Role Of Video-assisted Thoracoscopic Surgery Research Articles

Perioperative outcomes in redo VATS for pulmonary ipsilateral malignancy: A single center experience

BackgroundThe role of video-assisted thoracoscopic surgery for oncological major pulmonary resections is now well established; however, the literature within pulmonary re-operations is still limited. The purpose of this study is to evaluate the safety and efficacy of redo thoracoscopic resections for ipsilateral pulmonary malignancy. MethodsData from patients undergoing video-assisted thoracoscopic surgery at the Unit of Thoracic Surgery of Padua were analyzed, comparing the results between the first and second ipsilateral surgery. The retrospective study included patients who underwent 2 thoracoscopic surgeries for oncological reasons between 2015 and 2022. The variables considered included patients' baseline characteristics, pre, intra, and postoperative data. ResultsThe study enrolled 51 patients undergoing ipsilateral thoracoscopic re-operation. The statistical analysis showed that surgical time (95min vs 115min; p = 0.009), the presence of intrapleural adhesions at second surgery (30 % vs 76 %; p < 0.001), overall pleural fluid output (200 vs 560 ml; p = 0.003), time with pleural drainage (2 vs 3 days; p = 0.027), air leaks duration time (p = 0.004) and post-operative day of discharge (3 vs 4 days; p = 0.043) were significantly higher in the re-operation group.No statistical differences were observed between the 2 groups respect to R0 resection rate (90.2 % vs 89.1 %; p=>0.9) and complications (5.8 % vs 15.6 %; p = 0.11).The conversion rate to open surgery was 11.8 %. ConclusionAlthough some differences emerged between the first and second intervention, they had minimal impact on the clinical course of the patients.Therefore, thoracoscopic surgery has been shown to be safe and effective in re-operations with satisfying perioperative outcomes. To achieve such results, these procedures should be reserved for experienced surgeons.

The role of VATS in the removal of intrathoracic foreign bodies - a systematic review.

To date, no systematic review or meta-analysis study has been conducted regarding the use of video-assisted thoracoscopic surgery (VATS) in the removal of intrathoracic foreign bodies (FB). This systematic review aims to evaluate the feasibility of VATS in the removal of intrathoracic FBs. PubMed/MEDLINE, CINAHL, Web of Science, EMBASE, and Cochrane Library databases were systematically searched to identify reports published up to April 1, 2022. The initial systematic search revealed a total of 208 papers, of which only 54 studies reporting 71 cases were included in this systematic review. Among the patients, 46 (64.8%) were male, 22 (31%) were female, and 3 (4.2%) were unknown. The mean age was 34.5 ± 24.3years (1day to 98years). The patients were of 3 etiologic groups: iatrogenic (31, 43.7%), traumatic (28, 39.4%), and accidental (9, 12.7%). Most of the patients were emergency cases (27, 38%). The most frequently used imaging modalities to diagnose these foreign bodies were X-ray (46, 64.8%), followed by computed tomography (44, 62%), and ultrasonography (16, 22.5%). About 43% of all the foreign bodies were therapeutic equipment. The pleural cavity had the highest involvement (36.8%), followed by the lung parenchyma (14.6%) and thoracic cavity (13.2%). Regardless of the number of access ports, all the patients had a good clinical outcome. VATS is a safe and effective method for the removal of intrathoracic FBs from various thoracic sites that are associated with a good clinical outcome - in both elective and emergency cases.

Role of Video-Assisted Thoracoscopic Surgery in the Management of Pleural Empyema

Background: Video-assisted thoracoscopic surgery (VATS) has revolutionized surgical management of patients with empyema. Thoracoscopic management of empyema includes VATS debridement and decortication. VATS debridement has been employed by many centres as the primary treatment option for early-stage empyema. Objective: To evaluate the outcome of VATS over open thoracotomy. Methods: This cross-sectional study was conducted in the department of Thoracic Surgery of Combined Military Hospital Dhaka from 01 January 2017 to 30 May 2018 among 30 patients (20 patients underwent VATS and 10 patients underwent open decortication/OD). The results were viewed with respect to baseline characteristics, preoperative management, operative and postoperative course. Results: Operative time and median in-hospital length of stay were shorter for the VATS group: 128 vs 140 minutes (p &lt; .001), and 14 vs 11 days (p .03), respectively. The median postoperative length of stay was 12 days for the VATS group vs15 days for the OD group (p &lt; .001). Complications after Video Assisted Thoracic Surgery is less like prolonged air leakage, infection and atelectasis. Conclusions: VATS decortications for empyema thoracis, complex effusion, haemothorax yields better results than open decortications. Patients treated with VATS have less postoperative complications. VATS debridement and decortication is safe and effective treatment in the management of empyema thoracis. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 19-22

