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Abstract Introduction and Objective Cardiac tumors are often unrecognized until autopsies are performed or diagnosed from routine studies based on unspecific symptoms. The most common type of tumor is the myxoma, although rare, upon diagnosis an urgent surgical resection is often required. Previously the ideal surgical approach was a standard median sternotomy, however recently newer surgical techniques have been employed with excellent results. We describe a recent surgical approach via the right lateral minithoracotomy as a minimally invasive intervention with three cases that evidence an appropriate and ideal surgical approach. Method and Patients We present three cases of minimally invasive myxoma resection via the right lateral minithoracotomy. Results and discussion In this three-case series study, no complications were reported peri-operatively nor at the 6 and 12-month follow-ups. In comparison with international literature, surgical approaches in Colombia are comparable with successful resection and little or no complications peri-operatively. Conclusions The right lateral minithoracotomy appears to be a safe approach in myxoma resection. We hope to enhance and promote the surgical community in Colombia to opt for alternative less invasive approaches in these type of cases, to ensure excellent results and promote further research as seen in other countries.
Resumen Introducción y Objetivo Los tumores cardíacos no suelen ser diagnosticados hasta la realización de autopsia o en otros casos como hallazgos incidentales. El tumor cardiaco más común es el mixoma, aunque es poco frecuente; en el momento del diagnóstico a menudo se requiere una resección quirúrgica urgente. Anteriormente el enfoque quirúrgico era una atriotomía abierta derecha; sin embargo, recientemente se han empleado técnicas quirúrgicas nuevas con excelentes resultados. Describimos una técnica quirúrgica reciente a través de la minitoracotomía lateral derecha como un método mínimamente invasivo con tres casos que evidencian un método quirúrgico apropiado e ideal. Métodos y pacientes: Se presentan tres casos de resección mínimamente invasiva de mixomas a través de una minitoracotomía lateral derecha. Resultados y discusión: Es estos tres casos no se reportaron complicaciones perioperatorias ni durante el seguimiento a los 6 y 12 meses. En comparación con otras series de casos en la literatura, el enfoque en Colombia ha sido comparable tanto en los resultados exitosos como con las técnicas quirúrgicas, sin complicaciones asociadas. Conclusiones La minitoracotomía lateral derecha puede ser considerada segura en resección de mixoma. Con este tipo de reportes se espera suscitar en la comunidad médica la elección de alternativas quirúrgicas mínimamente invasivas para garantizar excelentes resultados y promover la investigación, como se evidencia en el resto del mundo.
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@#Objective To analyze the safety and follow-up results of on-pump coronary artery bypass grafting (CABG) for the treatment of multivessel diseases via left anterolateral minithoracotomy. Methods From January 2018 to March 2020, a total of 30 patients including 18 males and 12 females with an average age of 61.3±7.5 years having multivessel coronary heart diseases were treated in our hospital with on-pump CABG via left anterolateral minithoracotomy. Among them, 14 patients had three-vessel diseases and 16 patients had two-vessel diseases. Results There were 29 internal mammary artery-to-left anterior descending bypass grafts harvested in total while the rest were saphenous-vein bypass grafts. The average number of bypass vessels was 2.3±0.5. There was no perioperative death in the whole group, one patient underwent rethoracotomy due to hemorrhage, and one patient suffered acute renal insufficiency. The average time of postoperative tracheal intubation was 16.0±5.8 hours, and the postoperative ICU stay was 30.1±11.5 hours. Twenty five patients were followed up, including coronary CT angiography examinations at 6 months and 1 year after operation. Proximal anastomotic stenosis in one patient and distal anastomosis occlusion in one patient occurred. Conclusion On-pump CABG via left anterolateral minithoracotomy is safe for appropriately selected patients.
