Objective To explore the learning curve and evaluate the safety of uniportal complete video-assisted thoracoscopic surgery (VATS) lobectomy. Methods We reviewed retrospectively the clinical data of 133 patients, who underwent uniportal VATS between March 2015 and October 2016 in Sichuan Provincial Cancer Hospital. There were 79 males and 54 females at age of 52.21±10.77 years. Results All the 127 patients completed uniportal VATS, 4.51% (6/133) converted to open surgery. There were 78 patients with lobectomy, 6 patients with segmentectomy, 37 patients with wedge resection, 6 patients with pleural, mediastinal lymph node biopsy or mediastinal tumor resection. In the lobectomy group, mean surgical time was 148.75±34.12 min, mean blood loss was 118.87±59.96 ml, mean number of lymph nodes was 11.25±6.15, the mean duration of chest-tube placement was 2.17±1.35 days, and mean length of stay was 7.58±2.59 days. Conclusion Based on skillful performance of the conventional thoracoscopic lobectomy, the learning curve for single port thoracoscopic lobectomy comprises at least 20 patients. The uniportal VATS lobectomy is a safe and operable method of minimally invasive technique, and it is worthy to be applied in thoracic surgery.
Objective To investigate the clinical value of using videoassisted thoracoscopic lobectomy（VATS lobectomy） to treat primary nonsmall cell lung cancer(NSCLC) so that the videoassisted thoracoscopic surgery(VATS) can be better used in clinic. Methods From September 2007 to December 2008, seventysix NSCLC patients were collected. Thirtyseven patients underwent VATS lobectomy(VATS group), 21 male and 16 female with an average age of 60.4 years. Among them 20 underwent videoassisted minithoracotomy lobectomy, and 17 underwent total thoracoscopic lobectomy. Thirtynine patients underwent conventional thoractomy(conventional thoracotomy group), 32 male and 7 female with an average age of 58.7 years. Perioperative clinical and laboratory parameters of the two groups were compared. Results There was no severe complication and perioperative mortality in both groups. There were statistical significances between VATS group and conventional thoracotomy group in incision length (7.6±1.9 cm vs. 28.5±3.6 cm, t=-31.390,P=0.000), postoperative dosage of dolantin(160±125 mg vs.232±101 mg，t=-2.789,P=0.007), postoperative chest tube time(chest tube output＞100ml,4.8±2.5 d vs. 8.1±3.2 d，t=-4.944,P=0.000） and postoperative hospitalization time(12.1±3.0 d vs. 15.7±4.7 d，t=-3.945,P=0.000). There was no statistical significance between two groups in operation time（t=1.732，P=0.087）, intraoperative blood loss（t=-1.645，P=0.105） and the number of lymph node dissection（t=-0.088，P=0.930）. The total hospitalization expenses in VATS group were higher than that in conventional thoracotomy group, but there was no statistical significance（t=1.303，P=0.197）. The serum levels of glucose at 1st day after operation（7.2±1.2 mmol/L vs. 8.4±2.2 mmol/L, t=5.603,P=0.000）and the total count of white blood cell (12.7±3.8×10.9/L vs. 15.1±5.9×10.9/L,t=5.082,P=0.004) in VATS group were significantly lower than that in conventional thoracotomy group. The prealbumin(PA) level in VATS group was significantly higher than that in conventional thoracotomy group（215.0±45.5 mg/L vs.147.3+50.8 mg/L,t=-7.931,P=0.000). Conclusion VATS lobectomy could clean lymph node completely. Its advantages include less postoperative trauma, lower acute phase response, mild pain, rapid recovery, shorter hospitalization time and less economic burden. It could be an operation approach for early NSCLC patients who have been strictly selected.
Objective To investigate the security and feasibility of silk ligating for pulmonary artery in video-assisted thoracoscopic lobectomy, and to summarize the clinical skills. Methods We retrospectively analyzed the clinical data of 68 patients underwent the video-assisted thoracoscopic lobectomy from April 2013 to March 2015. There were 49 males and 19 females with the mean age of 59.6±10.3 years, ranging from 38 to 76 years. We divided the patients into an ECR60W cut-up group (31 patients) and a silk ligation group (37 patients). There were 22 males and 9 females patients with the average age of 59.3±9.9 years with ECR60W. There were 27 males and 10 females patients with the average age of 59.9±10.5 years with silk ligation. We observed the effect of hemostasis, and analyzed the amount of bleeding loss during operation, postoperative suction drainage and the cost of operation material between the two groups. Results There were 4 patients out of 68 converted to the open lobectomy, and all of them used ECR60W. The application of silk ligation for pulmo-nary artery could effectively control bleeding loss and avoid massive amount of bleeding due to the vascular tear in opera-tions. Furthermore, the application can reduce the rate of severe complications such as massive bleeding resulting from postoperative silk ligation slippage. There was a statistical difference between the two groups on the cost of operation mate-rials (P < 0.01). Conclusions Silk ligation for pulmonary artery in video-assisted thoracoscopic lobectomy is simple and prac-tical to apply. Compared with the ECR60W, it can significantly reduce the cost of operation material. It's worth to popularize in clinic.
