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

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

Tubeless video-assisted thoracoscopic surgery for primary palmar hyperhidrosis: A retrospective cohort study in a single center / 中国胸心血管外科临床杂志

@#Objective    To explore the safety, feasibility and superiority of tubeless video-assisted thoracoscopy in the treatment of primary palmar hyperhidrosis (PPH). Methods    The clinical data of 46 patients with palmar hyperhidrosis treated by thoracoscopy in the Department of Thoracic Surgery of the First Hospital of Lanzhou University from March 2017 to September 2020 were retrospectively analyzed. Among them, 22 received tubeless video-assisted thoracoscopic surgery, and were divided into a tubeless group, including 10 males and 12 females with an average age of 24.3±6.4 years; 24 received conventional thoracoscopic surgery, and were divided into a control group, including 13 males and 11 females with an average age of 23.5±4.8 years. The operation status, anesthesia effect and postoperative complications of the two groups were compared. Results    Forty-six patients successfully completed the operation with the assistance of thoracoscopy. There was no intraoperative transfer to thoracotomy, or intraoperative transfer to tracheal intubation in the tubeless group. Anesthetic recovery time (14.4±1.6 min vs. 20.1±1.8 min, P=0.000), time to get out of bed on the first postoperative day (3.1±0.6 h vs. 1.6±0.4 h, P=0.000), visual analogue score for postoperative pain (1.4±0.6 points vs. 3.4±1.1 points, P=0.000), postoperative hospital stay (1.7±0.5 d vs. 2.8±0.6 d, P=0.000), postoperative satisfaction rate of patients (95.5% vs. 66.7%, P=0.037) in the tubeless group were shorter or better than those in the control group. There was no statistical difference in age, gender, smoking history, palmar hyperhidrosis classification, palms or other  associated parts, the total time of bilateral surgery, intraoperative blood loss, postoperative complications, or compensatory hyperhidrosis (mild) between the two groups (P>0.05). Conclusion    Compared with traditional thoracoscopic surgery for PPH, tubeless video-assisted thoracoscopic surgery for PPH has the advantages of safety, reliability, light pain and quick recovery, in line with the concept of accelerated rehabilitation surgery.

External validation and comparison of different prediction models of postoperative nausea and vomiting in elderly patients with thoracoscopic partial pneumonectomy / 中国实用护理杂志

Objective:To investigate and compare the predictive effects of two postoperative nausea and vomiting (PONV) prediction models in elderly patients with thoracoscopic partial pneumonectomy.Methods:The total of 227 elderly patients who underwent thoracoscopic partial pneumonectomy in Brain Hospital Affiliated to Nanjing Medical University from October 2021 to January 2022 were collected. Apfel risk score and Koivuranta risk score were used to predict the risk of PONV in each patient. The area under the ROC curve was used to evaluate the discrimination ability of the two prediction models; Hosmer-Lemeshow goodness of fit test was used to evaluate the calibration of the two prediction models.Results:Among 227 patients, 74 had PONV, and the incidence of PONV was 32.6%. The area under the ROC curve of Apfel and Koivuranta risk scores in the risk prediction of PONV in elderly patients with thoracoscopic partial pneumonectomy were 0.640 and 0.683 respectively. There was no significant difference between the two ( Z=1.54, P>0.05). The Hosmer-Lemeshow goodness of fit test showed that the accuracy of the two models in predicting PONV risk in elderly patients with thoracoscopic partial pneumonectomy was better ( P>0.05). Conclusions:The difference between the two models in PONV risk prediction in elderly patients with thoracoscopic partial pneumonectomy is general, Koivuranta model is more suitable for predicting PONV in elderly patients with thoracoscopic partial pneumonectomy, but its applicability is still insufficient.

A pericardial hydatid cyst treated with video assisted thoracoscopy

Hydatid cyst disease is a significant health problem for undeveloped and developing countries. Humans are infected by way of contaminated dogs or contaminated uncooked vegetables. Cardiac hydatid cyst disease is uncommon, occurring in approximately 0.5% to 2% of patients with hydatid disease. Most cardiac hydatid cysts are located in the left ventricle and interventricular septum. The rate of pericardial hydatid cysts is (2-10) % of cardiac echinococcosis. Although cardiac involvement is rare, early diagnosis and treatment of this situation is important. Surgical options include sternotomy, thoractomy and video assisted thoracoscopy (VATS). In the present report, a 17-year-old girl with pericardial and hepatic hydatid cyst is described and it has been treated with left VATS for pericardial cyst. In the present patient, the hydatid cyst was located inside the pericardial cavity without myocardial involvement.

