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@#The precise localization of pulmonary nodules has become an important technical key point in the treatment of pulmonary nodules by thoracoscopic surgery, which is a guarantee for safe margin and avoiding removal of too much normal lung parenchyma. With the development of medical technology and equipment, the methods of locating pulmonary nodules are also becoming less trauma and convenience. There are currently a number of methods applied to the preoperative or intraoperative localization of pulmonary nodules, including preoperative percutaneous puncture localization, preoperative transbronchial localization, intraoperative palpation localization, intraoperative ultrasound localization, and localization according to anatomy. The most appropriate localization method should be selected according to the location of the nodule, available equipment, and surgeon鈥檚 experience. According to the published literatures, we have sorted out a variety of different theories and methods of localization of pulmonary nodules in this article, summarizing their advantages and disadvantages for references.
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Globally, the number of coronavirus disease-2019 (COVID-19) cases and deaths shows a declining trend since a peak in January 2022. For now, the pandemic phase looks to be ended, until a severe new variant may trigger another wave. At present, in India, small pockets of COVID-19 cases and post-COVID complications are still being reported. Therefore, physicians should remain vigilant about the atypical presentations and potential delayed or long-term complications of SARS-CoV-2 infection, even in individuals who had a mild COVID-19 infection. Here, we present the case of a 52-year-old male patient with a history of hypertension, who is a non-smoker and developed culture-negative pleural empyema 7 months after a mild COVID-19 infection. The patient was successfully treated with antibiotics and early video-assisted thoracoscopic surgery
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Background: Thymectomy has been identified as Constructive and active strategy for patients with Myasthenia gravis and thymic masses which have been done classically by Open Sternotomy technique and nowadays new Minimally invasive approaches have also been introduced. In this paper , Subxiphoid Uniportal VATS(Video Assis Method : ted Thoracoscopic Surgery) Thymectomy through a single port technique by utilizing the Subxiphoid approach has been discussed. I have improvised my technique pertaining to the requirements and better recovery and better post operative outcome of the patient .This procedure is indicated for all anterior mediastinal masses and maybe extended to lung cancer.The patient was placed in supine position instead of classical lithotomy position .Carbon dioxide insufflation was not used which led to faster recovery after the surgery.After dissection and resection of thymus Bilateral pleural drain were placed which was removed usually on Post Operative day 4 or 5 and patients were discharged afterwards. Several benefits of this Results: approach were observed and documented including reduced postoperative pain, Early extubation, better post operative outcome, and better dissection . In the near future ,the Subxiphoid approach has the potential to become Conclusion: GOLD STANDARD for Thymectomy and various other conditions
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Background: Primary spontaneous pneumothorax (PSP) is a common thoracic surgical emergency affecting otherwise healthy young individuals. Its treatment options range from observation to surgery in the form of video-assisted thoracoscopic surgery (VATS). Surgery, generally reserved for recurrence, is gradually being utilized for certain patients presenting with PSP for the first time. In this study, we aim to report our experience of VATS in the surgical management of first episodes of PSP. Methods: A retrospective review of prospectively maintained data on all the patients undergoing surgical management during the first presentation of PSP, over a period of 10 years, was done. Results: Over the period of 10 years, out of 95 patients who underwent thoracoscopic bullectomy for pneumothorax, a total of 42 patients had presented with PSP for the first time. Most (54%) were aged 20–40 years, with male predominance (83%); right-sided (69%); commonest symptom was shortness of breath (83.3%) with a median duration of symptoms of 5.9 days. Apical bullae were the commonest computed tomographic finding (88%). Majority of the patients underwent VATS via three ports, and multiple apical bullae were the most common intraoperative findings. Four patients (9.5%) had an air leak postoperatively, managed conservatively. Average intensive care unit stay was 23 hours; average chest tube duration was 3.6 days; and the average hospital stay was 8.2 days. There was no 30-day mortality and no recurrences were noted during a median follow-up of 2 years. Conclusion: Our initial experience with surgery for the first episode of PSP has been shown to be safe and effective. Larger and more robust studies with longer follow-ups would be necessary to better delineate the role of surgery in such patients.