Surgical therapy for early stage non small cell lung cancer: VATS versus Thoracotomy

Objectives: Non-Small Cell Lung Cancer (NSCLC) is the common cancer and the leading cause death of cancer. Lobectomy and lymph node dissection is optimal surgical treatment method for early stage of NSCLC. Video-assisted thoracoscopic surgery (VATS) approach is less trauma, quickly recovery, whereas those who advocate thoracotomy claim it as an ontologically superior procedure.&#x0D; The aims of the study are to evaluate the role of Video-Assisted Thoracoscopic Surgery for treating the patients who have early stage of NSCLC and comparing with conventional thoracotomy.&#x0D; Methods: All of patients with NSCLC in stage IA - IIB underwent lobectomy and lymph node dissection through VATS or thoracotomy are collected. Patient characteristics are compared. Operative data, complications are assessed and survived is assessed by Kaplan–Meier and Cox proportional hazards analysis. Follow-up from 14 to 66 months.&#x0D; Results: From May 2008 to August 2016, 57 patients with NSCLC stage IA - IIB underwent an attempt at VATS lobectomy and 60 patients underwent thoracotomy. There are 75 males and 42 females, mean age is 56.3, range 31 - 84. Lobectomy was performed in 106 cases and bilobectomy was performed in 11 cases. The mean operating time in VATS group is 157 minutes longer than conventional thoracotomy, which was 124 minutes. There was no statistic difference between 2 groups separated based on characteristics of patients. In 57 cases VATS, 5 cases were converted to thoracotomy. There was one death in conventional thoracotomy group. One patient had bleeding, needed to be re-operationed to control bleeding in each group. Prolonged air-leak presented in 7 cases (10.7%) in thoracotomy and 2 cases (3.8%) in VATS group. Hospitalization is 18.4 days in thoracotomy group and 12.8 days in VATS group. The 5-year OS rate was 67.8% in the VATS group and 71.6% in the thoracotomy group (p = 0.156). The 5-year DFS rate was 59.6% in the VATS group and 65.9% in the thoracotomy group (p = 0.065). Survival by Cox model was no different for VATS versus thoracotomy (hazard ratio 0.82; P = .21)&#x0D; Conclusion: Video-assisted thoracoscopic surgery is effective and safe method for surgical treatment of early stage of NSCLC. Surgery remains the primary therapy in the treatment of early-stage lung cancer. VATS was associated with less complication and shorter length of hospital stay. The 5 years survival is similar in VATS and conventional thoracotomy approach.

Video-Assisted Thoracoscopic Surgery versus Open Decortication in Chronic Pleural Empyema

Background: The role of video-assisted thoracoscopic surgery (VATS) for managing organized empyema is still limited. This study compared VATS versus open decortication in patients with chronic pleural empyema.&#x0D; Methods: This randomized controlled trial included 58 patients with stage III empyema. Patients were divided into two groups. Group A (n= 30) included patients who had decortication through an open thoracotomy, and Group B (n= 28) included VATS decortication patients. Two patients in the VATS group were converted to the open approach and were excluded from the analysis.&#x0D; Results: The mean age in Group A was 48.23 ± 8.44 years and 49.79 ± 7.85 years Group B (p= 0.47). There were 16 males (53.3%) in Group A and 15 (63.6%) in Group B (p= 0.99). The operative time was 336.0 ± 67.60 min in Group A and 291.07 ± 56.66 min in Group B (p= 0.01). There was no difference in intraoperative complications between groups. Postoperative hospital stay (p= 0.23) and ICU admission (p= 0.24) did not differ between groups. In Group A, the pain scale was 8 (6- 8), and it was 4 (2- 4) in Group B (p˂ 0.001). No difference was recorded in the postoperative complications between groups.&#x0D; Conclusion: The outcomes of VATS in managing stage III empyema are comparable to the open approach. VATS has the advantage of lower postoperative pain. VATS could be an alternative to open decortication in patients with stage III pleural empyema.