Da Vinci robot-assisted surgery versus video-assisted thoracoscopic surgery for resection of mediastinal tumors: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To summarize the experience of minimally invasive anterior mediastinal tumor resection in our center, and compare the Da Vinci robotic and video-assisted thoracoscopic approaches in the treatment of mediastinal tumor. Methods    A retrospective cohort study was conducted to continuously enroll 102 patients who underwent minimally invasive mediastinal tumor resection between September 2014 and November 2019 by the single medical group in our department. They were divided into two groups: a robotic group (n=47, 23 males and 24 females, average age of 52 years) and a thoracoscopic group (n=55, 29 males and 26 females, average age of 53 years). The operation time, intraoperative blood loss, postoperative thoracic drainage volume, postoperative thoracic drainage time, postoperative hospital stay, hospitalization expense and other clinical data of two groups were compared and analyzed. Results    All the patients successfully completed the surgery and recovered from hospital, with no perioperative death. Myasthenia gravis occurred in 4 patients of the robotic group and 5 of the thoracoscopic group. The tumor size was 2.5 (0.8-8.7) cm in the robotic group and 3.0 (0.8-7.7) cm in the thoracoscopic group. Operation time was 62 (30-132) min in the robotic group and 60 (29-118) min in the thoracoscopic group. Intraoperative bleeding volume was 20 (2-50) mL in the robotic group and 20 (5-100) mL in the thoracoscopic group. The postoperative drainage volume was 240 (20-14 130) mL in the robotic group and 295 (20-1 070) mL in the thoracoscopic group. The postoperative drainage time was 2 (1-15) days in the robotic group and 2 (1-5) days in the thoracoscopic group. There was no significant difference between the two groups in the above parameters and postoperative complications (P>0.05). The postoperative hospital stay were 3 (2-18) days in the robotic group and 4 (2-14) in the thoracoscopic group (P=0.014). The hospitalization cost was 67 489 (26 486-89 570) yuan in the robotic group and 27 917 (16 817-67 603) yuan in the thoracoscopic group (P=0.000). Conclusion    Compared with the video-assisted thoracoscopic surgery, Da Vinci robot-assisted surgery owns the same efficacy and safety in the treatment of mediastinal tumor, with shorter postoperative hospital stay, but higher cost.

Cardiac sympathetic denervation for conventional treatment refractory arrhythmias / Denervación simpática cardíaca en arritmias refractarias al tratamiento convencional

Abstract Objective: Cardiac sympathetic denervation (CSD) using video-assisted thoracoscopy is a therapeutic alternative for cardiac arrhythmias refractory to conventional treatment in patients with ventricular structural heart disease, mainly due to ischemia, and in patients with hereditary conditions associated with sudden death such as long QT syndrome. In general, it is performed in cases with recurrent episodes of ventricular tachycardia or electrical storm, in spite of conventional treatment. The objective of this study is to show the experience of this institution with DSCI in refractory patients to conventional management and the results derived from its application. Methods: This was an observational retrospective study. The records of patients with a history of ventricular arrhythmias treated in our center with pharmacological treatment, catheter ablation, or implantation of an implantable cardioverter-defibrillator (ICD), who underwent video-assisted CSD were analyzed and described. Results: A total of six patients were included in the study. Patients with structural heart disease were the most frequent, median age was 56 � 16 years; 67% were male. The procedure evolved without complications in any of the patients and an overall significant improvement was observed. A 24-month follow-up was conducted; two patients had recurrence episodes presenting as slow ventricular tachycardia without severe symptoms and a third patient presented an episode of ventricular fibrillation aborted by the ICD. Conclusion: Video-assisted CSD should be considered as a treatment option for patients with potentially dangerous arrhythmias that do not respond to conventional treatment, especially in recurrent ventricular tachycardia.

