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.

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.

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.

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.

Quality of life and influencing factors in lung cancer patients after video-assisted thoracic surgery / 中国胸心血管外科临床杂志

@#Objective    To investigate the short-term quality of life in patients after single-direction video-assisted thoracic surgery (VATS) for lung cancer, and explore the related influencing factors. Methods    Patients who underwent single-direction VATS for lung cancer in the Department of Thoracic Surgery, West China Hospital, Sichuan University from July 2020 to August 2021 were continuously selected. The QLQ-C30 and QLQ-LC13 were used to evaluate the quality of life of the patients after the surgery, and the influencing factors were analyzed. Results    A total of 193 patients were collected. There were 73 males aged 59.44±11.40 years, and 120 females aged 53.73±11.15 years. The QLQ-C30 score of the patients after single-direction VATS for lung cancer was 69.09±20.21 points. Univariate analysis and Pearson correlation analysis showed that age, occupation, anesthesia time, postoperative complications, postoperative antibiotic use time, postoperative hospital stay, insomnia, economic stress, hemoptysis, chest pain, dysphagia, arm or shoulder pain were associated with the quality of life (P≤0.05). The results of multiple regression analysis showed that anesthesia time, economic pressure, insomnia and chest pain had a significant impact on the overall quality of life 30 days after the surgery (P≤0.05). Conclusion    The anesthesia time, economic pressure, insomnia and chest pain are independent influencing factors for the quality of life after the VATS lung cancer surgery.

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.

Imaging characteristics and postoperative pathological analysis of bronchiolar adenoma / 中国胸心血管外科临床杂志

@#Objective    To analyze the pathological manifestations and imaging characteristics of bronchiolar adenoma (BA). Methods    The clinical data of 11 patients with BA who received surgeries in our hospital from January 2019 to September 2020 were retrospectively analyzed, including 5 males and 6 females aged 40-73 (62.40±10.50) years. The intraoperative rapid freezing pathological diagnosis, postoperative pathological classification, cell growth pattern, nuclear proliferation index Ki-67 and other immunohistochemical staining combined with preoperative chest CT imaging characteristics were analyzed. Results    The average preoperative observation time was 381.10±278.28 d. The maximum diameter of imaging lesions was 5-27 (10.27±6.34) mm. Eight (72.7%) patients presented with irregular morphology of heterogeneous ground-glass lesions, and 3 (27.3%) patients presented with pure ground-glass lesions. There were 10 (90.9%) patients with vascular signs, 8 (72.7%) patients with vacuolar signs, 1 (9.1%) patient with bronchus sign, 3 (27.3%) patients with pleural traction and 9 (81.8%) patients with burr/lobular sign. The surgical methods included sub-lobectomy in 10 patients and lobectomy in 1 patient. Five (45.5%) patients were reported BA by intraoperative frozen pathology. The postoperative pathological classification included 8 patients with distal-type and 3 patients with proximal-type, and the maximum diameter of the lesions was 4-20 (8.18±5.06) mm. Eight (72.7%) patients showed characteristic bilayer cell structure under microscope, and 10 (90.9%) patients showed thyroid transcription factor 1 expression in pathological tissues. The expression of NapsinA in intracavity cells was found in 9 (81.8%) patients. The Ki-67 index of the lesion tissue was 1%-5% (3.22%±1.72%). Conclusion    The pathological features and imaging findings of BA confirm the premise that BA is a neoplastic lesion. However, to identify BA as a benign or inert tumor needs more clinical data and evidence of molecular pathological studies.

Feasibility and safety of one-stage bilateral video-assisted thoracic surgery for resection of bilateral multiple pulmonary nodules / 南方医科大学学报

