Safety Of Video-assisted Thoracoscopic Surgery Research Articles

Evaluating VATS versus Open Surgery for Non-Small Cell Lung Cancer: A 5-year Retrospective Study.

The efficacy and safety of video-assisted thoracoscopic surgery (VATS) versus open thoracotomy in the treatment of non-small cell lung cancer (NSCLC) were evaluated with a focus on mediastinal lymph node dissection, postoperative recovery, and longterm outcomes including survival rates and disease-free intervals. Materials and Methods: This retrospective study analyzed data from 228 NSCLC patients treated at the Institute of Oncology Bucharest from 2016 to 2022. Both VATS and open surgical approaches were compared, with variables including demographic data, comorbidities, surgical outcomes, and postoperative complications meticulously recorded. Statistical significance was assessed using chi-square and independent samples t-tests. Results: Among the findings, VATS demonstrated significantly better two-year progression-free survival rates for patients in early stages (Stages 1-3) of NSCLC compared to open surgery, with p-values 0.01 and 0.001, respectively. In contrast, no significant difference was observed in Stage 4. Furthermore, VATS resulted in shorter operative times (mean 299 vs. 347 minutes, p 0.001), less estimated blood loss (98.68 mL vs. 160.88 mL, p 0.001), reduced chest tube duration (5.78 days vs. 12.17 days, p 0.001), and decreased hospital stays (12.0 days vs. 27.7 days, p 0.001). Conclusions: VATS is associated with improved long-term disease-free survival for early-stage NSCLC and more favorable short-term surgical outcomes, highlighting its advantages over open thoracotomy. Despite its benefits, VATS did not significantly reduce postoperative complications compared to open surgery.

506 Video-Assisted Thoracoscopic Surgery in Traumatic Rib Fractures in Comparison with Conventional Surgery: Systematic Review and Meta-Analysis

Abstract Aim This review aims to analyse the efficacy and safety of Video-assisted thoracoscopic surgery (VATS) in the management of traumatic rib fractures. Method A systematic review was performed in accordance with the PRISMA guidelines identifying literature regarding the use of VATS in rib fractures. The primary efficacy outcome included change in pain score. Safety outcomes included mortality, infection, and readmission. Meta-analysis was performed using the RevMan and R software. Results 11 studies were included, with a total of 866,044 patients, of which 1,510 underwent VATS and 12,555 underwent conventional surgery. Participants included were predominantly male (77.46%), and the mean age was 53.22 ± 10.61 years. Overall, a considerable decrease of 2.60 (95% CI [1.38 – 3.83]) points was noted in the pain score within the VATS group which was higher when compared to conventional surgery (SMD = -1.62, 95% CI [-2.25, -0.99], p<0.01). Similarly, the rates of surgical site infections (OR = 0.21, 95% CI [0.06 – 0.68], p<0.01) and pneumonia (OR = 0.15, 95% [0.03 – 0.84], p = 0.03) were lower in the VATS group. The rates of mortality within 30 days were only 2.09% (95% CI [1.43% - 3.04%]), and readmission rates were 3.48% (95% CI [0.65% - 16.59%]) in the VATS group. Conclusions The results of the study suggest that there is a significant improvement in the Quality-of-Life in terms of change in pain score and reduced rates of infection, that make VATS a suitable alternative to conventional surgery in the management of traumatic rib injuries. However, further studies exploring the long-term effects are warranted.

Video-Assisted Thoracic Surgery Without Intraoperative Fluoroscopy After Microcoil Localization

BackgroundSmall nodules and ground-glass opacities can present a challenge when surgeons rely on direct visualization or digital palpation. Preoperative localization improves nodule detection. We aimed to determine the efficacy and safety of video-assisted thoracoscopic surgery (VATS) nodulectomy without intraoperative fluoroscopy after computed tomography (CT)–guided microcoil localization of peripheral pulmonary nodules. MethodsThe cases of 147 consecutive patients (152 nodules) who underwent CT-guided microcoil localization (157 coils) followed by same-day VATS resection between 2016 and 2021 were retrospectively reviewed, and descriptive statistics were reported. ResultsAll 152 nodules (mean size, 13.5 ± 6.1 mm; mean distance to pleura, 4.2 ± 5.5 mm; 82 [54%] ground-glass nodules, 34 [22%] part-solid nodules) in study patients (mean age, 64.6 ± 11.8 years) were successfully resected. The technical success rate of percutaneous nodule localization with pleural tagging was 96% (150/157); the surgical efficacy of VATS nodulectomy without intraoperative fluoroscopy was 98% (149/152). Twelve patients (8%) required chest tubes after localization. Pathologic examination identified 24 benign and 123 malignant nodules, including 85 primary lung cancers. ConclusionsCT-guided microcoil localization with pleural tagging is safe and effective and obviates the need for intraoperative fluoroscopy.

