Introduction Of Video-assisted Thoracoscopic Surgery Research Articles

Comparison of two-lung and one-lung ventilation in bilateral video-assisted thoracoscopic extended thymectomy in myasthenia gravis: a retrospective study.

BackgroundMyasthenia gravis (MG) is an autoimmune disease, and early thymectomy is recommended. Since the introduction of video-assisted thoracoscopic surgery, the safety and effectiveness of carbon dioxide insufflation in the thoracic cavity (capnothorax) has been controversial. This study aimed to compare the safety and effectiveness of ventilation methods in bilateral video-assisted thoracoscopic extended thymectomy (BVET) with capnothorax.MethodsWe retrospectively investigated the medical records of patients with MG who underwent BVET between August 2016 and January 2018. Patients were divided into two groups: group D (n = 26) for one-lung ventilation and group S (n = 28) for two-lung ventilation. We set nine anesthesia time points (T0–T8) and collected respiratory and hemodynamic variables, including arterial O2 index (PaO2/FiO2).ResultsSpO2 at T1–T3 and T8 was significantly lower in group D than in group S. The FiO2 in group S was lower than that in group D at all time points. The number of PaO2/FiO2 ≤ 300 and PaO2/FiO2 ≤ 200 events was significantly higher in group D than in group S. Hemodynamic variables were not significantly different between the two groups at any time point. The duration of surgery and anesthesia was shorter in group S than in group D.ConclusionsThis retrospective study suggests that anesthesia using two-lung ventilation during BVET with capnothorax is a safe and effective method to improve lung oxygenation and reduce anesthesia time.

Video-assisted thoracoscopy for lung cancer: who is the future of thoracic surgery?

As the computer processing technique and display technology evolved dramatically, the surgical approach to early-stage non-small cell lung cancer (NSCLC) has made a rapid progress within the past few years. Currently, the gold standard for NSCLC is lobectomy. After the introduction of video-assisted thoracoscopic surgery (VATS), lung resection can now be conducted mini-invasively, enabling better prognosis for patients and better operation condition for surgeons. At the very beginning, the conventional two-dimensional (2D) system enabled operators to have a closer, magnified and illuminated view inside the body cavity than open thoracotomy. With the introduction of the glasses-assisted three-dimensional (3D) and glasses-free 3D display system, multiple viewing angles were further enhanced, thus a more stable, easier to master and less invasive video-assisted thoracoscopic surgery (VATS) appeared. However, given that the standard VATS is associated with limited maneuverability and stereoscopy, it restricts the availability in more advanced cases. Hopefully, most of the limitations of standard VATS can be overcome with the robotic-assisted thoracic surgery (RATS). The RATS system consists of a remote console and a robotic unit with 3 or 4 arms that can duplicate surgeons’ movements. Also, it provides a magnified, 3D and high definition (HD) operation field to surgeons, allowing them to perform more complicated procedures. Apart from these, some new technologies are also invented in combination with the existing surgery system to solve difficult problems. It is hoped that the higher costs of innovative surgical technique can be offset by the better patient outcomes and improved benefits in cost-effectiveness.

Study protocol for VIdeo assisted thoracoscopic lobectomy versus conventional Open LobEcTomy for lung cancer, a UK multicentre randomised controlled trial with an internal pilot (the VIOLET study)

IntroductionLung cancer is a leading cause of cancer deaths worldwide and surgery remains the main treatment for early stage disease. Prior to the introduction of video-assisted thoracoscopic surgery (VATS), lung...

Latest technology in minimally invasive thoracic surgery.

From the introduction of video-assisted thoracoscopic surgery (VATS) in the 1990s, to performing major lung resections using a uniportal VATS approach, technology has paved the way for the development of minimally invasive thoracic surgery. Natural orifice access to achieve a 'no port' approach, is also on the rise, with advancements in bronchoscopic techniques for diagnosis and therapy, as well as development of soft robotics to achieve desired flexibility, dexterity and stability in future platforms, which may involve in vivo deployment to bring the surgeon totally inside the body. Development of haptic feedback in robotic platforms to enhance the surgical experience is also a major goal, with vibrotactile and mechanical feedback generation, to replicate the traditional touch. In addition, the aid of technology in the form of procedural guidance mechanisms, like augmented reality, will further improve the safety and accuracy of future operations.

