ObjectiveTo explore an effective and safe drainage method, by comparing open thoracic drainage and conventional thoracic drainage for lung cancer patients after thoracoscopic pneumonectomy.MethodsThe clinical data of 147 patients who underwent thoracoscopic pneumonectomy from January 2015 to March 2018 in our hospital were retrospectively analyzed, including 128 males and 19 females. Based on drainage methods, they were divided into an open drainage group (open group) and a conventional drainage group (regular group). The incidence of postoperative complications, chest tube duration, drainage volume at postoperative 3 days, postoperative hospital stay, hospitalization cost and quality of life were compared between the two groups.ResultsPostoperative complication rate was lower in the open group than that in the regular group (10.20% vs. 23.47%, P=0.04). The chest tube duration of the open group was longer compared with the regular group (5.57±2.36 d vs. 3.22±1.23 d, P<0.001). The drainage volume at postoperative 3 days was less in the regular group. In the open group, ambulation was earlier, thoracocentesis was less and re-intubation rate was lower (all P<0.001). The postoperative hospital stay in the regular group was significantly longer than that in the open group (8.37±2.56 d vs. 6.35±1.87 d, P<0.001) and hospitalization cost was significantly higher (66.2±5.4 thousand yuan vs. 59.6±7.3 thousand yuan, P<0.001). Besides, quality of life in 1 and 3 months after operation was significantly better than that in the open group (P<0.001).ConclusionCompared with the regular chest drainage, the effect of open thoracic drainage is better, which can help reduce postoperative complications, shorten the length of hospital stay, reduce the hospitalization cost and improve the quality of postoperative life. It is worthy of clinical promotion.
ObjectiveTo explore the clinical efficacy of thoracoscopy-assisted modified Nuss procedure for pectus excavatum (PE) in children.MethodsThe clinical data of patients with PE who underwent thoracoscopy-assisted modified Nuss procedure from October 2013 to October 2020 in Daping Hospital were retrospectively analyzed.ResultsA total of 86 patients were collected, including 79 males and 7 females with a mean age of 14.03±3.36 years. The operations were performed successfully in all patients without intraoperative cardiac vascular injury or perioperative death. The mean operation time was 87.30±33.45 min, bleeding volume was 19.94±14.60 mL, and the postoperative hospitalization stay time was 6.89±2.59 d. Early postoperative complications included 2 patients of pneumothorax, 2 patients of wound fat liquefaction and infection, 2 patients of bar flipping and displacement. One patient had bar displacement 1 year after the surgery. The total complication rate was 8.14%. All patients were followed up for 3-42 months. The bars were taken out about 36 months after the surgery. According to the evaluation criteria of orthopedic effect, 68 (79.07%) patients were excellent, 10 (11.63%) patients were good, 5 (5.81%) patients were moderate and 3 (3.49%) patients were poor.ConclusionMinimally invasive and individualized shaping via the Nuss procedure for PE children is safe and convenient, with satisfied effect. It is worthy of popularization in the clinic.
Objective To assess the clinical value of preoperative localization coupled with computed tomography (CT) three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection. Methods The clinical data of 30 patients of combined subsegmental/segmental resection in our hospital from December 2019 to October 2021 were retrospectively collected. There were 19 males and 11 females with the mean age of 56.4 (32.0-71.0) years. The pulmonary nodules were located by CT-guided injection of glue before operation. The three-dimensional reconstruction image and operation planning were carried out by Mimics 21.0 software. ResultsThe operations were all successfully performed, and there was no conversion to open thoracotomy or lobectomy. The mean tumor diameter was 11.6±3.5 mm, the mean distance between the nodule and the visceral pleura was 13.6±5.6 mm, the mean width of the actual cutting edge was 25.0±6.5 mm, the mean operation time was 110.2±23.8 min, the mean number of lymph node dissection stations was 6.5±2.4, the mean amount of intraoperative bleeding was 50.8±20.3 mL, the mean retention time of thoracic catheter was 3.2±1.1 d, and the mean postoperative hospital stay was 4.5±1.7 d. There was 1 patient of subcutaneous emphysema, 1 patient of atrial fibrillation and 1 patient of blood in sputum. Conclusion Preoperative CT-guided injection of medical glue combined with CT three-dimensional reconstruction of pulmonary bronchus and blood vessels is safe and feasible in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection, which ensures the surgical margin and reserves lung tissues.