Video-Assisted Thoracoscopic Surgery (VATS) for Spontaneous Pneumothorax and Emphysematous Bullous Lung Disease: A Study From Northern India.

Introduction: Bullous lung disease is the most common cause of spontaneous pneumothorax. The management of the same is primarily surgical, aiming at the bullectomy, which was earlier performed by standard postero-lateral thoracotomy. The last two decades have seen more frequent use of video-assisted thoracoscopic surgery (VATS) for the same and has been shown to be a low morbidity, efficacious, and cost-effective method. In this study we assess the role of VATS in the spectrum of bullous lung disease.Method: The study was conducted in the Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, for a period of three years from January 1, 2016 to December 31, 2019 in which patients with bullous lung diseases were enrolled and the role of video-assisted thoracoscopic surgery was assessed in them.Results: The study included a total of 75 patients who were managed operatively either by VATS or open thoracotomy. In the study group, the average age of patients was 35.6 years (range 16-68 years). The most common presentation was only bullous lung disease (BLD) in 40% of patients followed by 32% of patients having both BLD and broncho-pleural fistula (BPF). Apical segmentectomy/non-anatomical wedge resection was done in 36% of patients whereas VATS bullectomy was done in 36% of patients. Elective conversion to thoracotomy was planned in six patients because of dense adhesions and thick pleural peel. We performed pleurodesis in almost all cases (96%). Mean blood loss in the VATS procedure was 48.7 ml and mean operative time was 67.2 minutes. Mean duration of hospital stay was 4.8 days. Forced expiratory volume (FEV1) increased significantly from a mean of 65.80% to 77.60%. There was significant increase in forced vital capacity (FVC) mean from 70.30% to 79.50%.Conclusion: VATS can be used as a safe, feasible and effective procedure in patients presenting with spontaneous pneumothorax and bullous lung disease with or without a broncho-pleural fistula or parenchymal leak. It should be preferred over the traditional open thoracotomy procedure, whenever feasible to do so, in view of decreased perioperative morbidity and better functional outcome.

Role of video-assisted thoracoscopic surgery in pulmonary metastasectomy.

There are sparse prospective studies investigating the role of video-assisted thoracoscopic surgery (VATS) in management of pulmonary metastasis. To prospectively investigate short-term surgical and pathological outcomes for PM patients operated on by VATS or open thoracotomy (OT) for management of lung secondaries. Between October 2017 and December 2020, patients undergoing pulmonary metastasectomy were recruited. Patients were assigned to undergo resection with either thoracotomy (group 1) or VATS (group 2) after multidisciplinary team discussions based on the number, size and location of pulmonary metastasis and underlying lung function. All related short-term surgical and pathologic outcomes for both groups were collected for analysis. Of 58 patients enrolled, 21 were in group 1 and 37 in group 2. Colorectal cancer primary represented 40% of the cases. Patients in the VATS group were more likely to have solitary lesions that are peripherally located and removed by wedge resection, as opposed to patients in the thoracotomy group, who had more anatomical lung resections. More new nodules were likely to be detected during surgery in thoracotomy than VATS cases (p = 0. 027). However, 8 (out of 15) of the newly detected lesions were not malignant. Operative time, blood loss and hospital stay were in favor of VATS procedures. In a highly selected cohort of pulmonary metastasis patients with favorable criteria (peripherally located, small, solitary/oligo-metastasis and cN0), VATS may provide acceptable onco-pathologic outcomes as compared to the standard open thoracotomy.

The Role of Video-Assisted Thoracoscopic Surgery in Pediatric Oncology: Single-Center Experience and Review of the Literature.