Objective To compare the surgical trauma between videoassisted thoracoscopic surgery(VATS) and conventional thoracotomy, and to investigate the possible minimally invasive mechanism. Methods Seventyseven patients who had undergone consecutive operations from April 2005 to January 2006 were chosen from cardiothoracic surgery department of Fujian Provincial Hospital. Twentytwo cases had spontaneous pneumothorax diagnosed by chest X-ray examination, twentynine had patent ductus arteriosus diagnosed by color echocardiography, and twentysix had congenital atrial septal defect. According to lesions and operative methods, the patients were divided into two groups: conventional thoracotomy group(CTH group) and videoassisted thoracoscopic surgery group(VATS group). The concentrations of serum C-reactive protein（CRP），interleukin6 (IL-6)，interleukin-8（IL-8） and tumor necrosis factor-α(TNF-α) were selected as indexes to measure surgical trauma. ARRAY360 specific protein and pharmaceutical analysis system were used to determine CRP automaticly at the day before operation and on the 1st, 2nd and 3rd day after operation. Radioimmunoassay was used to measure the concentrations of IL-6，IL-8 and TNF-α. Clinical indexes such as operative time, cardiopulmonary bypass (CPB) time, intraoperative blood lost, postoperative analgesic time and hospitalization time were analyzed and compared. Results Under the condition that patients had the same diseases, there was no statistical significance in preoperative concentrations of serum CRP，IL-6，IL-8 and TNFα between VATS group and CTH group（P=0.067, 0.062, 0.053,0.064）. The concentrations of serum CRP(P=0.045,0.043,0.044), IL-6(P=0.042，0.032，0.039), IL-8(P=0.046，0.045，0.048) and TNF-α(P=0.041，0.043，0.043) on the 1st, 2nd and 3rd day after operation were significantly lower in VATS group than that in CTH group (Plt;0.05). Compared with CTH group, there were less blood lost（P=0.032）, shorter postoperative analgesic time and hospitalization time（P=0.041） in VATS group. There was no statistical significance in CPB time between two groups. However, hospitalization time varied with different diseases. Conclusion Compared with conventional thoracotomy，videoassisted thoracoscopic surgery has less surgical trauma, less intraoperative blood lost, shorter postoperative analgesic time, and can make patients recover rapidly. So it is worth spreading.
Recently, the frequency of lung disease appears higher and more precise than previously estimated. Small pulmonary nodules (SPNs) are frequently detected on high-resolution computed tomography (CT) scans. For the reason of high rate of false positives by fine needle aspirate biopsy, small lung nodules often can not be confirmed by monitor or palpation with forceps. How to precisely locate and mark the nodule before the surgery is one of the most important things for video-assisted thoracoscopic surgery (VATS). We reviews the methods of location the pulmonary nodules before the surgery and analyzes the advantages and disadvantages of various methods.
ObjectiveTo investigate the changes in pulmonary function after video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS) segmentectomy.MethodsA total of 59 patients (30 males and 29 females) who underwent segmentectomy in the Affiliated Hospital of Qingdao University from July to October 2017 were included. There were 33 patients (18 males and 15 females) in the VATS group and 26 patients (12 males and 14 females) in the RATS group. Lung function tests were performed before surgery, 1 month, 6 months, and 12 months after surgery. Intra- and inter-group comparisons of lung function retention values were performed between the two groups of patients to analyze differences in lung function retention after VATS and RATS segmentectomy.ResultsThe forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) in the VATS group and the RATS group were significantly lower than those before surgery (P<0.05), and they increased significantly within 6 months after surgery (P<0.05). The recovery was not obvious after 6 months (P>0.05), and they were still lower than those before surgery. In addition, the retentions of FEV1 and FVC in the VATS group and the RATS group were similar in 1 month, 6 months, and 12 months after operation with no statistical difference(P>0.05). ConclusionPulmonary function decreases significantly in 1 month after minimally invasive segmentectomy, and the recovery is obvious in 6 months after the operation, then the pulmonary function recovery gradually stabilizes 12 months after surgery. FEV1 of the patients in the two groups recovers to 93% and 94%, respectively. There is no statistical difference in pulmonary function retention after VATS and RATS segmentectomy.
