The application of inpatient electronic medical records (EMRs) is a crucial component of modern healthcare informatization, and also a key factor in improving medical quality and safety. Establishing standardized EMRs for thoracic surgery helps to standardize treatment processes, improve medical efficiency, enhance quality of care, and better ensure patient safety. It also facilitates the collection and use of standardized and structured data, promoting clinical decision-making, the application of artificial intelligence, and the development of specialized clinical centers. Considering relevant national policies, information standards, clinical practice challenges and latest research findings in thoracic surgery EMRs, Chinese Association of Thoracic Surgeons, Cross-Strait Medicine Exchange Association’s Thoracic Surgery Professional Committee, WU Jieping Medical Foundation’s Lung Cancer Professional Committee, Zhejiang Provincial Thoracic Surgeons Associations and Fujian Provincial Thoracic Surgeons Associations have explored innovative paths for EMRs development. Through multiple rounds of professional discussions and research, the "Chinese expert consensus on quality control and management of electronic medical records for thoracic surgery (2024 version)" was formulated. It aims to provide a reference for the construction and application of inpatient EMRs for thoracic surgeons and information professionals across China, promoting continuous improvement in the informatization and medical standards of the thoracic surgery field, and contributing to the construction of "healthy China".
ObjectiveTo explore the clinical applications of 3D-CT reconstruction combined with 3D printing in the analysis of anatomical types and variations of bilateral pulmonary arteries. MethodsFrom January 2019 to February 2022, the clinical data of 547 patients who underwent anatomical lung lesion resection in our hospital were retrospectively collected. They were divided into a 3D-CT reconstruction plus printing technology group (n=298, 87 males and 211 females aged 53.84±12.94 years), a 3D-CT reconstruction group (n=148, 55 males and 93 females aged 54.21±11.39 years), and a non-3D group (n=101, 28 males and 73 females aged 53.17±10.60 years). ResultsIn the 3D-CT reconstruction plus printing technology group, the operation time of patients (right: 125.61±20.99 min, left: 119.26±28.44 min) was shorter than that in the 3D-CT reconstruction group (right: 130.48±11.28 min, left: 125.51±10.59 min) and non-3D group (right: 134.45±10.20 min, left: 130.44±9.53 min), which was not associated with the site of surgery; intraoperative blood loss (right: 20.92±8.22 mL, left: 16.85±10.43 mL) was not statistically different compared with the 3D-CT reconstruction group (right: 21.13±8.97 mL, left: 19.09±7.01 mL), but was less than that of the non-3D group (right: 24.44±10.72 mL, left: 23.72±11.45 mL). Variation was found in the right pulmonary artery of 7 (3.91%) patients and in the left pulmonary artery of 21 (17.65%) patients. We first found four-branched lingual pulmonary artery in 2 patients.ConclusionPreoperative CT image computer-assisted 3D reconstruction combined with 3D printing technology can help surgeons to formulate accurate surgical plans, shorten operation time and reduce intraoperative blood loss.
Extracorporeal membrane oxygenation (ECMO), as an extracorporeal life support technology, can provide respiratory support and hemodynamic support according to different modes. The significant advantages of ECMO in the treatment of acute respiratory distress syndrome and the development of its oxygenator, pump, and heparin-coated circuits have promoted its application and exploration in thoracic surgery. ECMO can be used during the perioperative period of lung transplantation and can be applied for patients who cannot maintain one-lung ventilation, or have a high risk of anesthesia, or undergo complex thoracic surgery involving trachea, carina, mediastinum and esophagus. This article will review the application and progress of ECMO in general thoracic surgery.
In recent years, the Chengdu Municipal Thoracic Surgery Quality Control Center has preliminarily established a regional quality control system for thoracic surgery through the development of standards, data reporting, and on-site supervision, achieving phased improvements. This review summarizes the current development of Chengdu’s thoracic surgery quality control system, including its organizational structure and scoring methodology, quality indicators based on structure–process–outcome, information technology infrastructure, and multicenter collaboration experiences, and outlines trends in surgical volume, minimally invasive procedure rates, human resources, and care quality metrics. It also analyzes existing challenges such as inter-hospital quality disparities and insufficient interoperability among information platforms. Drawing on domestic and international best practices, we propose development strategies to further enhance the homogenization and continuous improvement of thoracic surgery quality in the region. The Chengdu experience could offer a valuable model for building regional thoracic surgery quality control systems nationwide and for integration with the national quality control platform.
ObjectiveTo systematically evaluate the effectiveness, safety and ethics of Da Vinci Surigcal System (dVSS)in the field of cardiothoracic surgery, and provide evidence for its clinical application. MethodsWe searched VIP, CNKI, WanFang Database, CBM, official website of National Health and Family Planning Commission of People's Republic of China, PubMed, Cochrane Library, Google Scholar, WHO ICTRP search portal, ClinicalTrials.gov, Chinese Clinical Trial Registration Center, Australian-New Zealand Clinical Trials Registry and ISRCTN to collect clinical trials of dVSS for thoracic and cardiovascular diseases to evaluate its effectiveness, safety and ethics. The search time was from the establishment of each database to January 2014. The quality of included literatures was evaluated by Grades of Recommendations Assessment, Development and Evaluation (GRADE). ResultsA total of 31 studies were identified including 4 case control studies and 27 retrospective studies involving 1 037 patients. The quality of included literatures was all very low. dVSS had been widely used in cardiothoracic surgery including coronary artery bypass grafting, valvuloplasty or valve replacement, thoracic tumor resection, etc. Compared with conventional surgery and thoracoscopy, the safety and effectiveness of dVSS was good, while its economic burden was heavier for the patients. dVSS could benefit patients and improve clinical level of cardiothoracic surgery. The disciplines and qualification of dVSS application was legal, but the maturity of its clinical use needed improvement, and relevant measures were required. The ethics in the research, introduction and application of dVSS had some problems which deserved more attention. ConclusionsClinical use of dVSS in cardiothoracic surgery is relatively safe and effective, but research quality needs to be improved. More studies on the economics and ethics of dVSS are needed in the field of cardiothoracic surgery. Relevant measures of precaution, accountability and patient protection are required to further improve clinical application of dVSS in cardiothoracic surgery, and whole-process ethical supervision should be conducted with the help of existing clinical ethical review platform.
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.