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Abstract Objective: To compare the in-hospital outcomes of a right-sided anterolateral minithoracotomy with those of median sternotomy in patients who received a mitral valve replacement (MVR) because of rheumatic mitral valve stenosis (RMS). Methods: This is a retrospective analysis of 128 patients (34% male) with RMS between 2011 and 2015. The median age was 53 years (45; 56). The mean ejection fraction was 58.4±6.3%. All the subjects were divided into two groups - Group 1 contained 78 patients who underwent MVR via minithoracotomy (MT-MVR), while Group 2 contained 50 patients who underwent MVR via median sternotomy (S-MVR). Results: In the MT-MVR group, a mechanical prosthesis was implanted in 72% of cases, while it was implanted in 90% of cases in the S-MVR group (P=0.01). The duration of myocardial ischemia was similar (MT-MVR, 77±24 min; S-MVR, 70±18 min) (P=0.09). However, the cardiopulmonary bypass time was lower in the S-MVR group than in the MT-MVR group (99±24 min and 119±34 min, respectively) (P≤0.001). There was no difference in the duration of mechanical ventilation, intensive care unit stay, and hospitalization period. Postoperative blood loss was lower in the MT-MVR group (P≤0.001) than in the S-MVR group. There are no statistically significant differences in postoperative complications (superficial wound infection, stroke, delirium, pericardial tamponade, pleural puncture, acute kidney insufficiency, and implantation of pacemaker). The overall in-hospital mortality was 3.9% (P=0.6) Conclusion: The minimally invasive approach for RMS is feasible and has an excellent cosmetic effect without increasing the risk of surgical complications.
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Humans , Male , Female , Middle Aged , Heart Valve Prosthesis Implantation , Mitral Valve Stenosis/surgery , Stroke Volume , Thoracotomy , Retrospective Studies , Ventricular Function, Left , Treatment Outcome , Mitral ValveABSTRACT
We herein report a case of cardiac tumor resection through a right mini-thoracotomy. A 48-year-old man exhibited no symptoms. A mass was detected incidentally in the right atrium on computed tomography. We performed resection under cardiopulmonary bypass through a right mini-thoracotomy. Histopathological examination confirmed that this tumor was a lipoma. The patient's postoperative recovery was uneventful. He was discharged on postoperative day 6. As cardiac tumor resection through right mini-thoracotomy is minimally invasive, this approach may be useful for surgery in cases of benign cardiac tumors.
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Objective@#To compare the results of invasive dual mitral and aortic valve replacement(DVR) through anterolateral minithoracotomy(RT) and partial upper hemistemotomy(PS) approaches.@*Methods@#This was a retrospective, observational, cohort study of collected data on 30 patients undergoing dual mitral and aortic valve replacement between July 2009 and March 2018 at Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University. There were 10 male and 20 female patients, aging from 15 to 65 years with a mean age of(45.67±12.25) years. Of these, 8 were performed through right RT and 22 through PS. SPSS 23.0 was used to analysis gender, age, left ventricle ejection fraction, New York Heart Association class, perioperative complications, total operative duration, cardiopulmonary bypass duration, aortic cross clamp time, ICU monitoring time and postoperative hospital stay of the two groups.@*Results@#Both groups successfully completed minimally invasive double-valve replacement surgery, without middle-opening thoracic surgery. Compared with PS group, patients in the RT group had longer aortic cross clamp time[(109.00±27.80)min vs.(81.23±14.10)min, P=0.026], cardiopulmonary bypass duration[(152.13±27.15)min vs.(129.55±26.36)min, P=0.049]and total operative duration[(4.81±0.77)h vs.(4.15±0.44)h, P=0.006]. In addition, the ICU monitoring time and postoperative hospital stay of patients in RT group were shorter than PS group[(24.63±11.55)h vs.(30.55±13.21)h; (5.50±0.93)day vs.(6.59±3.88)day] but there were no statistically significant(P=0.273; P=0.442).@*Conclusion@#Minimally invasive dual mitral and aortic valve replacement via RT and PS are both safe and effective. The incision of RT group is more concealed than the PS group as well as retaining sternal integrity. However, the total operative duration, cardiopulmonary bypass duration and aortic cross clamp time were longer than PS group and the requirements of the surgeon are higher. The PS group has a shorter operation time and does not change the habit of the surgeon. It is more suitable for the heart center that proposed to launch the minimally invasive dual mitral and aortic valve replacement.
