Thoracoscopy Research Articles

Efficacy of Pleural Brush Cytology in the Diagnosis of Pleural Diseases

Background: The accurate diagnosis of pleural effusion remains a challenging clinical problem. Medical thoracoscopy has an established role in achieving the etiology of pleural effusion. Pleural biopsies provide us with best results, but if cytological results can be shown to give concordant results, therapy can be instituted early. Aim: The aim was to study the efficacy of pleural brush in diagnosing pleural diseases. Study Design: This is a prospective study. Patients and Methods: The study was done between December 2015 and June 2017 in all patients of undiagnosed exudative effusions who were taken for thoracoscopy. Both pleural biopsy and pleural brushings were obtained in each patient. Results: We present the data of 45 patients. The mean age was 59.68 years. Nodule was the most common finding on thoracoscopic examination. Pleural brush cytology was positive in 26 patients with malignancy, 13 for infection and 6 were inadequate. However, forceps biopsy was positive in 42 cases out of 45 (93.3%) in detecting malignancy and infectious diseases. Conclusion: Pleural brush cytology can help in increasing the diagnostic yield. It can also be used to commence early treatment of the patient.

Fibrinolysis versus thoracoscopy: Comparison of results in empyema management in the child.

OBJECTIVE:The objective of this study is to compare the outcome of treatment with drainage and urokinase (UK) versus thoracoscopy (TS) in pleural empyema secondary to complicated pneumonia.METHODS:This was a retrospective study of patients with complicated parapneumonic effusions between 2008 and 2019 treated with UK or TS. Epidemiological and evolutionary data compared days of fever, antibiotic, pre- and postprocedure stay, time to radiological resolution, and complications. The results were expressed as medians and the comparisons were made by the Mann–Whitney U-test.RESULTS:Of 143 patients with NC, 46 were empyemas (26 men), 25 were treated with TS, and 10 were treated with UK. The remaining 11 received combined treatment, being excluded from the study. There were no significant differences between TS versus UK in age (median 4 vs. 3 years), days of fever before the procedure (4 vs. 2) and after (2 vs. 2), days of antibiotic treatment before the procedure (4 vs. 4), overall hospital stay (15 vs. 13 days), and months until radiological normalization (2 vs. 2). The complications related to the therapy were scarce in both groups and had no impact on evolution. Patients with TS had a longer preprocedural stay (4 vs. 1; P < 0.001) and required fewer days of subsequent antibiotic after procedure (8 vs. 11; P = 0.03), and a shorter overall antibiotic treatment time (11 vs. 16; P = 0.03). They also had a shorter post-TS stay (9 vs. 12 days), although this difference did not become significant (P = 0.09).CONCLUSIONS:In our experience, the results obtained with both procedures are quite similar, although patients undergoing TS had a better evolution (fewer days of antibiotic and a tendency to less hospitalization), despite having been performed a priori in more evolved patients.

Surgical tactics for benign bronchial and lung tumors

Aim: to identify the efficient surgical tactics in case of benign broncho-pulmonary tumors taking into account co-morbidities and possibilities of video-assisted thora- cic operations. Materials and methods. Among 133 pa- tients with benign tumors of the lungs and bronchi 128 (96%) had tumors of peripheral localization, 5 (4%) — of the central one. All patients with peripheral tumors were operated on. Charlson index was used to assess the co-morbidity. Results. In 120 (90.2%) patients tumors were diagnosed during routine Х-ray examination or casual check-up.6 (4.5%) patients showed clinical symp- toms. The average terms of observation of patients with peripheral tumors were 7.8 months (Me — 6, Q1 — 2, Q3 — 7), with the central ones — 13.3 months (Me — 5, Q1 — 3, Q3 — 8). In 4 cases central tumors were removed by endoscopy methods using electroresection and argon plasma coagulation. In one case a stent was inserted. More than 2/3 of patients had co-morbid pathologies. Charlson index in co-morbid patients was 2.4±1.4, in the group of patients elder than 70 years — 4.8±0.9. All patients with peripheral tumors were operated on. The video thoracoscopy approach was used in 56 (42.1%) pa- tients, thoracotomy — in 67 (50.4%), video-assisted mi- nithoracotomy — in 6 (4.5%). In 5.2% of cases thoracosco- py was converted to thoracotomy. All peripheral tumors were mesenchymal ones. Post-operative complications developed in 7 (5.5%) patients. There were no mortality. Conclusion. Peripheral benign tumors of the lungs are asymptomatic and require urgent surgery with an express histology test to rule out lung cancer. Central tumors are mostly removed by endoscopy. Video thoracoscopy is the most efficient method to remove peri pheral tumors. Conversion to thoracotomy is usually necessary in case of a small size and deep tumor localization.

