoracic surgical emergency affecting otherwise healthy young individuals. Its treatment options range from observation to surgery in the form of video-assisted thoracoscopic surgery (VATS). Surgery, generally reserved for recurrence, is gradually being utilized for certain patients presenting with PSP for the first time. In this study, we aim to report our experience of VATS in the surgical management of first episodes of PSP. Methods: A retrospective review of prospectively maintained data on all the patients undergoing surgical management during the first presentation of PSP, over a period of 10 years, was done. Results: Over the period of 10 years, out of 95 patients who underwent thoracoscopic bullectomy for pneumothorax, a total of 42 patients had presented with PSP for the first time. Most (54%) were aged 20–40 years, with male predominance (83%); right-sided (69%); commonest symptom was shortness of breath (83.3%) with a median duration of symptoms of 5.9 days. Apical bullae were the commonest computed tomographic finding (88%). Majority of the patients underwent VATS via three ports, and multiple apical bullae were the most common intraoperative findings. Four patients (9.5%) had an air leak postoperatively, managed conservatively. Average intensive care unit stay was 23 hours; average chest tube duration was 3.6 days; and the average hospital stay was 8.2 days. There was no 30-day mortality and no recurrences were noted during a median follow-up of 2 years. Conclusion: Our initial experience with surgery for the first episode of PSP has been shown to be safe and effective. Larger and more robust studies with longer follow-ups would be necessary to better delineate the role of surgery in such patients.

Spontaneous pneumothorax in a young male athlete: A case report with review of literature

Spontaneous pneumothorax (SP) is a serious and life-threatening condition often caused by ruptured apical lung bulla in young male individuals. It is commonly associated with different syndromes but also occurs in healthy individuals. In this case report, we aim to discuss the etiology, clinical course, and surgical treatment of a 21-year-old male kickboxer with a right-sided pneumothorax that occurred during a sparring session. A chest tube with negative suction was inserted to resolve the pneumothorax. Because there was no visible resolution, video-assisted thoracoscopic surgery (VATS) was performed. During VATS, a large, apically placed, ruptured lung bulla, was revealed and removed. One month after surgery, the patient is in great clinical condition. There are no signs of a recurrence of SP.

Endoscopic Mini-or Less-Open Sublay Operation (E/MILOS) in ventral hernia repair: a minimally invasive alternative technique / Endoscopic Mini or Less Open Sublay Repair (E/MILOS) na correção das hérnias ventrais: uma alternativa técnica minimamente invasiva

ABSTRACT The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open or minimally invasive techniques2. The open methods lead to a higher surgical site infections incidence, meanwhile, the laparoscopic IPOM (intraperitoneal onlay mesh) increases the risk of intestinal lesions, adhesions, and bowel obstruction, in addition to requiring double mesh and fixation products which increase its costs and could worsen the post-operative pain3-5. The eTEP (extended/enhanced view totally intraperitoneal) technique has also arisen as a good option for this hernia repair. To avoid the disadvantages found in classic open and laparoscopic techniques, the MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair) concept, created by W. Reinpold et al. in 2009, 3 years after eTEP conceptualization, allows the usage of bigger meshes through a small skin incision and laparoscopic retro-rectus space dissection, as the 2016 modification, avoiding an intraperitoneal mesh placement6,7. This new technique has been called E-MILOS (Endoscopic Mini or Less Open Sublay Repair)8. The aim of this paper is to report the E-MILOS techniques primary experience Brazil, in Santa Casa de Misericórdia de São Paulo.

