Postoperative Thoracic Drainage Research Articles

Evaluation of the efficacy and safety of robot-assisted and video assisted thoracic surgery for early non-small cell lung cancer: A meta-analysis.

Radical resection of lung cancer and chemotherapy are the main methods for the treatment of early lung cancer, but surgical treatment is still the key and preferred method. To evaluate the efficacy and safety of robotic-assisted thoracic surgery (RATS) and video assisted thoracic surgery (VATS) for non-small cell lung cancer (NSCLC). The clinical cohort studies on the comparison of the effects of RATS and VATS in the treatment of NSCLC published in Web of Science, PubMed, The National Library of Medicine (NLM), China National Knowledge Infrastructure (CNKI) and Wanfang database from January 1, 2015 to December 31, 2022 were searched. Two researchers independently screened the literature, extracted the data, such as operation time, intraoperative conversion rate, intraoperative blood loss, number of lymph nodes dissected, and evaluated the quality of the included literature based on the Newcastle-Ottawa Scale (NOS). RevMan 5.3 software was used for Meat analysis. A total of 18 articles and 21,802 subjects were included. The results of the meta-analysis showed that the intraoperative blood loss of RATS was significantly less than that of VAS, and the difference was statistically significant [MD =-38.43 (95% CI: -57.71, -19.15, P< 0.001)]. Compared with VATS, the number of lymph nodes dissected in RATS was significantly higher [MD = 2.61 (95% CI: 0.47, 4.76, P= 0.02)]. The rate of conversion to thoracotomy in RATS was lower, and the difference was statistically significant [OR = 0.59 (95% CI: 0.50, 0.70, P< 0.001)]. There was no significant difference between RATS and VATS in operation time [MD =-9.34 (95% CI: -28.72, 10.04, P= 0.34)], postoperative thoracic drainage time [MD =-0.08 (95% CI: -0.42, 0.26, P= 0.64)], postoperative hospital stay [MD =-0.05 (95% CI: -0.19, 0.08, P= 0.42)], postoperative mortality [OR = 0.88 (95% CI: 0.56, 1.36, P= 0.56)] and postoperative complications [OR = 1.03 (95% CI: 0.93, 1.13, P= 0.57)]. Compared with VATS, the number of lymph nodes dissected in RATS was significantly more, and the removal of lesions and lymph nodes was more thorough and accurate. More flexible and precise operation avoids the injury of important blood vessels during operation, effectively reduces the amount of blood loss during operation, shortens the indwelling time of thoracic drainage tube, and is conducive to postoperative rehabilitation of patients.

Perioperative outcomes of uniportal versus three-port video-assisted thoracoscopic surgery in lung cancer patients aged ≥ 75 years old: a cohort study

BackgroundIncreasing attention has been raised on the surgical option for lung cancer patients aged ≥75 years, however, few studies have focused on whether uniportal video-assisted thoracoscopic surgery (VATS) is safe and feasible for these patients. This study aimed to evaluate short-term results of uniportal versus three-port VATS for the treatment of lung cancer patients aged ≥75 years.MethodsWe retrospectively evaluated 582 lung cancer patients (≥75 years) who underwent uniportal or three-port VATS from August 2007 to August 2021 based on the Western China Lung Cancer Database. The baseline and perioperative outcomes between uniportal and three-port VATS were compared in the whole cohort (WC) and the patients undergoing lobectomy (lobectomy cohort, LC) respectively. Propensity score matching (PSM) was used to minimize confounding bias between the uniportal and three-port cohorts in WC and LC.ResultsIntraoperative blood loss was significantly less in the uniportal than three-port LC (50 mL vs. 83 mL, P = 0.007) before PSM and relatively less in the uniportal than three-port LC (50 mL vs. 83 mL, P = 0.05) after PSM. Significantly more lymph nodes harvested (13 vs. 9, P = 0.007) were found in the uniportal than three-port LC after PSM. In addition, in WC and LC, there were no significant differences between uniportal and three-port cohorts in terms of operation time, the rate of conversion to thoracotomy during surgery, nodal treatments (dissection or sampling or not), the overall number of lymph node stations dissected, postoperative complications, volume and duration of postoperative thoracic drainage, hospital stay after operation and hospitalization expenses before and after PSM (P > 0.05).ConclusionsThere were no significant differences in short-term outcomes between uniportal and three-port VATS for lung cancer patients (≥75 years), except relatively less intraoperative blood loss (P < 0.05 before PSM and P = 0.05 after PSM) and significantly more lymph nodes harvested (P < 0.05 after PSM) were found in uniportal LC. It is reasonable to indicate that uniportal VATS is a safe, feasible and effective operation procedure for lung cancer patients aged ≥75 years.