Resumen Objetivo: La denervación simpática cardiaca izquierda (DSCI) por toracoscopia se ha convertido en una alternativa terapéutica para el manejo de arritmias cardíacas refractarias al tratamiento convencional en pacientes con cardiopatía estructural, principalmente isquémicos, y enfermedades hereditarias asociadas con muerte súbita como el síndrome de QT largo. Generalmente se realiza en quienes manifiestan episodios recurrentes de arritmias ventriculares o incluso tormenta eléctrica a pesar del tratamiento convencional. El objetivo de este estudio es mostrar la experiencia de esta institución con la DSCI en pacientes refractarios al manejo convencional y los resultados derivados de su aplicación. Métodos: Se revisaron los registros de 6 pacientes con antecedente de arritmias ventriculares tratados previamente con medicamentos y en algunos casos con ablación con catéter y la mayoría con desfibrilador automático implantable, que fueron llevados DSCI por toracoscopia video-asistida (VATS). Resultados: La principal enfermedad de base fue la cardiopatía estructural, la indicación más prevalente fue tormenta arrítmica incontrolable, la edad promedio fue de 56 +- 16 años, el 67% de los individuos fueron hombres. Este procedimiento no mostró complicaciones en ninguno de los pacientes y se encontró mejoría sintomática en todos los casos. Se realizó seguimiento por 24 meses; dos pacientes tuvieron recurrencias por taquicardia ventricular lenta sin síntomas severos y uno por fibrilación ventricular. Conclusion: La DSCI por VATS debe considerarse como opción terapéutica para pacientes con arritmias de difícil manejo.

Advances in the Study of the Effects of Video-assisted Thoracoscopic Segmentectomy on Pulmonary Function / 中国肺癌杂志

The National Comprehensive Cancer Network (NCCN) clinical practice guideline of non-small cell lung cancer (NSCLC) in 2018 points out that anatomic pulmonary resection is a preferred option for early stage NSCLC. With the development of video-assisted thoracoscopy, minimally invasive thoracic surgery represented by thoracoscopy has been widely used in clinical practice. Video-assisted thoracoscopic segmentectomy has become one of the treatment options for early stage NSCLC. Clinical studies have found that sublobar resection can achieve similar results and preserve more pulmonary function in the treatment of early stage NSCLC compared with lobectomy, but the changes of pulmonary function after segmentectomy are still controversial. This article focuses on the research progress of pulmonary function changes in NSCLC patients after video-assisted thoracoscopic segmentectomy.
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To Explore Clinical Value of Single-port Video-assisted Thoracoscopic Surgery in Elderly Patients with Non-small Cell Lung Cancer: Lobectomy, Segmentectomy and Lobectomy vs Segmentectomy / 中国肺癌杂志

BACKGROUND@#The morbidity of lung cancer has long been the highest in cancer. Stage I, stage II and partly of stage III non-small cell lung cancer (NSCLC) are mainly treated by surgery. Lobectomy and segmentectomy both are common lung resection methods. Video-assisted thoracoscopic surgery (VATS) has been widely used in clinical, and the application of single-portvideo-assisted thoracoscopic surgery (SP VATS) has gradually been recognized and accepted by professors. With increasing degree of eldly in society, eldly patients already have become inceasingly difficulties in the diagnosis and treatment of NSCLC. The aim of this study is to explore and analyze clinical value of SP VATS lobectomy and segmentectomy in elderly patients with NSCLC.@*METHODS@#In this retrospective observational study, the outcomes of 417 consecutive patients who had undergone SP VATS anatomic segmentectomy or lobectomy for NSCLC from May 2014 to December 2016 on department of thoracic surgery in Fujian Medical University Affiliated Union Hospital were examined, including 139 elderly-case (lobectomy vs segmentectomy: 124 vs 15) and 278 nonelderly-case (lobectomy vs segmentectomy: 248 vs 30). The condition of perioperative period and postoperative short-time recovery could be compared with lobectomy and segmentectomy between elderly and nonelderly cases and lobectomy and segmentectomy in elderly cases.@*RESULTS@#The morbidty of preoperative complications was significant difference (P0.05). Numbers of dissected lymph nodes and mediastinal nodal stations of SP VATS lobectomy in elderly patients with NSCLC were more than segmentectomy (P0.05). Postoperative drainage volume [(1,150.15±140.02) mL vs (853.53±177.04) mL] and duration [(7.00±1.31) d vs (5.00±0.74) d], duration of postoperative hospital stay [(3.18±1.32) d vs (5.04±1.30) d], costs [(70.06±5.23) thousands yuan vs (61.20±5.22) thousands yuan ] or postoperative complications (5.97% vs 20.00%)(P>0.05). Notwithstanding, group of SP VATS anatomic segmentectomy found more postoperative atrialfibrillation and the vein thrombosis of lower limbs (P<0.05).@*CONCLUSIONS@#Elderly patients having more basic diseases and taking increasely risk of postoperative complications. SP VATS anatomic segmentectomy andlobectomy do not increase the risk of elderly patients with surgery. SP VATS segmentectomy is as safe and effective as SP VATS lobectomy in elderly patients, who fit to undergo SP VATS segmentectomy seem to get as same short-time effect as SP VATS lobectomy.