Uniportal VATS for pectus excavatum: the Southern Switzerland experience.

The Nuss procedure is a minimally invasive approach used to treat the pectus excavatum. One to three curved metal bars are inserted behind the sternum in order to push it into a normal position. A bilateral thoracoscopy, with 3 or 4 incisions on each side, has been reported as a safe method to repair the chest. The aim of this observational cohort study is to evaluate the safety and efficacy of the modified uniportal thoracoscopic Nuss procedure. A retrospective review on 248 consecutive patients treated in Southern Switzerland in the last 5 years for chest deformity was performed. Conservative treatment with vacuum bel or dinamic compression was performed in 235 cases. Thirteen patients with pectus excavatum were surgically treated with a modified single-incision thoracoscopic approach and introduction of a single retrosternal Nuss Bar. Demographics, clinical characteristics, surgical data and results were analyzed and discussed. The male/female ratio was 11/2, with mean age of 20.75 (±5.05) years. The Haller index was 3.65±0.5. The operative duration was 68. 2±13.3 min and hospitalization stay ranged from 2 to 10 days. There was no instance of intraoperative cardiac perforation or macrovascular injury. No pleural effusion or infection was reported. The overall complication rate after a postoperative follow-up of 24.6±3 months was 7.6%, without mortality, major bleeding, infectious complications, displacement or recurrence. Patients satisfaction and postoperative pain were also analyzed. The modified single-incision thoracoscopic Nuss procedure is both safe and effective for pectus excavatum correction with non-recurrence after two years.

Analysis of the risk factors of hypoxemia in the anesthesia recovery period after thoracoscopic surgery

Objective To investigate the incidence of hypoxemia in the anesthesia recovery period after thoracoscopic surgery and explore the risk factors of hypoxemia and its predictive efficiency. Methods A total of 841 patients, aged 18-90 years, American Society of Anesthesiologists (ASA) physical status of Ⅰ‒Ⅲ , who were scheduled for thoracoscopic surgery from October 2017 to May 2019 in the Second Affiliated Hospital of Zhejiang University School of Medicine, were retrospectively analyzed in the current study. They were divided into a hypoxemia group and a non-hypoxemia group, according to the presence of hypoxemia in the anesthesia recovery period. Both groups were compared for their clinical data before and during surgery to evaluate the condition of hypoxemia in the recovery period. Their risk factors were analyzed by multivariate Logistic regression. A receiver operating characteristic (ROC) curve was established to examine its predictive efficiency towards hypoxemia. Results Among the 841 patients, 239 patients (28.4%) presented hypoxemia during the anesthesia recovery period. The risk factors of hypoxemia included age [odds ratio (OR)=1.028, 95% confidence interval (CI) 1.006-1.050], body mass index (BMI) (OR=1.217, 95%CI 1.111-1.333), hypertension (OR=2.462, 95%CI 1.564-3.875), mediastinal surgery (OR=2.756, 95%CI 1.605-6.873) and supine position (OR=2.230, 95%CI 0.936-5.314). For hypoxemia in the anesthesia recovery period, its area under the receiver operating characteristic curve (AUC) was 0.723 (95%CI=0.685-0.761, P<0.01), with a sensitivity of 63.6% and a specificity of 69.4%. Conclusions Extensive attention towards blood pressure control and body weight management before surgery, and comprehensive understanding the mechanism of hypoxemia caused by surgery at the supine position and active prevention, may reduce the incidence of hypoxemia during the anesthesia recovery period after thoracoscopic surgery. Key words: Thoracoscopy; Anesthesia recovery period; Hypoxemia; Risk factor

Thoracoscopic repair with simplified mattress sutures in the treatment of diaphragmatic hernia in neonates without posterolateral rim of diaphragm