Advances in techniques for identifying small pulmonary nodules.

Since the introduction of video-assisted thoracoscopic surgery, the demand for its use in resecting small pulmonary nodules has increased. In parallel, the development of high-resolution computed tomography has led to an increase in the detection of the early lung cancers appearing as nodules with ground-glass opacity. Several techniques to resect these small lesions have been devised, the most familiar of which is the use of a computed tomography-guided percutaneous hook wire. We recently developed virtual-assisted lung mapping to achieve safer and more reliable resection of these lesions. Virtual-assisted lung mapping is carried out using three-dimensional computed tomography, bronchoscopy, and fluoroscopically guided navigation to mark the lung surface with dye. A prospective study showed that this technique was safe and had a high success rate. Multiple marking around the targeted lesion allows for a sufficient surgical margin at resection. We recently introduced an electromagnetic navigation bronchoscopy system to confirm the sites to be marked by virtual-assisted lung mapping in the operating room prior to video-assisted thoracoscopic surgery. We are now studying a method to enable minimally invasive, safe, and reliable resection of lesions located deep in the lung parenchyma.

Video-assisted thoracoscopic thymectomy for thymoma: a single-center experience.

Background Thymoma is a primary tumor derived from the epithelial cells of the thymus, which is commonly seen in the mediastinum. Surgical thymectomy is the radical treatment for thymoma. The recent introduction of video-assisted thoracoscopic surgery has improved the quality of thymectomy surgery. The clinical characteristics of thymoma and the outcomes of video-assisted thoracoscopic thymectomy in Vietnamese patients are still lacking. The objectives of this study were to investigate the clinical and laboratory characteristics of thymoma and to evaluate the early results of video-assisted thoracoscopic thymectomy for thymoma in Vietnamese patients. Methods All 53 thymoma patients with or without myasthenia gravis who underwent video-assisted thoracoscopic thymectomy in Military Hospital 103, Vietnam, from October 2013 to July 2017 were included. Results The mean age was 46.5 7.1 years, and the female/male ratio was 1.2:1. Myasthenia gravis, mostly stage IIA, was present in 84.9% of patients. There was no hospital mortality or major postoperative complication. The mean operative time was 65 min, intensive care unit stay was 22 ± 5 h, and postoperative hospital stay was 7.5 ± 1.7 days. Conclusion Thoracoscopic thymectomy for thymoma in Vietnamese patients achieved improved cosmesis and was safe for both non-myasthenia gravis and myasthenia gravis patients.

Conversion to thoracotomy of video-assisted thoracoscopic closure of patent ductus arteriosus.

IntroductionPosterolateral thoracotomy was the access of choice in surgical treatment of patent ductus arteriosus (PDA) for many years before the introduction of video-assisted thoracoscopic surgery (VATS). The latter is thought to reduce postoperative pain and improve musculoskeletal system status. However, it carries a potential risk of conversion to thoracotomy.AimTo evaluate the rate, reasons and outcomes of VATS conversion to thoracotomy in surgical PDA patients.Material and methodsFrom 2012 to 2017, 112 children were qualified for VATS closure of symptomatic PDA. Among them, 19 (16.9%) with the median age of 19.4 months required conversion to thoracotomy. The predominant reasons for conversion, early mortality and morbidity as well as late survival were evaluated.ResultsThe overall conversion rate was 16.9% with an evident learning curve as it decreased significantly from more than 20% at the beginning to approximately 10% in the last 2 years. The predominant reasons were incomplete PDA closure (n = 6; 31.6%) followed by ductal bleeding after clip application (n = 5; 26.3%) and inadequate visualization (n = 5). One child died 48 h after the surgery due to acute cardiopulmonary failure (mortality 5.9%). All patients required postoperative chest tube insertion, and two of them developed postoperative pneumothorax. Neither deaths nor severe adverse events were noted throughout the follow-up period.ConclusionsThe rate of VATS PDA closure conversion to standard thoracotomy features a learning curve. Although it must be considered as a serious complication, probably it does not negatively affect either early the mortality rate or long-term survival.