OBJECTIVE@#To evaluate the feasibility and safety of one- stage bilateral video-assisted thoracic surgery (VATS) for resection of bilateral multiple pulmonary nodules (BMPNs).@*METHODS@#We analyzed the clinical characteristics, pathological features, perioperative outcomes and follow-up data of 41 patients with BMPNs undergoing one-stage bilateral VATS from July, 2011 to August, 2021.@*RESULTS@#One-stage bilateral VATS was performed uneventfully in 40 of the patients, and conversion to open surgery occurred in 1 case. The surgical approaches included bilateral lobectomy (4.9%), lobar-sublobar resection (36.6%) and sublobar-sublobar resection (58.5%) with a mean operative time of 196.3±54.5 min, a mean blood loss of 224.6±139.5 mL, a mean thoracic drainage duration of 4.7±1.1 days and a mean hospital stay of 14±3.8 days. Pathological examination revealed bilateral primary lung cancer in 15 cases, unilateral primary lung cancer in 21 cases and bilateral benign lesions in 5 cases. A total of 112 pulmonary nodules were resected, including 67 malignant and 45 benign lesions. Postoperative complications included pulmonary infection (5 cases), respiratory failure (2 cases), asthma attack (2 cases), atrial fibrillation (2 cases), and drug-induced liver injury (1 case). No perioperative death occurred in these patients, who had a 1-year survival rate of 97.6%.@*CONCLUSION@#With appropriate preoperative screening and perioperative management, one-stage bilateral VATS is feasible and safe for resection of BMPNs.

Population-based analysis of the epidemiology of the surgical correction of hyperhidrosis in 1,216 patients over 11 years: a cross-sectional study

Abstract BACKGROUND: Endoscopic thoracic sympathectomy is the definitive surgical treatment for hyperhidrosis and a nationwide study has suggested that cultural and socioeconomic factors play a role in the numbers of operations performed. Thus, there is a need to evaluate local data in order to understand the local epidemiology and trends in hyperhidrosis treatment. OBJECTIVE: To study the epidemiology of sympathectomy for treating hyperhidrosis in São Paulo, the largest city in Brazil. DESIGN AND SETTING: Population-based retrospective cross-sectional study. METHODS: Data on sympathectomies for treating hyperhidrosis between 2008 and 2018 were assessed from the database of the Municipal Health Department of São Paulo, Brazil. RESULTS: 65.29% of the patients were female, 66.2% were aged between 20 and 39 years and 37.59% had registered with addresses outside São Paulo. 1,216 procedures were performed in the city of São Paulo from 2008 to 2018, and 78.45% of them were in only two public hospitals. The number of procedures significantly declined over the years (P = 0.001). 71.63% of the procedures were associated with 2-3 days of hospital stay, only 78 intensive care unit days were billed and we did not observe any intra-hospital death. CONCLUSION: The profile of patients operated on in São Paulo (young women) is similar to that described in other populations. Sympathectomy is a very safe procedure, with no mortality in our series. There was a decreasing trend in the number of surgeries over the years.

Lobectomía por cirugía torácica videoasistida en el Centro Nacional de Cirugía de Mínimo Acceso / Lobectomy for Video-Assisted Thoracic Surgery at the National Center for Minimal Invasive Surgery

Introducción: La tasa de mortalidad de los tumores malignos de tráquea, bronquios y pulmón ocupa el segundo lugar en hombres y el primero en las mujeres. Según el anuario estadístico, hubo 5580 muertes por esta causa en 2020, con una tasa de mortalidad general en los hombres de 61,6 y de 38,1 en la mujer por 100 000 habitantes. Para el tratamiento del cáncer pulmonar en estadios tempranos la cirugía torácica videoasistida ha demostrado su seguridad y efectividad, con una baja morbilidad y una menor estancia posoperatoria. Objetivo: Mostrar los resultados de la lobectomía por cirugía torácica videoasistida en el Centro Nacional de Cirugía de Mínimo Acceso. Métodos: Se realizó un estudio prospectivo en una serie consecutiva de 29 pacientes operados con el diagnóstico de nódulo pulmonar. Para la obtención de la información se confeccionó una planilla de recolección para este fin y en todo momento se contó con el consentimiento informado de los pacientes. Se evaluaron las variables durante el pre, intra y posoperatorio. Resultados: Del total de 57 casos portadores de nódulos pulmonares, se realizó lobectomía por cirugía torácica videoasistida en 29, para un 50,9 por ciento; el 80 por ciento estaban en etapas I y II según el pTNM. Hubo un 31 por ciento de complicaciones y el índice de conversión fue del 20,7 por ciento. Conclusiones: La lobectomía por cirugía torácica video asistida es una técnica segura y de eficacia demostrada, factible de generalizar en nuestro medio(AU)