Aim: Video-assisted thoracoscopic surgery (VATS) has been widely used in the last decades. Nevertheless, the pros and cons of thoracoscopy vs. open surgery in pediatric oncology are still under debate. In literature, VATS has been applied for both diagnostic and ablative surgery to treat neurogenic tumors, thymic neoplasms, lung tumors and metastases, germ cell tumors, lymphoproliferative diseases, and other rare tumors. Recent reviews described excellent outcomes in pediatric oncology as well as in the treatment of adult lung cancer, with a significantly higher rate of mortality and complication in thoracotomy compared to VATS. We reviewed our experience on thoracoscopy in pediatric malignancy and compared it to the literature.Materials and Methods: This was a retrospective cohort-study of pediatric oncological patients who underwent VATS at our institution from 2007 to 2020, and a review of the recent literature on the topic.Results: A total of 43 procedures were performed on 38 oncological patients (18 males, 20 females). Median age was years 7.72 (0.35–18.6). Diagnosis: 10 neurogenic tumors, nine hematological diseases, five metastases, four lypoblastomas, three thymic pathologies, three germ cell tumors, two pleuropneumoblastomas, two myofibroblastic tumors, one myoepithelial carcinoma, one liposarcoma, and three suspected oncological mass. In three cases, a 3D model was elaborated to better plan the surgical approach. Diagnostic biopsies were 22 (51.1%), and ablative surgeries, 21 (48.9%). One neurogenic tumor was resected with the Da Vinci Robot. Median operative time was 120 min (30–420). A drain was left in place in 20 (46.5%) for a median of 4 days. Median length of hospitalization was 5 days (1–18). One case (2.3%) was converted (intraoperative bleeding). There were three post-operative complications (7.0%): one pneumonia, one pleural effusion, and one diaphragmatic paralysis (need for plication). Results were compared to recent literature, and morbidity and conversion rate were comparable to reviewed publications.Conclusion: VATS represents a valuable tool for diagnostic and therapeutic procedures in pediatric oncology. Nonetheless, it is a challenging technique that should be performed by expert surgeons on oncological and mini-invasive surgery. Three-dimensional reconstruction can optimize the pre-operative planning and guarantee a safer and more targeted treatment. Finally, the advent of robotics-assisted surgery represents a new challenge that may further implement the advantages of VATS.

Video-assisted pulmonary metastectomy is equivalent to thoracotomy regarding resection status and survival

BackgroundSurgical resection of pulmonary metastases leads to prolonged survival if strictly indicated. Usually, thoracotomy with manual palpation of the entire lung with lymph node dissection or sampling is performed. The aim of this study was to evaluate the role of video-assisted thoracoscopic surgery (VATS) in pulmonary metastectomy with curative intent.MethodsIn this study, all patients with suspected pulmonary metastasis (n = 483) who visited the Center for Thoracic Surgery in Regensburg, between January 2009 and December 2017 were analysed retrospectively.ResultsA total of 251 patients underwent metastectomy with curative intent. VATS was performed in 63 (25.1%) patients, 54 (85.7%) of whom had a solitary metastasis. Wedge resection was the most performed procedure in patients treated with VATS (82.5%, n = 52) and thoracotomy (72.3%, n = 136). Postoperative revisions were necessary in nine patients (4.8%), and one patient died of pulmonary embolism after thoracotomy (0.5%). Patients were discharged significantly faster after VATS than after thoracotomy (p < 0.001). Complete (R0) resection was achieved in 89% of patients. The median recurrence-free survival was 11 months (95% confidence interval 7.9–14.1). During follow-up, eight (12.7%) patients in the VATS group and 42 (22.3%) patients in the thoracotomy group experienced recurrence (p = 0.98). The median overall survival was 61 months (95% confidence interval 46.1–75.9), and there was no significant difference with regard to the surgical method used (p = 0.34).ConclusionsVATS metastasectomy can be considered in patients with a solitary lung metastasis. An open surgical approach with palpation of the lung showed no advantage in terms of surgical outcome or survival.