Efficacy and safety of video-assisted thoracoscopic surgery for pulmonary TB

OBJECTIVE: Compared with thoracotomy, video-assisted thoracoscopic surgery (VATS) has the advantage of post-operative recovery for patients undergoing surgery. However, studies comparing the efficacy of VATS with conventional traditional thoracotomy for treating patients with pulmonary TB (PTB) are inconsistent.METHODS: Five electronic databases were used to search studies on VATS and conventional thoracotomy for PTB up to 15 March 2022. Standardised mean differences (SMDs) and odds ratios (ORs) were calculated for comparison.RESULTS: A total of 14 were included. Compared with traditional thoracotomy, patients with drug-resistant TB treated using VATS had shorter operative time, less intra-operative bleeding, faster post-operative recovery and fewer post-operative complications (operation time: SMD -0.87, 95% CI -1.29 to -0.45; blood loss: SMD -1.31, 95% CI -1.71 to -0.92; duration of hospital stay: SMD -1.68, 95% CI -2.46 to -0.90; catheterisation time: SMD -1.56, 95% CI -2.39 to -0.73; post-operative complication: OR 0.40, 95% CI 0.27 to 0.60).CONCLUSION: Compared with conventional thoracotomy, VATS for patients with multidrug-resistant PTB undergoing lobectomy and wedge resection has the advantages of minor bleeding, shorter operative time, shorter hospital stay and post-operative pleural cavity drainage duration, and fewer post-operative complications, which can accelerate the post-operative recovery of patients.

The role of video-assisted thoracoscopy in the treatment of isolated closed chest trauma

The objective was to evaluate the effectiveness and safety of video-assisted thoracoscopic surgery for closed chest trauma and to determine the most favorable terms for performing surgical intervention in case of complicated closed chest injury.METHODS AND MATERIALS. The study included 95 patients who underwent video-assisted thoracoscopy (VATS) for closed chest trauma. Group I – operated within the first 5 days from the moment of injury; group II – operated within 5–10 days after injury; group III – operated later than 10 days after injury.RESULTS. Performing thoracoscopic intervention within the first 5 days after the injury significantly reduces the incidence of complications such as pneumonia, pleurisy, empyema. VTS allows safely and effectively performing various surgical procedures in case of complicated closed chest trauma, and diagnosing diaphragm injuries.CONCLUSION. Indications for video-assisted thoracoscopy should be set as early as possible.

Diagnostic yield and safety of transbronchial lung cryobiopsy and surgical lung biopsy in interstitial lung diseases: a systematic review and meta-analysis.

Transbronchial lung cryobiopsy (TBLC) is increasingly being used as an alternative to video-assisted thoracoscopic surgery (VATS) biopsy to establish the histopathologic pattern in interstitial lung disease (ILD). A systematic literature search of the PubMed and Embase databases, from October 2010 to October 2020, was conducted to identify studies that reported on diagnostic yield or safety of VATS or TBLC in the diagnosis of ILD. 43 studies were included. 23 evaluated the diagnostic yield of TBLC after multidisciplinary discussion, with a pooled diagnostic yield of 76.8% (95% confidence interval (CI) 70.6-82.1), rising to 80.7% in centres that performed ≥70 TBLC. 10 studies assessed the use of VATS and the pooled diagnostic yield was 93.5% (95% CI 88.3-96.5). In TBLC, pooled incidences of complications were 9.9% (95% CI 6.8-14.3) for significant bleeding (6.9% for centres with ≥70 TBLC), 5.6% (95% CI 3.8-8.2) for pneumothorax treated with a chest tube and 1.4% (95% CI 0.9-2.2) for acute exacerbation of ILD after TBLC. The mortality rates were 0.6% and 1.7% for TBLC and VATS, respectively. TBLC has a fairly good diagnostic yield, an acceptable safety profile and a lower mortality rate than VATS. The best results are obtained from more experienced centres.