Objective To explore the initial experience of thoracoscopic repair with simplified mattress sutures in the treatment of diaphragmatic hernia in neonates without posterolateral rim of diaphragm. Methods A retrospective review of the new simplified technique in 10 cases from March 2015 to October 2017 was performed.Of the patients, 6 cases were male, 4 cases were female.The age was 10min-1d, 7 cases were term newborns, and 3 cases were premature.The mean weight was 2.88 kg(ranged 2.3-3.5kg). All the 4 cases were left-sided.Two to three primary suture sites were taken from the relative intercostal region of the body surface projection of the defect.A snip incision about 1 mm of the skin was done.Two 2-0 non-absorbable sutures round the rib were inserted between the front edged of the defect and the diaphragm muscle through a syringe needle.The first thread was brought out of the body by the ring of the second thread and knot tying was made extracorporally.The posterolateral defect was closed; the knot was under the skin of intercostals space. Results Ten neonates with CDH were repaired successfully using this new simplified technique.The mean operative time was 37.5min(ranged 25-60min) for each CDH repair.No cases required conversion to open surgery, blood loss was minimal.The 10 cases were followed up for 16.5 months(ranged 5-24 months), with no death and no recurrence.One neonate complicated with subcutaneous emphysema postoperatively and healed in one week. Conclusion The new technique of thoracoscopic repairing with simplified mattress sutures when no posterolateral rim of diaphragm exists has all the advantages of thoracoscopy in neonates combined with the advantages of reduced operative time, simplicity, feasibility and definite curative effect and has the value of clinical popularization. Key words: Hernia, diaphragmatic; Thoracoscopy; Reconstructive surgical procedures; Infant, newborn

Risk assessment of venous thromboembolism based on Caprini model in lung cancer patients after thoracoscopic surgery

Objective To explore the risk assessment of venous thromboembolism (VTE) based on Caprini model in patients after thoracoscopic lobectomy and to analyze the related risk factors of VTE. Methods From January 2016 to January 2018, this study selected 42 early lung cancer patients with thoracoscopic lobectomy of Shandong Provincial Chest Hospital in control group, and selected 28 early lung cancer patients with VTE after surgery in observation group. This study also collected and compared the general information and the score of the Caprini risk assessment of patients between two groups, and analyzed the risk factors in the Caprini risk assessment model. Results The ages, preoperative fibrinogen, preoperative D-Dimer, the ratio of histories of malignant tumor, body mass index (BMI) ≥25 kg/m2, hypertension, hyperglycemia, lobectomy and smoking history of observation group were higher than those of control group with statistical differences (P<0.05) . The score of the Caprini risk assessment of observation group was higher than that of control group with statistical difference (P<0.01) . Multivariate analysis showed that risk factors of VTE of lung cancer patients after thoracoscopic surgery included the D-Dimer higher than critical value, smoking history and BMI≥25 kg/m2 with statistical differences (P<0.05) . Conclusions Caprini risk assessment model can effectively calculate the patients with VTE after thoracoscopic lobectomy, classify and quantize the incidence risk of deep vein thrombosis (DVT) . The high risk factors of patients with VTE after thoracoscopic lobectomy include the increased D-Dimer, overweight and heavy smoking. Key words: Venous thromboembolism; Thoracoscopes; Postoperative complications; Lobectomy; Caprini model; Risk assessment; Risk factors

Efficacy and safety of thoracoscopic bronchial sleeve lobectomy for central non-small cell lung cancer