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@#Objective To compare right anterolateral minithoracotomy and traditional median sternotomy in the treatment of left atrial myxoma. Methods Forty-one patients with left atrial myxoma treated in our hospital from January 2009 to January 2018 were divided into two groups according to the operation method: a right anterolateral minithoracotomy group including 15 patients, with 7 males and 8 females, aged 45.1±15.4 years; a median sternotomy group including 26 patients, with 10 males and 16 females, aged 49.4±11.9 years. The clinical data of the two groups were compared. Results There was no significant difference in preoperative clinical data between the two groups. All patients completed the operation without perioperative death. There was no significant difference in the operation time, cardiopulmonary bypass time, aortic clamp time or the incidence of postoperative complications between the two groups. However, compared with the median sternotomy group, the right anterolateral minithoracotomy group had shorter duration of mechanical ventilation, ICU stay and postoperative hospital stay, and less volume of drainage and blood transfusion 24 hours after surgery (all P<0.05). After 3–106 months follow-up, no recurrence was observed in both groups. Conclusion Compared with traditional median sternotomy for left atrial myxoma resection, right anterolateral minithoracotomy is safe, effective and less traumatic. It can be used as a routine treatment for left atrial myxoma.
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A 65-year-old man with a history of severe aortic valve regurgitation had undergone aortic valve replacement (AVR) via partial upper hemisternotomy at the age of 50 years. At that time, bioprosthetic valve was implanted. Fifteen years after the valve implantation, he presented with palpitations and chest tightness. Examination revealed bioprosthetic valve failure with consequent severe aortic valve regurgitation. Redo AVR via right anterior mini-thoracotomy was decided as the treatment strategy, and the procedure was successfully completed without complications. The patient underwent extubation on the day of the operation. His postoperative course was unremarkable, and he was discharged 13 days postoperatively. In this case, the patient had previously undergone partial upper hemisternotomy (classified as a minimally invasive cardiac surgery [MICS]) and showed only few adhesions in the pericardium, suggesting that MICS could be beneficial in cases involving re-operation.
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Objective To compare the results of invasive dual mitral and aortic valve replacement( DVR) through an-terolateral minithoracotomy( RT) and partial upper hemistemotomy( PS) approaches. Methods This was a retrospective, ob-servational, cohort study of collected data on 30 patients undergoing dual mitral and aortic valve replacement between July 2009 and March 2018 at Department of Cardiovascular Surgery, Zhongshan Hospital,Fudan University. There were 10 male and 20 female patients,aging from 15 to 65 years with a mean age of(45. 67 ± 12. 25) years. Of these, 8 were performed through right RT and 22 through PS. SPSS 23. 0 was used to analysis gender, age, left ventricle ejection fraction, New York Heart Associa-tion class, perioperative complications,total operative duration, cardiopulmonary bypass duration, aortic cross clamp time, ICU monitoring time and postoperative hospital stay of the two groups. Results Both groups successfully completed minimally inva-sive double-valve replacement surgery, without middle-opening thoracic surgery. Compared with PS group, patients in the RT grouphadlongeraorticcrossclamptime[(109.00±27.80)minvs.(81.23±14.10)min,P=0.026],cardiopulmonaryby-passduration[(152.13±27.15)minvs.(129.55±26.36)min,P=0.049]andtotaloperativeduration[(4.81±0.77)h vs. (4.15 ±0.44)h, P=0.006]. In addition, the ICU monitoring time and postoperative hospital stay of patients in RT group wereshorterthanPSgroup[(24.63±11.55)hvs.(30.55±13.21)h;(5.50±0.93)dayvs.(6.59±3.88)day] butthere were no statistically significant(P=0. 273;P=0. 442). Conclusion Minimally invasive dual mitral and aortic valve replace-ment via RT and PS are both safe and effective. The incision of RT group is more concealed than the PS group as well as retai-ning sternal integrity. However, the total operative duration, cardiopulmonary bypass duration and aortic cross clamp time were longer than PS group and the requirements of the surgeon are higher. The PS group has a shorter operation time and does not change the habit of the surgeon. It is more suitable for the heart center that proposed to launch the minimally invasive dual mi-tral and aortic valve replacement.
