ABSTRACT
@#Objective To discuss the safety and feasibility of no chest tube (NCT) after thoracoscopic pneumonectomy. Methods The online databases including PubMed, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to October 2020 to collect the research on NCT after thoracoscopic pneumonectomy. Two reviewers independently screened the literature, extracted the data, and evaluated the quality of the included studies. The RevMan 5.3 software was used for meta-analysis. Results A total of 17 studies were included. There were 12 cohort studies and 5 randomized controlled trials including 1 572 patients with 779 patients in the NCT group and 793 patients in the chest tube placement (CTP) group. Meta–analysis results showed that the length of postoperative hospital stay in the NCT group was shorter than that in the CTP group (SMD=–1.23, 95%CI –1.59 to –0.87, P<0.000 01). Patients in the NCT group experienced slighter pain than those in the CTP group at postoperative day (POD)1 (SMD=–0.97, 95%CI –1.42 to –0.53, P<0.000 1), and POD2 (SMD=–1.10, 95%CI –2.00 to –0.20, P=0.02), while no statistical difference was found between the two groups in the visual analogue scale of POD3 (SMD=–0.92, 95%CI –1.91 to 0.07, P=0.07). There was no statistical difference in the 30-day complication rate (RR=0.93, 95%CI 0.61 to 1.44, P=0.76), the rate of postoperative chest drainage (RR=1.51, 95%CI 0.68 to 3.37, P=0.31) or the rate of thoracocentesis (RR=2.81, 95%CI 0.91 to 8.64, P=0.07) between the two groups. No death occurred in the perioperative period in both groups. Conclusion It is feasible and safe to omit the chest tube after thoracoscopic pneumonectomy for patients who meet the criteria.
ABSTRACT
@#A 54-year-old asymptomatic man underwent a video-assisted thoracoscopic left pneumonectomy for squamous-cell carcinoma. During the surgery, a complete left pericardial defect was unexpectedly discovered, but no special intervention was made. The preoperative chest CT was reciewed, which showed the heart extended unusually to the left, but the left pericardial defect was not evident. The operation time was 204 min and the patient was discharged from hospital upon recovery 9 days after the surgery. The pathological result indicated moderately differentiated squamous-cell carcinoma (T2N1M0, stage ⅡB), and metastasis was found in the parabronchial lymph nodes (3/5). The patient did not receive chemotherapy after the surgery, and there was no signs of recurrence 6 months after the surgery. Complete pericardial defects usually do not endanger the lives of patients, and if the patient is asymptomatic, pneumonectomy is feasible.
ABSTRACT
@#Objective To investigate the efficacy of uniportal video-assisted thoracoscopic surgery (VATS) anatomic basal segmentectomy. Methods The clinical data of 15 patients who underwent uniportal VATS anatomic basal segmentectomy between June 2020 and December 2020 were retrospectively reviewed. There were 4 males and 11 females with a median age of 53 (32-70) years. The incisions were placed in the fifth intercostal space across the mid-axillary line. All basal segmentectomies were performed through the interlobar fissure or inferior pulmonary ligament approach following the strategies of single-direction and stem-branch. Results All patients underwent basal segmentectomy successfully with no conversion to multi-portal procedure or thoracotomy. The median operation time was 120 (90-160) min, median intraoperative blood loss was 20 (10-50) mL, median drainage time was 3 (2-5) d, and median postoperative hospital stay was 4 (4-10) d. The maximum diameter of the lesion in the resected basal segment was 1.2 (0.7-1.9) cm. The median resected lymph nodes were 7 (5-12). There was no evidence of nodal metastases. One patient suffered postoperative atelectasis and subsequent pneumonia. No perioperative death occurred. Conclusion Uniportal VATS anatomic basal segmentectomy is feasible and safe. It can be performed in a simple manner following the strategy of single-direction.