Efficacy and safety of video-assisted thoracoscopic surgery and thoracotomy in the treatment of pulmonary hydatid disease in the Tibetan Plateau: a retrospective study.

BackgroundAlthough video-assisted thoracoscopic surgery (VATS) plays an increasingly significant part in treating thoracic disease, the role of thoracotomy is not replaced in cystic echinococcosis. The aim of this study was to demonstrate the application of VATS and traditional thoracotomy in the treatment of pulmonary hydatid disease in Shigatse of the Tibet Plateau and to compare the clinical safety and efficacy of these two surgical approaches.MethodsA total of 53 patients with pulmonary hydatid who received thoracoscopic cystectomy with needle aspiration from January 2015 to December 2020 were enrolled in the study, and 126 patients who received thoracotomy during the same period were matched as the control group. The clinical characteristics, operative time, incidence of perioperative complications, length of stay, and hospitalization cost of the VATS and thoracotomy groups were analyzed to compare the safety and efficacy. Patients were followed up through telephone and outpatient service. In order to balance potential confounding baseline factors, propensity-score matching (PSM) was applied to establish a 1:1 VATS to thoracotomy group ratio.ResultsThere were statistically significant differences between the VATS group and the thoracotomy group in operative time, blood loss, drainage volume, and postoperative hospital stay (P<0.05), with the VATS group being superior to the thoracotomy group. There were no significant differences in postoperative complications, adverse imaging outcomes, or recurrence rates between the 2 groups. In terms of complications, there was no significant difference in the incidence of postoperative air leakage, atelectasis, or other common complications between the 2 groups, while the frequency of postoperative fever and incision infection in the thoracotomy group was significantly higher than that in the VATS group (P<0.05). Moreover, the postoperative recurrence rate between the 2 groups showed no significant difference after a 3-year follow-up.ConclusionsCompared to traditional thoracotomy, VATS had acceptable efficacy and safety and it could further accelerate postoperative recovery and reduce the cost in the treatment of pulmonary hydatid disease in the Tibetan Plateau. Thus, VATS should be promoted more widely to other Tibetan regions.

Uniportal VATS pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated?

BackgroundThe aim of this study is to compare the diagnostic efficacy and safety of video-assisted thoracoscopic surgery (VATS) with awake VATS (AVATS) pleural biopsy in undiagnosed exudative pleural effusions.MethodsThe diagnostic efficacy of pleural biopsy by uniportal VATS under general anesthesia or AVATS under local anesthesia and sedation performed by the same surgeon in patients with undiagnosed exudative pleural effusion between 2007 and 2020 were retrospectively evaluated. Test sensitivity, specificity, positive predictive value and negative predictive value were compared as well as age, gender, comorbidities, procedure safety, additional pleural-based interventions, duration time of operation and length of hospital stay.ResultsOf 154 patients with undiagnosed exudative pleural effusion, 113 (73.37%) underwent pleural biopsy and drainage with VATS, while 41 (26.62%) underwent AVATS pleural biopsy. Sensitivity, specificity, positive predictive value and negative predictive value were 92, 100, 100, and 85.71% for VATS, and 83.3, 100, 100, and 78.9% for AVATS, respectively. There was no significant difference in diagnostic test performance between the groups, (p = 0.219). There was no difference in the rate of complications [15 VATS (13.3) versus 4 AVATS (9.8%), p = 0.557]. Considering additional pleural-based interventions, while pleural decortication was performed in 13 (11.5%) cases in the VATS group, no pleural decortication was performed in AVATS group, (p = 0.021). AVATS group was associated with shorter duration time of operation than VATS (22.17 + 6.57 min. Versus 51.93 + 8.85 min., p < 0.001). Length of hospital stay was relatively shorter in AVATS but this was not statistically significant different (p = 0.063).ConclusionsOur study revealed that uniportal AVATS pleural biopsy has a similar diagnostic efficacy and safety profile with VATS in the diagnosis and treatment of patients with undiagnosed pleural effusion who have a high risk of general anesthesia due to advanced age and comorbidities. Accordingly, uniportal AVATS pleural biopsy may be considered in the diagnosis and treatment of all exudative undiagnosed pleural effusions.