Lymphoscintigraphy Findings are Associated with Outcome in Children with Chylothorax After Cardiac Surgery.

Postoperative chylothorax in patients with congenital heart diseases (CHD) results in poor outcomes if anatomical and functional abnormalities of the lymphatic system are present. While these abnormalities are typically diagnosed by intranodal lymphangiography and dynamic contrast magnetic resonance lymphangiography, the usefulness of lymphoscintigraphy in these patients has not been evaluated. Between January 2019 and December 2021, 28 lymphoscintigraphies were performed in our institution for investigating prolonged pleural effusion after cardiac surgery. The images were assessed by three board-certified pediatric cardiologists retrospectively to determine the likelihood of a central lymphatic flow disorder. The likelihood was scored (range 1-3) based on structural abnormalities and congestive flow in the lymphatic system. Those scores were summed and the likelihood was categorized as low to intermediate (< 8 points) or high (8 or 9 points). Median age at lymphoscintigraphy was 129days (IQR, 41-412days), it was performed at a median of 22days (IQR, 17-43) after surgery, and median score was 6 points (IQR, 4-7.5). Kendall's coefficient of concordance (0.867; p < 0.05) indicated high inter-rater reliability. Overall survival at 6months after surgery was 92.5% in the low-to-intermediate group but 68.6% in the high group (p < 0.05), and duration of postoperative thoracic drainage was 27 and 58days, respectively (p < 0.05). Lymphatic abnormalities detected by lymphoscintigraphy were associated with poorer outcomes. Lymphoscintigraphy was thought to be useful in assessing anatomic and functional lymphatic abnormalities, despite its minimal invasiveness.

Comparison of central venous catheter thoracic drainage and traditional closed thoracic drainage following minimally invasive surgery for esophageal carcinoma: a retrospective analysis

ObjectiveTo compare the effectiveness and safety of central venous catheter thoracic drainage (CVCTD) with traditional closed thoracic drainage (TCTD) after minimally invasive surgery for esophageal cancer.MethodsWe conducted a retrospective investigation of 103 patients who underwent minimally invasive esophageal cancer surgery at our institution between January 2017 and December 2019. Among them, 44 patients underwent CVCTD, while 59 received TCTD. We compared the following outcomes between the two cohorts: drainage volume, duration of drainage, postoperative complications (including pleural effusion, pulmonary infection, atelectasis, anastomotic leakage, etc.), length of hospital stay, and postoperative pain assessment.ResultsNo significant differences were observed between the experimental and control groups regarding postoperative thoracic drainage, the timing of postoperative tube removal, or postoperative complications. However, significant disparities were noted in the duration of postoperative hospitalization, drainage tube healing time, and pain threshold among the esophageal cancer patients in both cohorts (p < 0.05).ConclusionCVCTD is a secure and potent alternative to TCTD following minimally invasive surgery for esophageal carcinoma. It potentially contributes to reducing the incidence of postoperative complications while curtailing the duration of hospitalization. Additional research is warranted to substantiate these findings.

Clinical application of VATS combined with 3D-CTBA in anatomical basal segmentectomy.

This study aimed to summarize the clinical application experience of video-assisted thoracic surgery (VATS) combined with three-dimensional computed tomography-bronchography and angiography (3D-CTBA) in anatomical basal segmentectomy. Clinical data of 42 patients who underwent bilateral lower sub-basal segmentectomy by VATS combined with 3D-CTBA in our hospital from January 2020 to June 2022 were retrospectively analyzed; the patients included 20 males and 22 females, with a median age of 48 (30-65) years. Combined with the preoperative enhanced CT and 3D-CTBA techniques to identify the altered bronchi, arteries, and veins during the operation, the anatomical resection of each basal segment of both lower lungs was completed through the fissure approach or inferior pulmonary vein approach. All operations were successfully completed without conversion to thoracotomy or lobectomy. The median operation time was 125 (90-176) min, the median intraoperative blood loss was 15 (10-50) mL, the median postoperative thoracic drainage time was 3 (2-17) days, and the median postoperative hospital stay was 5 (3-20) days. The median number of resected lymph nodes was 6 (5-8). There was no in-hospital death. Postoperative pulmonary infection occurred in 1 case, lower extremity deep vein thrombosis (DVT) in 3 cases, pulmonary embolism in 1 case, and persistent air leakage in the chest in 5 cases, all of which were improved by conservative treatment. Two cases of pleural effusion after discharge were improved after ultrasound guided drainage. Postoperative pathology showed 31 cases of minimally invasive adenocarcinoma, 6 cases of adenocarcinoma in situ (AIS), 3 cases of severe atypical adenomatous hyperplasia (AAH), and 2 cases of other benign nodules. All cases were lymph node-negative. VATS combined with 3D-CTBA is safe and feasible in anatomical basal segmentectomy; consequently, this approach should be promoted and applied in clinical work.