Objective To explore the efficacy of thoracoscopic bronchial sleeve lobectomy for central non-small cell lung cancer (NSCLC), and to evaluate the safety of this operation. Methods The clinical data of 29 patients who underwent thoracoscopic bronchial sleeve lobectomy at Shanxi Provincial Cancer Hospital from May 2015 to September 2018 were retrospectively analyzed, and the surgical effect and safety were analyzed. Results Twenty-nine cases underwent thoracoscopic bronchial sleeve lobectomy. The types of resection included 13 cases of right upper, 10 cases of left upper, and 6 cases of left lower sleeve lobectomy. The operation time was 180-400 min, and the median time was 240 min. The bronchial anastomosis time was 35-60 min, and the median time was 48 min. The intraoperative blood loss was 150-460 ml, and the median blood loss was 220 ml. The number of lymph node dissection was 12-39 lymph nodes per patient, with a median of 19.6 lymph nodes per patient. The thoracic drainage tube was placed for 4-16 days after operation, with a median of 6 days; the postoperative hospital stay was 6-16 days, with a median of 9 days. The postoperative complication rate was 24.1% (7/29), including 1 case with pulmonary air leakage (> 7 days), 2 cases with pulmonary infections, 3 cases with arrhythmia, and 1 patient discharged from the hospital on the 7th day after surgery, but died of anastomotic fistula bleeding on the 40th day. The rest of the patients recovered smoothly after surgery. The median follow-up time was 6 months (3-12 months). No tumor recurrence or anastomotic stenosis was observed. Conclusion Thoracoscopic bronchial sleeve lobectomy is a safe and feasible surgical treatment for central NSCLC. Key words: Carcinoma, non-small-cell lung; Thoracoscopes; Sleeve lobectomy

Effect of dexmedetomidine or epidural blockade combined with general anesthesia on perioperative inflammatory cytokines in lung cancer patients undergoing video-assisted thoracoscopic surgery

Objective To investigate the effect of dexmedetomidine (Dex) or epidural blockade combined with general anesthesia on perioperative inflammatory cytokines in lung cancer patients undergoing video-assisted thoracoscopic surgery. Methods Ninety lung cancer patients [American Society of Anesthesiologists (ASA) Ⅰ-Ⅲ , age<70 years] undergoing video-assisted thoracoscopic surgery were divided into three groups according to a random number table: a general anesthesia group (group G), an epidural blockade combined with general anesthesia group (group GE) and a Dex combined with general anesthesia group (group GD), with 30 patients in each group. Patients in group GE underwent epidural catheterization at T7-T8 before anesthesia induction, while groups G and GD was given normal saline or 1 μg/kg Dex via an intravenous infusion pump over 10 min after anesthesia induction. Before induction (T0), at the end of surgery (T1), and 24 h after surgery postoperatively (T3), blood samples from the right internal jugular vein were taken to measure the levels of interleukins (IL-1β, IL-6, and IL-10) and tumor necrosis factor-α (TNF-α) by a double antibody sandwich ABC-ELISA method. The scores of Prince-Henry Pain Scale were evaluated 2 h after surgery (T2) and T3. The incidences of intraoperative hypotension, bradycardia and postoperative nausea and vomiting were recorded. Results Compared with those at T0, there were significant increases in the levels of IL-1 β , IL-6, and TNF-α and sharp decreases in the levels of IL-10 at T1 and T3 in all groups (P 0.05). The scores of Prince-Henry Pain Scale in group GE were lower than those in other two groups (P< 0.05). The incidence of nausea in groups GD and GE was significant lower than that in group G (P<0.05). Conclusions For lung cancer patients undergoing video-assisted thoracoscopic surgery under general anesthesia, a combined use of 1 μg/kg Dex can significantly relieve inflammatory response, to an extent comparable to epidural blockade combined with general anesthesia. Key words: Dexmedetomidine; Anesthesia, epidural; Anesthesia, general; Inflammation; Thoracoscopes; Lung cancer

Comparative analysis of different surgical methods for treating esophageal atresia