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@#Objective To explore the feasibility of early chest tube removal following single-direction uniportal video-assisted thoracoscopic surgery (S-UVATS) anatomical lobectomy. Methods The clinical data of consecutive VATS lobectomy by different surgeons in Xuzhou Central Hospital between May 2019 and February 2022 were retrospectively reviewed. Finally, the data of 1 084 patients were selected for analysis, including 538 males and 546 females, with a mean age of 61.0±10.1 years. These patients were divided into a S-UVATS group with 558 patients and a conventional group (C-UVATS) with 526 patients according to the surgical procedures. The perioperative parameters such as operation time, blood loss were recorded. In addition, we assessed the amount of residual pleural effusion and the probability of secondary thoracentesis when taking 300 mL/d and 450 mL/d as the threshold of chest tube removal. Results Tumor-negative surgical margin was achieved without mortality in this cohort. As compared with the C-UVATS group, patients in the S-UVATS group demonstrated significantly shorter operation time (P<0.001), less blood loss (P=0.002), lower rate of conversion to multiple-port VATS or thoracotomy (P=0.003), but more stations and numbers of dissected lymph nodes as well as less suture staplers (P<0.001). Moreover, patients in the S-UVATS demonstrated shorter chest tube duration, less total volume of thoracic drainage and shorter postoperative hospital stay, with statistical differences (P<0.001). After excluding patients of chylothorax and prolonged air leaks>7 d, subgroup analysis was performed. First, assuming that 300 mL/d was the threshold for chest tube removal, as compared with the C-UVATS group, patients in the S-UVATS group would report less residual pleural effusion and less necessitating second thoracentesis with residual pleural effusion>500 mL (P<0.05). Second, assuming that 450 mL/d was the threshold for chest tube removal, as compared with the C-UVATS group, the S-UVATS group would also report less residual pleural effusion and less necessitating second thoracentesis with residual pleural effusion>500 mL (P<0.05). Further multivariable logistic regression analysis indicated that S-UVATS was significantly negatively related to drainage volume>1 000 mL (P<0.05); whereas combined lobectomy, longer operation time, more blood loss and air leakage were independent risk factors correlated with drainage volume>1 000 mL following UVATS lobectomy (P<0.05). Conclusion The short-term efficacy of S-UVATS lobectomy is significantly better than that of the conventional group, indicating shorter operation time and less chest drainage. However, early chest tube removal with a high threshold of thoracic drainage volume probably increases the risk of secondary thoracentesis due to residual pleural effusion.
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@#Objective To assess the safety and clinical outcomes of segmentectomy in one- or two-staged video-assisted thoracoscopic surgery (VATS) for bilateral lung cancer. Methods We retrospectively enrolled 100 patients who underwent VATS segmentectomy for bilateral lung cancer at the Department of Thoracic Surgery of Peking Union Medical College Hospital from December 2013 to May 2022. We divided the patients into two groups: a one-stage group (52 patients), including 17 males and 35 females with a mean age of 55.17±11.09 years, and a two-stage group (48 patients), including 16 males and 32 females with a mean age of 59.88±11.48 years. We analyzed multiple intraoperative variables and postoperative outcomes. Results All 100 patients successfully completed bilateral VATS, and at least unilateral lung received anatomical segmentectomy. Patients in the one-stage group were younger (P=0.040), had lower rate of comorbidities (P=0.030), were less likely to have a family history of lung cancer (P=0.018), and had a shorter interval between diagnosis and surgery (P=0.000) compared with patients in the two-stage group. Wedge resection on the opposite side was more common in the one-stage group (P=0.000), while lobectomy was more common in the two-stage group. The time to emerge from anesthesia in the one-stage group was longer than that in the first and second operations of the two-stage group (P=0.000, P=0.002). Duration of surgery and anesthesia were similar between two groups (P>0.05). Total number of lymph node stations for sampling and dissection (P=0.041) and lymph nodes involved (P=0.026) were less in the one-stage group. Intraoperative airway management was similar between two groups (P>0.05). The one-stage group was associated with lower activities of daily living (ADL) scores. Conclusion Segmentectomy is safe in one- or two-staged VATS for bilateral lung cancer, including contralateral sublobectomy and lobectomy. Duration of surgery and perioperative complications are similar between two groups, but the one-stage group is associated with lower ADL scores. On the basis of comprehensive consideration in psychological factors, physical conditions and personal wishes of patients, one-staged sequential bilateral VATS can be the first choice.