Oxidized regenerated cellulose for a clear thoracoscopic view: a single-centre randomized trial.

During video-assisted thoracoscopic surgery (VATS), blood oozing from the surface of the access port wound can hamper the surgical view. Although this oozing is difficult to prevent, it can be decreased by placing a wound edge protector with oxidized regenerated cellulose (ORC) on the surface of the access port wound, thereby improving the surgical outcomes and safety of VATS. We conducted a prospective, single-centre, open-label, randomized clinical trial to evaluate the operative outcomes of VATS when using the ORC (ORC group) compared with operative outcomes without using the ORC (non-ORC group). The primary end point was interruption of the operation as a result of blood oozing from the surface of the access port wound. The secondary end points were the other intraoperative and postoperative outcomes. A total of 108 patients were divided into the ORC group (n = 54) and the non-ORC group (n = 54). Compared with the non-ORC group, the ORC group had fewer patients with an interruption in the operation (11.1% vs 51.8%; P < 0.001), less need for wound haemostasis of the access ports during wound closure (44.4% vs 72.2%; P = 0.003), similar rates of postoperative deaths and complications and a tendency for shorter operation times (149.3 vs 168.8 min, respectively; P = 0.083). The use of an ORC sheet around a wound edge protector for haemostasis can ensure a clear view during VATS. UMIN000031112.

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.

Modified uniportal video-assisted thoracoscopic surgery (VATS).

Video-assisted thoracoscopic surgery (VATS) for resectable lung cancer patients has been frequently used in the past decades. The potential beneficial advantages and safety of VATS has been shown in large patient series and meta-analyses. The strategy of limiting access to one incision in one intercostal space (uniportal VATS) has been adopted by some thoracic surgeons in recent years. We have described a modified uniportal VATS technique with its potential advantages. Modified uniportal VATS potentially offers better exposure, beneficial opportunities for education and improved comfort for the thoracic surgery team in clinical usage.

Current Surgical Management of Empyema Thoracis in Children: A Single-center Experience

Empyema is a morbid complication of pneumonia in children, whose gold standard of surgical treatment technique remains undefined. Historically, treatment consisted of open thoracotomy with decortication. We evaluate the effectiveness and safety of video-assisted thoracoscopic surgery (VATS) as a surgical treatment in for empyema thoracis in a pediatric population at a single institution from 2005 to 2013. After receiving Institutional Review Board approval, we performed a retrospective chart review of children surgically treated for empyema as a complication of pneumonia from 2005 to 2013. Charts were reviewed for the type of procedure performed (VATS or open thoracotomy), comorbid conditions, preoperative status, operative outcomes, and postoperative status. A total of 112 pediatric patients were treated surgically for empyema. Surgical treatment consisted of VATS in all cases; no open thoracotomy procedures were performed. The success rate of VATS in our study was 96.4 per cent. Mean total length of stay was found to be 8.8 days, whereas postoperative length of stay was 6.3 days. Mean postoperative chest tube duration was 3.4 days. Perioperative complication rate was 11.6 per cent, with respiratory failure being the most common complication. The data from our study demonstrate that the exclusive use of VATS in children for the surgical management of all stages of empyema was safe and produced results with high efficacy. We consider VATS to be the new gold standard for surgical drainage of empyema.

Simultaneous Posterior Fusion with Video Assisted Thoracoscopic Surgery (VATS) for Treatment of Kyphotic Deformities in Prone Position. A Series of 86 Cases