ABSTRACT
【Objective】 To compare and analyze clinical efficacy and safety of subxiphoid vs. intercostal video-assisted thoracoscopic surgery (VATS) thymic tumor resection. 【Methods】 We selected 124 patients from January 2015 to March 2019, who received VATS thymic tumor resection in the Thoracic Department of The First Affiliated Hospital of Xi'an Jiaotong University. We divided them into the subxiphoid VATS group with 47 cases and intercostal VATS group with 77 cases to analyze clinical characteristics, postoperation outcomes, complications, pain score, and short-term quality of life. 【Results】 There were no significant differences in operation time, blood loss, the rate of postoperative pneumonia, arrhythmia, phrenic nerve paralysis or myasthenia crisis between the two groups (P>0.05). Average hospital stay: It was shorter in subxiphoid VATS group than intercostal VATS group (P<0.05). Pain score: It was lower the first day and the third day after operation in subxiphoid VATS group than in intercostal VATS group (P<0.05). SF-36 health scale score: 3-month and 12-month postoperation score was higher in subxiphoid VATS group than in intercostal VATS group (P<0.05). 【Conclusion】 Subxiphoid VATS thymic tumor resection is safe and feasible; compared with intercostal approach, it can significantly reduce wound pain and improve short-term quality of life.
ABSTRACT
@#Objective To explore the feasibility and short-term efficacy of uniportal and three-port single-direction video-assisted thoracoscopic surgery (S-VATS) anatomical lobectomy for lung cancer. Methods Clinical data of 60 lung cancer patients, including 40 males and 20 females with an average age of 62.2±9.0 years, who received S-VATS anatomic lobectomy and systematic lymph nodes dissection by the same surgeon in our hospital between July 2016 and January 2019 were retrospectively analyzed. These patients were divided into a uniportal S-VATS group and a three-port S-VATS group according to surgical procedures, with 30 patients in each group. The clinical data of the two groups were compared. Results There was no conversion to thoracotomy, surgical port addition, or mortality in this cohort, with tumor-negative surgical margin. There was no statistical difference in the operation time between the two groups (70.8±16.4 min vs. 73.7±14.3 min, P>0.05). Meanwhile, both groups showed similar intraoperative blood loss, stations and numbers of dissected lymph nodes, incidence of operation-related complications, duration and volume of chest tube drainage, as well as postoperative hospital stay (P>0.05). Besides, pain score of the patients in the uniportal S-VATS group was significantly lower than that of the three-port S-VATS group on postoperative 3-14 d (P<0.05). The mean duration of follow-up was 10 months, and all the patients were survived without tumor recurrence or metastasis. Conclusion The transition from three-port S-VATS to uniportal S-VATS anatomical lobectomy for treatment of lung cancer is feasible. However, further studies are needed to elucidate the optimal resection sequence of pulmonary vessels.
ABSTRACT
@#Objective To evaluate the feasibility and safety of improving chest drainage procedure by applying postoperative chest drainage with central venous catheter for uniportal video-assisted thoracoscopic surgery (VATS) lobectomy in fast track recovery. Methods Between July 2016 and March 2018, a total of 150 patients who underwent uniportal VATS lobectomy by the same chief surgeon were recruited. All patients were randomly divided into two groups including a trial group and a control group. In the trial group, there were 44 males and 28 females with an average age of 47±11 years. Central venous catheter and 26F silicone rubber tuber were used and chest tube was removed when drainage volume less than 300 ml/d. Chest X ray was conducted three days after discharge from hospital and the central venous catheter was removed after thoracentesis. In the control group, there were 40 males and 29 females with an average ages of 52±13 years, 26 F silicone rubber tuber and chest tube were removed when drainage volume less than 100 ml/d. The clinical effectiveness was compared between the two groups. Results No statistically significant difference was observed between the trial group and the control group in the date of preoperative general information, the occurrence of postoperative complications and the visual analogue score on Day1 after the operation. However, the visual analogue score, intubation time, post-operative length of stay, the frequency of using tramadol were all significantly shorter or lower in the trial group when compared with the control group (P<0.05). Seven patients of the trial group suffered moderate pleural effusion after intubation, which was significantly more than that of the control group (P<0.05). Six patients recovered after thoracentes through central venous catheter. The average amount of pleural effusions before removing the central venous catheter was 74.8 ml. Conclusion The use of central venous catheter and 26 F silicone rubber tuber after uniportal VATS lobectomy is safe and feasible for the early removal of chest tube. It is beneficial to fast track recovery.