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Objective To evaluate the short-term outcomes and postoperative inflammatory cytokine changes in patients with lung cancer treated with robot-assisted thoracoscopic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS). Methods A total of 270 patients with lung cancer treated by minimally invasive surgery were selected for the study, and the surgical procedures were selected according to the patients' economic conditions and preferences. Among them, 132 patients completed the operation through RATS, and 138 patients completed the operation through VATS. The clinical data of the two groups were compared. Results All patients successfully completed radical lung cancer surgery, and no perioperative deaths were reported. Intraoperative bleeding, postoperative drainage time, postoperative hospital stay, number of lymph nodes dissected, and number of lymph nodes dissected groups were more advantageous in the RATS group compared with the VATS group (P < 0.05). In terms of operative time, total postoperative chest drainage, and hospitalization cost, the VATS group had an advantage (P < 0.05). The postoperative levels of CRP, PCT, IL-6, IL-8, IL-10, and TNF-α increased in both groups, compared with preoperative levels, and the increases in the RATS group were lower than those in the VATS group. Conclusion RATS offers technical and short-term efficacy advantages for the treatment of lung cancer but comes with the disadvantage of high cost. Post-operative inflammatory cytokine elevation is lower in the RATS group, and inflammatory response to the organism is less severe.
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Objective To compare the perioperative efficacy and safety of da Vinci robot-assisted thoracoscopic surgery (RATS) for treatment of anterior mediastinal tumors through subxiphoid versus lateral thoracic approaches under the laryngeal mask anesthesia. Methods We retrospectively analyzed the clinical data of 102 patients with anterior-mediastinal tumors treated by RATS under laryngeal mask anesthesia completed by the same operator. Forty-five patients underwent the subxiphoid approach (subxiphoid group), and 57 patients were treated with the lateral thoracic approach (lateral thoracic group). The operating time, intraoperative bleeding, and total postoperative drainage volume in the two groups were compared and analyzed. Results All patients successfully completed resection of the anterior mediastinal tumor without the occurrence of perioperative death. In terms of total postoperative drainage volume, postoperative drainage time, postoperative hospital stay, and VAS pain on postoperative days 2 and 3, the subxiphoid group was more advantages (P < 0.05). No statistically significant difference was found between the two groups in terms of operative time, docking time, total operative time, intraoperative bleeding volume, postoperative day 1 VAS pain score, or postoperative complications (P > 0.05). Conclusion The subxiphoid approach of RATS is safe and feasible for resection of anterior mediastinal tumors. Compared with the lateral thoracic approach, the subxiphoid approach has advantages in terms of rapid postoperative recovery and postoperative pain.
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OBJECTIVE To observe the effects of low-dose esketamine on analgesia and inflammatory factors after thoracoscopic surgery. METHODS Totally 120 patients who underwent thoracoscopic lobectomy in our hospital from October 2021 to March 2022 were selected and randomly divided into low-dose group （group A）， conventional-dose group （group B）， normal saline group （group C） by using the random number table method， with 40 patients in each group. All the patients were anesthetized with traditional general intravenous anesthesia， group A and B were anesthetized with low dose or normal dose （0.2 or 0.5 mg/kg） of Esketamine hydrochloride injection， and group C was given normal saline intravenously. The visual analog scale （VAS） score 0， 6， 24， 48 h after operation and the consumption of sufentanil 24 h after operation were compared among 3 groups. The levels of white blood cell count （WBC）， neutrophil percentage， C-reactive protein （CRP）， tumor necrosis factor-α （TNF-α）， interleukin-1 （IL-1） and IL-6 were compared 30 min before and 24 h after surgery. The Pittsburgh sleep quality index （PSQI） score and the Beck depression inventory （BDI） score were compared before operation and 0， 1， 2 d after operation， and the occurrence of adverse reaction was also recorded. RESULTS At 0， 6 and 24 h after operation， VAS scores and the consumption of sufentanil within 24 h after operation in group A and B were significantly lower than group C； VAS score 6 h after operation in group A was significantly lower than that in group B （P＜0.05）. The levels of WBC， neutrophil percentage， CRP， TNF-α， IL-1 and IL-6 in the 3 groups 24 h after surgery were significantly increased， compared with 30 min before surgery； the levels of above indexes in group A and B were significantly lower than those in group C （P＜0.05）. PSQI score and BDI score 0， 1 and 2 days after operation in group A and B were significantly lower than those in group C， while BDI score 0 day after operation in group A was significantly lower than that in group B （P＜0.05）. The total incidence of adverse reaction in group A， B and C were 5.0%， 10.0% and 17.5%， without statistical significance （P＞0.05）. CONCLUSIONS The low-dose esketamine has significant analgesic effect after thoracoscopic surgery， can reduce the levels of inflammatory factors after surgery and improve sleep quality and depression， with good safety.