Introduction: The mortality rate of malignant tumors of the trachea, bronchi and lung ranks second in men and first in women. According to the Health Statistics Yearbook, there were 5,580 deaths from this cause in 2020, with a general mortality rate for men of 61.6 and 38.1 for women per 100,000 inhabitants. For the treatment of lung cancer in early stages, video-assisted thoracic surgery has demonstrated its safety and effectiveness, with low morbidity and a shorter postoperative stay. Objective: To show the results of video-assisted thoracic surgery lobectomy at the National Center for Minimal Invasive Surgery. Methods: A prospective study was carried out in a consecutive series of 29 patients operated on with a diagnosis of pulmonary nodule. A collection form was prepared to obtain the information and the informed consent of the patients was obtained at all times. The variables were evaluated during the pre, intra and postoperative period. Results: Fifty seven (57) cases with pulmonary nodules formed the total of this study. Twenty nine of them (29) underwent lobectomy by video-assisted thoracic surgery (50.9 percent). 80 percent were in stages I and II according to pTNM. There were 31 percent complications and the conversion rate was 20.7 percent. Conclusions: Video-assisted thoracic surgery lobectomy is a safe and proven technique, which is feasible to generalize in our setting(AU)

Erector spinae plane block on pain management after thoracic surgical approaches due to COVID-19 complications. Case reports / Bloqueio do plano dos músculos eretores da espinha no manejo de dor pós-abordagens cirúrgicas torácicas por complicações da COVID-19. Relato de casos

ABSTRACT BACKGROUND AND OBJECTIVES: Erector spinae plane block is an interfascial plane block used as a tool for management of pain resulting from thoracic and abdominal surgical procedures described in the literature since 2016 and widely used in clinical practice. In the context of the pandemic caused by Sars-CoV-2, multiple pulmonary complications arising from severe viral pneumonia and respiratory failure that required surgical approaches for their investigation and/or treatment were observed. The present study's objective was to present a series of three cases of patients affected by COVID-19 who had pulmonary complications due to infection or exacerbation of previous pulmonary diseases caused by the new coronavirus, in which the continuous fascial plane block was successfully used for postoperative pain management. CASE REPORTS: Three cases of patients with COVID-19 viral pneumonia requiring diagnostic or therapeutic thoracic surgery who underwent erector spinae plane block for perioperative pain management were presented. CONCLUSION: The use of a catheter with continuous infusion of local anesthetic was useful for reducing analgesic rescue and maintaining good postoperative analgesia with no evidence of adverse effects in the presented patients, also allowing acceleration of postoperative recovery and a better outcome for the patients.

RESUMO JUSTIFICATIVA E OBJETIVOS: O bloqueio do plano dos músculos eretores da espinha é um bloqueio do plano interfascial usado como ferramenta para manejo de dor consequente a procedimentos cirúrgicos torácicos e abdominais descrito na literatura desde 2016 e amplamente utilizado na prática clínica. No contexto da pandemia causada pelo Sars-CoV-2, foram observadas múltiplas complicações pulmonares decorrentes de pneumonia viral grave e insuficiência respiratória que demandaram abordagens cirúrgicas para sua investigação e/ou tratamento. O objetivo deste estudo foi apresentar uma série de três casos de pacientes acometidos pela COVID-19 que tiveram complicações pulmonares pela infecção ou exacerbação de doença pulmonar prévia causada pelo novo coronavírus, nos quais o recurso do bloqueio do plano fascial contínuo foi utilizado para manejo de dor pós-operatória com sucesso. RELATO DOS CASOS: Foram apresentados três casos de pacientes acometidos pelo COVID-19 em sua forma de pneumonia viral, para os quais houve necessidade de cirurgia torácica diagnóstica ou terapêutica, e que foram submetidos ao bloqueio do plano dos músculos eretores da espinha para manejo da dor perioperatória. CONCLUSÃO: O uso de cateter com infusão contínua de anestésico local foi útil para a diminuição dos resgates analgésicos e manutenção de boa analgesia pós-operatória sem evidência de efeitos adversos nos pacientes apresentados, possibilitando ainda a aceleração da recuperação pós-operatória e um melhor desfecho para os pacientes.

