ObjectiveTo investigate the safety, feasibility and advantages of subxiphoid uni-portal thoracoscopic thymectomy.MethodsClinical data of 65 patients undergoing subxiphoid uni-portal thoracoscopic thymectomy in our hospital from September 2018 to March 2019 were retrospectively analyzed. They were treated as a subxiphoid surgery group, including 36 males and 29 females, aged 49.5 (29-71) years. The incision with the length of about 3 cm was located approximately 1 cm under the xiphoid process. From January 2016 to December 2017, 65 patients received intercostal uni-portal thoracoscopic thymectomy, who were treated as a control group, including 38 males and 27 females, aged 48.9 (33-67) years. All patients who were clinically diagnosed with thymic tumor before surgery were treated with total thymectomy. After surgery, expectoration and analgesia were used.ResultsThere was no statistically significant difference in general clinical data, lesion size, intraoperative blood loss, postoperative catheterization time, postoperative hospital stay and postoperative pathology between the two groups. All operations were successfully completed, and the patients in both groups recovered uneventfully after surgery. Visual analogue scale scores on the 1st, 3rd, 7th and 30th day after surgery in the subxiphoid surgery group were lower than those in the control group.ConclusionThe subxiphoid uni-portal thoracoscopic approach can achieve total thymectomy with less trauma and faster postoperative recovery.
Objective To compare the digital drainage system and the traditional drainage system in the patients after lung surgery, and to evaluate the advantages of digital drainage system. Methods A retrospective analysis of consecutive 42 patients with lung surgery between September 2016 and May 2017 in Beijing University International Hospital was done. There were 30 males and 12 females with a median age of 34 years ranging 19-81 years. After the surgery 21 patients adopted Thopaz digital drainage device (a DDS group), and the other 21 patients adopted traditional drainage (a TDS group). Duration of air leakage and chest tube placement, length of hospital stay, thoracic drainage volume within 48 h and hospitalization expenses in the two groups were compared. Results The patients in the two groups were all successfully discharged. Compared with the TDS group, duration of air leakage and chest tube placement and length of hospital stay significantly shortened in the DDS group (35.6±16.3 h vs. 48.2±20.1 h, P=0.02; 50.0±16.1 h vs. 62.0±20.4 h, P=0.03; 5.9±2.3 d vs. 7.8±3.5 d, P=0.02), and thoracic drainage volume within 48 h and hospitalization expenses showed no significant statistical difference between the two groups. Conclusion Using digital drainage system after lung surgery can significantly shorten the duration of air leakage and the postoperative drainage, at the same time, without increasing the overall hospitalization expenses.
ObjectiveTo investigate the effectiveness and safety of robotic lobectomy in clinical N0 lung malignant tumor≥3 cm. MethodsWe retrospectively analyzed the clinical data of 182 patients with lung malignant tumor≥3 cm receiving robotic or thoracoscopic lobectomy at Shanghai Chest Hospital in 2019. The patients were divided into a robotic surgery group (RATS group) and a thoracoscopic surgery group (VATS group). There were 39 males and 38 females with an average age of 60.55±8.59 years in the RATS group, and 51 males and 54 females with an average age of 61.58±9.30 years in the VATS group. A propensity score matching analysis was applied to compare the operative data between the two groups. ResultsA total of 57 patients were included in each group after the propensity score matching analysis. Patients in the RATS group had more groups of N1 lymph node dissected (2.53±0.83 groups vs. 2.07±0.88 groups, P=0.005) in comparison with the VATS group. No statistical difference was found in operation time, blood loss, postoperative hospital stay, number of N1 and N2 lymph nodes dissected, groups of N2 lymph node dissected, lymph node upstage rate or postoperative complications. The hospitalization cost of RATS was higher than that of VATS (P＜0.001). ConclusionIn contrast with thoracoscopic lobectomy, robotic lobectomy has similar operative safety, and a thorough N1 lymphadenectomy in patients with clinical N0 lung malignant tumor≥3 cm.
Objective To investigate the clinical outcomes of subxiphoid video-assisted thoracoscopic thymectomy for myasthenia gravis. Methods The clinical data of the 85 patients undergoing video-assisted thoracoscopic thymectomy for myasthenia gravis in Department of Cardiothoracic Surgery, Huashan Hospital affiliated to Fudan University between January 2014 and July 2016 were studied. Subxiphoid approach video-assisted thoracoscopic thymectomy (SXVT) and through traditional unilateral approach video-assisted thymectomy (TVAT) were compared. The clinical outcomes of SXVT and TVAT were compared. Results There was no surgical death and no statistical difference between the two groups in drainage time, postoperative volume of drainage, postoperative hospital stay and bleeding volume during operation (P>0.05). However, the acute chest pain after surgery, as well as the postoperative chest pain, and operative time were less in the the SXVT group than that in the TVAT group (P<0.05). Conclusion SXVT for myasthenia gravis is safe and executable. It can alleviate intercostal neuralgia and abnormal chest wall feeling. And it should be considered in the treatment of myasthenia gravis.
ObjectiveTo investigate the clinical effect of thoracoscopic lobectomy versus segmentectomy in the treatment of T1bN0M0 non-small cell lung cancer (NSCLC). MethodsClinical data of 181 patients with T1bN0M0 NSCLC admitted to our hospital from 2012 to 2015 were retrospectively analyzed. They were divided into a lobectomy group and a segmentectomy group according to surgical methods. There were 117 patients in the lobectomy group (46 males and 71 females aged 61.32±8.94 years) and 64 patients in the segmentectomy group (20 males and 44 females aged 58.55±12.57 years). Perioperative indicators and prognosis were compared between the two groups. ResultsThe segmentectomy group had longer operation time, less intraoperative blood loss, shorter postoperative hospital stay and more preservation of lung function compared with the lobectomy group (P<0.05). The lobectomy group had higher consolidation tumor ratio, bigger tumor diameter, and more lymph node sampling compared with the segmentectomy group (P<0.05). There was no statistical difference in 5-year overall survival or recurrence-free survival between the two groups (P<0.05). ConclusionFor patients with T1bN0M0 NSCLC, thoracoscopic segmentectomy and lobectomy have similar prognosis, but segmentectomy has advantages with less injury and faster recovery over lobectomy.
ObjectiveTo explore the clinical application effects of using no drainage tube in mediastinal tumor resection via thoracoscopic subxiphoid approach. MethodsA retrospective analysis was conducted on the clinical data of patients who underwent mediastinal tumor resection via thoracoscopic subxiphoid approach at the Fourth People's Hospital of Zigong City from January 2020 to February 2024. Patients were divided into a non-drainage tube group and a drainage tube group, and their perioperative data were compared. ResultsA total of 149 patients were included, and there were 111 patients of thymoma, 5 patients of teratoma, and 33 patients of cyst. There were 77 patients in the non-drainage tube group, including 40 males and 37 females, aged 28-79 (53.72±13.34) years; there were 72 patients in the drainage tube group, including 33 males and 39 females, aged 26-80 (55.60±11.06) years. The differences in postoperative pain score at 48 hours, maximum postoperative pain score, postoperative hospital stay, postoperative drainage tube-related complications, and the number of temporary analgesics used after surgery between the two groups were statistically significant (P<0.05). ConclusionThe use of non-drainage tube technology in mediastinal tumor resection through thoracoscopic subxiphoid approach can reduce postoperative pain and the number of temporary analgesics used, as well as decrease the incidence of drainage tube-related complications.