RESUMO O tratamento cirúrgico ideal para correção das hérnias ventrais ainda é motivo de grande discussão1. O fechamento do defeito associado a utilização de telas para reforço da parede abdominal são passos fundamentais da terapia cirúrgica, podendo ser realizados tanto pela via aberta quanto pelas técnicas minimamente invasivas2. A via aberta apresenta maiores taxas de infecção de sítio cirúrgico, enquanto o reparo laparoscópico IPOM (intraperitoneal onlay mesh) acarreta um risco aumentado de lesões intestinais, aderências e obstruções intestinais, além de requerer uso de telas de dupla face e dispositivos de fixação que encarecem o procedimento e não raro aumentam a dor no pós-operatório3-5. A técnica eTEP (extended/enhanced view totally extraperitoneal), tem ganhado importância, mostrando-se uma boa opção para a correção das hérnias ventrais também2. A fim de se evitar as desvantagens das técnicas abertas e laparoscópicas "clássicas" o conceito MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair), desenvolvido por W. Reinpold et al. em 2009, 3 anos antes do advento do eTEP, possibilita ao cirurgião o uso de telas de grandes dimensões no plano retromuscular através de uma pequena incisão na pele e dissecção laparoscópica deste espaço, conforme modificação realizada em 2016, evitando a colocação de uma tela no espaço intraperitoneal6-7. Esta nova técnica passou a se chamar EMILOS (Endoscopic Mini or Less Open Sublay Repair)8 Este artigo tem como objetivo relatar nossa experiência inicial no emprego da técnica E-MILOS no Brasil, na Santa Casa de Misericórdia de São Paulo.

Da-Vinci robot-assisted thoracic surgery versus video-assisted thoracic surgery for non-small cell lung cancer: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To compare the surgical efficacy of Da-Vinci robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for non-small cell lung cancer (NSCLC). Methods    Online databases including PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP and CBM from inception to 18 February, 2022 were searched by two researchers independently. The references of related studies were also searched to re-enroll the potential studies. The quality of the studies was evaluated with Newcastle-Ottawa Scale (NOS). The meta-analysis was performed by RevMan 5.3. Results     A total of 43 studies including 33 089 patients were enrolled in the final study. The NOS scores of the included studies were ≥6 points. The results of meta-analysis showed that the operation time was longer [MD=8.50, 95%CI (1.59, 15.41), P=0.020], the blood loss was less [MD=−46.58, 95%CI (−62.86, −30.29), P<0.001], the dissected lymph nodes stations were more [MD=0.67, 95%CI (0.40, 0.93), P<0.001], the dissected lymph nodes were more [MD=2.39, 95%CI (1.43, 3.36), P<0.001], the conversion rate was lower [OR=0.52, 95%CI (0.46, 0.59), P<0.001], the time of chest tube drainage was shorter [MD=−0.35, 95%CI (−0.58, −0.11), P=0.004], the length of hospital stay was shorter [MD=−0.32, 95%CI (−0.45, −0.19), P<0.001], and the recurrence rate was lower [OR=0.51, 95%CI (0.36, 0.72), P<0.001] in the RATS group than those in the VATS group. The rate of overall postoperative complications [OR=0.95, 95%CI (0.89, 1.01), P=0.110] and postoperative mortality rate [OR=0.85, 95%CI (0.62, 1.16), P=0.300] were not significantly different between the two groups. Conclusion    Compared with VATS, although RATS prolongs the operation time, it does not increase the incidence of postoperative complications and mortality rates. Moreover, RATS can dissect more lymph nodes, effectively control intraoperative bleeding, shorten the duration of chest drainage tube indwelling and shorten the postoperative hospital stay to a certain extent.

Safety and feasibility of thoracic sympathectomy in the treatment of primary palmar hyperhidrosis based on ambulatory surgery / 中国胸心血管外科临床杂志