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Objective To observe the effect of calcified lymph nodes on video-assisted thoracoscopic surgery (VATS) lobectomy in the chronic obstructive pulmonary disease (COPD) patients with lung cancer. Methods A retrospective analysis was conducted on the COPD patients with lung cancer who underwent VATS lobectomy in the Department of Thoracic Surgery in the First Affiliated Hospital of Hebei North University from May 2014 to May 2018.The patients were assigned into a calcified lymph node group and a control group according to the presence or absence of calcified lymph nodes in CT,and the size,morphology,and calcification degree of the lymph nodes were recorded.The operation duration,intraoperative blood loss,chest tube retention time,hospitalization days,and overall complication rate were compared between the two groups. Results The 30 patients in the calcified lymph node group included 17 patients with one calcified lymph node and 13 patients with two or more calcified lymph nodes,and a total of 65 calcified lymph nodes were recorded.The calcified lymph nodes with the size ≤5 mm were the most common (53.8%),and complete calcification was the most common form (55.4%) in lymph node calcification.The mean operation duration had no significant difference between the calcified lymph node group and the control group (t=-1.357,P=0.180).The intraoperative blood loss (t=-2.646,P=0.010),chest tube retention time (t=-2.302,P=0.025),and hospitalization days (t=-2.274,P=0.027) in the calcified lymph node group were higher than those in the control group. Conclusion Calcified lymph nodes increase the difficulty and risk of VATS lobectomy in the COPD patients with lung cancer.The findings of this study are conducive to predicting the perioperative process of VATS lobectomy.
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Humans , Blood Loss, Surgical , Retrospective Studies , Lung Neoplasms/surgery , Pulmonary Disease, Chronic Obstructive , Calcinosis , Lymph NodesABSTRACT
@#Objective To investigate the perioperative efficacy and safety of all-port robotic lobectomy versus thoracoscopic lobectomy in stageⅠA non-small cell lung cancer. Methods The clinical data of patients with stageⅠA non-small cell lung cancer who underwent lobectomy with lymph node dissection performed by the same operator in our center from June 2019 to June 2022 were retrospectively analyzed. The patients were divided into a robotic group and a thoracoscopic group according to different procedures. We compared the relevant indexes such as operation time, intraoperative bleeding, number of lymph node dissection stations, number of lymph node dissection, postoperative tube time, postoperative hospitalization time, closed chest drainage volume, postoperative pain, postoperative complications and hospitalization cost between the two groups. Results There were 83 patients in the robotic group, including 34 males and 49 females with a median age of 60.0 (53.0, 67.0) years, and 94 patients in the thoracoscopic group, including 36 males and 58 females with a median age of 60.5 (54.0, 65.3) years. There was no conversion to thoractomy or death in postoperative 90 days in both groups. No statistical difference was seen in the operation time, total postoperative drainage volume and postoperative complication rates between the two groups (P>0.05). Patients in the robotic group had less intraoperative bleeding (P<0.001), more lymph node dissection stations (P=0.002) and numbers (P=0.005), less postoperative pain (P=0.002), and shorter postoperative time with tubes (P=0.031) and hospital stay (P<0.001). However, the surgery was more expensive in the robotic group (P<0.001). Conclusion All-port robotic surgery is safe and effective for patients with early-stage non-small cell lung cancer with less intraoperative bleeding, more lymph node dissection, less postoperative pain, and shorter hospital stay compared with the thoracoscopic surgery.