Comparación de resultados de la Cirugía Torácica Convencional y la Uniportal en el Instituto Nacional de Oncología y Radiobiología / Comparison of results of Conventional and Uniportal Video-Assisted Thoracic Surgery in the National Institute of Oncology and Radiobiology

Introducción: La cirugía torácica videoasistida por un solo puerto (Uniportal VATS) se ha convertido hoy en uno de los abordajes más utilizados para resecciones pulmonares en muchos centros de cirugía torácica del mundo, en Cuba su introducción es bastante reciente y todavía se encuentra en fase inicial. Objetivo: Comparar los resultados obtenidos por cirugía torácica abierta y Uniportal VATS en pacientes intervenidos en el Instituto Nacional de Oncología y Radiobiología de La Habana (INOR) durante enero de 2016 a abril de 2017. Material y Métodos: Estudio observacional descriptivo de corte longitudinal retrospectivo con 60 pacientes atendidos en el INOR durante enero de 2016 a abril de 2017 a los cuales se les realizó cirugía torácica. Resultados: Veinticuatro pacientes fueron operados por Uniportal VATS y 36 a través de la toracotomía, primaron las lesiones del lado derecho, el procedimiento más realizado fue lobectomía. Los estadíos predominantes fueron IA y IB, la mayoría de los procedimientos fue realizada en tres horas o menos, 8 casos se convirtieron, 13 sufrieron complicaciones. La estadía media de los pacientes tratados con Uniportal VATS fue menor que los que recibieron la toracotomía abierta. Conclusiones: El abordaje Uniportal se caracterizó por ser seguro, tener una gran versatilidad, pocas complicaciones y por mejorar la recuperación postquirúrgica del paciente y acelerar su reincorporación a las actividades de la vida cotidiana(AU)

Introduction: Single-port Video Assisted Thoracic Surgery (Uniportal VATS) has currently become one of the most commonly used approaches for lung resections in many Thoracic Surgery Centers around the world. In Cuba, its introduction is quite recent and it is still in its initial phase. Objective: To compare the results obtained by open thoracic surgery and Uniportal VATS in patients who underwent surgery in the National Institute of Oncology and Radiobiology of Havana (INOR) from January 2016 to April 2017. Material and Methods: An observational descriptive longitudinal retrospective study was conducted in 60 patients who underwent Thoracic Surgery in the INOR during 2016 - April 2017. Results: A total of 24 patients were operated through Uniportal VATS and 36 underwent thoracotomy. The lesions predominantly affected the right side and lobectomy was the most performed surgical procedure. Stages IA and IB predominated. Most of the procedures were carried out in 3 hours or less, 8 cases were converted and 13 suffered from complications. The average postoperative length of stay in hospital for patients who underwent Uniportal VATS was reduced compared to those who underwent open thoracotomy. Conclusions: Uniportal VATS is characterized by being a safe procedure with few complications and great versatility. It improves postoperative recovery of patients and accelerates their return to daily life activities(AU)

Benefit of video-assisted thoracic surgery in the emergency of a complicated postpartum diaphragmatic hernia / Beneficio de la cirugía torácica video-asistida en la emergencia de una hernia diafragmática posparto complicada

Abstract Diaphragmatic hernia during pregnancy or puerperium are rare entities that, in the event of a complication, represent a life-threatening emergency for both mother and the unborn child. Resolution in many cases requires a combined access through the thoracic and abdominal cavity to manage the complica tions of necrosis and/or perforation of an abdominal viscera. To treat the thoracic cavity, thoracotomy is the most described approach. Even more, the minimally invasive access by video-assisted thoracic surgery (VATS) is not widely referenced in the literature despite its clear benefits of this technique in the recovery of patients, even in emergencies. We present the case of a postpartum right diaphragmatic hernia, complicated by necrosis of the colonic wall, treated by combined VATS approach and laparotomy in the emergency.