Objective To compare three surgical treatments for mediastinal mass with myasthenia gravis. Methods Retrospective analysis was performed on the clinical data of 53 patients who underwent extended thymectomy between January 2010 and December 2017 in our hospital. There were 29 males and 24 females, aged 17-73 years. Patients were divided into three groups according to the surgical methods: a group A (video-assisted thoracoscopic surgery with the da Vinci robotic system, n=22), a group B (video-assisted thoracoscopic surgery, n=12) and a group C (median sternotomy, n=19). The gender distribution, age, intraoperative blood loss, operation time, postoperative extubation time, postoperative hospital stay, Osserman classification of myasthenia gravis, postoperative myasthenic remission rate, etc were compared in three groups. Results No perioperative death was observed in 53 patients. One patient in the group C suffered from postoperative myasthenic crisis and improved after active treatment. One patient with video-assisted thoracoscopic surgery was converted to median sternotomy due to the intraoperative injury of the left brachiocephalic vein. Compared with the group B and group C, the group A had shorter operation time, less intraoperative blood loss and drainage on the first postoperative day and fewer days of extubation. Postoperative hospital stay was less in the group A than that in the group C (P<0.05). The postoperative myasthenic remission rate was higher in the group A than that in the other two groups, but there was no statistical difference. Conclusion Because of the robot’s unique minimally invasive advantage, in this study, the outcome of patients with myasthenia gravis treated with Da Vinci robots and thymectomy is better than that of the remaining two groups in terms of perioperative outcomes and myasthenic remission rate. But long-term results and a large of number matching experiments are needed to confirm. However, it is undeniable that robotic surgery must be the future of the minimally invasive surgery.
ObjectiveTo explore the safety, feasibility and superiority of tubeless video-assisted thoracoscopy in the treatment of primary palmar hyperhidrosis (PPH).MethodsThe clinical data of 46 patients with palmar hyperhidrosis treated by thoracoscopy in the Department of Thoracic Surgery of the First Hospital of Lanzhou University from March 2017 to September 2020 were retrospectively analyzed. Among them, 22 received tubeless video-assisted thoracoscopic surgery, and were divided into a tubeless group, including 10 males and 12 females with an average age of 24.3±6.4 years; 24 received conventional thoracoscopic surgery, and were divided into a control group, including 13 males and 11 females with an average age of 23.5±4.8 years. The operation status, anesthesia effect and postoperative complications of the two groups were compared.ResultsForty-six patients successfully completed the operation with the assistance of thoracoscopy. There was no intraoperative transfer to thoracotomy, or intraoperative transfer to tracheal intubation in the tubeless group. Anesthetic recovery time (14.4±1.6 min vs. 20.1±1.8 min, P=0.000), time to get out of bed on the first postoperative day (3.1±0.6 h vs. 1.6±0.4 h, P=0.000), visual analogue score for postoperative pain (1.4±0.6 points vs. 3.4±1.1 points, P=0.000), postoperative hospital stay (1.7±0.5 d vs. 2.8±0.6 d, P=0.000), postoperative satisfaction rate of patients (95.5% vs. 66.7%, P=0.037) in the tubeless group were shorter or better than those in the control group. There was no statistical difference in age, gender, smoking history, palmar hyperhidrosis classification, palms or other associated parts, the total time of bilateral surgery, intraoperative blood loss, postoperative complications, or compensatory hyperhidrosis (mild) between the two groups (P>0.05).ConclusionCompared with traditional thoracoscopic surgery for PPH, tubeless video-assisted thoracoscopic surgery for PPH has the advantages of safety, reliability, light pain and quick recovery, in line with the concept of accelerated rehabilitation surgery.
ObjectiveTo analyze the effect of 3D simulation technique in thoracoscopic lobectomy.MethodsFrom June 2015 to January 2018, 124 patients with left lower lobe resection underwent thoracoscopy with single-port thoracoscopic surgery, including 64 males and 60 females, aged 42–83 years. They were randomly divided into two groups including an experimental group (preoperatively given 3D simulation surgery in 59 patients) and a control group (preoperatively not given 3D simulation surgery in 65 patients). The clinical effect between the two groups was compared.ResultsAll patients recovered without any death during hospitalization. In the experimental group, the operation time, intraoperative blood loss and postoperative hospital stay were significantly less than those in the control group (P<0.05). There was no significant difference in postoperative drainage volume, and duration of drainage tube retention and analgesic drug usage between the two groups (P>0.05).Conclusion3D simulation technique for thoracoscopic lobectomy has advantage in short operation time, minor trauma and quick recovery. It has a guiding role in the preoperative planning of lung cancer surgery and is worthy of popularization and application.