ABSTRACT
Objective To investigate the effects of video-assisted thoracoscopic surgery (VATS) teaching in clinical education of the five-year undergraduates.Methods 50 undergraduate clinical interns were divided randomly into the experimental group and control group.The experimental group was applied with traditional method combined with VATS,and the interns studied the radical operation of lung cancer under thoracoscopy,while the control group was applied with traditional method.After the course,all students accepted theory and clinical examination,and a questionnaire survey was conducted.SPSS 18.0 was used for statistical analysis,and t-test was adopted for theoretical and clinical examination results.Questionnaire survey was conducted by chi-square test.Results ①Theory test:compared with control group,the scores of case analysis [(38.92 ± 2.50) vs.(34.56 ± 3.10)] and total scores [(79.92 ± 4.04) vs.(74.64 ± 4.82)] were improved (P＜0.05).②Clinical test:compared with control group,the scores of experimental group [(82.86 ± 4.46) vs.(76.04± 4.78)] were improved (P＜0.05).③Questionnairesurvey:there was statistical difference between the two groups in promoting the interest in learning,improving the comprehension of knowledge and approving of the teaching method used (P＜0.05).Conclusion VATS teaching method has positive effect on clinical education of the five-year undergraduates,and it should be worthy of extending.
ABSTRACT
@#To share the clinical experience of thoracoscopic unidirectional posterolateral basal segmentectomy via inferior pulmonary ligament. Methods All the patients were in the healthy lateral position, with endoscopy holes in the 8th intercostal space of the middle axillary line and 2-3 cm operation holes in the 5th intercostal space of the front axillary line. Anatomical segmentectomy of the posterolateral basal vein, bronchus and artery was performed through the inferior pulmonary ligament upward in turn. The clinical data of this group were analyzed retrospectively. Results From December 2015 to October 2018, 32 patients underwent thoracoscopic unidirectional posterolateral basal segmentectomy, including 8 males and 24 females, aged 13-71 (52.6±13.7) years. All patients successfully completed the operation, including 9 patients of left lower pulmonary posterolateral basal segmentectomy, 23 patients of right lower pulmonary posterolateral basal segmentectomy. The operation time was 80-295 (133.4 ±40.5) minutes, intraoperative bleeding volume was 20-300 (52.6±33.8) mL, drainage time was 2-14 (4.2±2.3) days, hospitalization time was 4-15 (6.9 ±2.4) days. No death occurred during hospitalization. Postoperative complications included atelectasis in 1 patient and persistent pulmonary leakage over 3 days (4 or 6 days respectively) in 2 patients , chylothorax in 1 patient. All of them recovered smoothly after non-operative treatments. Postoperative pathology showed that 29 patients of primary adenocarcinoma or atypical adenomatoid hyperplasia, including 5 patients of adenocarcinoma in situ, 9 patients of micro-invasive adenocarcinoma, 12 patients of invasive adenocarcinoma, 3 patients of atypical adenomatoid hyperplasia. One patient was of intestinal metastatic adenocarcinoma, 1 patient of inflammatory lesion and 1 patient of bronchiectasis. 3-21(9.6±4.6) lymph nodes were resected in the patients with primary pulmonary malignant tumors. And no metastasis was found. Conclusion The operation of thoracoscopic unidirectional posterolateral basal segmentectomy via inferior pulmonary ligament is easy. There is no need to open intersegmental tissue. It can protect lung tissue better. The operative method is worthy of clinical promotion.
ABSTRACT
Objective To compare the clinical efficacy of VATS and suture ligation in the treatment of SP patients under video-assisted thoracoscopic surgery (VATS). Methods From January to December in 2016, 58 cases of spontaneous pneumothorax patients were selected as the research object, randomly divided into observation group (n = 29) and control group (n = 29), the observation group with VATS stapler treatment, the control group with VATS suture treatment. The effect of surgical treatment in the two groups was evaluated comprehensively. Results The operation time and intraoperative blood volume of the observation group were lower than those of the control group (P < 0.05), the operation cost was higher than that of the control group (P < 0.05), and there was no difference in postoperative tube time and hospitalization time (P > 0.05); There was no significant difference in the incidence of postoperative complications between the two groups (P > 0.05); There was no significant difference between the two groups in the postoperative pain score and the duration of the use of the pain killer (P > 0.05); The recurrence rate of the observation group was significantly lower than that of the control group (P < 0.05). Conclusion The two kinds of surgical treatment of pneumothorax were safe and effective, and the prognosis is good, but the VATS suture bleeding volume and operation time is better than that of VATS suture, and lower recurrence rate, and VATS suture surgery is low, in the clinical operation method selection according to the actual condition need.
