[Video-assisted Thoracoscopic Surgery for Chest Trauma].

Video-assisted thoracoscopic surgery (VATS) is now commonly used in emergency surgery to confirm the site of injury and observe the thoracic cavity, especially in cases of chest trauma with stable vital signs. VATS was used in all 33 chest trauma surgeries performed at our department from October 2009 to July 2023. The common injury mechanisms were traffic trauma and falls, but there were also cases of trauma from a bullhorn, heavy machinery and farm equipment, and penetrating injury. The common surgical procedures were treatment of rib fractures and pulmonary suture or partial lung resection, followed by treatment of diaphragmatic injuries. Unusual surgical procedures included extrapleural hematoma drainage, pericardial drainage, hemostasis of intrathoracic bleeding from thoracic vertebral fracture, and lobectomy for airway bleeding. Here, we report our surgical policies and techniques for chest trauma. First, the thoracic cavity should be observed thoracoscopically to determine the site of injury. The key to repair is placement of a small thoracotomy directly above the rib fracture site, where dislocation is largest, followed by suture repair of the lung and diaphragm by combining direct and thoracoscopic views.

[Three-dimensional and 4K Three-dimensional Uniportal Video-assisted Thoracoscopic Surgery for Mediastinal and Chest Wall Disease During Respiratory Surgery].

Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy has recently been used with increasing frequency by thoracoscopic surgeons, even in Japan. However, few reports have previously described uniportal VATS for mediastinal and chest wall disease. From April 2008 to December 2022, 159 patients were treated for mediastinal and chest wall disease. We divided the patients into three groups based on the type of surgery:robot-assisted thoracoscopic surgery( RATS), n=21;multi-portal surgery (using a two-dimensional [2D] system), n=55;and uniportal surgery, n=83. Of the 83 cases in the uniportal surgery group, 49 underwent surgery with a three-dimensional( 3D) or 4K-3D system. The operation duration, blood loss, and postoperative stay duration were compared among the groups. A p-value of <0.05 was considered statistically significant. The operation duration, intraoperative blood loss, and postoperative stay duration were significantly lower in the uniportal group (3D, 4K-3D) than in the multi-portal group (2D), with respective p-values of 0.001, 0.034, and 0.005. The RATS group showed a reduced blood loss trend, but not to a significant degree. In conclusion, our findings suggest that a 3D system can optimize surgical performance compared to a 2D system. In particular, using a 4K-3D system with high-definition imaging and stereoscopic vision enables surgeons to perform less-invasive thoracoscopic surgery than would otherwise be feasible.

[Palmar Hyperhidrosis Associated with the Azygos Lobe].

A 66-year-old man visited our department because of palmar hyperhidrosis. Computed tomography had revealed division of the right upper lobe by a fissure and the azygos vein, and the presence of an azygos lobe had been diagnosed. Endoscopic thoracic sympathectomy (resection of T3 ganglion) was performed. Adhesion between the azygos lobe and parietal pleura was dissected to pulling out the azygos lobe and the sympathectomy was safely performed.

[Three-dimensional (3D)-Video-assisted Thoracic Surgery (VATS) and Robot-assisted Thoracic Surgery(RATS)].

We firstly introduced a 3-dimensional system [3D-video-assisted thoracic surgery (VATS)] to the world in 2012, and have since performed 3D-VATS-lobectomy. From March 2012 to October 2019, 224 patients for lung cancer were treated by 3D-VATS. Since then, we have added resection of mediastinal tumors and 3D-uniportal-VATS. One of the advantages of the 3D-VATS is the spatial depth. The disadvantages are a bad mood and dizziness. Since the introduction of robot-assisted thoracic surgery (RATS) in April 2018, its use has become widespread, even in Japan. RATS has the potential for enormous growth in the future. To avoid any risk of surgery, safety measures are important to the team from around the day. In the near future, there will be a distinction between robotic surgery and 2D, 3D-VATS.

[Single-incision thoracoscopic surgery( SITS) for mediastinal disease].

The use of single-incision laparoscopic surgery is spreading widely, even in Japan, however, in the field of thoracic surgery, there exist no previous reports on the use of the Wound retractor system in single-incision thoracoscopic surgery (SITS) for mediastinal disease. We herein describe the 1st cases of video-assisted SITS of the mediastinum. Fifteen patients (5 males, 10 females) with mediastinal disease underwent SITS. The average age of the patients was 66.8( 44 ~ 90) years. The mean operative time was 186.2 minutes. Chest drainage tubes were not placed in 12 cases. Chest tubes were removed after 2.5 days in three cases. The mean postoperative hospital stay was 3.3 (2 ~ 8) days. In this report, the use of an access instrument for SITS is presented. We performed extended thymectomy using Vein harvest during surgery in patients with myasthenia gravis. The device could be handled successfully, thereby avoiding interferences between the operator and assistants. In conclusion, we believe that SITS is a feasible and safe procedure that is beneficial in selected cases.