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BACKGROUND@#With the extensive application of segmental lung resection in the treatment of early-stage lung cancer, how to complete segmentectomy more accurately and minimally invasively has become a research hotspot. The aim of this study is to explore the application of three-dimensional computed tomography bronchography and angiography (3D-CTBA) combined with perfusion area recognition technique in single-hole thoracoscopic complex segmentectomy.@*METHODS@#From January 2021 to January 2022, the clinical data of 112 consecutive patients undergoing single-port thoracoscopic complex segmentectomy in the Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University were retrospectively analyzed. The three-dimensional reconstruction combined with perfusion area identification technique was used to perform the operation and the clinical data were analyzed.@*RESULTS@#The average operation time was (141.1±35.4) min; the initial time of intersegmental plane display was (12.5±1.7) s; the maintenance time of intersegmental plane was (114.3±10.9) s; the intersegmental plane was clearly displayed (100%); the amount of bleeding was [10 (10, 20)] mL; the total postoperative drainage volume was (380.5±139.7) mL; the postoperative extubation time was (3.9±1.2) d; and the postoperative hospitalization time was (5.2±1.6) d. Postoperative complications occurred in 8 cases.@*CONCLUSIONS@#The advantages of 3D-CTBA combined with perfusion area recognition technique are fast, accurate and safe in identifying intersegmental boundary in single-port thoracoscopic complex segmentectomy, which could provide guidances for accuratding resection of tumors, shortening operation time and reducing surgical complications.
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Humanos , Neoplasias Pulmonares/patología , Broncografía , Neumonectomía/métodos , Estudios Retrospectivos , Cirugía Torácica Asistida por Video/métodos , Tomografía Computarizada por Rayos X , Angiografía/métodos , PerfusiónRESUMEN
@#Objective To analyze the operation outcomes and learning curve of uniportal video-assisted thoracoscopic surgery (VATS). Methods All consecutive patients who underwent uniportal VATS between November 2018 and December 2020 in Shangjin Branch of West China Hospital of Sichuan University were retrospectively enrolled, including 62 males and 86 females with a mean age of 50.1±13.4 years. Operations included lobectomy, segmentectomy, wedge resection, mediastinal mass resection and hemopneumothorax. Accordingly, patients' clinical features in different phases were collected and compared to determine the outcome difference and learning curve for uniportal VATS. Results Median postoperative hospital stay was 5 days, and the overall complication rate was 8.1% (12/148). There was no 30-day death after surgery or readmissions. Median postoperative pain score was 3. Over time, the operation time, incision length and blood loss were optimized in the uniportal VATS lobectomy, the incision length and blood loss increased in the uniportal VATS segmentectomy, and the postoperative hospital stay decreased in the uniportal VATS wedge resection. Conclusion Uniportal VATS is safe and feasible for both standard and complex pulmonary resections. While, no remarkable learning curve for uniportal VATS lobectomy is observed for experienced surgeon.
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@#Objective To explore the feasibility and short-term efficacy of uniportal and three-port single-direction video-assisted thoracoscopic surgery (S-VATS) anatomical lobectomy for lung cancer. Methods Clinical data of 60 lung cancer patients, including 40 males and 20 females with an average age of 62.2±9.0 years, who received S-VATS anatomic lobectomy and systematic lymph nodes dissection by the same surgeon in our hospital between July 2016 and January 2019 were retrospectively analyzed. These patients were divided into a uniportal S-VATS group and a three-port S-VATS group according to surgical procedures, with 30 patients in each group. The clinical data of the two groups were compared. Results There was no conversion to thoracotomy, surgical port addition, or mortality in this cohort, with tumor-negative surgical margin. There was no statistical difference in the operation time between the two groups (70.8±16.4 min vs. 73.7±14.3 min, P>0.05). Meanwhile, both groups showed similar intraoperative blood loss, stations and numbers of dissected lymph nodes, incidence of operation-related complications, duration and volume of chest tube drainage, as well as postoperative hospital stay (P>0.05). Besides, pain score of the patients in the uniportal S-VATS group was significantly lower than that of the three-port S-VATS group on postoperative 3-14 d (P<0.05). The mean duration of follow-up was 10 months, and all the patients were survived without tumor recurrence or metastasis. Conclusion The transition from three-port S-VATS to uniportal S-VATS anatomical lobectomy for treatment of lung cancer is feasible. However, further studies are needed to elucidate the optimal resection sequence of pulmonary vessels.