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@#Objective To compare and analyze the occurrence of acute and chronic pain after subxiphoid and transcostal thoracoscopic extended thymectomy. Methods A retrospective analysis was performed on 150 patients who underwent thoracoscopic extended thymectomy in our hospital from July 2020 to June 2022, among whome 30 patients received subxiphoid video-assisted thoracic surgery, and 120 patients received transcostal video-assisted thoracic surgery. The patients were matched by the propensity score matching method. Postoperative pain was evaluated by numeric rating scale (NRS). The intraoperative conditions and postoperative pain incidence were compared between the two groups. Results After matching, 60 patients were enrolled, 30 in each group, including 30 males and 30 females with an average age of 50.78±12.13 years. There was no difference in the general clinical data between the two groups (P>0.05), and no perioperative death. There were statistical differences in the intraoperative blood loss, postoperative drainage volume, postoperative catheter duration, postoperative hospital stay, postoperative pain on 1 d, 2 d, 3 d, 7 d, 3 months and 6 months after the surgery (P<0.05), but there was no statistical difference in the operation time or the postoperative 14 d NRS score (P>0.05). Further univariate and multivariate analyses for postoperative chronic pain showed that surgical method and postoperative 14 d NRS score were risk factors for chronic pain at the 3 months and 6 months after the surgery (P<0.05). Conclusion The subxiphoid thoracoscopic extended thymectomy has advantages over transcostal thoracoscopic surgery in the postoperative acute and chronic pain.
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@#Objective To compare the clinical efficacy of subxiphoid video-assisted thoracoscopic surgery (XVATS) and conventional intercostal VATS (CVATS) extended thymectomy for myasthenia gravis (MG). Methods The clinical data of MG patients who underwent extended thymectomy in the Department of Thoracic Surgery of Xuzhou Central Hospital from October 2016 to October 2021 and finished the follow-up were retrospectively reviewed. They were divided into an XVATS group and a CVATS group according to the procedure. The perioperative variables and clinical efficacy of the two groups were compared. Results A total of 84 patients were collected, including 43 males and 41 females, with a mean age of 52.3 years. There were 41 patients in the XVATS group and 43 patients in the CVATS group. There was no mortality, cardiopulmonary thrombosis, prolonged air leak, or mediastinal infection. Additionally, the CVATS group recorded 5 (11.6%) patients of conversion to open thoracotomy, 1 (2.3%) patient of postoperative MG crisis, 1 (2.3%) patient of bleeding in thorax, and 1 (2.3%) patient of chylothorax. The operation time (127.4±50.4 min vs. 122.9±38.6 min), intraoperative bleeding [46.9 (25.7, 79.2) mL vs. 45.7 (21.9, 92.1) mL], incidence of complications [0 vs. 7.0% (3/43)], chest tube duration (4.3±1.9 d vs. 4.8±2.8 d), follow-up time (19.1±8.5 months vs. 22.5±13.7 months), the proportion of residual mediastinal fat tissue [12.2% (5/41) vs. 4.7% (2/43)], and total MG remission rate [29.3% (12/41) vs. 51.2% (22/43)] were not statistically different between the two groups (P>0.05). However, the two groups showed significantly different incidence of conversion to open thoracotomy [0 vs. 11.6% (5/43), P=0.024], postoperative hospital stay time (8.2±3.3 d vs. 11.4±5.8 d, P=0.003) and total drainage volume [396.7 (173.8, 542.5) mL vs. 218.8 (102.1, 430.0) mL, P=0.038]. Conclusion XVATS extended thymectomy is technically safe and feasible; however, more evidence is warranted before the recommendation of this approach for the treatment of MG.
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@#Objective To summarize the efficacy of robot-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) in the treatment of left upper lobectomy for non-small cell lung cancer. Methods The clinical data of patients with non-small cell lung cancer who underwent left upper lobectomy with RATS or VATS in our center from January 2019 to October 2021 were retrospectively analyzed. The patients were divided into two groups according to surgical methods: a RATS group and a VATS group. The baseline clinical data and results were compared between the two groups. Results A total of 145 patients were included. There were 78 males and 67 females with a mean age of 59.9 years. There were 63 patients in the RATS group and 82 patients in the VATS group. There was no death within 30 days after operation in both groups. In the RATS group, the drainage volume on the second postoperative day (233.49±83.94 mL vs. 284.88±120.21 mL, P=0.003), total operative time (126.94±29.50 min vs. 181.59±61.51 min, P=0.000), intraoperative resection time of the left upper lobe (76.48±27.52 min vs. 107.23±47.84 min, P=0.000), intraoperative blood loss (P=0.000), and conversion rate to thoracotomy (P=0.018) were significantly better than those in the VATS group. The group (5.41±0.94 groups vs. 4.83±1.31 groups, P=0.002) and number (18.27±7.39 vs. 12.76±6.54, P=0.000) of dissected lymph nodes in the RATS group were significantly more than those in the VATS group. The differences in the drainage volume on the first day after operation, postoperative intubation time, postoperative hospital stay or postoperative complications between the two groups were not statistically significant (P>0.05). Conclusion The application of RATS in the left upper lobectomy for non-small cell lung cancer is safe and feasible, and has obvious advantages over VATS.