Uniportal versus multiportal video-assisted thoracoscopic lobectomy under the concept of enhanced recovery after surgery: A case control study / 中国胸心血管外科临床杂志

@#Objective     To compare the effect of uniportal and multiportal thoracoscopic lobectomy, and to explore the advantages and applications of uniportal thoracoscopic lobectomy in enhanced recovery after surgery. Methods     Totally 169 patients with video-assisted thoracoscopic lobectomy in Department of Thoracic Surgery of Sichuan Cancer Hospital from January to December 2016 were enrolled. There were 99 males and 70 females with age of 60.83±7.24 years. Patients were divided into two groups: a uniportal group (78 patients) and a multiportal group (91 patients) . Patients’ clinical and pathological materials were collected. Postoperative pain, complications and hospital stay, etc of the two groups were compared. Results     All patients were successfully discharged without serious postoperative complication or death. Patients in the multiportal group had smaller surgical incisions than that in the uniportal group (3.12±0.73 cm vs. 6.38±1.50 cm, P=0.016). Pain scores at postoperative 24 and 48 hours of the uniportal group were less than those of multiportal group (4.18±1.67 vs. 6.54±1.83, 3.05±1.47 vs. 4.68±1.64, P<0.05). Operation data, postoperative complications and hospital stay were similar in both groups. Conclusion     Uniportal video-assisted thoracoscopic lobectomy makes smaller incisions and can further reduce postoperative pain and dosage of morphine. The operation is safe and worthy of wide application in enhanced recovery after surgery.

Short-term postoperative pain of robot-assisted versus thoracolaparoscopic McKeown esophagectomy for esophageal carcinoma: A non-randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective    To investigate the short-term postoperative pain between robot-assisted and thoracolaparoscopic McKeown esophagectomy for esophageal carcinoma. Methods    We prospectively analyzed clinical data of 77 patients with esophageal carcinoma in our hospital between September 2016 and February 2017. The patients were allocated into two groups including a robot group and a thoracolaparoscopic group. The patients underwent robot assisted McKeown esophagectomy in the robot group and thoracolaparoscopic McKeown esophagectomy in the thoracolaparoscopic group. There were 38 patients with 30 males and 8 females at average age of 60.80±6.20 years in the thoracolaparoscopic group, and 39 patients with 35 males and 4 females at average age of 60.90±7.20 years in the robot group. Results    There was no statistical difference between the two groups in terms of the postoperative usage of analgesic drugs. The patients in the robot group experienced less postoperative pain on postoperative day 1, 3, 5, 6 and 7 than the patients in the thoracolaparoscopic group. The mean value of visual analogue scale (VAS) on postoperative day 1, 3, 5, 6 and 7 for the robot group and the thoracolaparoscopic group was 3.20±1.10 versus 2.70±0.90 (P=0.002), 2.75±0.96 versus 2.40±0.98 (P=0.030), 2.68±1.08 versus 2.02±0.8 (P=0.005); 2.49±0.99 versus 1.81±0.88 (P=0.003), 2.27±0.83 versus 1.51±0.61 (P<0.001), respectively. Conclusion    Compared with the thoracolaparoscopic group, patients receiving robot assisted McKeown esophagectomy experience less postoperative short-term pain. However, the long-term postoperative pain for these patients needs to be further studied.