Effectiveness of precise and quantitative rapid pulmonary rehabilitation nursing program for elderly patients with lung cancer during the perioperative period: A randomized controlled trial.

Preoperative rehabilitation should improve the functional condition of patients. Improvements in metabolism, lung mechanics, cardiovascular function, and muscle-function can be achieved by pulmonary rehabilitation. Hence, we focused on elderly patients with lung cancer undergoing surgery, and assessed the effectiveness of a rapid and precise pulmonary rehabilitation nursing program during the perioperative period. This randomized controlled trial at the department of thoracic surgery; Shanghai pulmonary hospital, China during 2021 was conducted amongst 218 elderly patients with lung cancer treated by surgical operation into either a precision quantitative nursing model nursing group (experimental group) or a perioperative routine nursing group (control group). After individual planning of the pulmonary rehabilitation nursing outpatient clinic, nurses distributed breathing trainers, instructed the patients in breathing training, and supervised the patients after the operation. For our evaluation we considered pulmonary function tests, postoperative thoracic drainage tube indwelling times, postoperative hospital stays, postoperative complication rates, and postoperative quality of life results. The experimental group showed better pulmonary function, length of hospital stay, and quality of life outcomes than the control group, but the differences were not statistically significant. However, we found a significantly higher postoperative complications rate in the control group (11.9%) than in the experimental group (3.7%; p=0.02). Strengthening pulmonary rehabilitation nursing interventions for elderly patients with lung cancer during the perioperative period can reduce their postoperative complications and promote their rapid recovery. Clinical Trial: Registration Number - ChiCTR2100042916.].

A comparison of total thoracoscopic versus robotic approach for cardiac myxoma resection: a single-center retrospective study

Advances in instrumentation and technique have facilitated minimally invasive surgeries for cardiac myxoma treatment. This study aims to compare the clinical outcomes between the thoracoscopic and robotic approaches for myxoma resection. Intraoperative data and postoperative data of 46 patients who underwent either thoracoscopic (n = 15) or robotic (n = 31) cardiac myxoma resection in our center between July 2013 and September 2022 were retrospectively compared. There was no in-hospital death in either group. Meanwhile, the operative time and cardiopulmonary bypass time were significantly shorter in the robotic group than in thoracoscopic group (P = 0.015 and P = 0.035, respectively). Furthermore, shorter ICU stays (P = 0.006), shorter postoperative mechanical ventilation time (P = 0.035) and less thoracic drainage (P = 0.040) were observed in the robotic group. However, the operating room costs and total hospital costs were both significantly lower in thoracoscopic group (P = 0.004 and P = 0.007, respectively). There was no significant difference between two groups regarding the incidence of postoperative complications (P > 0.05). Lastly, a faster return to exercise was noted in robotic group than in thoracoscopic group (Log-Rank χ2 = 4.094, P = 0.043). Both approaches can be safe and feasible for myxoma resection. However, regardless of higher expenses, the robotic myxoma resection approach provides shorter operation time, less postoperative thoracic drainage, and faster recovery than total thoracoscopic technique.

Thoracoscopic Partial Pneumonectomy with and without Postoperative Thoracic Drainage Tube.

To compare thoracic drainage tube placement on clinical outcomes and serum CRP, IL-6, cortisol in patients undergoing thoracoscopic partial pneumonectomy. Analytical study. Yulin Second Hospital, China, between January 2017 and January 2022. Methodology: Eighty-four patients with lung cancer who underwent thoracoscopic partial pneumonectomy were studied. A thoracic drainage tube was placed postoperatively (Group A, n=41). Otherwise, a thoracic drainage tube was not placed if an air leak was not detected in the suction-induced leak test postoperatively (Group B, n=43). Difference effect was compared. Postoperative hospitalisation time and incidence of postoperative subcutaneous emphysema in Group A were lower than those in Group B (p<0.001 and p=0.038 respectively). On the 1st day before surgery, the differences in serum CRP, IL-6, and cortisol were not significant between the two groups (p= 0.443, 0.644, and 0.738 respectively); on the 1st day after surgery, levels of serum CRP, IL-6, and cortisol in Group A were lower than those in Group B (p<0.001, p<0.001, and p=0.001 respectively). Postoperative hospitalisation time and the frequency of postoperative subcutaneous emphysema were lower in patients of thoracoscopic partial pneumonectomy without placing thoracic drainage tubes. The degree of surgery-induced stress was also lower. The decision not to leave the thoracic drainage tube may be considered reasonable and safe if the criteria are carefully selected. Thoracoscopy, Thoracic tube drainage, Partial pneumonectomy, Cortisol, IL-6, CRP level.

A single-center study of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors.