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@#Objective To compare the perioperative outcomes of atypical segmentectomy between robotic-assisted thoracoscopic surgery (RATS) and conventional video-assisted thoracoscopic surgery (VATS) in early-stage non-small cell lung cancer (NSCLC). Methods The data of patients who underwent minimally invasive anatomic atypical segmentectomy in our hospital from October 2016 to December 2021 were collected. These patients were divided into a RATS group and a VATS group according to the operation method. Propensity score (PS) matching was used to select patients with close clinical baseline characteristics, and the perioperative results of the two groups were compared. Results A total of 1 048 patients were enrolled, including 320 males and 728 females, with a mean age of 53.51±11.13 years. There were 277 patients in the RATS group and 771 patients in the VATS group. After 1∶1 PS matching, 277 pairs were selected. Both groups were well balanced for age, sex, smoking history, body mass index, Charlson comorbidity index, pulmonary function, tumor size, tumor location, and histological type. All patients were R0 resection, and there were no deaths within 30 days after surgery. The RATS group had shorter operative time [85 (75, 105) min vs. 115 (95, 140) min, P<0.001] and less blood loss [50 (30, 100) mL vs. 60 (50, 100) mL, P=0.001]. There were no statistical differences between the two groups in lymph node resection, conversion to thoracotomy, thoracic drainage time, total amount of thoracic drainage or postoperative complications (P>0.05). Conclusion Both RATS and VATS atypical segment-ectomies are safe and feasible for early-stage NSCLC. RATS can effectively shorten the operative time, and reduce blood loss.
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Objective:To improve the understanding of acute pain after thoracoscopic surgery in patients with early-stage lung adenocarcinoma, to analyze and screen out the independent risk factors that may induce acute postoperative pain. The patients' surgery experience may get improved through the corresponding timely and effective interventions.Methods:We retrospectively reviewed the clinical data of 204 patients with early-stage lung adenocarcinoma who were treated by a single medical team of our center from May 2021 to October 2021, and analyzed the assessment results of acute postoperative pain. Patients were grouped according to the general condition, past medical history, social and spiritual attributes, lesion characteristics, surgical approaches and anesthetic methods. Comparison of proportions of acute postoperative pain between the groups were made, and independent risk factors were identified.Results:A total of 84 males and 120 females were enrolled, with a mean age of(57.9±11.5)years old and a median operation time of 120(110, 145) min. No serious complication or perioperative death occurred in the whole group. Postoperative pain control failed in 76 cases(37.3%), 24 cases(11.8%) suffered from severe postoperative pain, and 33 cases(16.2%) required additional intramuscular injection of strong analgesics after surgery. Those who were younger than 60 years old, with a university degree or above, received two-incision surgery, operated for more than 2 h, received general anesthesia only, or in a state of depression, had significantly higher rates of postoperative acute pain, compared with their respective control groups( P<0.05). The independent risk factors for acute pain after thoracoscopic surgery included age( P=0.002), history of alcoholism( P=0.014), number of incisions( P=0.016), operation time( P=0.010), depression status( P=0.037) and enhanced anesthetic method( P=0.012). Conclusion:A large amount of patients with early-stage lung cancer suffered from acute pain after thoracoscopic surgery, which seriously affected their treatment experience and even quality of life. Young patients with a history of alcoholism and depression status were high-risk groups for postoperative acute pain. Applying Uniportal video-assisted thoracoscopic surgery, reducing the operation time as much as possible, and choosing enhanced analgesic anesthesia represented by epidural block combined with general anesthesia might be effective ways to reduce the probability of acute postoperative pain.