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Objective To compare the short-term perioperative outcomes of video-assisted mini-thoracotomy(VAMT),multiple port-video-assisted thoracoscopic surgery(MP-VATS)and single utility port-VATS(SP-VATS)in treatment of early stage non-small cell lung cancer(NSCLC).Methods A total of 157 cases of early stage NSCLC patients were collected and divided into three groups:66 cases received VAMT treatment as group VAMT;45 cases received MP-VATS treatment as group MP-VATS;46 cases received SP-VATS treatment as group SP-VATS.The intraoperative and postoperative conditions,lung function indexes including forced expiratory volume in one second(FEV1),forced vital capacity(FVC)and maximal voluntary ventilation(MVV)among the groups were compared.Results There were no significant differences in the operation time and the number of lymph node dissection among the SP-VATS group,MP-VATS group and group VAMT[(154.89±32.34)min vs(158.43±36.78)min vs(161.21±40.02)min,(12.34±4.55)pieces vs(12.47±3.81)pieces vs(11.78±3.32)pieces,P>0.05];the incision length,blood loss,amount and time of postoperative drainage and the postoperative ambulation in groupSP-VATS were significantly lower than group MP-VATS and VAMT[(4.11±0.65)cm vs(6.42±0.65)cm vs(12.14±2.23)cm;(170.31±45.68)ml vs(166.23±43.21)ml vs(228.96±63.21)ml;(623.42±231.56)ml vs(681.23±278.54)ml vs(924.54±324.51)ml;(5.27±1.32)d vs(7.43±2.27)d vs(7.66±2.89)d;(3.36±0.78)d vs(4.62±1.26)d vs(4.78±1.43)d,all P0.05);After surgery,the lung function(FEV1,FVC,MVV)among the three groups were significantly decreased,and the group SP-VATS was significantly higher than VAMT group(P0.05).Conclusion The SP-VATS for early stage NSCLC has similar short-term efficacy with VAMT and MP-VATS,but SP-VATS has faster recovery and maller postoperative pulmonary dysfunction.
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Aplastic anemia is a syndrome characterized by pancytopenia, and performing an open heart operation for patients with this syndrome may be associated with an increased surgical risk for both bleeding and post-surgical infection. We report a case of mitral regurgitation complicated with aplastic anemia that underwent a mitral valve repair via a right lateral minithoracotomy. The patient was a 70-year-old woman who presented with shortness of breath on exertion. She was found to have aplastic anemia based on pancytopenia (WBC 2,150/µl, Hgb 8.8 g/dl, PLT 5.0×10<sup>4</sup>/µl) and the results of a bone marrow biopsy. Echocardiography showed severe mitral valve insufficiency at the same time, and the patient was referred for surgery. To deal with the decrease in white blood cells and platelets, prior to surgery, a granulocyte colony-stimulating factor was administered, 30 units of platelet concentrate were transfused during the operation, and mitral valve repair via a right lateral minithoracotomy was performed. After surgery, there were no complications due to infection or bleeding, and the subsequent course was favorable. Several studies have reported the advantages in right minithoracotomy of less intraoperative bleeding and a lower infection rate compared with full sternotomy. In cases of this kind, in which there is a tendency toward bleeding and ease of infection, we believe that right lateral minithoracotomy may be a useful option to consider.