Resumen Las hernias diafragmáticas durante el embarazo o puerperio son entidades raras que, en caso de complicación, representan una emergencia potencialmente mortal tanto para la madre como para el feto. La resolución en muchos casos requiere un acceso combinado a través de la cavidad torácica y abdominal para manejar las complicaciones de la necrosis o perforación de las vísceras abdominales. Para tratar la cavidad torácica, la toracotomía es la vía más descrita. Más aún, el acceso mínimamente invasivo mediante cirugía torácica video-asistida (VATS) no está ampliamente referenciado en la literatura a pesar de los claros beneficios de esta técnica en la recuperación de los pacientes, incluso en emergencias. Presentamos el caso de una hernia diafragmática derecha posparto, complicada por necrosis de la pared colónica, tratada combinado VATS y laparotomía en la urgencia.

Pleurectomía parietal y decorticación pulmonar por cirugía torácica asistida por video (VATS) monopuerto versus toracotomía / Parietal pleurectomy and pulmonary decortication by single-portvideo-assisted thoracic surgery (VATS) versus thoracotomy

Introducción. El avance de la cirugía torácica abierta a cirugía torácica asistida por vídeo por tres puertos, y sus posteriores efectos en la recuperación de los pacientes, conllevó al desarrollo de la técnica por un solo puerto, que ha mostrado beneficios en el postoperatorio.El objetivo de este estudio fue comparar los resultados postquirúrgicos de los pacientes sometidos a pleurectomía parietal y decorticación pulmonar toracoscópica asistida por video monopuerto y los obtenidos por toracotomía convencional, en una clínica de cuarto nivel, entre 2016 y 2019. Métodos. Estudio descriptivo, en el que se incluyeron 79 pacientes llevados a pleurectomía parietal y decorticación pulmonar por toracoscopia asistida por vídeo monopuerto y 25 pacientes operados por toracotomía convencional. Se evaluaron variables sociodemográficas, clínicas y postoperatorias. Se utilizaron las pruebas de Chi2 o de Fisher y las pruebas t de Student y Mann Whitney. Resultados. La mediana de edad fue menor en el grupo de pacientes operados por toracotomía convencional (28 años, RIC: 26­48, p=0,0005). No hubo diferencia en los tiempos quirúrgicos. Se encontró menor intensidad del dolor y disminución en los días con tubo de tórax, uso de antibióticos, días de UCI y días de estancia hospitalaria en el grupo de pacientes operados por toracoscopia asistida por vídeo monopuerto (p<0,05). Discusión. Este estudio refuerza la tendencia de mejores resultados postquirúrgicos, menos días de uso del tubo de tórax, uso de antibióticos, necesidad de UCI y días de estancia hospitalaria general con la técnica asistida por vídeo monopuerto comparado con la toracotomía abierta convencional

Introduction. The advancement from open to video-assisted thoracic surgery through three ports, and its sub-sequent effects on the recovery of patients, led to the development of the single port technique, which has shown benefits in the postoperative period. The objective of this study was to compare the postsurgical results of patients undergoing parietal pleurectomy and video-assisted single-port thoracoscopic pulmonary decortication to those obtained by conventional thoracotomy, in a fourth level clinic, between 2016 and 2019.Methods. Descriptive study, in which 79 patients underwent parietal pleurectomy and pulmonary decortication by single-port video-assisted thoracoscopy and 25 patients operated by conventional thoracotomy were included. Sociodemographic, clinical and postoperative variables were evaluated. The Chi-square or Fisher tests, and the t Student and Mann Whitney t tests were used.Results. The median age was lower in the conventional thoracotomy group (28 years; IQR: 26-48; p= 0.0005). There were no differences in surgical times. Lower pain level, and a decreased in days with chest tube, antibiotic use, need for ICU and of hospital stay were reported in the single-port video-assisted thoracoscopy group compared to conventional thoracotomy technique (p < 0.05). Discussion. This study reinforces the trend of better postsurgical results, fewer days of chest tube use, use of antibiotics, need for ICU and days of general hospital stay with the single-port video-assisted technique compared to conventional open thoracotomy

Toracostomía abierta: en ocasiones la mejor opción / Open thoracostomy: Sometimes the best option