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Objective:To investigate the safety and feasibility of Ivor-Lewis procedure under uniportal video-assisted thoracoscopy(VATS) for esophageal cancer and Siewert type I esophago-gastric junction carcinoma.Methods:The patients with middle-lower segment esophageal cancer or Siewert type I esophago-gastric junction carcinoma received minimally invasive esophagectomy between October 2020 and June 2021, and the clinical data was collected and analyzed.Results:26 patients received Ivor-Lewis procedure underwent uniportal VATS, while 45 patients underwent McKeown surgery under multiport VATS. The average operation time of patients in the two groups were(265±110)min and (235±94)min, and the average intraoperative blood loss were(80±57)ml and(105±60)ml. The mean number of lymph nodes removed in the surgery were (19.3±2.9) and 18.6±2.7 respectively in two groups, and the mean length of hospital stay was(7.5±3.5)days and(8.3±2.7)days. The incidence of perioperative complications were not significantly different in two groups. The VAS score of patients received Ivor-Lewis procedure underwent uniportal VATS was lower than that of patients received McKeown surgery in ostoperative day 1, day 3, day 7 and 1 month. The difference was statistically significant in two groups( P<0.05). Conclusion:The Ivor-Lewis procedure under uniportal VATS for esophageal cancer and Siewert type I esophago-gastric junction carcinoma has the advantage of less postoperative pain, and the procedure is feasible in clinical practice.
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It is not an uncommon situation to encounter a patient with anesthesia having multiple co-morbidities. Here, we report the successful anesthetic management of an immunosuppressed 53-year-old female patient with hypertrophic obstructive cardiomyopathy, stage IV chronic kidney disease, and chronic lung infection who was posted for minimally invasive video-assisted thoracoscopy requiring one lung ventilation. Intraoperative hemodynamic stability was maintained with etomidate, fentanyl, cisatracurium, desflurane, and dexmedetomidine with accurate bispectral depth for sedation and precise fluid guidance with transesophageal echocardiography. The entire anesthetic conduct was planned to avoid the left ventricular outflow tract obstruction and maintain a steady-state hemodynamic balance. This case report is a learning experience of how close vigilance with appropriate use of monitoring and knowledge about disease per se resulted in an uneventful perioperative period.
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@#Objective To discuss the safety and feasibility of no chest tube (NCT) after thoracoscopic pneumonectomy. Methods The online databases including PubMed, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to October 2020 to collect the research on NCT after thoracoscopic pneumonectomy. Two reviewers independently screened the literature, extracted the data, and evaluated the quality of the included studies. The RevMan 5.3 software was used for meta-analysis. Results A total of 17 studies were included. There were 12 cohort studies and 5 randomized controlled trials including 1 572 patients with 779 patients in the NCT group and 793 patients in the chest tube placement (CTP) group. Meta–analysis results showed that the length of postoperative hospital stay in the NCT group was shorter than that in the CTP group (SMD=–1.23, 95%CI –1.59 to –0.87, P<0.000 01). Patients in the NCT group experienced slighter pain than those in the CTP group at postoperative day (POD)1 (SMD=–0.97, 95%CI –1.42 to –0.53, P<0.000 1), and POD2 (SMD=–1.10, 95%CI –2.00 to –0.20, P=0.02), while no statistical difference was found between the two groups in the visual analogue scale of POD3 (SMD=–0.92, 95%CI –1.91 to 0.07, P=0.07). There was no statistical difference in the 30-day complication rate (RR=0.93, 95%CI 0.61 to 1.44, P=0.76), the rate of postoperative chest drainage (RR=1.51, 95%CI 0.68 to 3.37, P=0.31) or the rate of thoracocentesis (RR=2.81, 95%CI 0.91 to 8.64, P=0.07) between the two groups. No death occurred in the perioperative period in both groups. Conclusion It is feasible and safe to omit the chest tube after thoracoscopic pneumonectomy for patients who meet the criteria.
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@#Objective To compare the effectiveness and safety of preoperative lung localization by microcoil and anchor with scaled suture. Methods A total of 286 patients underwent CT-guided puncture localization consecutively between October 2019 and December 2020 in our hospital. According to the different methods of localization, they were divided into a microcoil group (n=139, including 49 males and 90 females, aged 57.92±10.51 years) and an anchor group (n=147, including 53 males and 94 females, aged 56.68±11.31 years). The clinical data of the patients were compared. Results A total of 173 nodules were localized in the microcoil group, and 169 nodules in the anchor group. The localization success rate was similar in the two groups. However, the anchor group was significantly better than the microcoil group in the localization time (8.15±2.55 min vs. 9.53±3.08 min, P=0.001), the pathological receiving time (30.46±14.41 min vs. 34.96±19.75 min, P=0.029), and the hemoptysis rate (10.7% vs. 30.1%, P=0.001), but the pneumothorax rate was higher in the anchor group (21.3% vs. 11.0%, P=0.006). Conclusion Preoperative localization of small pulmonary nodules using anchor with suture is practical and safe. Due to its simplicity and convenience, it is worth of promotion in the clinic.