Objective To investigate the difference in the clinical efficacy by thoracoscopy or thoracotomy for treating esophageal atresia. Methods Thirty-one cases of type-Ⅲ esophageal atresia undergoing surgical treatment from February 2015 to May 2018 at the Department of Pediatric Surgery of Fujian Provincial Maternity and Children′s Hospital were included, and according to the different surgical methods they were divided into thoracoscopic group (15 cases) and thoracotomy group (16 cases). The operation duration, blood loss, postoperative chest drainage time, posto-perative hospital stay and postoperative complications were analyzed between 2 groups. Results The mean time of operation was (181.33±13.86) min in the thoracoscopic surgery group and (139.06±10.98) min in the thoracotomy group, the thoracoscopic group had longer operation duration than thoracotomy group, and there was a significant difference in operation duration between two groups (t=9.44, P=0.000); mean blood loss was (3.07±0.96) mL in the thoracoscopic surgery group and (5.06±1.12) mL in the thoracotomy group, the thoracoscopic group had less amount of blood loss than thoracotomy group, and there was a significant difference in blood loss between two groups(t=-5.29, P=0.000); mean postoperative chest drainage time was(11.67±1.34) d in the thoracoscopic group and (12.25±1.06) d in the thoracotomy group, and there was no significant difference in postoperative chest drainage time between two groups(t=-1.34, P=0.19); mean time of postoperative hospitalization time was(15.20±0.94) d in the thoracoscopic group and (16.00±0.96) d in the thoracotomy group, and there was a significant difference in the postoperative hospitalization time between two groups (t=-2.33, P=0.027); the anastomotic leak rates were 33.33% (5 cases) versus 25.00% (4 cases) with closed or open approaches, respectively; anastomotic stricture rates were 40.00%(6 cases) versus 31.25% (5 cases) with closed or open approaches, respectively.There was no significant difference in postoperative incidence of anastomotic fistula and anastomotic stenosis between two groups. Conclusions Compared with thoracotomy in the treatment of esophageal atresia, thoracoscopic approach has smaller incision and less bleeding, less chest deformity, short hospital stay postoperatively, so it is safe and effective.However, the surgeon must have experience in doing thoracoscopic operation. Key words: Thoracoscopic surgery; Thoracotomy; Esophageal atresia

Thoracoscopic repair of congenital diaphragmatic hernia with hernia-ring pin in neonates

Objective To evaluate the indications and outcomes of thoracoscopic repair with hernia-ring pin (TRHP) applied in neonates with congenital diaphragmatic hernia (CDH). Methods Fifty-six cases diagnosed as CDH were collected from Department of Neonatal Surgery or Cardiothoracic Surgery in Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology from May 2013 to September 2018.Patients were divided into thoracoscopic repair (TR) group and TRHP group, and the data, including birth weight, pregnant weeks, ages at operation, hospital stay postoperatively and the number of recurrence cases were compared, between the 2 groups.The size of defect was coded into A, B, C and D grades.Status of patients was grouped into Ⅰ, Ⅱ, Ⅲ, Ⅳ, and Ⅴstages according to the defect size and complicated congenital heart disease. Results There were 7 cases in TRHP group, including 3 boys and 4 girls.Four cases belonged to A-class defect and 3 cases were of B-class defect, respectively.The contents of the hernia included small intestine, colon, kidney and spleen.Six cases presented left CDH and 1 case presented right CDH.One of the left CDH cases and the 1 right CDH case had hernia sac.The right CDH neonate presented haematuria in the first day and the second day postoperatively, whose symptom disappeared after treatment.The follow-up time was (12.17±3.41) months, and no recurrent cases were found.All the cases in TRHP group belonged to Ⅰ or Ⅱ stage.There were 49 cases in the TR group.Among them, 29 cases belonged to class-A defect, 18 cases class-B defect, and 4 cases class-C defect, respectively.Cases classified into A and B defects were in stageⅠorⅡ, and cases classified into C defect were in stage Ⅲ.In those 45 cases belonged to A or B defect, 40 cases presented left CDH and 5 case presented right CDH.Among them, 5 neonates had hernia sac.The contents of the hernia included small intestine, colon, kidney and spleen.There were significant differences in the operative time [(83.47±10.28) min vs.(54.29±17.09) min, P<0.05] and length of stay postoperatively [(12.76±5.89) d vs.(7.86±2.03) d, P<0.05] in both groups.TRHP was carried out by the same surgeon, and he also operated on other 18 cases in TR group.Compared with the operative time of cases operated by the same surgeon in both groups, significant diffe-rence was found [(83.47±10.28) min vs.(54.29±17.09) min, P<0.05]. The cases were followed up for (46.17±6.92) months postoperatively and 4 recurrent cases were tracked.One A defect and 1 B defect patients had recurrence 1 month or 2 months postoperatively.Two C defect cases were found to have recurrence postoperatively in 2 months or 6 months, respectively.All 4 cases mentioned above recovered by reoperation.The risk of recurrence in C defect CDH cases existed as high as 21.5 times compared with the A or B defect cases. Conclusions It is safe to repair CDH by THRP in neonates with CDH A or B defect, for their operative time may be shorter.TRHP should be highly recommend for CDH cases with A or B defect. Key words: Thoracoscope; Infant, newborn; Diaphragmatic hernia; Hernia-ring pin