To study the feasibility, safety, and efficacy of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors, and summarize the treatment experiences and surgical skills. A single-center retrospective analysis of 37 patients with pediatric mediastinal neurogenic tumors was conducted. Clinical charactersistics and postoperative complications were all analyzed. All the operations were successfully completed. There was no statistically significant difference in tumor diameter between the two groups (p> 0.05). The open surgery group had an average operation time of 96.5± 32.38 min, while the thoracoscopic surgery group had an average operation time of 78.3± 24.51 min (p< 0.05). The thoracoscopic surgery group had significantly lower intraoperative blood loss than the open surgery group (p< 0.05). In addition, the duration of the postoperative thoracic drainage tube was 5.43 ± 0.76 days in the open surgery group, which was longer than the 2.38 ± 0.87 days in the thoracoscopic surgery group (p< 0.05). Furthermore, the postoperative length of hospital stay was an average of 10.23 ± 1.43 days for the open surgery group, longer than for the thoracoscopic surgery group (4.36 ± 0.87 days) (p< 0.05). Thoracoscopic surgery has several advantages in the treatment of pediatric mediastinal neurogenic tumors and is worthy of clinical popularization and application. For giant mediastinal malignant neurogenic tumors, puncture biopsy and adjuvant chemotherapy can be performed before surgery to lessen the tumor volume and enlarge the operation space, which would reduce bleeding and complications.

The Effect of CT Imaging Technology in the Diagnosis of Thoracic and Cardiac Surgery Diseases.

In order to increase doctors' cognition of the three-dimensional anatomical structure of cardiothoracic and cardiothoracic surgery and increase the diagnosis rate and cure rate of cardiothoracic surgery diseases, the authors propose a method of CT imaging technology for diagnosing cardiothoracic surgery diseases. Through the joint Hookwire positioning of 3D-CTBA, application in thoracoscopic segmentectomy and CT energy spectrum curve, retrospective analysis of diagnosis of intrathoracic lymph node metastasis in non-small-cell lung cancer, 3D-CTBA and CT-guided Hookwire localization, and preoperative CT-enhanced scanning were performed using two methods. The experimental results showed that the chest tube placement time, postoperative thoracic drainage volume, and postoperative hospital stay after the first operation all showed a good trend. The diagnostic sensitivity was 87.1%. The specificity was 92.6%. The correct index was 79.7%. The accuracy was 91.3%. The positive predictive value was 79.4%. And the negative predictive value was 95.7%. These data prove that CT imaging technology has high diagnostic value for thoracic and cardiac surgery diseases and can effectively help the formulation and implementation of thoracic and cardiac surgery diseases.

Clinical analysis of subxiphoid single-port thoracoscopic surgery for simultaneous bilateral lung lesion resection

ObjectiveTo investigate the efficacy and safety of simultaneous subxiphoid single-port thoracoscopic resection of bilateral lung lesions.MethodsThis retrospective study analyzed the clinical data of 72 patients who underwent resection of bilateral lung lesions at the Department of Thoracic Surgery in the First Affiliated Hospital of University of Science and Technology of China between August 2020 and January 2022. Surgery-related parameters were compared between patients who underwent subxiphoid single-port thoracoscopy (subxiphoid group, 36 patients) and patients who underwent intercostal single-port thoracoscopy (intercostal group, 36 patients).ResultsCompared to the intercostal group, the subxiphoid group exhibited significantly better postoperative catheterization time (P = 0.013), postoperative thoracic drainage, postoperative visual analog scale pain scores at 24 and 48 h, and incision pain and numbness at 1 and 3 months after surgery (all P < 0.05). There were no significant differences in operation time, intraoperative blood loss, or postoperative complications between the two groups (all P > 0.05). There were no cases of perioperative mortality, conversion to thoracotomy, or serious complications in either group.ConclusionSubxiphoid single-port thoracoscopic surgery for simultaneous resection of bilateral lung lesions is safe and effective, reduces postoperative acute and chronic pain, decreases trauma, allows faster recovery, and is more consistent with the concept of minimally invasive surgery than bilateral intercostal single-port thoracoscopy. Thus, this subxiphoid single-port thoracoscopic surgery approach should be considered for clinical application.

Comparison of two preoperative positioning techniques and unpositioning methods in non-intubated video-assisted thoracoscopic surgery.