Results of treatment for catamenial pneumothorax since the introduction of video-assisted thoracoscopic surgery: a systematic review

Catamenial pneumothorax is an uncommon form of pneumothorax in women of reproductive age (1); it is strongly related to endometriosis and menses. Diaphragmatic changes, such as holes or endometrial implants, were features in patients with catamenial pneumothorax (2). Endometriosis of the visceral pleura was sometimes observed (2,3). Although some theories have been suggested, the etiology is not known in detail. Treatment was difficult because patients with catamenial pneumothorax have frequent recurrences (2). Optimal treatments for catamenial pneumothorax have not been conclusively confirmed. We need to understand the etiology or pathophysiology of the disease to resolve these problems, including recurrences in patients with catamenial pneumothorax. For that reason, the report by Bricelj et al. (1) is very important, and focusing on the period after the introduction of video-assisted thoracoscopic surgery (VATS) is informative.

Catamenial pneumothorax since introduction of video-assisted thoracoscopic surgery : A systematic review.

Catamenial pneumothorax is an uncommon form of spontaneous pneumothorax in women. The exact epidemiology and pathogenesis remain elusive. Video-assisted thoracoscopic surgery is used for diagnostic and therapeutic purposes. The aim of this review was to analyze the demographic features, intraoperative findings, treatment methods and outcome in catamenial pneumothorax patients. In addition, we assessed the relationship between catamenial pneumothorax and pelvic endometriosis. A PubMed search of medical literature, published from January 1993 (video-assisted thoracoscopic surgery first described in literature) to January 2015, using the keywords "catamenial pneumothorax" was performed. Our study complied with the preferred reporting of items for systematic reviews and meta-analysis principles. Atotal of 182 patients were included in the analysis, including 4patients treated at our institution. The inclusion criteria of were recurrent (at least two) episodes of spontaneous pneumothorax in relation to onset of menses. Age at time of diagnosis, side affected, diagnosis of pulmonary endometriosis, intraoperative findings, histological confirmation of thoracic endometriosis, methods of treatment and outcome were recorded. In 2.9% of the patients no pathological lesions were found; however, 59.3% had endometrial implants and 57.0% diaphragmatic perforations. Pelvic endometriosis was reported in 39.5% patients. Patients with diagnosed pelvic endometriosis showed asignificantly higher rate of endometrial implants and histologically confirmed endometriosis lesions than patients without pelvic endometriosis. In 26.9% of patients, recurrence was observed after treatment. Video-assisted thoracoscopic surgery provides good diagnostic and therapeutic results; however, 25% of patients experienced recurrence despite adequate treatment. Astrong association exists between thoracic and pelvic endometriosis in catamenial pneumothorax patients.

A Randomized Controlled Trial of Postthoracotomy Pulmonary Rehabilitation in Patients with Resectable Lung Cancer

Little is known about the effects of rehabilitation for patients with lung cancer after thoracotomy. The primary objective of this study was to evaluate the effect of a multidisciplinary rehabilitation program on quality of life (QOL) and secondary objectives were to determine its effects on pain and exercise capacity and the feasibility of combining rehabilitation with adjuvant chemotherapy. Patients who had undergone a thoracotomy for lung cancer were randomized between rehabilitation and usual care. Rehabilitation consisted of twice-weekly training for 12 weeks starting 1 month after hospital discharge, scheduled visits to pain specialists, and medical social work. QOL and pain were measured with validated questionnaires at baseline and after 1, 3, 6, and 12 months. Exercise tolerance was assessed at baseline and after 3 months with a 6-minute walking distance test. The study closed prematurely because of the introduction of video-assisted thoracoscopic surgery. Of 57 randomized patients, 49 patients (23 active and 26 control) were analyzed. QOL was not significantly different between groups, although, the active group reported more pain after 3 and 6 months and more limitations because of physical problems after 3 months. In the active group, 6-minute walking distance improved by 35 m from preoperative baseline, as opposed to the control group that showed a decline by 59 m (p = 0.024 for difference). Patients treated with adjuvant chemotherapy showed decreased attendance at training sessions. Rehabilitation did not result in a better QOL. Exercise tolerance improved at the cost of more pain and more limitations because of physical problems. We suggest that rehabilitation is better postponed for 3 to 4 months after hospital discharge.

