RESUMEN
@#Objective To explore the safety and feasibility of the application of video-assisted thoracic surgery (VATS) anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis. Methods From June 2014 to June 2018, 19 patients with bilateral localized bronchiectasis underwent single-stage bilateral thoracic surgery with VATS anatomic segmentectomy, including 11 males and 8 females aged 38.0±12.5 years. The clinical efficacy of the surgery was evaluated. Results All surgeries were successfully completed, of which 17 were bilateral VATS, 2 were unilateral VATS with the other lateral converted to thoracotomy. The average number of bilateral resected segments was 4-8 (5.9±1.2). Mean operation time was 330.0±40.0 min and mean blood loss was 150.0±60.0 mL. Mean ventilator-assisted breathing time was 6.0±1.8 h, mean duration of chest-tube placement was 4.0±1.0 d and mean hospital stay time was 14.0±1.5 d. Three patients suffered pulmonary infection and 1 patient received tracheotomy. No perioperative death occurred. Arterial oxygen pressures on postoperative day (POD) 1 (F=340.18, P<0.05) and POD 3 (F=131.26, P<0.05) were significantly lower than that before operation, arterial carbon dioxide pressures on POD 1 (F=46.62, P<0.05) and POD 3 (F=48.21, P<0.05) were significantly higher than that before operation, and pulse oximeter saturation on POD 1 was significantly lower than that before operation (F=210.82, P<0.05). The patients were followed up for one to five years without recurrence. Conclusion Application of VATS anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis is safe and feasible with strictly selected patients. Postoperative airway management is very important. The surgery is worthy of wide clinical practice.
RESUMEN
@#Objective To evaluate the feasibility and safety of single utility port video-assisted thoracoscopic surgery (VATS) anatomic segmentectomy for lung diseases. Methods We performed a retrospective review of 155 patients undergoing single utility port VATS anatomic segmentectomy from January 2015 to December 2016. There were 62 males and 93 females with a mean age of 53 (24–82) years. Two ports were used. The camera was through the port for observation which was about 1.5 cm in length and located at the 7th or 6th intercostal space. The instruments were through port for operation that was about 3–4 cm in length and located at the 4th or 3th intercostal space. Pulmonary segment vessel and segmental bronchi were cut and stitched by Hemolock or linear cut stapler. Different segments were separated by linear cut stapler. Perioperative data were collected and analyzed. Results One patient was performed suture under the auxiliary operating hole (three holes) because of pulmonary artery bleeding. The remaining 154 patients underwent single utility port VATS anatomic segmentectomy successfully. No conversion to open procedure or lobectomy was found and there was no perioperative mortality. The median operative time was 102 (65–150) min and the median blood loss in operation was 118 (50–300) ml. The thoracic drainage time was 3.8 (2–7) d and the median hospital stay after operation was 5.6 (3–9) d . Major morbidity occurred in 8 patients (5.2%) including hemoptysis (in 2 patients), pneumonia (in 2 patients), aerodermectasia (in 1 patient), pleural effussion (in 1 patient) and local atelectasis (in 1 patient). All of them above healed after symptomatic treatment. Patholocal examination showed there were 139 patients of primary lung carcinoma (pathologically staged as Tis-T1bN0M0), 9 patients of benign diseases and 7 patients of metastasis tumor. Conclusion Single utility port VATS anatomic segmentectomy procedure is safe and feasible. It can be utilized as an option for those with non-small cell lung cancer staged Ⅰa and those unable to tolerate pulmonary lobectomy.