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@#Objective To investigate the effects of subxiphoid uniportal video-assisted thoracoscopic surgery (SUVATS) and intercostal uniportal VATS (IUVATS) in lobectomy for non-small cell lung cancer (NSCLC). Methods A total of 428 patients with NSCLC who underwent lobectomy via SUVATS or IUVATS from July 1st to 31st, 2019 in Shanghai Pulmonary Hospital were enrolled. Patient characteristics, perioperative outcomes and postoperative pain scores at different time points were collected. The patients were divided into a SUVATS group (80 patients, 42 males and 38 females with an average age of 58.8±9.6 years) and an IUVATS group (348 patients, 161 males and 187 females, with an average age of 61.2±10.0 years). The clinical effectiveness of the two groups was compared. Results There was no significant difference in sex (P=0.314), age (P=0.052), preoperative pulmonary function (P=0.701), combined chronic comorbidities (chronic cardiovascular disease, P=0.775; chronic obstructive pulmonary disease, P=0.678) and postoperative pathology (P=0.132) between the two groups. Compared with the IUVATS group, patients in the SUVATS group had longer operation time (155.6±34.4 min vs. 141.3±27.0 min, P<0.001), less intraoperative blood loss (165.2±160.6 mL vs. 223.7±272.4 mL, P<0.001), shorter time of chest tube use (4.3±2.0 d vs. 4.9±1.9 d, P=0.011) and less postoperative pain score at different time points (postoperative 8 h, P<0.001; postoperative day 1, P=0.019; postoperative day 2, P=0.015; the day before discharge, P<0.001). Conclusion SUVATS is a safe and effective technique for lobectomy in NSCLC patients with less postoperative pain and can promote postoperative recovery.
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@#In recent years, subxiphoid uniportal video-assisted thoracoscopic surgery is one of the most important innovations in the field of mini-invasive thoracic surgery. Because it avoids the injury of intercostal nerve, previous studies have shown that it can significantly reduce the perioperative and long-term incision pain. The operation is technically more difficult, so the selection of patients is more strict compared with the traditional intercostal surgery. Some special surgical techniques are needed during the operation, and special lengthening instruments should be used. We hope that the experience described in this paper will be continuously supplemented and improved with the further development of this technique, and will produce greater reference value.
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BACKGROUND@#In recent years, the technique of uniportal video-assisted thoracoscopic surgery has been developed. As a new surgical method, its feasibility and safety have not been generally recognized. The aim of this study is to review the technology in the treatment of lung cancer patients in stage I to part of stage IIIa.@*METHODS@#The clinical data of patients accepted thoracoscopic resection of lung cancer by a same medical group from May 2018 to March 2019 in The First Affiliated Hospital of Soochow University were retrospectively analyzed. After remove of cases that did not meet the requirements, the patients were divided into uniportal group (55 cases) and biportal group (87 cases). The clinical data of the two groups were collected and statistically analyzed.@*RESULTS@#All the 142 patients underwent lobectomy and systemic lymph node dissection. There is no perioperative death in both groups. There was no significant difference in age, location of tumors, pathological type, size of tumors and pathological tumor-node-metastasis (pTNM) staging between uniportal group and biportal group (P>0.05). The operation time [(167.65±43.85) min vs (181.71±51.28) min], the intraoperative bleeding volume [(57.45±50.19) mL vs (87.47±132.54) mL], the indwelling time of drainage tube [(4.82±2.82) d vs (5.84±3.43) d] and the hospital stay [(6.91±3.88) d vs (7.74±3.87) d] were less in uiportal group compared to biportal group, though no significant difference occurred (P>0.05 ). The total drainage volume of uniportal group was significantly lower than that of biportal group [(1,064.82±776.38) mL vs (1,658.71±1,722.38) mL], and the visual analogue score of 24 hours and 72 hours after operation [(4.73±0.73) points vs (5.25±0.74) points; (2.16±0.71) points vs (2.55±0.86) points] were lower in uniportal group (P<0.05).@*CONCLUSIONS@#Uniportal video-assisted thoracoscopic radical resection of lung cancer is safe and feasible for stage I to part of stage IIIa lung cancer patients.