BackgroundUsing the non-intubated video-assisted thoracoscopic surgery (VATS) approach for small pulmonary nodules (SPNs) can accelerate patients’ postoperative recovery. However, locating the SPNs intraoperatively by palpation can be difficult for thoracic surgeons. The advantages of using different preoperative positioning materials are different, especially for pulmonary-nodule-location-needle (P-N-L-N) and the microcoil. This retrospective study analyzed the advantages of two preoperative positioning techniques for VATS under non-intubation anesthesia.MethodsThe data were collected for a total of 150 patients with pulmonary nodules who underwent non-intubated VATS at the First People’s Hospital of Yunnan Province from January 2018 to January 2021. The patients were divided into a preoperative positioning group (including a P-N-L-N group and microcoil group) and an unlocalized group. These included patients were all compliant with surgical guidelines and were suitable for preoperative localization. Their intraoperative and postoperative indicators were compared, and among these indicators, the operative time, number of postoperative drainage days, postoperative total drainage volume, postoperative discharge time was efficacy group and the intraoperative blood loss was safety group.ResultsPreoperative localization helped surgeons to explore nodules faster intraoperatively and remove SPNs precisely under non-intubated VATS. But the advantages of using different preoperative positioning materials are different. Positioning with either microcoil or P-N-L-N resulted in less operation time (P-N-L-N group: 94.90±28.42 min, microcoil group: 112.80±28.6 min, P<0.05), less intraoperative blood loss (P-N-L-N group: 35.80±21.17 mL, microcoil group: 75.00±65.22 mL, P<0.001) and less postoperative thoracic drainage volume (P-N-L-N group: 64.90±181.96 mL, microcoil group: 648.52±708.81 mL, P<0.001). However, the postoperative discharge time (P-N-L-N group: 5.02±1.35 days, microcoil group: 5.40±2.79 days, P=0.38) and postoperative drainage time(P-N-L-N group: 2.58±1.70 days, microcoil group: 3.18±2.49 days, P=0.16) was not statistically significant. Positioning with P-N-L-N seemed to have a better auxiliary effect for non-intubated VATS, suggesting its use can assist surgeons to determine the location of the lesion more accuracy intraoperatively. There was no significant difference in the pathological results among the groups.ConclusionsLocalization of SPNs is beneficial in non-intubated VATS, and the use of P-N-L-N was more effective than the microcoil in reducing operative time, intraoperative blood loss, postoperative total drainage volume, and postoperative discharge time.

Surgical strategy for malignant pleural mesothelioma: the superiority of pleurectomy/decortication.

Both extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) are used for the surgical treatment of malignant pleural mesothelioma (MPM). This study aimed to compare the operative and clinical outcomes and survival between EPP and P/D. We performed a retrospective analysis of the surgical and clinical data of 40 patients who underwent either EPP (n = 18) or P/D (n = 22) for MPM at our institution between January 2000 and December 2018. In comparison to EPP, P/D was associated with a higher intraoperative bleeding volume (1175 vs 1805ml, p = 0.0020) and greater duration of postoperative thoracic drainage (3 vs 16days, p < 0.0001). Adjuvant chemotherapy was more common after P/D (81.8%) than after EPP (33.3%; p = 0.0024). For epithelioid-type MPM, overall survival (OS) and recurrence-free survival (RFS) were significantly better in patients who underwent P/D in comparison to those who underwent EPP (p = 0.040 and p = 0.015, respectively), with no difference for the biphasic and sarcomatoid types of MPM. A Cox proportional hazards regression model identified P/D as a significant favorable prognostic factor for OS [hazard ratio (HR), 0.391; 95% confidence interval (CI), 0.175-0.871; p = 0.022] and RFS (HR, 0.418; 95% CI, 0.190-0.920; p = 0.030). Based on our findings, P/D may be superior to EPP for improving the prognosis of patients with resectable epithelioid-type MPM.

Safety and feasibility of esophagectomy following combined neoadjuvant immunotherapy and chemotherapy for locally advanced esophageal cancer: a propensity score matching.

This study aims to investigate the efficacy and feasibility of esophagectomy following combined neoadjuvant immunotherapy and chemotherapy for locally advanced esophageal cancer. We retrospectively identified patients who were treated with neoadjuvant immunotherapy and chemotherapy (NICT, n = 27) or chemotherapy alone (NCT, n = 95) at our institution between January, 2017 and April, 2021. The primary end point was 30-day complications. Major complications were defined as Clavien-Dindo classification grade ≥ 3. Secondary end points were interval to surgery, operation time, postoperative thoracic drainage, thoracic drainage tube stay, 30-day readmission rate, and 30-day mortality. Propensity score matching (PSM) was used to reduce bias caused by potential confounding. All patients included successfully completed neoadjuvant therapy and underwent McKeownminimally invasiveesophagectomy negative margins. Out of 122 eligible patients, 26 patients in NICT group and 52 patients in NCT group were identified by 1:2 PSM. After PSM, the clinical stage was matched and demographic characteristics of the two groups were well balanced, including age, gender, BMI, ASA status, age-adjusted Charlson index, smoking, drinking, chemotherapy regimens, neoadjuvant cycle, tumor location, lymphadenectomy, pathological stage, histologic sub-type, anastomotic position, route of gastric conduit, procedure type, and operative approach were comparable between groups after PSM. Although NICT group had a higher incidence of pneumonia and pleural effusion, however, the CCI index, other complication and major complications were comparable between the two groups. There were no significant differences in operation time, intraoperative blood loss, thoracic drainage tube stays, thoracic drainage volume, ICU stay, postoperative hospital stay and hospital cost. Furthermore, 30-day mortality, 30-day readmission, ICU readmission were similar in both groups. Based on our preliminary experience, esophagectomy is safe and feasible following combined neoadjuvant immunotherapy with chemotherapy for locally advanced esophageal cancer.