El tratamiento quirúrgico del empiema ha evolucionado, desde la medicina hipocrática, a través de los años, teniendo como premisa el drenaje. Con los avances médicos, el abordaje mínimamente invasivo se ha convertido en el estándar, dejando de lado otras técnicas quirúrgicas. La toracostomía abierta, en pacientes seleccionados, puede llegar a ser la última y mejor opción para el control del foco infeccioso: es una opción quirúrgica para el tratamiento de los empiemas en pacientes mórbidos y en fase de organización, cuando otros tratamientos han fallado, con una aceptable morbilidad y mortalidad. Esta técnica debe estar en el arsenal terapéutico del cirujano. Presentamos una serie de 4 casos de pacientes con empiema en fase de organización, en los cuales el riesgo quirúrgico era muy alto, por lo que se optó por realizar una toracostomía abierta, con éxito

The surgical treatment of empyema has evolved from Hippocratic medicine over the years, with drainage as its premise. With medical advances, the minimally invasive approach has become the standard, leaving aside other surgical techniques. Open thoracostomy, in selected patients, may become the last and best option for the control of the infectious focus: it is a surgical option for the treatment of empyemas in morbid patients and in the organization phase when other treatments have failed, with an acceptable morbidity and mortality. This technique should be in the surgeon's therapeutic arsenal. We present a series of four cases of patients with empyema in the organization phase, in which the surgical risk was very high, so it was decided to perform an open thoracostomy, which turn out successful

Neumotórax espontáneo y enfisema bulloso bilateral / Spontaneous pneumothorax and bilateral bullous emphysema

Introducción. El objetivo de este artículo fue reportar el caso de un paciente con antecedente de enfisema bulloso bilateral que le ocasionó un neumotórax persistente de difícil tratamiento. Caso clínico. Se trata de un paciente de 50 años de edad con diagnóstico de neumotórax asociado con un enfisema bulloso bilateral, en quien estaba contraindicado el tratamiento quirúrgico. El cuadro clínico comenzó con dolor en el hemitórax derecho y disnea, que se fue intensificando hasta el punto de no tolerar el decúbito. En la radiografía de tórax se observó colapso del pulmón derecho con múltiples bulas en ambos pulmones, por lo que se practicó una pleurotomía mínima alta derecha. La evolución del paciente no fue favorable por persistir el neumotórax, lo cual llevó al uso de un tratamiento alternativo. Discusión. En los pacientes con neumotórax persistente por enfisema bulloso bilateral sin indicación quirúrgica, el talco es una alternativa menos invasiva para lograr una sínfisis pleural con buenos resultados, método cuya utilidad se demuestra

Introduction. The aim of this report was to present the case of a patient with a history of bilateral bullous emphysema that causes a persistent pneumothorax that was difficult to treat. Clinical case. This is a 50-year-old patient diagnosed with pneumothorax associated with bilateral bullous emphysema, in whom surgical treatment being contraindicated. The clinical picture began with pain in the right hemithorax and dyspnea, which intensified to the point of not tolerating decubitus. In the chest X-ray, collapse of the right lung was observed with multiple bullae in both lungs, therefore a right upper minimum pleurotomy was performed. The patient's evolution was not favorable due to persisting pneumothorax, which led to the use of an alternative treatment. Discussion. In patients with persistent pneumothorax due to bilateral bullous emphysema without surgical indication, talc is a less invasive alternative to achieve a pleural symphysis with good results, a method whose utility is demonstrated

Reasons for Conversion to Thoracotomy in 83 Cases during Video-assisted Thoracic Surgery Lobectomy: A Summary of 1,350 Consecutive Operations by A Single Surgical Team / 中国肺癌杂志