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BACKGROUND: This study aims to evaluate whether or not the method of right vertical axillary minithoracotomy (RVAM) is preferable to and as reliable as conventional sternotomy surgery, and also assesses its cosmetic results. METHODS: Thirty-three patients (7 males, 26 females) with atrial septal defect were admitted to the Cardiovascular Surgery Clinic of Cukurova University from December 2005 until January 2010. The patients' ages ranged from 3 to 22. Patients who underwent vertical axillary minithracotomy were assigned to group I, and those undergoing conventional sternotomy, to group II. Group I and group II were compared with regard to the preoperative, perioperative and postoperative variables. Group I included 12 females and 4 males with an average age of 16.5+/-9.7. Group II comprised 14 female and 3 male patients with an average age of 18.5+/-9.8 showing similar features and pathologies. The cases were in Class I-II according to the New York Heart Association (NYHA) Classification, and patients with other cardiac and systemic problems were not included in the study. The ratio of the systemic blood flow to the pulmonary blood flow (Qp/Qs) was 1.8+/-0.2. The average pulmonary artery pressure was 35+/-10 mmHg. Following the diagnosis, performing elective surgery was planned. RESULTS: No significant difference was detected in the average time of the patients' extraportal circulation, cross-clamp and surgery (p>0.05). In the early postoperative period of the cases, the duration of mechanical ventilator support, the drainage volume in the first 24 hours, and the hospitalization time in the intensive care unit were similar (p>0.05). Postoperative pains were evaluated together with narcotic analgesics taken intravenously or orally. While 7 cases (43.7%) in group I needed postoperative analgesics, 12 cases (70.6%) in group II needed them. No mortality or major morbidity has occurred in the patients. The incision style and sizes in all of the patients undergoing RVAM were preserved as they were at the beginning. Furthermore, the patients of group I were mobilized more quickly than the patients of group II. The patients of group I were quite pleased with the psychological and cosmetic results. No residual defects have been found in the early postoperative period and after the end of the follow-up periods. All of the patients achieved functional capacity per NYHA. No deformation of breast growth has been detected during 18 months of follow-up for the group I patients, who underwent RVAM. CONCLUSION: To conclude, the repair of atrial septal defect by RVAM, apart from the limited working zone for the surgeon in these pathologies as compared to sternotomymay be considered in terms of the outcomes, and early and late complications. And this has accounted for less need of analgesics and better cosmetic results in recent years.
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Female , Humans , Male , Analgesics , Breast , Drainage , Follow-Up Studies , Heart , Heart Septal Defects, Atrial , Hospitalization , Intensive Care Units , Narcotics , New York , Pain, Postoperative , Postoperative Period , Pulmonary Artery , Sternotomy , Ventilators, MechanicalABSTRACT
We experienced an extremely unusual case of a 37-year-old woman who suffered from hemothorax soon after subclavian vein catheterization. Many case reports of a hemothorax or hematoma after central vein catheterization through the great vessels, such as the subclavian vein and internal jugular vein, have been published. However, this rare case showed a pinpoint-sized active bleeding site from a pulmonary arteriole rupture. During an emergency operation using thoracoscopy-assisted minithoracotomy, this bleeding site was successfully managed by primary repair.
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Adult , Female , Humans , Arterioles , Catheterization , Catheterization, Central Venous , Catheters , Emergencies , Hematoma , Hemorrhage , Hemothorax , Jugular Veins , Rupture , Subclavian Vein , VeinsABSTRACT
Objective To compare the effect of video-assisted minithoracotomy(VAMT)and video-assisted thoracoscopic surgery(VATS)for spontaneous pneumothorax.Methods 98 patiens with spontaneous pneumothorax allocated to VAMT or VATS were selected.The operation time,blood loss during operation,score of postoperative pain,time of postoperative drainage,postoperative hospital stay,surgery cost,rate of complication and recurrence were compared between the two groups.Results All patients were cured.The operation time,postoperative hospital stay and surgery cost were significantly different between VAMT and VATS groups(all P ＜0.05).The parameters of two groups were similar in score of postoperative pain,time of post-operative drainage,blood loss during operation,rate of complication and recurrence(all P ＞ 0.05).Conclusion VAMT was as effective as VATS,but the operation time,postoperative hospital stay and surgery cost was significantly better than VATS.
