Persistent air leaks (PAL) is a common complications after pulmonary operation. Risk factors include operationrelated and general factors. At present， stapling device, staple line buttressing, pleural tent, and pneumoperitoneum are the main methods for management. This review described the definition, risk factors, qualitative and quantitative evaluation, and recent progress in air leak prevention and management.
Quality control of general thoracic surgery contains many links including the qualification and technical conditions of medical institutions, preoperative diagnostic system, surgery, postoperative management, pathological diagnosis and follow-up. Standards of quality control should be based on evidence-based medicine, and general rules with detailed criteria. As one of the core concepts of quality control, fine management is ought to strictly follow clinical practice guideline of thoracic surgery, to be clear with quality standards of each key link in clinical pathway, and to improve the clinical quality control system that combines self-evaluation and supervision and inspection.
With the wide utilization of high-resolution computed tomography (HRCT) in the lung cancer screening, patients detected with pulmonary ground-glass nodules (GGNs) have increased over time and account for a large proportion of all thoracic diseases. Because of its less invasiveness and fast recovery, video-assisted thoracoscopic surgery (VATS) is currently the first choice of surgical approach to lung nodule resection. However, GGNs are usually difficult to recognize during VATS, and failure of nodule localization would result in conversion to thoracotomy or extended lung resection. In order to cope with this problem, a series of approaches for pulmonary nodule localization have developed in the last few years. This article aims to summarize the reported methods of lung nodule localization and analyze its corresponding pros and cons, in order to help thoracic surgeons to choose appropriate localization method in different clinical conditions.
[Abstract]The rapid development of domestically produced high-end medical endoscopes, particularly those incorporating 4K ultra-high-definition and fluorescence imaging, has shown significant promise in minimally invasive thoracic surgery. This expert consensus systematically delineates the clinical applications and value of these advanced technologies in various thoracic procedures, including wedge resection, anatomical segmentectomy, and bronchial sleeve resection. Furthermore, it establishes a scientific, quantitative evaluation system for these domestic thoracoscopes. The proposed framework comprises four primary indicators (reliability, efficiency & cost-effectiveness, clinical performance, and service & support) and 14 secondary indicators, each with a defined weight. This consensus aims to provide technical guidance for clinicians, direct future research and development for manufacturers, and ultimately promote the widespread adoption of high-quality domestic medical endoscopes, thereby advancing the national medical equipment industry.
With the development of thin section axial computed tomography scan, the detection rate of pulmonary ground-glass nodules (GGN) continues increasing. GGN has a special natural growth history: pure ground-glass nodules (PGGN) smaller than 10 mm can hold steady for a long term, surgery resection is unnecessary, patients need regular follow up. Larger part solid ground-glass nodules (PSN) with a solid component can be malignant early stage lung cancer, which requires early surgery intervention. Establishment of a standard definition of GGN growth, investments in the long term natural growth history of GGN, validation of the clinical, radiology and genetic risk factors would be beneficial for the management of GGN patients.
Histopathology is still the golden standard for the diagnosis of clinical diseases. Whole slide image (WSI) can make up for the shortcomings of traditional glass slices, such as easy damage, difficult retrieval and poor diagnostic repeatability, but it also brings huge workload. Artificial intelligence (AI) assisted pathologist's WSI analysis can solve the problem of low efficiency and improve the consistency of diagnosis. Among them, the convolution neural network (CNN) algorithm is the most widely used. This article aims to review the reported application of CNN in WSI image analysis, summarizes the development trend of CNN in the field of pathology and makes a prospect.
Systematic lymph nodes dissection has been a standard procedure in lung cancer surgery, while the manipulation of mediastinal lymph nodes for early stage lung cancer remains controversial since surgeons have been weighing the advantages and disadvantages of different methods of lymph node dissection. With an increasing in early stage non-small cell lung cancer patients in recent years, there are more and more intensive studies especially focusing on the mediastinal lymph nodes dissection of clinical stage ⅠA lung cancer. In this review, the lymph nodes management of clinical stage ⅠA non-small cell lung cancer, especially systematic lymph nodes dissection and sampling as well as lobe-specific lymph node dissection, are summarized.
Acute pulmonary embolism (PE) is a common disorder with significant morbidity and mortality in patients who underwent pulmonary ground-glass nodules (GGN) resection. We should make efforts to increase surgeons' awareness of risk factors of PE and their understanding of the effectiveness of prevention strategies. Using the optimal risk assessment model to identify high-risk patients and give them the individualized prophylaxis. Early diagnosis and accurate risk stratification is mandatory to reduce the rates of PE, to decrease health care costs and shorten the length of stay. This article summarizes the risk factors, diagnostic process, risk assessment models, prophylaxis and therapy for the PE patients who underwent GGN resection.
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.