Video-assisted thoracoscopic lobectomy after neoadjuvant chemotherapy for non-small cell lung cancer: a multicenter propensity-matched study

BackgroundThe role of video-assisted thoracoscopic surgery for the treatment of non-small-cell lung cancer after neoadjuvant chemotherapy remains controversial. The aim of this study is to demonstrate the reliability of video-assisted lobectomy compared to the open approach by evaluating perioperative and long-term outcomes.MethodsIn this retrospective, multicentric study from January 2010 to December 2018, we included all patients with non-small-cell lung cancer who underwent lobectomy through the video-assisted or open approach after neoadjuvant chemotherapy. The perioperative outcomes, including data concerning the feasibility of the surgical procedure, the occurrence of any medical and surgical complications and long-term oncological evidence, were collected and compared between the two groups. To minimize selection bias, propensity score matching was performed.ResultsA total of 286 patients were enrolled: 193 underwent thoracotomy lobectomy, and 93 underwent VATS lobectomy. The statistical analysis showed that surgical time (P < 0.001), drainage time (P < 0.001), days of hospitalization (P < 0.001) and VAS at discharge (P = 0.042) were lower in the VATS group. The overall survival and disease-free survival were equivalent for the two techniques on long-term follow-up.ConclusionsVATS lobectomy represents a valid therapeutic option in patients affected by non-small-cell lung cancer after neoadjuvant chemotherapy. The VATS approach in our experience seems to be superior in terms of the perioperative outcomes, while maintaining oncological efficacy.

The role of video-assisted thoracoscopic surgery in the diagnosis of interstitial lung disease.

When a clinical context is indeterminate for idiopathic pulmonary fibrosis (IPF), or a chest high-resolution computed tomography (HRCT) pattern is not indicative of typical or probable usual interstitial pneumonia (UIP) in patients with interstitial lung disease (ILD), surgical lung biopsy should be considered to make a confident diagnosis on the basis of multidisciplinary diagnosis (MDD). The aim of this study was to evaluate the role and safety of video-assisted thoracoscopic surgery (VATS) in patients with ILD. A total of 143 patients with ILD underwent VATS at Toho University Medical Center Omori Hospital between March 2004 and April 2017. We conducted a retrospective study on the usefulness and safety of VATS in the diagnosis of ILD under MDD. The 30-day mortality was 0%. The postoperative complication rate was 12.6%, which included 5 cases of pneumothorax after discharge (3.5%), 4 cases of prolonged air leakage (2.8%), and 2 cases of acute exacerbation (1.4%). Three of 9 cases (33.3%) complicated by pneumothorax after discharge or prolonged air leakage were resected specimens of pleuroparenchymal fibroelastosis (PPFE). Two patients had acute exacerbation, who were ultimately diagnosed as having idiopathic unclassifiable IP and had histologically significant irregular dense fibrosis and numerous fibroblastic foci. The comparison between chest HRCT and histopathological findings revealed 55 cases of possible UIP [UIP (45%), NSIP (25%), and unclassifiable IP (29%)] and 21 cases of inconsistent with UIP [UIP (10%), NSIP (33%), organizing pneumonia (10%), unclassifiable IP (24%), and PPFE (24%)]. VATS can be safely performed to obtain a confident diagnosis for appropriate treatment strategies in patients with ILD.

Video-assisted thoracoscopic surgery in the management of malignant pleural disease

Surgical treatment of malignant pleural diseases is usually indicated in advanced disease with a limited prognosis. associated with significant morbidity. Minimally invasive approaches must be offered as first line treatment since they reduce chest wall trauma, preserve respiratory muscle function and therefore expedite recovery. Most of the evidence for therapeutic video-assisted thoracoscopic surgery (VATS) pleural surgery is for primary malignant pleural mesothelioma (MPM) whilst in the treatment of metastatic non-small cell lung cancer (NSCLC) therapeutic VATS is concerned mainly in the prevention of pleural effusion or the treatment of malignant empyema. An increasing amount of management decisions using VATS in malignant pleural disease is evidence-based. There have been and continue to be well constructed clinical trials of the various potential therapeutic applications of VATS in this context. VATS allow for therapeutic manipulation of the pleural environment including dissection techniques aimed at symptom control by direct tumour debulking. We will consider the role of VATS in the management of malignant pleural disease in the context of a lung that will expand; when the lung is entrapped and when the lung is entrapped by a malignant empyema. In the first scenario the therapeutic choice is between simple VATS administration of chemical pleurodesis or the more controversial subtotal parietal pleurectomy. When the lung is entrapped but the cavity still cleans the choice is between the insertion of an indwelling pleural catheter (IPC) or the highly disputed VATS visceral pleurectomy to re-expand the lung. When a malignant effusion becomes infected the entrapped lung may form a malignant pleural empyema and the debate is between just debridement or the more technically challenging decortication. We will attempt to evaluate all of these procedures and formulate a management algorithm.