Video-Assisted Thoracoscopic Thymectomy as an Optimal Treatment in Myasthenia Gravis

Background: Myasthenia gravis is a neurological disorder characterized by muscle weakness. The role of thoracoscopic thymectomy in the treatment of this disease is controversial, but has some advantages that include less pain, shorter hospital stays, and better cosmetic results. Objectives: After the introduction of video-assisted thoracoscopic surgery (VATS) thymectomy, there has been increased interest in the use of this technique for myasthenia gravis. We conducted a retrospective study to assess the safety and efficacy of VATS thymectomy in treatment of myasthenia gravis. Patients and Methods: The medical records of 50 patients who underwent VATS thymectomy for the treatment of myasthenia gravis between May 2005 and June 2010 in Afzalipour Hospital, (affiliated to Kerman Medical University of Sciences, Iran) were reviewed. The patients were examined for response to treatment; for patients who were not available for examination, data was obtained through telephone conversations. Results: Forty-three of 50 patients were accessible. Of these, 34 were female and 16 were male, with a mean age of 34.8 years. The treatment responses were remission, 6 (16%); improvement, 30 (70%); and without change, 7 (16%). The total positive response to treatment was 84 percent. Conclusions: VATS thymectomy has been considered as a safe and effective treatment in myasthenia gravis and was associated with low mortality and morbidity. VATS thymectomy is recommended for the treatment of myasthenia gravis.

Single-Institution Experience on Robot-Assisted Thoracoscopic Operations for Mediastinal Diseases

: After the introduction of video-assisted thoracoscopic surgery 20 years ago, the minimally invasive techniques in thoracic surgery have found a growing application. The recent introduction of robotic technology has increased the potentiality of thoracoscopic technique leading to an expansion of indications and applications, particularly for the management of mediastinal diseases. We reviewed our experience in robot-assisted thoracoscopic resection of benign and malignant mediastinal diseases. : Between 2002 and 2010, 108 patients (79 women and 29 men; median age 38 y) underwent robot-assisted thoracoscopy using the "da Vinci" robotic system for several mediastinal diseases. There were 100 thymectomies, 3 resections of paravertebral tumors, 1 thymic cyst, 1 ectopic goitre, 1 ectopic mediastinal parathyroidectomy, 1 thymic carcinoid, and 1 foregut cyst. Ninety-five (87.9%) patients were affected by myasthenia gravis. : All procedures were completed successfully using the da Vinci robot; no open conversions were required, but in three (2.8%) cases, a fourth access was added. There was no surgical mortality; four (3.6%) patients had postoperative complications (two hemothorax, one chylothorax, and one fever) treated conservatively. Median operation time was 120 (range 60-300) minutes and median hospitalization was 3 (range 2-14) days. Global benefit rate for patients with myasthenia gravis reached the value of 93.4% with progressive improvement over years. : Several mediastinal operations may be feasible by using a robot-aided thoracoscopic approach. The technical innovations offered by robotic instrumentation make all procedures safer and easier when compared with standard thoracoscopic approach, with particular reference for application in mediastinal field.

Adequate debridement and drainage of the mediastinum using open thoracotomy or video-assisted thoracoscopic surgery for Boerhaave’s syndrome

BackgroundBoerhaave’s syndrome has a high mortality rate (14–40%). Surgical treatment varies from a minimal approach consisting of adequate debridement with drainage of the mediastinum and pleural cavity to esophageal resection. This study compared the results between a previously preferred open minimal approach and a video-assisted thoracoscopic surgery (VATS) procedure currently considered the method of choice.MethodsIn this study, 12 consecutive patients treated with a historical nonresectional drainage approach (1985–2001) were compared with 12 consecutive patients treated prospectively after the introduction of VATS during the period 2002–2009. Baseline characteristics were equally distributed between the two groups.ResultsIn the prospective group, 2 of the 12 patients had the VATS procedure converted to an open thoracotomy, and 2 additional patients were treated by open surgery. In the prospective group, 8 patients experienced postoperative complications compared with all 12 patients in the historical control group. Four patients (17%), two in each group, underwent reoperation. Six patients, three in each group, were readmitted to the hospital. The overall in-hospital mortality was 8% (1 patient in each group), which compares favorably with other reports (7–27%) based on drainage alone.ConclusionsAdequate surgical debridement with drainage of the mediastinum and pleural cavity resulted in a low mortality rate. The results for VATS in this relatively small series were comparable with those for an open thoracotomy.

