ObjectiveTo evaluate clinical outcomes of single utility port video-assisted thoracoscopic surgery (VATS) lobectomy for patients with early-stage peripheral non-small cell lung cancer. MethodsWe retrospectively analyzed the clinical data of 46 consecutive patients with early-stage peripheral non-small cell lung cancer who underwent single utility port complete VATS lobectomy in the First Affiliated Hospital of Hebei north University from December 2012 through November 2014. There were 39 male patients and 7 female patients with their age of 42-76 (60.26±4.38) years (VATS group). There were 58 patients with early-stage peripheral non-small cell lung cancer who underwent lobectomy via traditional thoracotomy including 47 male and 11 female patients with their age of 44-73 (61.42±3.67) years for the same period (conventional thoracotomy group). Clinical outcomes were compared between the two groups. ResultsAll the operations were successful. There was no conversions during single utility port VATS lobectomy, and no periopera-tive death in both groups. The VATS group had significantly less blood loss (126.10±48.56 ml vs. 260.84±69.70 ml), and amount of thoracic drainage (230.52±50.22 ml vs. 380.16±96.24 ml, P<0.05). Hospital stay was significantly shorter in the VATS group than the conventional thoracotomy group (6.42±1.40 days vs. 9.64±2.08 days, P<0.05). However, there was no significant difference between the VATS group and the conventional thoracotomy group with regard to the opera-ting time (146.25±19.68 minutes vs. 139.26±25.39 minutes), number of lymph nodes procured (13.56±2.31 vs. 14.12±3.06), and postoperative complications (13.0% vs. 19.0%, P>0.05). ConclusionSingle utility port VATS lobectomy for patients with early-stage peripheral non-small cell lung cancer is technically feasible, with less blood loss and shorter hospital stays for achieving acceptable standards of lymph node dissection. It is a promising surgical procedures for patients with early-stage peripheral non-small cell lung cancer.
ObjectiveTo explore the safety and feasibility of the application of video-assisted thoracic surgery (VATS) anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis.MethodsFrom June 2014 to June 2018, 19 patients with bilateral localized bronchiectasis underwent single-stage bilateral thoracic surgery with VATS anatomic segmentectomy, including 11 males and 8 females aged 38.0±12.5 years. The clinical efficacy of the surgery was evaluated.ResultsAll surgeries were successfully completed, of which 17 were bilateral VATS, 2 were unilateral VATS with the other lateral converted to thoracotomy. The average number of bilateral resected segments was 4-8 (5.9±1.2). Mean operation time was 330.0±40.0 min and mean blood loss was 150.0±60.0 mL. Mean ventilator-assisted breathing time was 6.0±1.8 h, mean duration of chest-tube placement was 4.0±1.0 d and mean hospital stay time was 14.0±1.5 d. Three patients suffered pulmonary infection and 1 patient received tracheotomy. No perioperative death occurred. Arterial oxygen pressures on postoperative day (POD) 1 (F=340.18, P<0.05) and POD 3 (F=131.26, P<0.05) were significantly lower than that before operation, arterial carbon dioxide pressures on POD 1 (F=46.62, P<0.05) and POD 3 (F=48.21, P<0.05) were significantly higher than that before operation, and pulse oximeter saturation on POD 1 was significantly lower than that before operation (F=210.82, P<0.05). The patients were followed up for one to five years without recurrence.ConclusionApplication of VATS anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis is safe and feasible with strictly selected patients. Postoperative airway management is very important. The surgery is worthy of wide clinical practice.
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.
ObjectiveTo increase the advantage and decrease the disadvantage of posterior approach for uniportal video-assisted thoracic surgery (VATS) right upper lobectomy.MethodsData of 97 consecutive patients who received uniportal VATS right upper lobectomy using posterior approach in the semiprone position were retrospectively analyzed from Dec, 2014 to Dec, 2017. There were 41 males and 56 females at age of 26–79 (57.8±10.6) years. The hilar structure was cut from posterior to anterior one by one. The mediastinal lymph nodes were dissected if lung cancer was diagnosed.ResultsNinety three of 97 patients were successfully completed with uniportal VATS right upper lobectomy using posterior approach, 3 of them were completed with posterior approach combined with anterior approach, and 1 of them needed thoracotomy. The mean operative time was 76–192 (127.0±32.0) min. The thoracic drainage time was 2–20 (3.4±2.7) d. The postoperative length of hospital stay was 3–23 (5.4±3.1) d. There were postoperative complications in 7 patients and no postoperative mortality.ConclusionPosterior approach for uniportal video-assisted thoracic surgery right upper lobectomy is safe and feasible, which can decrease the fatigue of both the surgeon and the assistant. It also provides with better exposure of posterior mediastinum, less dragging lung, and less interference of the instruments and help keep the clear surgical field. In complicated cases, posterior approach could combine with anterior approach to complete the VATS lobectomy.