Learning curve for uniportal video-assisted thoracoscopic anatomical segmentectomy.

BackgroundAnatomical segmentectomy by uniportal video-assisted thoracoscopic surgery (U-VATS) is a delicate surgical procedure. Hitherto, only few studies have assessed the learning curves of anatomical segmentectomy by U-VATS, with varying data available. The present study aimed to investigate the learning curve and clinical advantages for U-VATS segmentectomy.MethodsThe medical records of patients who underwent U-VATS or non-U-VATS segmentectomy between August 2017 and May 2020 were retrospectively reviewed. Cumulative sum (CUSUM) analysis was employed to illustrate the learning curve of U-VATS segmentectomy. Perioperative parameters were used to determine the structural intervals of the learning curve, and to compare U-VATS and non-U-VATS segmentectomy.ResultsIn total, 122 patients receiving U-VATS segmentectomy and 98 patients receiving non-VATS segmentectomy were included. Of these, 116 patients underwent successful U-VATS segmentectomy, while the other six patients underwent conversions. The structural intervals of 20–29 cases and 58–63 cases were determined as the threshold according to the CUSUM analyses. The learning process of U-VATS segmentectomy was therefore divided into three phases. Interestingly, the perioperative parameters differed significantly between Phases 1 and 3, including operative time (Op-T), postoperative hospital stays (Po-Hst), postoperative thoracic drainage (Po-D), and operative failure (Po-F) rates (P<0.05). Moreover, U-VATS segmentectomy in Phase 3 was associated with significantly shorter Po-Hst and Op-T, less Po-D, and reduced postoperative pain compared with non-U-VATS (P<0.05).ConclusionsU-VATS segmentectomy is an ideal alternative to non-U-VATS segmentectomy. Surgeons can preliminarily complete U-VATS anatomical segmentectomy after performing 20–29 cases, and can master the surgical techniques after completing 58–63 cases.

Clinical evaluation of the rapid recovery of patients who underwent video-assisted thoracoscopic lung surgery under non-intubated anesthesia.

BackgroundNon-intubated anesthesia thoracoscopic surgery is an evolving form of minimally invasive thoracic surgery. It has had encouraging results in the treatment of lung cancer, and the current concept of enhanced recovery after surgery has become indispensable to surgical treatment. Our center retrospectively evaluated the clinical effect of rapid postoperative rehabilitation in patients who underwent thoracoscopic lung surgery under non-intubated anesthesia.MethodsThe clinical data of 192 patients undergoing video-assisted thoracoscopic surgery (VATS) at the Department of Thoracic Surgery of The First People’s Hospital of Yunnan Province were retrospectively analyzed. Among them, 75 received double-lumen endotracheal intubation anesthesia, and 117 received a laryngeal mask instead of endotracheal intubated anesthesia. Comparing the intra-and post-operative indicators difference of these 2 groups.ResultsThere were no significant differences in the postoperative complications, length of hospital stay, hemoglobin counts and platelet count 24 h after surgery between the non-intubated anesthesia and intubated anesthesia groups (P>0.05). In terms of the postoperative rehabilitation indicators of the VATS patients, the non-intubated anesthesia group had an earlier recovery in terms of water (food) intake, out-of-bed activity, and defecation (exhaust) times (P<0.001), less postoperative complications and adverse throat reactions (P<0.05), and higher levels of satisfaction (P<0.05) than the intubated anesthesia group. Compared to the intubated anesthesia group, the non-intubated anesthesia group had fewer changes of white blood cell counts, neutrophil percentages and lymphocytes percentages 24 h postoperatively (9.25×109 vs. 7.67×109, P=0.045; 7.06 vs. 5.53, P=0.039; 1.45 vs. 1.27, P=0.017), significant reduction pleural drainage after restoring oral intake in postoperative 24 and 48 h (198.43 vs. 131.07 and 114.04 vs. 57.47 mL, P<0.001), shorter postoperative thoracic tube drainage times (3.73 vs. 3.13 d, P<0.001). Notably, there was no difference between the smoking history and previous medical history of the patients in the 2 groups.ConclusionsCompared to intubation by general anesthesia, non-intubated thoracoscopic anesthesia is a safe and effective option. Patients who undergo non-intubated thoracoscopic lung surgery have a rapid recovery after surgery. Thus, it is worthy of promotion in clinical surgery settings.