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Objective The aim of this study was to explore the feasibility and efficacy of single port video-assisted thora coscopic surgery(S-VATS) lobectomy for lung cancer.Methods Clinical data of consecutive 140 cases of lung cancer patients underwent S-VATS lobectomy with systematic lymph nodes dissection by the same group of surgeons between January 2013 and January 2016 was retrospectively analyzed,wbich was compared with 60 cases of multi-port VATS(M-VATS,M group) lobectomy in this period.The patients of S-VATS were divided into four groups according to the sequence of surgery(group A,B,C and D,35 cases in each group).The operation time,blood loss,number of dissected lymph nodes and nodal stations,the rate of S-VATS conversion to M-VATS or thoracotomy,postoperative complications,postoperative chest drainage as well as hospital stay were compared respectively between the five groups.Results There were no significant difference between the groups in terms of age,gender,BMI,comorbidity and T staging(PP ＞ 0.05).No one was converted to thoracotomy,and all of the sur gical specimens were negative (R0).Besides,the operation time of group A[(200.3 ± 46.3) min] was noticeably longer than that in group B [(170.9 ± 27.7) min],group C [(154.6 ± 25.0) min],group D [(142.6 ± 32.8) min] and group M [(137.3 ± 27.7) min] (P ＜ 0.05).Besides,the operation time of group B was longer than group D and M (P ＜ 0.05) while the operation time of group C was longer than group M(P =0.026),and there was no significant difference between group D and M (P =0.996).In addition,the blood loss in group A [(304.3 ± 119.0) ml] was significantly more than that of group B [(282.9 ±89.1)ml],group C[(232.9 ±82.2)ml],group D[(202.8 ±72.7)m1] and group M[(200.0 ±70.7)ml] (P ＜ 0.05) whilst the blood loss of group B was markedly more than that of group D and M (P ＜ 0.05),and no significant difference was indicated between group C,D and M(P ＞ 0.05).Moreover,there were 6 cases of blood vessel injury and 7 cases conversion to multi-port VATS in group A,which was evidently more than the other groups(P ＜ 0.05).Furthermore,the pain score of group A was remarkably higher than the other groups (P ＜ 0.05).However,the number of dissected lymph nodes,postoperative complications and chest drainage and hospital stay were similar among all the groups (P ＞ 0.05).Conclusion S-VATS lobectomy for treatment of lung cancer is feasible and effective with learning curve of nearly 70 cases,but it does not demonstrate any advantage compared with M-VATS.
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Objective The aim of this study was to explore the feasibility and efficacy of single port video-assisted thora coscopic surgery(S-VATS) lobectomy for lung cancer.Methods Clinical data of consecutive 140 cases of lung cancer patients underwent S-VATS lobectomy with systematic lymph nodes dissection by the same group of surgeons between January 2013 and January 2016 was retrospectively analyzed,wbich was compared with 60 cases of multi-port VATS(M-VATS,M group) lobectomy in this period.The patients of S-VATS were divided into four groups according to the sequence of surgery(group A,B,C and D,35 cases in each group).The operation time,blood loss,number of dissected lymph nodes and nodal stations,the rate of S-VATS conversion to M-VATS or thoracotomy,postoperative complications,postoperative chest drainage as well as hospital stay were compared respectively between the five groups.Results There were no significant difference between the groups in terms of age,gender,BMI,comorbidity and T staging(PP ＞ 0.05).No one was converted to thoracotomy,and all of the sur gical specimens were negative (R0).Besides,the operation time of group A[(200.3 ± 46.3) min] was noticeably longer than that in group B [(170.9 ± 27.7) min],group C [(154.6 ± 25.0) min],group D [(142.6 ± 32.8) min] and group M [(137.3 ± 27.7) min] (P ＜ 0.05).Besides,the operation time of group B was longer than group D and M (P ＜ 0.05) while the operation time of group C was longer than group M(P =0.026),and there was no significant difference between group D and M (P =0.996).In addition,the blood loss in group A [(304.3 ± 119.0) ml] was significantly more than that of group B [(282.9 ±89.1)ml],group C[(232.9 ±82.2)ml],group D[(202.8 ±72.7)m1] and group M[(200.0 ±70.7)ml] (P ＜ 0.05) whilst the blood loss of group B was markedly more than that of group D and M (P ＜ 0.05),and no significant difference was indicated between group C,D and M(P ＞ 0.05).Moreover,there were 6 cases of blood vessel injury and 7 cases conversion to multi-port VATS in group A,which was evidently more than the other groups(P ＜ 0.05).Furthermore,the pain score of group A was remarkably higher than the other groups (P ＜ 0.05).However,the number of dissected lymph nodes,postoperative complications and chest drainage and hospital stay were similar among all the groups (P ＞ 0.05).Conclusion S-VATS lobectomy for treatment of lung cancer is feasible and effective with learning curve of nearly 70 cases,but it does not demonstrate any advantage compared with M-VATS.
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Objective To compare the ultrafine chest drainage tube with traditional thick hose as lower tube after uniport thoracoscope pulmonary nodules resection(segmentectomy,lobectomy) and evaluate its efficacy and safety.Methods Ultrafine chest drainage tube was applied in 55 patients underwent uniport thoracoscopy pulmonary resection,and traditional thick closed drainage hose was applied in another 55 patients in the same period as the control group.Postoperative drainage quantity,drainage time,pain score and incision healing between two group were compared.Results No statistically difference was found in two groups at thoracic drainage quantity on 1 day,2 days postoperative and total drainage time.But statistically difference was found in thoracic drainage quantity on 3 days postoperative,pain score and incision healing(P ＜0.05).Conclusion Ultrafine chest drainage tube has little trauma,definite clinical effect and can be easily accepted by patients.