ABSTRACT
Objective: To observe the therapeutic effect of video-assisted thoracoscopic surgery (VATS) with iodine tincture pleurodesis on malignant pleural effusion (MPE). Methods:Clinical data from 47 MPE cases were retrospectively analyzed. Based on different treatments, the 47 cases were divided into Groups A (n. 25) and B (n. 22), which used iodine tincture and talc powder as a hard-ener, respectively. Provided that all cases were conclusively diagnosed as MPE, and the patients underwent VATS pleural biopsy and pleurodesis, Groups A and B were comparable. The authors then compared the postoperative effectiveness rates (both complete and par-tial remissions), the volume of chest drainage, the incidence of adverse reactions, and the drainage time of the chest tube between the two groups. Results:Difficulty in breathing was proven to be less severe among all cases after the operation, and none of the patients suffered from acute lung injuries. After the operation, Group A exhibited an effectiveness rate of 96.0%, whereas Group B presented a rate of 95.5%, which indicates that no significant difference was found between the two groups (P>0.05). The total incidence of adverse reactions was 32.0%in Group A and 63.6%in Group B, with a significant difference between the two (P<0.05). Conclusion:VATS io-dine tincture pleurodesis has been proven to be as therapeutically effectual as talc pleurodesis and has resulted in fewer adverse reac-tions. This finding suggests that VATS iodine tincture pleurodesis has a promising potential in clinical practice because of its definite cu-rative effect, simple management, high security, fewer adverse reactions, and reasonable cost.
ABSTRACT
Objective To investigate the effect of video-assisted thoracoscopic surgery( VATS) in thoracic disease,and the feasibility to carry out VATS for basic hospital. Methods The data of VATS treatment were collected to compare the differences between study group and control group,and evaluate the the feasibility to carry out VATS for basic hospital. Results The operation time was (100. 75±22. 72) min, blood loss was (54. 27±26. 21) mL,postoperative drainage was (920. 67±171. 99) mL. The postoperative complications were fewer,post-operative hospital stay was shorter,incision time was shorter(P=0. 000) and pain scores was lower(P=0. 000) in study group than that in control group. Basic hospital has the capacity to conduct this technical. Conclusion VATS is feasible to carry out in basic hospital.
ABSTRACT
Nonossifying fibromas are not uncommon, but those described in the rib are unique. We report the case of a 15-year-old patient with symptoms of chest wall pain for 5 days who underwent a video-assisted thoracoscopic rib resection for a 2.5-cm rib mass. Unexpectedly, pathological results revealed a nonossifying fibroma of the rib. The results showed excellent cosmesis and new bone formation because of the preservation of the overlying periosteum.
Subject(s)
Adolescent , Humans , Fibroma , Osteogenesis , Periosteum , Ribs , Thoracic Surgery, Video-Assisted , Thoracic WallABSTRACT
Catamenial hemoptysis is a rare condition that's characterized by recurrent hemoptysis occurring in association with menstruation, and this is associated with the presence of intrapulmonary or endobronchial endometrial tissue. The diagnosis of pulmonary endometriosis can be made according to a typical clinical history and with exclusion of other causes of recurrent hemoptysis. Treatment of pulmonary endometriosis can be medical or surgical; however, the optimal management of this condition is still a matter of debate. Medical therapy may be problematic, due to recurrence of symptoms despite hormonal ablation, and adverse effects from long-term hormone therapy can also be a problem. We report here on a case of pulmonary endometriosis in a 23-year-old woman who presented with hemoptysis that occurred during the first 3 days of menstruation, and this happened over a 4 month period. She was successfully treated by video-assisted thoracoscopic surgery (VATS). No more hemoptysis was noted during 12 months of follow-up.