Background Data: The traditional position of the patient during VATS procedureis the lateral decubitus. This make the surgeon oriented to the field since this thesame position of the traditional thoracotomy and make it easy for conversionto open surgery if needed. Prone position; although may be difficult; has theadvantage of performing two major procedures; posterior fusion and anteriorreconstruction by at same time with minimized morbidity and mortality.Purpose: To evaluate the efficacy and safety of VATS in management of differentdorolumbar spine pathologies.Study Designs: Prospective clinical case study.Patients and Methods: Eighty six cases of kyphotic deformities due to variouspathologies (28 cases of fractures, 42 infection, 16 tumors) were treated bysimultaneous posterior fusion techniques and anterior reconstruction by VATSusing bone grafts, cages and spacers while the patient is in prone position. Themean follow up of the patients was 26.1 months. All patients were evaluatedradiographically preoperatively, postoperatively and at the end of follow upusing Cobb angle. Radiographs at the final follow up were assessed for fusion.VAS was used to evaluate pain of the thoracoscopic mini incision. All caseswere assessed neurologically by Frankel grading system and Denis pain scorefor back pain at the end of follow up. Operative time, intra and postoperativecomplications and blood loss were reported.Results: The mean age was 40.3 years. The regional Cobb angle improved from34.7° preoperatively to 11.6° postoperatively. Most of patients had improvedon both Frankel grading system and scores of pain. There was no indication toconvert any case to open procedure. No serious intraoperative complicationoccurred but one case of massive bleeding due to injury of one intercostal vesselthat has been controlled thoracoscopically. The postoperative complicationsincluded chest infection, delayed lung inflation, intercostals neuralgia andtransient neurological deficits.Conclusion: VATS using limited mini-incison provide an excellent and safeapproach for management of dorsolumbar pathologies. Prone position facilitateshandling of the spine both anteriorly and posteriorly at the same time to get themaximum benefit offered by both approaches without excessive morbidity tothe patient. (2012ESJ020)

Diagnostic and Therapeutic Performance of Video-Assisted Thoracoscopic Surgery (Vats) in Investigation and Management of Pleural Exudates

Video-assisted thoracoscopic surgery (VATS) is the gold standard investigation for diagnosis of pleural exudates. It is invasive and it is important to ensure that it is performed to acceptable national standards. We assumed that VATS empyema fluid culture would not contribute further to microbiological diagnosis in referred culture-negative empyemas. Eighty-six consecutive external referrals for VATS for diagnosis of a cytology-negative pleural exudate (or for further management of the exudate) were studied retrospectively. Diagnostic yield, pleurodesis efficacy and complications were compared to national standards and good practice recommendations. VATS empyema fluid microbiological culture results were compared to pre-VATS empyema fluid culture results. VATS was performed well within national standards with a diagnostic yield of 82.3% for cytology-negative exudates, 100% pleurodesis efficacy, 5.8% postoperative fever, with only one significant complication (1.2% rate) and no deaths. Compliance with good practice pleural fluid documentation points was greater than 70%. VATS empyema fluid culture positivity (84.6%) was significantly higher than pre-VATS fluid culture (35%). VATS was performed to acceptable standards. These data confirm the utility and safety of VATS in the right context but also suggest the potential diagnostic utility of VATS empyema fluid culture. Further studies are required to investigate this latter possibility further.

Comparison of the efficacy and safety of video-assisted thoracoscopic surgery with the open method for the treatment of primary pneumothorax in adults

OBJECTIVE:To determine whether video-assisted thoracoscopic surgery is as effective as the traditional open method through axillary thoracotomy for the management of primary spontaneous pneumothorax in adults.MATERIALS AND METHODS:This retrospective study was conducted at King Hussein Medical Center in the period between March 2002 and March 2007. Eighty-two patients were included in this study. The patients were divided in two groups: group A, which included patients who underwent video-assisted thoracoscopic surgery; and group B, which included patients who underwent open technique through axillary thoracotomy. Efficiency of the procedure, operative time, postoperative complications, length of hospital stay, time to return to work and recurrence were compared between the two groups.RESULTS:There were 79 males (96.3%) and 3 females (3.7%) with a mean age of 23.7 ± 4.2 years for group A patients and 24.2 ± 4.6 years for group B patients (range 16–37 years). Forty-one patients (50%) underwent video-assisted thoracoscopic surgery (group A), and 41 patients (50%) underwent open surgical technique through axillary thoracotomy (group B). Postoperative complication occurred in 8 patients (19.3%) from among those who underwent open technique and 6 patients (14.6%) from among those who underwent thoracoscopic technique. There was no perioperative mortality in both groups. Postoperative pain, volume of blood loss, period of air leak and hospital stay were less in group A, although the operative time was less in group B.CONCLUSION:Video-assisted thoracoscopic surgery is an efficient and safe method for the treatment of patients with primary pneumothorax in the adults.