Comparison of single-port, multi-port video-assisted thoracoscopic and open lobectomy for children: a single-center experience.

The feasibility of single-port video-assisted thoracic surgery (SPVATS) for pediatric lobectomy has not been clearly established. We compared the feasibilities of single-port (SP), multi-port (MP) VATS and open lobectomy (OL) for surgical treatment of children with lung disease. In this study, we retrospectively analyzed and compared data for 22,19 and 30 pediatric lung disease patients who had been subjected to SP, MP and OL, respectively. These procedures were performed between March, 2012 and August, 2020 at the Second Affiliated Hospital of Wenzhou Medical University. Perioperative clinical indicators were analyzed. Compared to OL, SP was associated with lower intraoperative blood loss (p = 0.008), lower postoperative thoracic drainage volume (p = 0.041),shorter chest drainage duration (p = 0.002) and hospital stay (p = 0.001). Operation time (p = 0.437), volume of estimated blood loss (p = 0.979), conversion rate to thoracotomy (p = 0.861), total thoracic drainage volume (p = 0.824), duration of chest tube drainage (p = 0.543), length of hospital stay (p = 0.812) and incidences of postoperative complications were comparable in MP and SP groups. SPVATS is a safe and feasible approach for lobectomy in pediatrics, with comparable postoperative clinical outcomes to MPVATS and better outcomes relative to OL. However, studies with large sample sizes in multicenter should be performed to verify our findings.

Five-step maneuver of transthoracic single-port assisted laparoscopic lower mediastinal lymph node dissection for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction

Objective: Surgical operation is the main treatment for advanced adenocarcinoma of esophagogastric junction (AEG). Due to its special anatomic location and unique lymph node reflux mode, the surgical treatment of Siewert II AEG is controversial. Lower mediastinal lymph node dissection is one of the most controversial points and a standard technique has not yet been established. This study is aim to explore the safety and feasibility of five-step maneuver of transthoracic single-port assisted laparoscopic lower mediastinal lymph node dissection for Siewert type II AEG. Methods: A descriptive case series study was conducted. The intraoperative and postoperative data of 25 patients with Siewert type II AEG who underwent five-step maneuver of transthoracic single-port assisted laparoscopic lower mediastinal lymph node dissection in Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2019 to April 2021 were retrospectively analyzed. Five-step maneuver was as follows: In the first step, the subcardiac sac was exposed; the right pulmonary ligament lymph nodes and the anterior thoracic paraaortic lymph nodes were dissected cranial to inferior pericardium, left to left edge of thoracic aorta. In the second step, the left diaphragm was opened, and a 12 mm trocar was placed through the 6-7 rib in the left anterior axillary line. The supra-diaphragmatic nodes were dissected through the thoracic operation hole. In the third step, the left inferior pulmonary ligament was severed. The anterior fascia of thoracic aorta was incised to join the anterior space of thoracic aorta formed in the first step and then the lymphatic tissue was dissected upward until the exposure of left inferior pulmonary vein. In the fourth step, the posterior pericardium was denuded retrogradely from ventral side to oral side to the level of left inferior pulmonary vein, right to right pleura, and then the right pulmonary ligament lymph nodes were completely removed. In the fifth step, the esophagus was denuded, and the esophagus was transected 5 cm above the tumor using a linear stapler to complete the dissection of lower thoracic paraesophageal lymph nodes. Results: Operations were successfully completed in 25 patients without conversion, intra-operative complication and perioperative death. Total gastrectomy was performed in 19 cases and proximal gastrectomy in 6 cases. The mean operative time was (268.7±85.6) minutes, the mean estimated blood loss was (90.4±44.2) ml, the mean time of lower mediastinal lymph node dissection was (38.6±10.3) minutes, and the mean harvested number of lower mediastinal lymph node was 5.9±2.9. The length of esophageal invasion was >2 cm in 7 cases and ≤ 2 cm in 18 cases. Eight patients (33.0%) had lower mediastinal lymph node metastasis, including 3 cases with esophageal invasion >2 cm and 5 cases with esophageal invasion ≤ 2 cm. The mean time to postoperative first flatus was (5.5±3.1) days. The average time of postoperative thoracic drainage was (5.9±2.9) days. The mean hospital stay was (9.7±3.1) days. Two patients (8.0%) developed postoperative grade IIIa complications according to the Clavien-Dindo classification, including 1 case of pancreatic fistula and 1 case of pleural effusion, both of whom were cured by puncture drainage. Conclusions: Five-step maneuver of transthoracic single-port assisted laparoscopic lower mediastinal lymph nodes dissection for Siewert type II AEG is safe and feasible. Which can ensure sufficient lower mediastinal lymph node dissection to the level of left inferior pulmonary vein.