Clinical application of three-dimensional computed tomography bronchography and angiography in thoracoscopic segmentectomy

Objective To explore the clinical value of three-dimensional computed tomography bronchography and angiography (3D-CTBA) in thoracoscopic dissection or combined segmentectomy. Methods The clinical data of 30 patients with isolated or multiple pulmonary nodules from September 2017 to August 2019 were retrospectively analyzed. All cases were treated with 3D-CTBA to locate the nodules accurately before operations, in order to explicit the courses of bronchi and vessels, and to observe the variations. The target bronchi, arteries and veins were resected accurately during the operations, and the intersegmental plane was determined by expansion-collapse method. Results 13 patients underwent segmentectomy and 17 patients underwent combined segmentectomy. The diameter of the nodule was (11.56±3.79)mm; the depth of the nodule (the shortest distance from the visceral pleura) was (13.88±3.96)mm; the operation time was (134.94±18.68)min, and the intraoperative bleeding volume was (94.38±37.94)ml. No cancer metastasis was found by rapid pathological examination of lymph nodes during operations. No conversion to thoracotomy. The indwelling time of thoracic tube was (3.69±1.30)days, and the hospitalization days after operations was (4.81±1.47)days. No serious complications or death during the perioperative period. Conclusions Preoperative 3D-CTBA has advantages in pulmonary segmentectomy, which is a safe and effective method for accurate segmentectomy. Key words: Imaging, three-dimensional; Bronchography; Thoracoscopy; Pneumonectomy

The application of 3D reconstruction technique in thoracoscopic posterior basal segmentectomy

Objective To explore the safety and effectiveness of 3D reconstruction in thoracoscopic posterior basal segmentectomy (S10). Methods Between March 2018 to September 2018, 14 patients underwent thoracoscopic anatomical resection of the posterior basal segment of the lung (S10). Results Of the 14 patients, including 5 males and 9 females, age (52.2±5.3)years, size (1.1±0.6)cm, 6 left S10 and 8 right S10. The number of pathological type of microinvasive adenocarcinoma, benign nodule, and metastatic carcinoma was 12, 1, and 1 cases. The average preoperative planning time was (44.9±5.7)min, and the average operation time was (134.8±26.3)min. The blood loss was (25.5±4.1)ml, with (8.1±2.7) lymphadenectomy, no positive metastasis. The coincidence rate of 3D reconstruction and intraoperative anastomosis in the tumor location, B10, A10, and V10 were 100%(14/14), 100%(14/14), 93%(13/14) and 71%(10/14). The median duration of chest tube insertion was (2.3±2.1)day. The incidence of postoperative complications was 21%(3/14), including 7%(1/14) of air leakage, 7%(1/14) of arrhythmia, 14%(2/14) of pulmonary infection, and 14%(2/14) of operation. All the cutting edge was >2 cm. There was no perioperative death, no conversion to thoracotomy or lobectomy. The mean follow-up time was (8.1±2.2)months. There were no recurrence, metastasis or death in the 14 patients. One patient had chronic cough and no hemoptysis. Conclusions Preoperative 3D reconstruction make the anatomic thoracoscopic posterior basal segmentectomy (S10) safer and more effective. Key words: Imaging, three-dimensional; Bronchography; Thoracoscopy; Pneumonectomy

Feasibility of simultaneous thoracoscopic mitral and tricuspid valvuloplasty in treatment of degenerative heart disease