@#Objective    To investigate the clinical safety and feasibility of thoracic sympathectomy in the treatment of palmar hyperhidrosis based on ambulatory surgery. Methods    A retrospective analysis of 74 patients who underwent thoracoscopic sympathectomy in the Department of Thoracic Surgery of the First People's Hospital of Yunnan Province from January 2017 to April 2021 was performed, including 35 males and 39 females aged 12-38 (21.32±4.13) years. Patients were divided into two groups according to different treatments. There were 34 patients in a control group (adopting traditional surgery), and 40 patients in an observation group (adopting ambulatory surgery). The clinical effects of the two groups were compared. Results    No massive bleeding, conversion to thoracotomy, postoperative pneumo-thorax or severe pneumonia occured in all patients. Univariate analysis of intraoperative indexes showed that the two groups had no statistical difference in total hospitalization cost, operation time, anesthesia time or postoperative waiting time (P>0.05). The amount of intraoperative blood loss in the observation group was less than that in the control group (P<0.05). The time of postoperative out of bed and recovery of walking capacity and the incidence of electrolyte disturbance in the observation group were shorter or lower than those in the control group (P<0.05). There was no statistical difference in white blood count, neutrophils count or postoperative 24 h pulse oxygen saturation fluctuation peak between the two groups (P>0.05). Conclusion    Based on the optimized diagnosis and treatment model, thoraco-scopic sympathectomy with laryngeal mask airway which is performed during ambulatory surgery, is feasible and worth popularizing in thoracic surgery.

Short-Term Efficacy and Postoperative Inflammatory Cytokine Changes in Lung Cancer Treated with Da Vinci Robot-assisted Versus Video-assisted Thoracoscopic Surgery / 肿瘤防治研究

Objective To evaluate the short-term outcomes and postoperative inflammatory cytokine changes in patients with lung cancer treated with robot-assisted thoracoscopic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS). Methods A total of 270 patients with lung cancer treated by minimally invasive surgery were selected for the study, and the surgical procedures were selected according to the patients' economic conditions and preferences. Among them, 132 patients completed the operation through RATS, and 138 patients completed the operation through VATS. The clinical data of the two groups were compared. Results All patients successfully completed radical lung cancer surgery, and no perioperative deaths were reported. Intraoperative bleeding, postoperative drainage time, postoperative hospital stay, number of lymph nodes dissected, and number of lymph nodes dissected groups were more advantageous in the RATS group compared with the VATS group (P < 0.05). In terms of operative time, total postoperative chest drainage, and hospitalization cost, the VATS group had an advantage (P < 0.05). The postoperative levels of CRP, PCT, IL-6, IL-8, IL-10, and TNF-α increased in both groups, compared with preoperative levels, and the increases in the RATS group were lower than those in the VATS group. Conclusion RATS offers technical and short-term efficacy advantages for the treatment of lung cancer but comes with the disadvantage of high cost. Post-operative inflammatory cytokine elevation is lower in the RATS group, and inflammatory response to the organism is less severe.

Clinical application of preferential manual bronchoplasty in single-port video-assisted thoracoscopic upper lobectomy: A retrospective analysis in a single center / 中国胸心血管外科临床杂志

@#Objective     To explore the safety and feasibility of preferential manual bronchoplasty in single-port video-assisted thoracoscopic surgery (VATS) upper lobectomy. Methods    The clinical data of 457 patients with non-small cell lung cancer who underwent single-port VATS lobectomy in the Department of Thoracic Surgery of Peking University First Hospital from March 2020 to March 2022 were retrospectively analyzed. The patients were divided into a preferential manual bronchoplasty group and a traditional single-port VATS lobectomy group with a 1 : 1 propensity score matching for further research. Results     A total of 204 patients were matched, and there were 102 patients in each group. There were 50 males and 52 females aged 62.2±10.1 years in the preferential bronchoplasty group, and 49 males and 53 females aged 61.2±10.7 years in the traditional single-port VATS group. The preferential bronchoplasty group had shorter surgical time (154.4±37.0 min vs. 221.2±68.9 min, P<0.01), less bleeding (66.5±116.9 mL vs. 288.6±754.5 mL, P=0.02), more lymph node dissection (19.8±7.5 vs. 15.2±4.7, P<0.01), and a lower conversion rate to multi-port or open surgery (2.3% vs. 13.8%, P=0.04) in left upper lobe resection. In the right upper lobe resection surgery, there was no statistical difference in postoperative results between two groups. There was no perioperative death or occurrence of bronchopleural fistula in both groups. Conclusion    Compared with traditional single-port VATS upper lobectomy, preferential bronchoplasty has similar safety and feasibility. In addition, priority bronchoplasty in left upper lobectomy has the advantages of shorter surgical time, less bleeding, more lymph node dissection, and lower conversion rate to multi-port or open surgery.