BACKGROUND@#Video assisted thoracic surgery (VATS) is the main surgical method for lung cancer. The aim of this study was to analyze the reasons for conversion to thoracotomy in 83 cases among 1,350 consecutive cases who underwent video-assisted thoracic surgery (VATS) lobectomy by a single surgical team, in order to achieve a deeper understanding of the rules and the opportunity for conversion to thoracotomy in VATS lobectomy under normal conditions.@*METHODS@#The clinical data of 1,350 patients who underwent VATS lobectomy between September 21, 2009 and June 1, 2020, by a single surgical team in the Fifth Department of Thoracic Surgery of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. There were 773 males and 577 females, aged 8-87 years, with a median age of 61.3 years, including 83 cases of benign diseases, 38 cases of lung metastases, and 1,229 cases of primary lung cancer. The cases with stage I, II and IIIa were 676, 323 and 230, respectively. The cases of left upper, left lower, right upper, right middle, right lower, right middle and upper and right middle and lower lobectomy were 301 (22.30%), 231 (17.11%), 378 (28.00%), 119 (8.81%), 262 (19.41%), 16 (1.19%) and 43 (3.19%), respectively.@*RESULTS@#In the cohort of 1,350 consecutive patients with VATS lobectomy, 83 patients (6.15%) were converted to thoracotomy for different reasons. The conversion rate of benign lesions was significantly higher than that of malignant tumors (P<0.05). The conversion rate in stage IIIa was significantly higher than that in stage I and II (P<0.05). The conversion rate of combined lobectomy was significantly higher than that of single lobectomy (P=0.001). The conversion rate of left upper lobectomy was significantly higher than that of other single lobectomy (P<0.001). The conversion rate of right middle lobectomy was significantly lower than that of other single lobectomy (P=0.049). The main reasons for conversion were vascular injury (38.55%), lymph node interference (26.51%) and dense adhesion in thoracic cavity (16.87%). In the conversion group, the total operation time was (236.99±66.50) min and the total blood loss was (395.85±306.38) mL. The operation time in patients converted to thoracotomy due to lymph node interference was (322.50±22.68) min, which was significantly longer than that in the other groups (P<0.05). The intraoperative blood loss in patients converted to thoracotomy due to vascular injury was (560.94±361.84) mL, which was significantly higher than that in the other groups (P<0.05). With the increase in surgical experience, the number of vascular injuries gradually decreased at the early stage, mid-stage and late stage (P=0.045).@*CONCLUSIONS@#In VATS lobectomy, benign lung lesions and more advanced malignant tumors led to more surgical difficulties and higher conversion rate. The conversion rate was different in different lobectomy sites, with the highest in left upper lobectomy, and the lowest in right middle lobectomy. Vascular injury, lymph node interference and dense adhesion were the main reasons for conversion to thoracotomy, which led to prolonged operation time and increased blood loss. With the increasing number of surgical cases, the rate of conversion to thoracotomy in VATS lobectomy continues to decline, which may be mainly due to the more advanced treatment of pulmonary vessels.

A comparative analysis of the short-term efficacy of lung segmentectomy by Da Vinci robot and video-assisted thoracoscopy for stage ⅠA non-small cell lung cancer / 中华胸心血管外科杂志

Objective:To compare the short-term outcomes of segmentectomy for stage ⅠA non-small cell lung cancer by two surgical methods.Methods:A retrospective analysis was performed on 101 patients with stage ⅠA non-small cell lung cancer and undergoing segmentectomy admitted to the Department of Thoracic Surgery of The General Hospital of the Northern Theater Command from July 2016 to July 2020, including 50 patients who underwent Da Vinci robotic segmentectomy and 51 patients who underwent video-assisted thoracoscopic segmentectomy during the same period. By collecting the clinical data of the patients, the operation time, intraoperative blood loss, lymph node dissection stations, lymph node dissection number, drainage volume on the first day after the operation, total drainage volume on the third day after the operation, postoperative chest catheter insertion time, postoperative hospitalization days, and postoperative complication rate were compared and analyzed.Results:Patients in both groups successfully completed pulmonary segmental resection, and there were no cases of conversion to thoracotomy and perioperative death.Compared and analyzed the postoperative clinical results of the two groups, the intraoperative blood loss [(34.40±12.96) ml vs.(85.10±26.41)ml, P=0.000], the number of lymph node dissection stations(4.72±1.20 vs. 3.60±1.40, P=0.000) and the number of lymph node dissection(15.14±5.91 vs. 10.76±5.26, P=0.000) showed statistically significant differences, and RATS group was superior to VATS group.There were no statistically significant differences in operation time[(153.90±21.88) min vs.(155.39±25.04) min, P=0.751], drainage volume on the first day after surgery[(217.80±76.94) ml vs.(210.98±86.98) ml, P=0.678], total drainage volume three days after surgery[(612.60±169.93) ml vs.(595.10±203.90) ml, P=0.641], duration of chest drainage tube after operation[(5.36±2.33) days vs.(5.18±2.54) days, P=0.706], postoperative hospitalization days[(7.50±2.35) days vs.(7.47±2.93) days, P=0.956]and postoperative complication incidence. Conclusion:Da Vinci robot segmentectomy is a safe and effective surgical method, with less bleeding and more lymph node dissection stations and number than video-assisted thoracoscopic segmentectomy for stage ⅠA non-small cell lung cancer.