Survival of the fittest: the role of video-assisted thoracoscopic surgery in thoracic impalement injuries.

Trauma is the leading cause of death among those under the age of 45 in Taiwan (1). According to the literature, thoracic injuries account for approximately 25% of trauma-related deaths, with an estimated one-third of these mortalities being immediate because of injury severity (2).

Evolving role of video-assisted thoracoscopic surgery in the management of spontaneous primary and secondary pneumothorax

Background: Video-assisted thoracoscopic surgery (VATS) has been increasingly advocated as the preferred treatment for the first episode of primary spontaneous pneumothorax (PSP), in contrast to the current guidelines of the American College of Chest Physicians and the British Thoracic Society recommending tube thoracostomy. Materials and Methods: We retrospectively reviewed the medical records of our patients who underwent VATS for primary or secondary SP from January 2005 to December 2015. Results: There were 36 patients, with the mean age of 43.6 ± 20.5 years, and 72.2% of them were male and 66.7% with PSP. 75.0% of SSP patients had chronic obstructive pulmonary disease versus 0% for PSP (P = 0.001). 50% of PSP and 66.7% of SSP patients had experienced previous SP. About 16.7% (PSP) and 0% (SSP) of patients with index pneumothorax and 75.0% (PSP) and 25.0% (SSP) of patients with multiple pneumothoraces underwent early VATS, while the remaining had delayed VATS for a prolonged air leak. Postoperative air leak occurred in 1 (4.2%) PSP patient, which healed with doxycycline pleurodesis, and in 4 (33.3%) SSP patients, which required thoracotomy in three patients and redo-VATS in one patient for control. Operative mortality was 0% versus 8.3% for PSP and SSP, respectively (P = 0.351). In patients with extended follow-up, ipsilateral recurrence occurred only in one SSP patient at 36 months. Conclusion: Index SP was mostly treated by the tube thoracostomy, except for recent years, when VATS was recommended to young adult patients with index PSP, because of zero operative mortality, lower recurrence, and less time away from work or school. However, for SSP patients, VATS was reserved primarily for persistent air leak or recurrence.

Thoracoscopic lobectomy after induction therapy-a paradigm shift?

Video-assisted thoracoscopic approaches (or VATS) have gained significant momentum in the management of locally advanced NSCLC in the current era. Accrual of experiences and concurrent improvements in instrumentation and video technology have further enhanced its role in patients with stage IIIA (N2) non-small cell lung cancer (NSCLC). However, substantial controversy exists around the notion of mediastinal staging and restaging after induction therapy, the utility of induction chemotherapy versus chemoradiation for N2 disease, and subsequent role of video-assisted thoracoscopic surgery (VATS) lobectomy following induction therapy. This perspective will closely examine these issues in the context of existing guidelines and contemporary studies.

Clinical history and surgical management of parapneumonic empyema what is the role of video-assisted thoracoscopic surgery (VATS)?

Pleural empyema represents a frequent disease, characterized sometimes by blurred and unspecific signs or symptoms but requiring timely diagnosis in order to plan the most appropriate therapeutic regimen. Several classifications have proposed and the most widely used is the American Thoracic Society (ATS) one, according to increasing severity depending of the extent of disease. Different therapeutic strategies such as conservative regimens (antibiotic therapy and chest tube placement) and surgical one (empyemectomy with pleural decortication) were applied. To this date, minimally invasive surgery is assuming an important role in the management of empyema and represents the gold standard in stage II disease and a valid alternative to the classical approach in stage III in absence of a complete obliteration of the pleural space. Aim of the work is to define, through a comprehensive review of literature, the role of video-assisted thoracoscopic surgery according to limits and advantages compared to conservative methods and the most invasive surgical approaches.

The role of video-assisted thoracoscopic surgery in the first rib resection for thoracic inlet syndrome

The role of video-assisted thoracoscopic surgery in the first rib resection for thoracic inlet syndrome

The role of video-assisted thoracoscopic surgery for management of symptomatic pleural effusion after coronary artery bypass surgery: a best evidence topic report.