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Objective To guide clinical operation,the invasion,efficacy,convalescence by different operating ways on cardiac surgery were studied.Methods Left axillary minithoracotomy was applied to 41 patients with ductus atteriosus(A group);right axillary minithoracotomy was applied to 46 patients with atrial soptal defect (ASD),ventricular septal dofect(VSD),triple-symptom complex of Fallot(C group);49 patients with replacement of valvular heart,VSD,ASD,totralogy of Fallot,left atrial myxoma were operated in substernal segment minithoracotomy (D group).The comparison between above groups and the regular left chest posterolateral operation on 42 patients (B group) and the sternal median operation on 77 patients (E group)was carried out.Results (1) A group had such advantages as the operation time,hemorrhage volume,hospital day,compared with B group [(38±13) min vs (64±14) min,(17±12) ml vs (200±100) ml,(6±2) d vs(11±3) d,respectively](P<0.01).(2) There were difference in extra corporeal circulation time,bemorrhage volume and hospital day between C group and E group[(39±8) min vs (68±8)min,(150±150) ml vs (700±300)ml,(8±3)d vs(12±4)d,respectively](P<0.01 or <0.05).There were difference in hemorrhage volume,fluence between D group and E group (P<0.05).Conclusion Small incision,slight trauma,less hemorrhage,slight ache,quick recovery,concealed incision and so on are characteristic of the left subaxillary minithoracotomy for ligation of ductus arteriosus,the right subexillary minithoracotomy for opening heart operation with heart beating and the substernal segment minithoracotomy for opening heart operation with extra corporeal circulation.
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[Objective]To find a better minimally invasive surgical operation in teenagers suffered from spontaneous hematopneumothorax caused by pulmonary bullae.[Methods]To analyse 86 cases of patients with pulmonary bullous through transaxilary minithoracotomy from February 2001 to February 2007.[Results]It was observed from 6 months to 6 years after operation with few recrudescence,more curative effects.[Conclusions]Compared with traditional methods,it was a perfect technique for its small traumatism,rapid resume,scarce syndrome and approving curative effect.
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Objective To discuss the effectiveness of heart operation through subaxillary minithoracotomy.Methods Subaxillary minithoracotomy heart operation was carried out in 378 cases between March 1995 and October 2004.The operation was performed under beating heart and without the occlusion of the ascending aorta in 81 cases of atrial septal defect, 32 cases of ventricular septal defect,and 16 cases of other diseases.The operation was completed under low temperature and extracorporeal circulation in other 249 cases.Results The operation was accomplished smoothly in all the cases.The operation time was 167?2.0 min,and the extracorporeal circulation time was 28.1?16.6 min.Postoperatively,1 patient with double-chamber anormaly of the right ventricle was given a tracheotomy because of an acute laryngeal edema,1 patient with tetralogy of Fallot died of low cardiac output syndrome,1 patient had a cerebral embolism,2 patients experienced an incision fat liquefaction,and the remaining patients recovered uneventfully.A follow-up for 2 months ~ 10 years(mean,5.1 years) in 366 patients revealed a full range of physical activities.One case of ventricular septal defect with residual shunt and 1 case of cerebral embolism were fully recovered.Conclusions Subaxillary minithoracotomy open heart operation has advantages of minimal invasion,quick recovery,simplicity of performance,and good cosmetic results.