The clinical efficacy of all-port robotic versus thoracoscopic lobectomy in stageⅠA non-small cell lung cancer: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To investigate the perioperative efficacy and safety of all-port robotic lobectomy versus thoracoscopic lobectomy in stageⅠA non-small cell lung cancer. Methods    The clinical data of patients with stageⅠA non-small cell lung cancer who underwent lobectomy with lymph node dissection performed by the same operator in our center from June 2019 to June 2022 were retrospectively analyzed. The patients were divided into a robotic group and a thoracoscopic group according to different procedures. We compared the relevant indexes such as operation time, intraoperative bleeding, number of lymph node dissection stations, number of lymph node dissection, postoperative tube time, postoperative hospitalization time, closed chest drainage volume, postoperative pain, postoperative complications and hospitalization cost between the two groups. Results    There were 83 patients in the robotic group, including 34 males and 49 females with a median age of 60.0 (53.0, 67.0) years, and 94 patients in the thoracoscopic group, including 36 males and 58 females with a median age of 60.5 (54.0, 65.3) years. There was no conversion to thoractomy or death in postoperative 90 days in both groups. No statistical difference was seen in the operation time, total postoperative drainage volume and postoperative complication rates between the two groups (P>0.05). Patients in the robotic group had less intraoperative bleeding (P<0.001), more lymph node dissection stations (P=0.002) and numbers (P=0.005), less postoperative pain (P=0.002), and shorter postoperative time with tubes (P=0.031) and hospital stay (P<0.001). However, the surgery was more expensive in the robotic group (P<0.001). Conclusion    All-port robotic surgery is safe and effective for patients with early-stage non-small cell lung cancer with less intraoperative bleeding, more lymph node dissection, less postoperative pain, and shorter hospital stay compared with the thoracoscopic surgery.

Chinese expert consensus on the inflatable video-assisted mediastinoscopic transhiatal esophagectomy / 中国胸心血管外科临床杂志

@#With the widespread application of minimally invasive esophagectomy, inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE) has gradually become one of the alternative surgical methods for transthoracic esophagectomy due to less trama, fewer perioperative complications and better short-term efficacy. However, there is no uniform standard for surgical methods and lymph node dissection in medical centers that perform IVMTE, which affects the standardization and further promotion of IVMTE. Therefore, on the basis of fully consulting domestic and foreign literature, our team proposed an expert consensus focusing on IVMTE, in order to standardize the clinical practice, guarantee the quality of treatment and promote the development of IMVTE.

Learning curve of CT-guided localization with medical glue for single pulmonary nodule before video-assisted thoracic surgery / 中国胸心血管外科临床杂志

@#Objective    To evaluate the learning curve of CT-guided medical glue localization for pulmonary nodule before video-assisted thoracic surgery (VATS). Methods    The clinical data of the patients with pulmonary nodules who underwent CT-guided medical glue localization before VATS in our hospital from July 2018 to March 2021 were retrospectively analyzed. The patients were divided into 3 groups: a group A (from July 2018 to August 2019), a group B (from September 2019 to June 2020) and a group C (from July 2020 to March 2021). The localization time, morbidity, complete resection rate and other indexes were compared among the three groups. Results    A total of 77 patients were enrolled, including 24 males and 53 females aged 57.4±10.1 years. There were 25 patients in the group A, 21 patients in the group B, and 31 patients in the group C. 77 pulmonary nodules were localized. There was no significant difference among the groups in the basic data (P>0.05). The localization time in the group C was 10.6±2.0 min, which was statistically shorter than that in the group A (15.4±4.4 min) and group B (12.9±4.3 min) (P<0.01). The incidence of complications in the group C was lower than that in the group A and group B (25.8% vs. 52.0% vs. 47.6%, P=0.04). The success rate of localization of the three groups was not statistically different (P=0.12). Conclusion    There is a learning curve in CT-guided medical glue localization for single pulmonary nodule before VATS. After the first 46 cases, the operation time can be shortened, and the incidence of complications can be decreased.