Perioperative nursing for patients during 3D video-assisted pneumonectomy / 现代临床护理

Objective To explore the perioperative nursing for the patients during 3D video-assisted pneumonectomy. Method The data and nursing experience of 33 cases after 3D video-assisted thoracic surgery from June 2015 to December 2016 were reviewed retrospectively. Results Pneumonectomy was operated in 33 cases, with the operation time (including fast freezing time) of (90～580) min and bleeding volume of (50～1200) mL. The postoperative hospitalization time was (4.0～5.5) d. Postoperative pneumonia occurred in 2 cases and paroxysmal atrial fibrillation occurred in one case, all of which were cured. Conclusion The nursing strategy of preoperative overall assessmentand intervention, respiratory function training and lung rehabilitation exercise guidance and postoperative reinforced oxygen therapy and the management of liquid, body position, chest tube and pains is the guarantee of the surgical success.

Comparison of two types of myocardial infarction models in Beagle dogs / 中国比较医学杂志

Objective The purpose of this study was to compare two types of myocardial infarction ( MI) models in Beagle dogs. Methods 30 dogs were divided randomly into three groups ( n =10 ) . ① The sham?operated group underwent pericardiotomy but without coronary artery ligation. The other two model groups were made under video?assisted thoracoscopy ( VATS) , where the left anterior descending coronary artery was closed by titanium clips:②The direct vision group:the minimally invasive closure of the artery was performed under direct vision. In this group, the thoracoscopic operation was performed through a 3?0 cm small incision opened at the margin of the left third rib. ③ The thoracoscopic group:the video?assisted thoracoscope was inserted into the chest through a 1?0 cm exploratory hole in the midline of the third rib, and the surgical instruments were inserted through two 0?5 cm operating holes at the para?sternum line of the third rib and midclavicular line of the fourth rib. Electrocardiogram ( ECG) was recorded and the levels of serum creatine kinase?MB ( CK?MB) and troponin I ( cTnI) were measured after modeling. The heart tissue samples were examined by histology using HE staining. The success rate of model establishment, durations from skin incision to chest closing and the wound healing were recorded. Results Compared with the sham?operated group, changes of myocardial infarction were observed in the two model groups ( ECG S?T segment elevation, increased serum CK?MB and cTnI levels, myocardial ischemia and fibrosis, and reduced amount of cardiomyocytes ) . The survival rate was 90% in both of the two model groups. The operating time was shorter in the minimally invasive surgery under direct vision group, and the wound healing time was shorter in the thoracoscopic group. Conclusions The myocardial infarction models generated by minimally invasive surgery have less trauma and low mortality in the dogs. This model is suitable for investigation of pathophysiological mechanism associated with myocardial infarction.

A control study of video -assisted thoracoscopic surgery (VATS)and conventional thoracotomy in treatment of thoracic esophagus cancer / 中国基层医药

Objective To investigate the effect of video -assisted thoracoscopic surgery (VATS)and conventional thoracotomy in treatment of thoracic esophagus cancer,to provide the reference for clinical.Methods 90 cases of thoracic esophageal cancer in our hospital from January 2012 to January 2015 were chosen as the research subjects.They were randomly divided into observation group(application of VATS treatment)and the control group (application of traditional open chest surgery).The quantity difference,chest drainage,hospitalization time,complica-tions,recovery conditions and other indicators of bleeding were compared in the two groups.Results The operation time of the observation group[(267.6 ±76.5)min]was shorter than that of the control group[(324.4 ±87.6)min]. The amount of intraoperative bleeding[(235.3 ±79.5)mL],drainage volume[(327.5 ±95.2)mL]of the observation group were less than the control group[(398.2 ±98.3)mL and (752.6 ±156.4)mL].Postoperative hospitalization time[(12.2 ±3.2)d]of the observation group was shorter than the control group[(15.8 ±4.4)d].The differences were statistically significant (t =3.276,8.644,15.575,4.439,all P 0.05).The complication rate of the observation group was lower than that of the control group,the difference was statistically significant (χ2 =4.865,P <0.05).Conclusion In the treatment of thoracic esophageal carcinoma,VATS and conventional thoracotomy surgery has good effect,and VATS has small injury,less complication.