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Objective To assess the value of lobectomy by video-assisted mini-thoracotomy(VAMT) for the treatment of peripheral pulmonary carcinoma.Methods From January 2004 to December 2007,56 cases of peripheral pulmonary carcinoma underwent VAMT lobectomy under general anaesthesia in our hospital.Of the patients,5 had the tumor in the upper lobe of the right lung,2 in the middle lobe of the right lung,19 in the superior lobe of the right lung,8 in the upper lobe of the left lung,and 22 in the superior lobe of the left lung.All the tumors were no more than 5 cm in diameter.All the cases were intubated with double-lumen tubes and then one-lung ventilation was performed.With the patients being placed in a lateral position,a mini-incision(6.0-8.0 cm in length) was made at the fourth or fifth intercostal space.And another 1.5-cm incision was made at the sixth intercostal space along the midaxillary line for introducing the video-thoracoscope.The resected pulmonary lobe was removed though the mini-incision.Afterwards,enlarged lymph nodes were dissected as routine.Results During the operation,no incision was prolonged in the cases.A mean of 14 lymph nodes were removed(ranged from 9 to 31).The mean operation time was(145?35) min(range,120 to 220 min),and the intraoperative hemorrhage was 100 to 450 ml [(210?48) ml].The patients were discharged from hospital in 5 to 11 days(mean,7 days).Seven of the patients developed complications including thoracic effusion in 5 and atelectasis in 2.The patients were followed up for 1 year,3 of them died during the period(1 year survival rate:94.6%).Conclusion VAMT lobectomy is feasible and safe for peripheral lung cancer.
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Objective To study the reliability and feasibility of video-assisted thorascopic lymphadenectomy for complete resection of non-small cell lung cancer(NSCLC).Methods From May 2007 to October 2008,31 patients with NSCLC underwent video-assisted thorascopic radical lobectomy combined with systemic lymphadenectomy in our hospital.The patients were divided into video-assisted thorascopic surgery(VATS) group(n=14) and video-assisted mini-thoracotomy(VAMT) group(n=17).The numbers of removed and metastatic lymph nodes were counted.The results and the follow-up outcomes were compared between the two groups.Results No patient dead or showed serious perioperative complications in both the groups.No significant differences were found between the VATS and VAMT groups in the operation time [(193?92) min vs(188?101) min,t=0.143,P=0.887],blood loss [(592?123) ml vs(648?120) ml,t=-1.297,P=0.211],number of removed lymph nodes [(14.6?7.5) vs(15.2?4.5),t=0.262,P=0.795],or 1-year rate of recurrence or metastasis [21.4%(3/14) vs 13.3%(2/15),P=0.651].Conclusion For patients with NSCLC,no significant difference exists between the outcomes of video-assisted thorascopic surgery and video-assisted mini-thoracotomy.
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Objective To evaluate the value of mini-thoracotomy for open heart surgery.Methods From December 1995 to January 2008,810 patients including 660 cases of congenital heart diseases,129 cases of valvular heart diseases and 21 cases of heart myxoma,underwent open heart surgery by mini-thoracotomy through cardiopulmonary bypass in our hospital.Among the cases,superior median sternotomy was performed on 36 patients,inferior median sternotomy was made on 59,right parasternal mini-thoracotomy was carried out in 3,right anterolateral thoracotomy was done on 658,and right axillary mini-thoracotomy was used in 54.A total of 382 patients received beating-heart surgery.Results The postoperative mortality in our patients was 1.5%(12 cases).In this series,the mean postoperative mechanical ventilation time,drainage volume,and hospital stay were(6.7?4.2) hours,(210?165) ml,and(7.4?4.9) days respectively.421 of the patients received no blood transfusion.None of the patients developed sternal dehiscence or mediastinal infection.Follow-up was available in 690(85%) of the patients up to a mean of(48.2?25.3) months,none of them died during the period.The cardiac function of the patients was significantly improved after the operation(preparation vs postoperation: 310 cases vs 478 cases for grade Ⅰ,438 vs 212 for grades Ⅱ-Ⅲ,and 62 vs 0 for grade Ⅳ,Z=-13.21,P=0.000).The mean cardiothoracic ratio was decreased significantly after the operation(0.51?0.11 vs 0.53?0.08,t=4.065,P=0.000),while the left ventricular ejection fraction was increased markedly(0.63?0.11 vs 0.57?0.11,t=-10.529,P=0.000).Conclusions The mini-thoracotomy is superior in cosmetic results and the postoperative morbidity rates of sternal malformation and infection.Proper selection of patients,good exposure of the surgical field,and skillful surgical procedures are crucial for the outcomes of the operation.
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0.05).Conclusion VAMT is as effective as VATS,whereas it can achieve a shorter operation time.