A best evidence topic in thoracic surgery was written addressing whether video-assisted thoracoscopic surgery (VATS) talc pleurodesis could be justified in patients with pleural effusion (PE) after coronary artery bypass graft (CABG) surgery and no-responded to repeated thoracentesis. Ten papers were identified to answer the question. Of these, two were case-series study including ≥4 patients, 7 retrospective analytical studies, and one observational study but no randomized controlled trial (RCTs) was included in the analysis. The score of the level of evidence was low; only one study presented a level of evidence of 2, 7 studies a level of 3b; and two studies a level of evidence of 4. The incidence of symptomatic post-CABG PE ranged from 2% to 9.7%. Management strategies included medical management, thoracentesis, and/or surgical drainage. Most of the authors treated early and late PE with thoracentesis or chest drainage, while VATS with pleurodesis was reserved only for selected patients with persistent effusion after repeating thoracentesis and/or chest drainage. All studies but one do not include follow-up, thus rendering it difficult to define the real role of thoracentesis or chest drainage as definitive treatments for effusion, given the incomplete data regarding how many patients' effusions recur. Conversely, with follow up reported, no case of recurrence was found after VATS procedure. In patients who underwent delayed VATS, it was common to identify the formation of tenacious peel that trapped the lung. In three cases conversion to thoracotomy was required to decorticate the inflammatory peel that covered the pleura and did not allow the lung re-expansion. However, only five papers showed that VATS for management of post-CABG PEs is safe and efficacious and its use could help to prevent trapped lung through the resection of adhesions and loculations sometimes associated with multiple previous thoracentesis or chest drainage. As the low grade of evidence from the present analysis, future randomized controlled studies are wanted to define the real effectiveness of VATS in this field.

Glasses-free three-dimensional endoscopic bronchoplasty, arterioplasty, and angioplasty of the superior vena cava for the radical treatment of right middle upper lung cancer.

The role of video-assisted thoracoscopic surgery (VATS) radical resection in the treatment of lung cancer has widely recognized. Studies have demonstrated that the thoracoscopic radical treatment of lung cancer can achieve similar long-term survival as that of conventional open surgeries; meanwhile, it can be applied for bronchial sleeve resection that is more challenging for most thoracic surgeons. Bronchial sleeve pneumonectomy can avoid total pneumonectomy when removing tumors, and therefore it can lower the surgery-associated mortality and improve the long-term survival by maximizing the preservation of lung function. Thus, it has become a standard procedure for central-type lung cancer. We have completed a glasses-free three-dimensional (3D) complete thoracoscopic surgery in a patient with central-type lung cancer in his right lung. During the surgery, we found the tumor had invaded the right pulmonary trunk, right main bronchus, and lateral wall of superior vena cava.

Is Video-Assisted Thoracoscopic Surgery Adequate in Treatment of Pulmonary Hydatidosis?

Surgical management of pulmonary hydatid cyst disease has been well established. However, there are still limited data on the role of video-assisted thoracoscopic surgery in treatment of this disease. The aim of this study is to identify the advantages and disadvantages of minimally invasive surgery and compare the outcomes with patients undergoing thoracotomy in this parasitic disease. The medical records of 77 patients (53 male, 24 female) undergoing surgery for pulmonary hydatid cyst disease between January 2011 and January 2014 were reviewed. Removal of the hydatid cyst was completed using video-assisted thoracoscopic surgery in 39% (n = 30) of the patients, whereas open thoracotomy was used in 61% (n = 47). Conversion rate was 21%. Statistical analysis was used to assess differences in drainage amount, time to drain removal, length of surgery, length of hospital stay, and pain scores. Probability values of less than 0.05 were considered significant. The drainage amount, time to drain removal, length of surgery, duration of narcotic analgesics usage, and visual analog scale scores in the thoracotomy group were significantly longer than those of the thoracoscopy group. Postoperative complications occurred in 4.3% of thoracotomy and in 13.3% of thoracoscopy patients. There was no mortality in either group. During the follow-up period, no recurrence was detected. Video-assisted thoracoscopy for surgery of pulmonary hydatid cyst disease is superior to open thoracotomy causing less postoperative pain, a better cosmetic result, a shorter surgical time, a lower drainage volume, and a shorter time to drain removal in a selected group of patients. The fear of recurrence because of incomplete isolation of the cyst during removal was not a concern regarding our technique.