ObjectiveTo summarize the efficacy of clips and staplers for left atrial appendage in the thoracoscopic treatment of atrial fibrillation. Methods The clinical data of patients with atrial fibrillation treated in Xinhua Hospital from 2015 to 2016 were retrospectively analyzed. All patients received Mei's minimally invasive surgery for atrial fibrillation. Among them, patients were recruited in a clip group by clipping the left atrial appendage. The other patients were recruited in a stapler group to resect the left atrial appendage by stapler. Follow-up was conducted by outpatient clinic and telephone. Postoperative heart rhythm was recorded by the patient's symptoms, electrocardiogram and 24 h holter. Cranial magnetic resonance, cardiac CT and echocardiography were performed at least once during follow-up. Results There were 30 patients in the clip group, including 20 males and 10 females, with an average age of 65.7±7.1 years. There were 30 patients in the stapler group, including 20 males and 10 females with an average age of 66.8±5.4 years. All patients successfully received the procedure, with no conversion to thoracotomy or perioperative death. Sinus rhythm was maintained at discharge in 56 (93.3%) patients. Till June 2020, 59 patients were followed up for 42-66 (54.1±7.3) months and 1 patient in the clip group was lost. The residual length of the left atrial appendage was 3.9±1.8 mm in the clip group and 3.9±2.8 mm in the stapler group, and there was no statistical difference between the two groups (P=0.910). Kaplan-Meier curve indicated that there was no statistical difference in the maintenance of sinus rhythm between the two groups (P=0.757). During the follow-up period, all patients had no cerebrovascular adverse events such as stroke or embolism. Conclusion Clipping and resection of the left atrial appendage in thoracoscopic atrial fibrillation surgery are both safe and effective methods, which effectively prevent stroke. The atrial appendage clip makes the minimally invasive surgical intervention of the left atrial appendage safer and more convenient.
ObjectiveTo investigate the short-term efficacy and safety of thoracoscopy-assisted epicardial radiofrequency ablation for atrial fibrillation (AF) and/or left atrial appendage exclusion (LAAE).MethodsThe clinical data of 12 patients with solitary AF admitted to Beijing Tiantan Hospital from November 2018 to August 2020 were retrospectively analyzed, including 7 males and 5 females, with an average age of 65.2±5.3 years. Of them, 2 had paroxysmal AF, 1 had persistent AF and 9 had permanent AF.ResultsNo patient died during hospitalization, 5 patients underwent radiofrequency ablation for AF and LAAE, and 6 received LAAE alone. The operation time was 293±70 min in radiofrequency ablation for AF+LAAE patients and 71±14 min in LAAE patients. Two patients restored sinus rhythm, two restored after electric cardioversion, and one remained AF in AF+LAAE patients. Postoperatively, 1 patient had pleural effusion and 1 had subcutaneous emphysema. No stroke was observed.ConclusionThoracoscopy-assisted radiofrequency ablation for AF and/or LAAE reduce the risk of procedure, and provide alternative approach to treat AF-associated diseases. However, large sample size studies using prospective cohort designs are required to corroborate the present findings.
ObjectiveTo investigate the efficacy of uniportal video-assisted thoracoscopic surgery (VATS) anatomic basal segmentectomy.MethodsThe clinical data of 15 patients who underwent uniportal VATS anatomic basal segmentectomy between June 2020 and December 2020 were retrospectively reviewed. There were 4 males and 11 females with a median age of 53 (32-70) years. The incisions were placed in the fifth intercostal space across the mid-axillary line. All basal segmentectomies were performed through the interlobar fissure or inferior pulmonary ligament approach following the strategies of single-direction and stem-branch.ResultsAll patients underwent basal segmentectomy successfully with no conversion to multi-portal procedure or thoracotomy. The median operation time was 120 (90-160) min, median intraoperative blood loss was 20 (10-50) mL, median drainage time was 3 (2-5) d, and median postoperative hospital stay was 4 (4-10) d. The maximum diameter of the lesion in the resected basal segment was 1.2 (0.7-1.9) cm. The median resected lymph nodes were 7 (5-12). There was no evidence of nodal metastases. One patient suffered postoperative atelectasis and subsequent pneumonia. No perioperative death occurred.ConclusionUniportal VATS anatomic basal segmentectomy is feasible and safe. It can be performed in a simple manner following the strategy of single-direction.
Objective To compare the effect of uniportal and multiportal thoracoscopic lobectomy, and to explore the advantages and applications of uniportal thoracoscopic lobectomy in enhanced recovery after surgery. Methods Totally 169 patients with video-assisted thoracoscopic lobectomy in Department of Thoracic Surgery of Sichuan Cancer Hospital from January to December 2016 were enrolled. There were 99 males and 70 females with age of 60.83±7.24 years. Patients were divided into two groups: a uniportal group (78 patients) and a multiportal group (91 patients) . Patients’ clinical and pathological materials were collected. Postoperative pain, complications and hospital stay, etc of the two groups were compared. Results All patients were successfully discharged without serious postoperative complication or death. Patients in the multiportal group had smaller surgical incisions than that in the uniportal group (3.12±0.73 cm vs. 6.38±1.50 cm, P=0.016). Pain scores at postoperative 24 and 48 hours of the uniportal group were less than those of multiportal group (4.18±1.67 vs. 6.54±1.83, 3.05±1.47 vs. 4.68±1.64, P<0.05). Operation data, postoperative complications and hospital stay were similar in both groups. Conclusion Uniportal video-assisted thoracoscopic lobectomy makes smaller incisions and can further reduce postoperative pain and dosage of morphine. The operation is safe and worthy of wide application in enhanced recoveryafter surgery.