A modified approach of port-access lymphadectomy for locally advanced non-small cell lung cancer: A single center experience / 中南大学学报(医学版)

Objective: Systematic nodal dissection (SND) is an important component of locally advanced non-small cell lung cancer (NSCLC), but modification of this procedure is rarely reported. In this paper, we reported a modified technique of systematic mediastinal lymph node dissection (MLND) of operable lung cancer by video-assisted thoracic surgery (VATS). Parallel upward dissection (the PUD technique) was named due to this modification and the efficacy of the PUD technique was evaluated as well.Methods: We summarized the tips of the PUD technique and its version was updated in surgical aspect. The design and procedure sequence of the PUD technique were introduced in detail as well as its pros and cons. A retrospective study was performed on 998 cases of locally advanced NSCLC which accepted the PUD procedure in Department of Thoracic Surgery, Second Xiangya Hospital, Central South University, from 2012 to 2020. The perioperative mortality and the incidence of general and serious complications (such as recurrent laryngeal nerve injury, bronchopleural fistula) were analyzed. Results: All the 998 cases were operated successfully with the PUD technique and few post-operation complications were found. There was no perioperative mortality and severe complication such as recurrent laryngeal nerve injury and bronchopleural fistula. Conclusion:The PUD technique is safe and convenient and it can be a good supplement to the existing surgical techniques for locally advanced lung cancer.

Subxiphoid and subcostal arch thoracoscopic versus unilateral thoracoscopic thymectomy for the treatment of thymic abnormalities with myasthenia gravis: A propensity-score matching study / 中国胸心血管外科临床杂志

@#Objective    To compare clinical effects of extended thymectomy for the treatment of thymic abnormalities with myasthenia gravis (MG) between subxiphoid and subcostal arch thoracoscopic resection (SR) and the unilateral thoracoscopic resection (UR) by a propensity-score matching analysis. Methods    We retrospectively analyzed the clinical data of 612 patients who presented with MG and were admitted to Tangdu Hospital of Air Force Military Medical University between December 2011 and December 2018. Of these patients, 520 patients underwent subxiphoid and subcostal arch thoracoscopic extended thymectomy (a SR group) and 92 unilateral thoracoscopic extended thymectomy (a UR group). Ninety-two patients in the SR group were matched with the UR group by propensity-score matching analysis. There were 52 males and 40 females with an average age of 26-70 (50.2±10.3) years in the SR group, and 47 males and 45 females with an average age of 20-73 (51.5±12.1) years in the UR group. The operation time, intraoperative blood loss, thoracic drainage time, postoperative hospital stay, thorough adipose tissue removal, postoperative remission of MG, patients’ satisfaction score, pain and complications were compared and analyzed between the two groups. Results    All operations were accomplished successfully, without conversion to thoracotomy of the two groups. There were statistical differences between the two groups in operation time (46.2±19.5 min vs. 53.4±23.5 min), chest drainage duration (0 d vs. 3.4±1.2 d), hospital stay (2.9±1.9 d vs. 3.6±1.7 d), patients’ satisfaction score (7.9±2.1 points vs. 6.7±1.2 points) and pain scores (all P<0.05). There were no statistical differences between the two groups in intraoperative blood loss (52.2±12.7 mL vs. 51.2±10.3 mL), peripheral adipose tissue removal (8.1±0.6 vs. 7.9±0.9), remission rate of MG (89.1% vs. 85.9%) and rate of postoperative complications (10.9% vs. 6.5%) (all P>0.05). Conclusion    Subxiphoid and subcostal arch thoracoscopic extended thymectomy is a safe and feasible minimally invasive procedure for the management of MG with thymic abnormalities.