Clincal effect and anatomy of single lung ventilation by double-lumen endotracheal intubation / 局解手术学杂志

Objective To investigate the effects of two different methods of double-lumen endotracheal intubation in minimally invasive thoracoscopic surgery. Methods Based on different methods of endotracheal intubation,120 patients with bullae and spontaneous pneumo-thorax were randomly divided into the single left intubation group (60 cases) and the left and right intubation group (60 cases). The opera-tion time,blood loss,chest drainage volume,the time of pulmonary air leaks,white blood cell count and other indexes of the two groups were evaluated. Results The proportion of patients whose atelectasis degree was over 50% in the left and right intubation group occupied 48%, and it occupied 32% in patients whose atelectasis degree was over 70%. While the corresponding data in the single left intubation group were 5. 00% and 93% respectively. The differences were statistically significant (P<0. 01). The operative time and postoperative indicators of the single left intubation group were more significantly lower than those in the left and right intubation group. Conclusion The left double-lu-men endotracheal intubation has obvious advantages in maintenance and control of lung expansion and pulmonary ventilation during surgery, and it should be used in video assisted thoracoscopy surgery.

Pleurodesis with single utility port video-assisted thoracoscopic surgery in the treatment of malignant pleural effusion / 肿瘤研究与临床

Objective To discover the effect of pleurodesis with single utility port vido-assested thoracic surgery on patients with malignant pleural effusion.Methods Clinical pleurodesis data of 24 patients with malignant pleural effusion were analyzed retrospectively.Results After treatment,all the patients were no perioperative deaths.The operation time was 32 to 83 min,and average time was 34.5 min.The time of extubation was 4 to 15 d,and average time was 5.6 d.Among 24 patients with pleurodesis underwent regularly postoperative CT scan and follow-up,one case died of a brain metastasis after five months later,the other patients were survive more than six months.Conclusions Pleurodesis with single utility port video-assisted thoracoscopic surgery in the treatment of malignant pleural effusion is a minimally invasive,effective and practical method.

Estrategias y problemas asociados a la analgesia postoracotomía / Strategies and problems associated with postoperative analgesia after thoracotomy

Introducción: la toracotomía es una de las incisiones quirúrgicas más dolorosas. La exposición quirúrgica de la cavidad torácica causa daño a múltiples estructuras nociceptivas en la pared del tórax y las vísceras cardiopulmonares. Existe una alta incidencia de dolor posoperatorio agudo y crónico que puede retardar la recuperación y causa la invalidez a largo plazo. La prevención y tratamiento del dolor después de la toracotomía es un desafío que puede requerir una variedad de intervenciones y es de vital importancia para minimizar las complicaciones pulmonares. Objetivo: exponer las estrategias para la prevención y tratamiento de este tipo de dolor. Métodos: revisión exhaustiva de la literatura disponible en cuanto a las estrategias basadas en evidencias para la prevención y tratamiento del dolor post-toracotomía. Resultados: el tratamiento subóptimo del dolor después de la toracotomía tiene consecuencias importantes, en especial en los pacientes con limitada reserva pulmonar siendo la más frecuente e importante la disfunción pulmonar. Se exponen los principios generales del tratamiento del dolor post-toracotomía y se abordan las técnicas actuales para su control. Conclusiones: la analgesia epidural torácica es actualmente el estándar para la analgesia tras la cirugía de tórax y en ausencia de contraindicaciones todos los pacientes programados para la cirugía torácica deben tener colocado un catéter epidural torácico preoperatorio.

Background: thoracotomy is one of the most painful surgical incisions. The surgical exposure of the thoracic cavity causes damage to multiple structures in the nociceptive chest wall and cardiopulmonary viscera. There is a high incidence of chronic and acute postoperative pain that can delay the recovery and cause long-term disability. The prevention and treatment of post-thoracotomy pain is a challenge that may require a variety of surgeries and is of vital importance to minimize pulmonary complications. Objective: to show strategies for the prevention and treatment of this type of pain. Methods: a detailed review of the available literature in relation to evidence-based strategies for the prevention and treatment of post-thoracotomy pain was made. Results: the suboptimal treatment of post-thoracotomy pain has important implications, especially in patients with limited pulmonary reserve, being pulmonary dysfunction the most frequent and important one. The general principles for the treatment of post-thoracotomy pain and current techniques to deal with its control are shown. Conclusions: thoracic epidural analgesia is currently the standard analgesia after a thoracic surgery and in the absence of contraindications, all patients scheduled for this type of surgery should have been placed a preoperative thoracic epidural catheter.

