Clinical analysis of the feasibility and safety of single utility port robot-assisted lung resection / 中国胸心血管外科临床杂志

@#Objective    To investigate the feasibility and safety of single utility port Da Vinci robot-assisted lung resection via anterior approach. Methods    The clinical data of 21 patients who underwent single utility port Da Vinci robot-assisted lung resection from February to March 2021 were retrospectively analyzed. There were 10 males and 11 females, with a median age of 50 (34-66) years. The operation time, blood loss, postoperative hospitalization time, postoperative complications and other indicators were analyzed. Results    All patients completed the operation successfully with no transition to thoracotomy or perioperative death. Overall surgery time was 103 (70-200) min, Docking time was 5 (3-10) min, operation time was 81 (65-190) min. The blood loss was 45 (20-300) mL. All patients had malignant tumors, the number of dissected lymph node station was 3 (1-6), and the number of lymph nodes was 5 (2-16). The postoperative indwelling time was 3 (2-5) d. The postoperative hospitalization time was 5 (3-7) d. The pain score for the first 3 days after surgery was 3±1 points. Conclusion    Single utility port robot-assisted lung resection via anterior approach is safe, less traumatic, more convenient and effective, which can be gradually promoted and applied to clinical trials.

Application of Three-dimensional Reconstruction in Single Utility-port Thoracoscopic Segmentectomy for Early Stage Non-small Cell Lung Cancer: A Propensity Score-matched Analysis / 肿瘤防治研究

Objective To evaluate the clinical value of 3D reconstruction in the single utility-port thoracoscopic segmentectomy of early stage NSCLC by propensity score matching (PSM). Methods We retrospectively analyzed clinical data of 150 early stage NSCLC patients undergoing single utility-port thoracoscopic segmentectomy. The patients were divided into reconstruction group (n=58) and non-reconstruction group (n=92) according to 3D reconstruction. PSM was performed on two groups to compare perioperative outcomes. Results Procedures were successfully completed on all patients, without perioperative death. In each group, 43 patients were successfully matched after PSM on the basis of 8 confounding factors, age, gender, smoking status, BMI, maximum tumor diameter on CT, tumor location, % FEV1 and type of planned segmentectomy. After PSM, in complex segmentectomy, the patients in the reconstruction group had shorter operation time (155.77±30.17 vs. 212.94±66.49min, P < 0.001) and less blood loss (46.00±25.94 vs. 88.79±68.36ml, P=0.002), compared with the non- reconstruction group. Conclusion Preoperative 3D reconstruction could help improve the efficiency of single utility-port thoracoscopic surgery for complex segmentectomy and reduce intraoperative bleeding.

Single utility port video-assisted thoracoscopic anatomic segmentectomy for lung diseases: 155 cases report / 中国胸心血管外科临床杂志

@#Objective To evaluate the feasibility and safety of single utility port video-assisted thoracoscopic surgery (VATS) anatomic segmentectomy for lung diseases. Methods We performed a retrospective review of 155 patients undergoing single utility port VATS anatomic segmentectomy from January 2015 to December 2016. There were 62 males and 93 females with a mean age of 53 (24–82) years. Two ports were used. The camera was through the port for observation which was about 1.5 cm in length and located at the 7th or 6th intercostal space. The instruments were through port for operation that was about 3–4 cm in length and located at the 4th or 3th intercostal space. Pulmonary segment vessel and segmental bronchi were cut and stitched by Hemolock or linear cut stapler. Different segments were separated by linear cut stapler. Perioperative data were collected and analyzed. Results One patient was performed suture under the auxiliary operating hole (three holes) because of pulmonary artery bleeding. The remaining 154 patients underwent single utility port VATS anatomic segmentectomy successfully. No conversion to open procedure or lobectomy was found and there was no perioperative mortality. The median operative time was 102 (65–150) min and the median blood loss in operation was 118 (50–300) ml. The thoracic drainage time was 3.8 (2–7) d and the median hospital stay after operation was 5.6 (3–9) d . Major morbidity occurred in 8 patients (5.2%) including hemoptysis (in 2 patients), pneumonia (in 2 patients), aerodermectasia (in 1 patient), pleural effussion (in 1 patient) and local atelectasis (in 1 patient). All of them above healed after symptomatic treatment. Patholocal examination showed there were 139 patients of primary lung carcinoma (pathologically staged as Tis-T1bN0M0), 9 patients of benign diseases and 7 patients of metastasis tumor. Conclusion Single utility port VATS anatomic segmentectomy procedure is safe and feasible. It can be utilized as an option for those with non-small cell lung cancer staged Ⅰa and those unable to tolerate pulmonary lobectomy.