Objective To explore the risk factors and short-term clinical effect of conversion to open thoracotomy during thoracoscopic lobectomy for lung cancer patients. Methods We retrospectively analyzed the clinical data of 423 lung cancer patients who were scheduled for thoracoscopic lobectomy between March 2011 and November 2015.There were 252 males and 171 females at median age of 60 (24-83) years. According to the patients who were and were not converted to thoracotomy, they were divided into a conversion group (378 patients) and a video-assisted thoracic surgery group (a VATS group, 45 patients). Then, clinical data of two groups were compared, and the risk factors and short-term clinical effect of unplanned conversions to thoracotomy were analyzed. Results Lymph nodes of hilar or/and interlobar fissure closely adhered to adjacent vessels and bronchi was the most common cause of unexpected conversions to thoracotomy in 15 patients (33.3%), followed by sleeve lobectomy in 11(24.4%) patients, uncontrolled hemorrhage caused by intraoperative vessel injury in 8 patients, tumor invasion or extension in 5 patients, difficulty of exposing bronchi in 3 patients, close adhesion of pleural in 2 patients, incomplete interlobar fissure in 1 patient. Conversion did translate into higher overall postoperative complication rate (P=0.030), longer operation time (P<0.001), more intraoperative blood loss (P<0.001). In the univariable analysis, the type of operation, the anatomical site of lung cancer, the lymph node enlargement of hilar in CT and the low diffusion capacity for carbon monoxide (DLCO) were related to conversion. Logistic regression analysis showed that the independent risk factors for conversion were sleeve lobectomy (OR=5.675, 95%CI 2.310–13.944, P<0.001), the lymph node enlargement of hilar in CT (OR=3.732, 95%CI 1.347–10.341, P=0.011) and DLCO≤5.16 mmol/(min·kPa)(OR=3.665, 95%CI 1.868–7.190, P<0.001). Conclusions Conversion to open thoracotomy during video-assisted thoracic surgery lobectomy for lung cancer does not increase mortality, and it is a measure of reducing the risk of surgery. Therefore, with high-risk patients who may conversion to thoracotomy, the surgeon should be careful selection for VATS candidate. And, if necessary, the decision to convert must be made promptly to reduce short-term adverse outcome.
Abstract: Objective To summarize the clinical experiences of applying completely videoassisted thoracoscopic lobectomy in pulmonary diseases treatment, and evaluate its safety, indication and efficacy. Methods We retrospectively analyzed the clinical data of 47 patients with pulmonary diseases undergoing completely videoassisted thoracoscopic lobectomy at the First People’s Hospital of Yunnan Province between October 2008 and November 2010. Among the patients, there were 35 males and 12 females with their age ranged from 30 to 72 years averaging at 61.5 years. Adenocarcinoma was present in 27 patients, squamous carcinoma in 9 patients, small cell carcinoma in 1 patient, tuberculosis in 3 patients, bronchiectasis in 3 patients, pulmonary inflammatory pseudotumor in 2 patients, hamartoma in 1 patient, and giant bulla in 1 patient. All patients underwent completely videoassisted thoracoscopic lobectomy which was carried out through three miniinvasive incisions without the use of rib spreader. Systemic lymph node dissection was performed for patients with malignancies. Blood loss, operation time, the rate of conversion to thoracotomy, postoperative hospital stay, and complications were observed. Results Completely videoassisted thoracoscopic lobectomy was successfully performed in 44 patients, and the other 3 patients were changed to open thoracotomy due to bleeding in one patient, T3 tumor in one patient and accidentally injured bronchus in one patient. The overall conversion rate was 6.4% (3/47). The mean operation time, blood loss and postoperative hospital stay were respectively 120±45 minutes, 150±80 ml, and 7±2 days. No perioperative death occurred. There were 9 patients of complications including lymphatic fistula, air leak, atrial fibrillation and atelectasis, and they all recovered after conservative treatment. Fortyfour- patients were followed up for -1 to 23 months with 3 patients missing. One-patient had bloody sputum during the followup, but recovered spontaneously later. Brain metastasis occurred to a stage Ⅲa patient with primary lung cancer 9 months after operation, and the patient survived after treatment with gamma knife. No recurrence happened to the other patients and their quality of life was good. Conclusion Completely videoassisted thoracoscopic lobectomy is a safe and feasible surgical procedure for patients with earlystage lung cancer and benign pulmonary lesions which need lobectomy. However, it is necessary to select the patients carefully in the early period of practising.