Functional results of lung volume reduction surgery in 43 patients with severe chronic obstructive pulmonary emphysema / 中华胸心血管外科杂志

Objective To evaluate the outcome of lung volume reduction surgery (LVRS)under video-assisted thoracoscopy in patients with severe chronic obstructive pulmonary emphysema.Methods The follow-up date of 68 patients with severe emphysema underweut LVRS by video-assisted thoracoscopy were analyzed retrospectively betweeu June 2002 to June 2012.Mean FEV1.0 、FCV 、RV、PO2 、PCO2 、mean 6MWT were assessed before their surgery and 6 months,1-year and 2-years after their surgery respectively.Results Compared with their preoperative results,Lung function,arterial blood gasanalysis and 6-minute walk distance (6-MWD) increased outstanging.Conclusion LVRS by VATS provides significant clinical and physiological improvement for the majority of patients with severe chronic obstructive pulmonary emphysema.

Videotoracoscopía en cáncer de ovario avanzado con sospecha de compromiso torácico / Video-assisted thoracoscopy in advanced ovarian cancer with a probable thoracic involvement

Objetivo: Evaluar la experiencia con videotoracoscopía en pacientes con sospecha de cáncer de ovario avanzado con probable compromiso del tórax. Método: Se analiza las pacientes con sospecha clínica e imagenológica de cáncer de ovario avanzado que presentan derrames pleurales moderado y severo, así como procesos tumorales torácicos para evaluar la posibilidad de citorreducción óptima o completa. Todos los casos sometidos a este procedimiento entre enero de 2009 a Agosto de 2011, son analizados con énfasis en el diagnóstico y en los hallazgos a la videotoracoscopía, así como sus resultados. Resultados: 11 pacientes con clínica y tomografía axial computarizada de tórax sospechoso de compromiso pleural o pulmonar, son sometidas al procedimiento previo al intento de citorreducción abdominopélvica. La edad promedio fue de 62 años y Ca 125 promedio de 1030 U/ml. En 6 pacientes se encontró enfermedad macroscópica pleural, la biopsia fue positiva para adenocarcinoma en 5. Dos de ellas se consideraron no citorreducible en abdomen y se indicó neoadyuvancia. La tercera se citorredujo en forma óptima. En 2 pacientes se indicó neoadyudancia por tener residuo tumoral torácico mayor a 1 cm, consideradas citorreducibles en abdomen. De las 6 pacientes sin enfermedad torácica, 4 se citorredujeron óptimamente, una falleció previo a la cirugía abdominal y otra resultó un tumor ovárico benigno. Conclusión: La videotoracoscopía es útil para evaluar enfermedad torácica y tomar decisiones en relación a la citorreducción abdominal o neoadyuvancia en cáncer avanzado de ovario.

Objective: To describe the experience with video-assisted thoracic evaluation in patients with suspected advanced ovarian cancer with a probable thoracic involvement. Method: Patients with clinical and imaging suspicion of advanced ovarian cancer who have pleural effusions, and thoracic tumor processes are examined to evaluate the possibility of optimal debulking. All cases that underwent this procedure between January 2009 to August 2011, were studied with emphasis on diagnosis, results and findings at videotho-racoscopy. Results: 11 patients with a suspected thoracic commitment, with clinical and computerized axial tomography scan, undergo the procedure previous to an abdominopelvic cytoreductive surgery attempt. The average age was 62 years and CA 125 of 1030 U/ml average. Macroscopic pleural disease was found in 6 patients, but in 5 of them the biopsy gave positive for adenocarcinoma. Two of them were not considered for a cytoreductive surgery in the abdomen and neoadjuvant therapy was indicated. The third patient of the 5 previously mentioned, underwent an optimal cytoreduction. In 2 patients, neoadjuvant therapy was indicated for having residual tumor in the thorax greater than 1 cm, although they were considered for a cytoreductive surgery in the abdomen. Of the 6 patients without chest involvement, 4 underwent an optimal cytoreductive surgery, and one died before the abdominal surgery and the other had a benign ovarian tumor. Conclusion: Videothoracoscopy is useful for diagnosing thoracic metastasis and making decisions regarding cytoreduction and neoadjuvant therapy in advanced ovarian cancer.