Subject(s)
Female , Humans , Young Adult , Endometriosis , Follow-Up Studies , Hemoptysis , Menstruation , Recurrence , Thoracic Surgery, Video-AssistedABSTRACT
Objective To evaluate the feasibility of video-assisted thoracoscopic resection of thymoma for myasthenia gravis.Methods Between July 2005 and February 2006,10 patients with thymoma were enrolled in this study.After double lumen intubation,video-assisted thoracoscopic resection of the thymus and thymoma was performed on the patients under total intravenous anesthesia.The largest tumor in this series was 6 cm ? 4 cm ? 3 cm.For a three-trocar technique,three incisions with a length of 1,3,or 1.5 cm were made respectively at the fifth intercostal space on the midaxillary line,fourth intercostal space on the middle between the anterior axillary line and midclavicular line,and sixth intercostal space on the anterior axillary line.During the operation,to expose the ipsilateral thymus and part of the contralateral thymus,the mediastinal pleura was cut along the internal thoracic artery,and superior vena cava or phrenic nerve.The thymus was then separated,and the thymic vein was dissected along the brachiocephalic vein and ligated.All the patients received radiotherapy after the operation with a dose of 4000 cGy.Results The operation time ranged from 70 to 130 minutes(mean,110 minutes)and the blood loss was less than 100 ml in all the cases.After the operation,7 patients presented Masaoka stage Ⅰ and 3 were at stage Ⅱ.No patient died or had cardiopulmonary complications or myasthenia crisis.The symptoms of myasthenia gravis were relieved in 1 week.The patients were followed up for 8 to 15 months(mean 13.0 months).During the period,none of them developed recurrence,metastasis,or aggravation of the myasthenia gravis.Conclusions It is feasible to resect stage Ⅰ to Ⅱ thymoma by video-assisted thoracoscopy.The procedure is minimal invasive with a few postoperative complications and good cosmetic outcomes.
ABSTRACT
Objective:To study the clinical results and the hospitalization cost of video-assisted thoracoscopic surgery (VATS) with ligation and suture for the treatment of spontaneous pneumothorax.Methods:Thirteen patients were treated by VATS with ligation and suture.The consumed time of operation,duration of the chest drainage,amount of the chest drainage,percentage of patient discontinuing anodyne within the postoperative 24 hours,the average length of hospitalization and the hospitalization cost were analysed.Results:Satisfactory therapeutic effects were found in all cases without postoperative death and complications. The average hospitalization time was 3 days.VATS with ligation and suture was preferable to transaxillary minithoracotomy (TAMT) in the clinical results.The hospitalization cost is less for VATS with ligation and suture (7372.47?871.3) than that with Endo-GIA (12524.32?2962.18) (P
ABSTRACT
We present a minimal invasive technique for the treatment of broncho-pleural fistula (BPF) after pulmonary lobectomy with lung cancer. 2 cases of BPF were found at the 4th and 7th day after pulmonary lobectomy respectively. They were reoperated on by VATS, direct resuture of stump and consolidation with acrylic or fibrin glue. Both cases were cured. Authors consider mentioned procedure might be a feasible therapeutic approach for early broncho-pleural fistula.
ABSTRACT
Subclavian catheters were used in the treatment of chronic renal failure patients waiting for the maturation of AV fistula. But, it sometimes causes fatal complications. Of these, massive bleeding into pleural cavity after subclavian vein cannulation is a rather rare but causes very serious complication. Most of patients with hemothorax are successfully treated with conservative treatment(i.e. pleural drainage, maintaining the circulatory volume, treatment of possible coagulopathy) but it sometimes needs surgery. We recently experienced a case of ARDS complicated by hemothorax which was successfully treated with thracooscopic drainage. We reviewed the pathogenesis of ARDS by hemothorax and suggested the guidlines for the treatment of massive hemothorax using video-assisted thoracoscopic surgery.
Subject(s)
Humans , Catheterization , Catheters , Drainage , Fistula , Hemorrhage , Hemothorax , Kidney Failure, Chronic , Pleural Cavity , Subclavian Vein , Thoracic Surgery, Video-AssistedABSTRACT
Objective:To compare the clinical results of video-assisted thoracoscopic surgery (VATS) with transaxillary minithoracotomy (TAMT) for the treatment of spontaneous pneumothorax (SP).Methods:Thirty patients were treated by VATS and 43 by TAMT.The consumed time of the operation,duration of the chest drainage,the amount of the chest drainage,the percentage of the patient without using anodyne within the postoperative 24 hour and the average time of hospitalization were compared.Results:The consumed time of the operation,the duration of the chest drainage and the average time of hospitalization were significantly shorter in group VATS than in group TAMT ( P