Efficacy comparison of single utility port and multiple utility ports thoracoscopic lobectomy for peripheral lung cancer / 肿瘤研究与临床

Objective To compare the clinical efficacy of single utility port and multiple utility ports thoracoscopic lobectomy in the treatment of peripheral lung cancer, and to study the operation skills, relative merit and feasibility of the single utility port thoracoscopic lobectomy. Methods The clinical data was analyzed retrospectively for 223 cases with stage Ⅰ orⅡ of peripheral lung cancer who underwent thoracoscopic lobectomy from July 2011 to November 2014 in Shanxi Provincial Cancer Hospital. Among 223 cases, 78 cases received single utility port thoracoscopic lobectomy (single utility port group), 145 cases received 2 or 3 utility ports thoracoscopic lobectomy (multiple utility ports group). The clinical outcomes involved time of operation, intraoperative blood loss,chest drainage, postoperative hospital stay, stations of lymph node dissection, numbers of lymph node dissection, rate of turn to open, postoperative complications, 2-year survival rate and disease free survival rate. Results No perioperative death occurred in both groups. There was no statistical difference between single utility port group and multiple utility ports group in operation time [(157.4 ±13.6) min vs. (151.3 ±23.2) min], intraoperative blood loss [(180.77 ±59.97) ml vs.(171.31 ±77.51) ml],chest drainage [(370.26 ±146.09) ml vs. (351.17 ±159.07) ml], lymph node dissection stations (4.29±0.65 vs. 4.21±0.73), lymph node dissection number (11.50±2.30 vs. 11.04±2.29), rate of turn to open [(5.13 ％ (4/78) vs. 4.83 ％ (7/145)], incidence of postoperative complications [17.95 ％ (14/78) vs. 15.86％(23/145)], postoperative hospital stay [(8.74±0.51) d vs. (9.48±0.63) d], 2-year survival rate [96.15 ％(75/78) vs. 93.79％(136/145)] and 2-year disease free survival rate [80.77 ％ (63/78) vs. 82.07 ％ (119/145)] (all P>0.05). Conclusions The single utility port thoracoscopic lobectomy could achieve the same clinical results as the multiple utility ports. The single utility port thoracoscopic lobectomy is a safe, effective and feasible surgical procedure.

Comparison Between Double-port and Three-port Video-assisted Thoracoscopic Lobectomy / 中国微创外科杂志

Objective To evaluate the clinical outcomes of double-port video-assisted thoracoscopic lobectomy. Methods We retrospectively analyzed the clinical data of 72 patients who underwent double-port video-assisted thoracoscopic lobectomy(DP group)from October 2014 to December 2015 in our hospital.A paired comparison was made with 72 patients who had the same lesion location and the nature(benign or malignant)and underwent three-port video-assisted thoracoscopic lobectomy(TP group)in the same period.The clinical outcomes included operation time, intraoperative blood loss,the number of lymph node, the chest tube time,postoperative hospital stay, incision pain VAS scores within three days and complications.Postoperative follow-ups were taken with telephone calls or out-patient reviews. Results No operative morality occurred in both groups.There were no statistical significances between the DP Group and the TP Group in intraoperative blood loss[(107.9 ±56.6)ml vs.(95.0 ± 46.8)ml,t=1.490,P=0.138],the number of lymph node(13.9 ±2.7 vs.14.5 ±2.6,t=1.358,P=0.177)and complication rate[11.1%(8/72)vs.9.7%(7/72),χ2=0.074,P=0.785].The DP group had significant longer operation time[(153.6 ± 22.6)min vs.(143.6 ±25.8)min, t=2.474, P=0.015], shorter chest tube time[(5.2 ±1.7)d vs.(6.4 ±1.1)d, t=5.029,P=0.000],shorter postoperative hospital stay[(6.1 ±1.6)d vs.7.6 ±1.2, t=6.364, P=0.000], and lower incision pain VAS scores within three days[(12.3 ±1.9)points vs.(14.4 ±1.8)points, t=6.808, P=0.000]as compared to the TP group.No short-term complication was noticed in both groups during a follow-up time ranged from 6 to 20 months. Conclusions Double-port video-assisted thoracoscopic lobectomy is safe and feasible.It is a preferred surgical mode for selected cases.