Clinical application and analysis of single-port laparoscopic and thoracoscopic McKeown esophagectomy for esophageal cancer

Objective: To explore the application value of single-port laparoscopic and thoracoscopic McKeown esophagectomy for esophageal cancer. Methods: A retrospective study was conducted to collect clinical data of 34 patients with esophageal cancer who were admitted to the Department of Thoracic Surgery, the First Affiliated Hospital of Fujian Medical University, from August to November 2020. All of them, 24 males and 10 females aged from 43 to 75 with an average of (62±4) years, underwent single-port laparoscopic and thoracoscopic McKeown esophagectomy.In the thoracic part, esophageal separation and mediastinal lymph node dissection were performed with conventional 4-ports thoracoscopy in the left lateral-prone position. In the abdominal part, gastric separation and lymph node dissection were accomplished with single-port laparoscopic retrograde three-step gastric separation: firstly, the lesser omentum was dissociated, the left liver lobe was suspended with purse-string needle and thread, after that the left gastric blood vessel and lymph node was dissected; secondly, the esophageal hiatus was separated, and the gastric cardia was cut off; finally, the spleen and stomach ligaments were dissociated to complete these steps. The operation time,volume of intraoperative blood loss, time for out-of-bed activities, time of postoperative drainage tube removal,volume of thoracic drainage fluid, short-term postoperative commplications,the postoperative pathological diagnoses, the time of their discharge from hospital and results of follow-up were observed. Results: All patients underwent successfully single-port laparoscopic and thoracoscopic esophagectomy without any conversion to open surgery; the operative time of the patients was 194-285 (240±21)min, including 53-105(60±13)min for the thoracic part and 40-73(49±7)min for the abdominal part. The volume of intraoperative blood loss was 15-110(60±20) ml. The numbers of mediastinal lymph node dissected and abdominal lymph nodes harvested were 10-25(13±3), 6-16(9±3)respectively. The 34 patients resumed out-of-bed activities on the 2nd to 3rd day after the operation. The thoracic closed drainage tube and left cervical drainage were removed 2 days after the operation. The thoracic Abel drainage tube was removed 5 days after the operation. The total volume of postoperative thoracic drainage fluid was 100-500(300±100)ml. No obvious sign of anastomotic leakage, anastomotic stenosis, chylothorax or gastric emptying disorder was found after the operation. Eight cases were complicated with temporal hoarseness, and 4 patients with pneumonia which was cured by antibiotics. The mean postoperative hospital stay was 8 days(6, 8), and patients were discharged after they could take a routine semi-liquid diet. The postoperative pathological diagnoses of all patients were squamous cell carcinoma, and the postoperative pathological stage was T1-3N0-1M0. Thirty-four patients were followed up for 60 (40, 75) days after the operation. During the follow-up period, no complication or death occurred. In addition, neither recurrence nor metastasis was observed. Conclusion: Single-port laparoscopic and thoracoscopic McKeown esophagectomy for esophageal carcinoma is safe and feasible, with good short-term efficacy. Therefore we consider it an alternative minimally invasive surgery for esophageal cancer.

SV-VATS exhibits dual intraoperative and postoperative advantages

BackgroundThe merits of spontaneous ventilation video-assisted thoracic surgery (SV-VATS) are still controversial. Our team retrospectively evaluated the intraoperative and postoperative advantages of this surgical approach, comparing with mechanical ventilation video-assisted thoracic surgery (MV-VATS).MethodsWe did a single center retrospective study at the First Affiliated Hospital of Yunnan Province. 244 patients were eventually assigned to the SV-group and MV-group, and their intraoperative indicators and thoracic surgery postoperative data were included in the comparison.ResultsThe SV-group exhibited markedly less intraoperative bleeding and postoperative thoracic drainage, and the bleeding volume was correlated with the volume and duration of drainage. Further analysis showed that, patients undergoing SV-VATS had less activation of white blood cells and neutrophils after surgery, but they also had lower serum albumin concentrations. Risks of short-term postoperative complications, including inflammatory reactions, malignant arrhythmias, constipation, and moderate or more pleural effusions, were also significantly reduced in the SV-group. Additionally, hospitalization cost was lower in the SV-group than that in the MV-group.ConclusionsSV-VATS is suitable for various types of thoracic surgery, and effectively reduce intraoperative bleeding and postoperative thoracic drainage. With less postoperative inflammatory response, it reduces the risk of short-term postoperative complications. It is also able to help to reduce the financial burden of patients.