Experiencia inicial en videotoracoscopía: Hospital Base Osorno / Initial experience in videothoracoscopy: Base Hospital Osorno

Introducción: La videotoracoscopía constituye un abordaje mínimamente invasivo del tórax de gran desarrollo en las últimas décadas, permitiendo la realización de prácticamente todos los procedimientos quirúrgicos del tórax. El objetivo de este trabajo es presentar nuestra experiencia inicial con el uso de la videotoracoscopía, sus resultados y realizar una revisión de la literatura. Material y métodos: Se revisó una serie de casos retrospectiva de todos los pacientes intervenidos por vía videotoracoscópica en el Hospital Base Osorno, entre Octubre del 2005 y Septiembre del 2011. Resultados: Se realizaron 31 videotoracoscopías en 29 pacientes. Dieciocho (62 por ciento) pacientes fueron de sexo masculino y 11 (28 por ciento) de sexo femenino. La edad promedio fue de 46,2 +- 16 años de edad. Las indicaciones más frecuentes fueron: estudio de nódulos pulmonares sospechosos de metástasis, empiema pleural y derrame pleural en estudio. Los procedimientos realizados con mayor frecuencia fueron debridaje y aseo, biopsia incisional y biopsia en cuña de nódulos pulmonares. El tiempo operatorio promedio fue de 80,1 +- 43,4 minutos. El tiempo de hospitalización post operatoria promedio fue de 10 +- 10,1 días (rango 1 a 36 días). No hubo mortalidad perioperatoria en la serie. Discusión: Nuestros resultados son satisfactorios y acorde a los reportados en la literatura.

Introduction: the video-assisted thoracoscopy (VATS) is a minimally invasive approach to thoracic surgery with a great development in recent decades, allowing the performance of almost all thoracic surgical procedures. The aim of this study is to present our initial experience with the use of VATS, its results and review the literature. Material and methods: We reviewed a retrospective case series of all patients undergoing VATS in the Hospital Base Osorno between October 2005 and September 2011. Results: We performed 31 VATS in 29 patients. Eighteen (62 percent patients were male and 11 (28 percent female. The average age was 46.2 +- 16 years. The most frequent indications were: study of suspected pulmonary metastasis, pleural empyema and pleura effusion. The most frequently performed procedures were drainage, incisional biopsy and wedge biopsy of lung nodules. The mean operative time was 80.1 +- 43.4 minutes. The mean postoperative hospital stay was 10 +- 10.1 days (range 1 to 36 days). There was no mortality. Discussion: Our results are satisfactory and consistent with those reported in the literature.

The Safety and Usefulness of Combined Video-Assisted Mediastinoscopic Lymph Adenectomy and Video-Assisted Thoracic Surgery Lobectomy for Left-sided Lung Cancer / 대한흉부외과학회지

BACKGROUND: The use of video-assisted thoracic surgery (VATS) to perform major pulmonary resection with systematic node dissection (SND) for lung cancer by is commonly used in clinics. However, the feasibility of SND by VATS remains controversial. Video-assisted mediastinal lymphadenectomy (VAMLA) increases the quality of mediastinal lymph node staging in lung cancer. The video-mediastinoscope allows systematic lymphadenectomy by bimanual preparation. This study was conducted to assess safety and usefulness and clinical feasibility of VAMLA expanding Linder-Dahan mediastinoscope with VATS lobectomy for left sided lung cancer. MATERIAL AND METHOD: Between February 2004 to April 2008, a total 50 patients who underwent VATS lobectomy for left sided lung cancer were analyzed retrospectively. Thirty patients (group A) underwent VAMLA followed by VATS lymphadenectomy and 20 patients (group B) underwent VATS lymphadenectomy for SND. RESULT: There were no statistical differences in operation times, chest tube indwelling times, or hospital days between the 2 groups. The number of dissected total nodes (p=0.001) and N2 nodes (p=0.013) were higher in group A than in group B, but there was no difference in N1 nodes. Postoperative complications included 2 prolonged air leakages (> or =10 days) in each group, one pneumonia in group A, and one vocal cord palsy in group B. There were no early operative mortalities. CONCLUSION: Mediastinal staging of resectable lung cancer is performed by VAMLA. This new technique is the basis for VATS lobectomy particularly for left-sided lung cancer, because a higher percentage of mediastinal lymph nodes undergo complete resection using VAMLA.