Single Utility Port Video-assisted Thoracoscopic Resection of Mediastinal Tumor:Report of 55 Cases / 中国微创外科杂志

Objective To explore the clinical value of single utility port video-assisted thoracoscopic surgery ( VATS ) for mediastinal tumor . Methods A retrospective analysis was performed on clinical data of 55 patients with mediastinal tumor who received surgical treatment with single utility port video-assisted thoracoscopic surgery in this department from December 2013 to June 2016.Routinely, the surgery was conducted by intraoperatively inserting the thoracoscope via an incision at the seventh intercostals space on the midaxillary line as the observation hole , and making a 3-4 cm transverse incision at the fourth intercostals space between the midaxillary line and the anterior axillary line as the operation hole .Postoperatively , the observation hole served as the passage for closed thoracic drainage tube . Results Among the 55 patients, 50 received total thoracoscopic surgery .In 3 cases with relatively large tumor, the surgery was conducted with additional assisted small incisions .Thoracotomy was carried out in another 2 cases due to bleeding when separating pulmonary artery branch and difficult hemostasis under thoracoscopy .The surgery duration was (100 ±46) min, the intraoperative blood loss was (85 ±38) ml, the postoperative chest drainage volume was (450 ±80) ml, the postoperative time to chest tube withdrawal was (3.0 ±1.6) d, and the postoperative duration of hospital stay was (6.2 ±1.5) d in the 50 cases of VATS.All the patients recovered well .Postoperatively , there were 1 case of myasthenic crisis , 2 cases of pneumothorax and 3 cases of pleural effusion, all of which were improved with symptomatic treatment .All the 55 cases were followed up for 2-24 months (mean, 11.2 ±7.3 months) and there were no tumor recurrences . Conclusion Single utility port VATS of mediastinal tumor resection has advantages in safety , efficacy, and cosmetic outcomes , being worthy of further clinical application .

Comparison of short-term perioperative outcomes of different thoracoscopic surgery in treatment of early stage non-small cell lung cancer / 临床外科杂志

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.

Comparison of uniportal VATS and single utility port VATS in treatment of spontaneous pneumothorax / 中国内镜杂志

Objective To compare the efficacy of uniportal VATS and single utility port VATS in treatment of spontaneous pneumothorax.Method From January 2013 to December 2015, we retrospectively collected clinical data of 53 patients with spontaneous pneumothorax who were treated with uniportal VATS, as study group; compared with control group: 53 patients received single utility port VATS in the same period. The clinical data was compared between the two groups, including the operation time, intraoperative blood loss, drainage time, postoperative extubation time, postoperative pain score, postoperative hospitalization and recurrence.Results All patients were successfully completed the operation, no death and serious complications occurred. There were no significant differences in intraoperative blood lose, duration of chest drainage, duration of hospital stay and incidence of serious postoperative complications between two groups (P > 0.05). Mean Visual Analogic Scale (VAS) score for 24 h post-operative pain was: (2.60 ± 0.71) for uniportal VATS and (3.38 ± 0.84) for single utility port VATS (P > 0.05), 72 h post-operative pain was: (1.30 ± 0.51) for uniportal VATS and (1.58 ± 0.62) for single utility port VATS (P > 0.05). Follow up 5 ~ 36 months, median follow up was 19 months. No recurrence occurred during follow up.Conclusions The study suggested that both surgical approaches to spontaneous pneumothorax are safe and effective. Significant differences were found for early post-operative pain between the two approaches, the uniportal way is better. It is worthy of clinical promoting.

Clinical comparative study between Uniportal and single port video-assisted thoracoscopic surgery forⅠA stage non-small cell lung cancer / 实用肿瘤学杂志

Objective To evaluate the clinical effect of Uniportal video -assisted thoracoscopic surgery and single utility port video-assisted thoracoscopic surgery for ⅠA stage non-small cell lung cancer .Methods A total of 81 patients with ⅠA stage non-small cell lung cancer was admitted to our hospital from January 2015 to November 2015 .The patients were divided into control group and observation group .51 patients of control group received single utility port video -assisted thoracoscopic surgery , while other 30 patients of observation group received Uniportal video -assisted thoracoscopic surgery .Results The incision length of observation group was(4.27 ±0.29) cm,operative time was (208.80 ±61.12) mins.The volume of blood intra -operation was (92.33 ±73.75)mL;the number of lymph nodes dissection was (15.62 ±5.12),post-operative drainage within 24 hours was(401.70 ±53.31)mL;drainage tube retention was (6.30 ±3.01)days;postoperative hospitalization time was(19.03 ±5.85)days.The incidence rate of postoperative complications was 13.33%.The incision length of control group was(3.86 ±0.23)cm.The operative time was(184.30 ±51.36)mins;The volume of blood intra-operation was(84.90 ±80.98)mL,the number of lymph nodes dissection was (15.84 ±5.66),post-operative drainage within 24 hours was(398.00 ±52.73)mL;drainage tube retention was(6.10 ±3.25)days;postoperative hospitalization time was(18.69 ±6.81) days;The incidence rate of postoperative complications was 25.49%, there were no significant difference between the two groups (P>0.05).VAS pain score of the observation group was(2.32 ±0.94)and it was(4.18 ±0.95)in control group,and observation group was significantly better than the control group(P<0.05).Conclusion Uniportal video -assisted thoracoscopic surgery has the benefit of less trauma and pain ,and it is worth using widely .