Thoracoscopic Surgery: Indications and Outcome

Video-assisted thoracoscopic surgery (VATS) has become an established technique in both diagnostic and therapeutic thoracic surgery procedures. In an attempt to evaluate the current indications and outcome of this technique, 143 VATS procedures, which were performed over a three-year period, were retrospectively evaluated. Indications included lung biopsy in 46, recurrent or persistent pneumothorax in 42, and pleural disease in 16 patients. Other indications included sympathectomy in eight, mediastinal mass in three, pericardial window in three, metastasectomy in three, and staging of lung cancer in two patients. There was one postoperative death (0.7%), a patient with massive pleural effusion and end-stage renal and hepatic failure. Conversion to formal thoracotomy was necessary in six patients (4.2%), and was the result of adhesions in four, bleeding in one, and failure to identify the lesion in one patient. Diagnostic procedures were considered successful in 44 out of 46 lung biopsies (95.7%), 15 out of 16 pleural disease cases (93.8%), and two lung cancer staging cases. The other 79 therapeutic VATS procedures were all effective, both in the long and short term, apart from two cases of prolonged air leak after VATS for pneumothorax, one of which was considered a failure (2.4%). VATS should be available in each thoracic surgery unit. It is both safe and effective in a variety of diagnostic and therapeutic procedures.

Video assisted thoracoscopic surgery (VATS) in Asia--its impact and implications.

Within a short period of time, video assisted thoracoscopic surgery (VATS) has revolutionised the practice of thoracic surgery. Most of the existing literature, however, is concentrated on the technical aspects. We examined the impact of VATS on our practice and its implications. We reviewed our thoracic case load two years before and two years after the introduction of VATS in our hospital. We have witnessed a rapid and progressive increase in our thoracic case load since the introduction of VATS. With increased experience, proportionally more cases were performed using VATS compared to conventional surgical access. The increased case load covered a wide range of thoracic diseases with the majority for spontaneous pneumothorax and pleural diseases. The higher case load is due to increased referrals which at least partly reflect earlier acceptance by both the patients and their physicians for surgical intervention. The changing indications for surgery and the high cost associated with VATS, however, could place extra demand on the healthcare, especially for some countries in Asia. Cost containment is therefore a high priority here. More research is greatly needed in this area.

Perspectives on thoracoscopy in general thoracic surgery

ew advances have had such a rapid and widespread F influence on surgical practice as has the introduction of video-assisted thoracoscopic surgery in recent years. The challenge to adapt to this patient-driven demand has been overwhelming, exciting, and, at times, unsettling. As surgeons, we are accustomed to initiate a change in our technique, or in our surgical approach to a problem, based on our own experience and on information derived from publications and presentations at scientific meetings. Once we are satisfied that a new procedure or approach is well founded and produces documented benefits, we then consider incorporating it into our practice. However, with regard to thoracoscopy, I believe many of us have felt stampeded by the demands of patients, the aggressive marketing by hospitals and individual surgeons, and the hype sometimes generated by equipment manufacturers. The result has been the rapid dissemination and widespread use of thoracoscopic techniques without the perspective, the critical analysis, and the long-term follow-up that are ordinarily essential factors in a surgeon’s decision-making process. It is with these thoughts in mind that I have attempted to analyze the impact of thoracoscopy on the practice of general thoracic surgery. There can be no doubt that the introduction of thoracoscopic procedures into thoracic surgery is on balance a very positive development. The very fact that it is new, different, and fun adds excitement to a specialty that has, with few exceptions, changed little over the past 25 years. This in itself is a benefit. Furthermore, the reduced morbidity often associated with thoracoscopic procedures has focused our attention, as never before, on cost, morbidity, and patient acceptance. Thus, matters of postoperative pain relief, length of hospital stay, time off work, and overall cost-effectiveness have become issues for all surgical procedures, not just those performed thoracoscopically. It is my impression that we are more attentive to these issues than we once were. It is in fact specifically these issues that surgeons favoring thoracoscopic procedures have focused on. Unfortunately, however, other equally or more important issues have been ignored or received scant attention. Furthermore, even in the area of morbidity and cost-effectiveness, few data have been accurately documented. There is a general