Objective To clearly define and describe the difference of analgesic actions and side effects between dezocine and parecoxib sodium in video-assisted thoracic surgery (VATS) lobectomy. Methods Ninety patients underwent thoracotomy (lobectomy) and were hospitalized in the Department of Thoracic Surgery, West China Hospital, Sichuan University between August 2015 and January 2016. Patients were randomly divided into two groups including a parecoxib sodium group (a PG group, 43 patients) and a dezocine group (a DG group, 47 patients). We analyzed the occurrence of side effects in the two groups, as well as other outcomes including visual analogous scores and location of the pain et al. Results The occurrences of nausea, vomit and abdominal distention in the PG group (9.30%, 2.33%, 13.95%) were significantly lower than those of the DG group (25.53%, 17.02%, 40.43% , P=0.046, P=0.032, P=0.009) in the early period after operation. Pain scores at the postoperative 12 h, 24 h, 48 h and 72 h in the PG group (2.56±0.96, 2.47±0.96, 1.93±0.99, 0.98±1.24) were better than those of the DG group (4.00±1.60, 3.62±1.48, 3.36±1.55, 2.47±1.78,P=0.000, P=0.000, P=0.000, P=0.002). And the same results were found in the postoperative coughing VAS assessment. The mostly reported pain location was the chest drainage, incision site and chest wall in turn. Postoperative pain properties, in turn, were swelling, stabbing pain and numbness. Conclusion Postoperative pain after VATS lobectomy may be adequately controlled using parecoxib sodium. The low pain scores and decreased adverse effects are achieved.
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.
Abstract：?Objective?To evaluate clinical outcomes of single utility port complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with early-stage lung cancer.?Methods?We retrospectively analyzed the clinical data of 162 consecutive patients with early-stage lung cancer who underwent single utility port complete VATS lobectomy from September 2009 to October 2011 in Chinese PLA General Hospital （single utility port group），and compared them with 221 patients with early-stage lung cancer who underwent video-assisted mini-thoracotomy （VAMT） lobectomy in the same period （VAMT group）. The clinical outcomes including operation time, intraoperative blood loss, lymph node dissection number, time to first activity out of bed, chest drainage duration and postoperative complications, were compared between the two groups.?Results?No perioperative death was observed in both groups. There were statistical differences in the intraoperative blood loss （162.8±75.6 ml vs. 231.4±62.8 ml）, time to first activity out of bed （2.2±0.3 d vs. 3.7±0.5 d） , and chest drainage duration （3.5±0.2 d vs. 4.6±0.4 d） between the two groups （P＜0.05）. There was no statistical difference in operation time （133.7±22.0 min vs. 124.9±25.7 min） , lymph node dissection number （11.7±1.9 vs. 12.5±2.7）， and incidence of serious postoperative complications （7.4% vs. 8.1%）between the two groups.?Conclusion?Single utility port complete VATS lobectomy and lymph node dissection are safe and reliable for patients with early-stage lung cancer with less injury and better postoperative recovery compared with VAMT.
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.
ObjectiveTo investigate the safety and feasibility of thoracoscopic lobectomy without mechanical suture.MethodsThe data of 28 consecutive patients (a non-mechanical suture group, 16 males and 12 females at age of 61.23±11.10 years) who underwent non-mechanical suture anatomic thoracoscopic lobectomy performed by the same surgeon from March 2015 to March 2018 were analyzed retrospectively, and 28 patients (18 males and 10 females at age of 59.45±13.39 years) who underwent completely anatomic thoracoscopic lobectomy with endoscopic stapler (a mechanical suture group) in the same period were matched. The clinical effectiveness of the two groups was compared.ResultsThe operation time between the non-mechanical suture group (136.30±53.46 min) and the mechanical suture group (109.63±44.61 min) showed a statistical difference (P<0.05). While in term of intraoperative bleeding volume (65.00 ml vs. 50.00 ml), postoperative thoracic drainage time (3.73 days vs. 3.56 days), thoracic drainage volume (538.60 ml vs. 563.70 ml), postoperative hospital stay (5.58 days vs. 5.35 days) and postoperative complication rate (5/28 vs. 6/28), there was no statistical difference between the two groups. Hospitalization expense was significantly different between the two groups (35 438.30 yuan vs. 51 693.60 yuan).ConclusionNon-mechanical suture thoracoscopic anatomic lobectomy is safe and feasible, and can significantly reduce the medical cost but prolong the operation time.
ObjectiveTo discuss the advantage and disadvantage of uniport video-assisted thoracic surgery (VATS) versus single utility port VATS in the surgical treatment of benign thoracic diseases. MethodsFrom January 2012 to December 2014, 125 patients with benign thoracic diseases who underwent VATS by the same performer were divided randomly into two groups including a uniport VATS group or a single utility port VATS group. There were 41 males and 24 females with a mean age of 47.5±16.6 years in the uniport VATS group. There were 39 males and 21 females with a mean age of 45.1±15.7 years in the single utility port VATS group. Then the patients were followed up. The perioperative data and follow-up results were compared between two groups. ResultsThe total 125 patients of operations were performed successfully according the established plan, without increasing incisions or transferring to thoracotomy. There were no statistical differences between two groups in operative time (48.9±11.3 min vs. 47.1±11.0 min), intraoperative bleeding volume (26.9±15.4 ml vs. 23.8±13.2 ml), postoperative 24 h chest tube drainage volume (81.5±36.9 ml vs. 77.3±31.2 ml), postoperative chest tube drainage time (2.8±2.0 d vs. 3.4±2.2 d), the pain score on the 3rd postoperative day (2.6±1.2 points vs. 2.6±1.3 points), average in-hospital stay (4.9±2.1 d vs. 5.1±2.2 d) or postoperative complications (P > 0.05). The patients were followed up for 3-24 months. All patients achieved satisfactory results with no recurrence. ConclusionsCompared with single utility port VATS, uniport VATS does not prolong operation time or consume more materials, and has advantages of minimally invasion and higher acceptance. It is a safe and feasible approach in surgical treatment of benign thoracic diseases and worthy of popularization and application.