Objective To retrospectively summarize the feasibility of mitral valvuloplasty (MVP) and tricuspid valvuloplasty (TVP) performed under Video-assisted right thoracic small incision in patients with degenerative heart valve disease in our center at the same time. Methods A total of 118 patients with degenerative heart valve disease from March 2016 to March 2018 were retrospectively summarized. They had mitral valve stenosis or insufficiency, secondary right ventricular dilatation or pulmonary hypertension, moderate and severe functional tricuspid regurgitation, diastolic tricuspid annular diameter/body surface area>21 mm/m2 measured by ultrasonography, or corresponding clinical symptoms of mitral and tricuspid valve lesions, and the indications of MVP and TVP were evaluated at the same time. Among them, 68 cases were treated with traditional median thoracotomy in control group, and other 50 cases were treated with Video-assisted right thoracic small incision in observation group. Then to compare surgical indicators including success rate, perioperative complications, operation time, cardiopulmonary bypass time, ventilator time, ICU stay time, thoracic drainage volume, blood transfusion volume and stay-in hospital days after operation; cardiac function indicators including left ventricular ejection fraction (LVEF), left ventricular diameter, right ventricular diameter, pulmonary artery pressure, residual mitral and tricuspid regurgitation and cardiac function classification; mid-term complications after 28.9 months of median follow-up. Results There was no difference of success rate in the two groups (P>0.05), but perioperative complications rate in observation group was less than control group, ICU stay time and stay-in hospital days were shorter, thoracic drainage volume and blood transfusion volume were lower (χ2=4.230, t=7.658, 4.659, P 0.05), but LVEF, right ventricular diameter, pulmonary artery pressure, cardiac function grade, left ventricular diameter, residual mitral and tricuspid regurgitation after operation in the two groups were all no differences (t=0.765, P>0.05). Furtherly, there was no difference of mid-term complications in the two groups (P>0.05). Conclusion It can bring better safety of simultaneous MVP and TVP with Video-assisted right thoracic small incision for degenerative valvular heart disease, which can achieve the same clinical effect as traditional surgical methods. Total thoracoscopy may benefit more in alleviating surgical trauma, promoting early recovery after operation, and have the same effect in cardiac structure and function changes and mid-term follow-up prognosis. Key words: Video-assisted; Mitral valvuloplasty; Tricuspid valvuloplasty; Degenerative heart valve disease

Effect of diversified health education on the knowledge, belief and practice and rehabilitation of respiratory function training in patients undergoing thoracoscopic radical mastectomy

Objective To investigate the effect of diversified health education on the Knowledge, Belief and Practice and rehabilitation of respiratory function training in patients undergoing thoracoscopic radical mastectomy. Methods A total of 85 patients with thoracoscopic radical resection of lung cancer from January 2016 to December 2017 were enrolled. The patients were divided into treatment group (January 2016 to December 2016, 43 cases) and control group (January 2017 to December 2017, 42 cases). The control group was given respiratory function training under the guidance of routine health education, while the treatment group was given respiratory function training under the guidance of diversified health education. After 3 months of follow-up, the levels of KBP, lung function, and complications of respiratory function training were compared between the two groups. Results The Knowledge, Belief and Practice scores of respiratory function training in the treatment group were 13.12±1.24, 17.65±2.12 and 17.12±2.24, which were significantly higher than those in the control group (10.65±1.16, 15.32±1.62, 15.23±1.60), and the differences were statistically significant (t=9.479, 5.684, 4.467, P<0.05); the first second of forced expiration (FEV1) accounted for the predicted value (FEV1%), forced vital capacity (FVC%), and FEV1/FVC were (78.32±6.45)%, (65.78±4.35)%, (73.12±5.25), significantly higher than the control group (71.26±7.45)%, (58.70±5.65)%, (65.65±6.12), and the differences were statistically significant (t=4.674, 6.483, 6.045, P <0.05); the 6.98%(3/43) of complications such as atelectasis, pulmonary infection, and pleural effusion were significantly lower than 28.57% (10/42) in the control group (χ2=6.818, P<0.05). Conclusions Diversified health education can improve the level of KBP and behavior of respiratory function training in patients undergoing thoracoscopic radical resection of lung cancer, improve lung function and reduce postoperative complications. Key words: Thoracoscopy; Radical resection of lung cancer; Diversified health education; Respiratory function training; Knowledge, belief and practice

Effects of thoracic paravertebral nerve block at different time points on postoperativelong-term quality of life in patients undergoing thoracoscopic radical resection of lung cancer

Objective To evaluate the effect of thoracic paravertebral nerve block (TPVB) at different time points on postoperative long-term quality of life in the patients undergoing thoracoscopic radical resection of lung cancer. Methods One hundred and fifty patients of both sexes, aged 25-64 yr, with body mass index of 18-24 kg/m2, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, scheduled for elective radical resection of lung cancer, were divided into 3 groups (n=50 each) by a random number table method: preoperative TPVB group (P1 group), TPVB at the end of operation group (P2 group) and preoperative TPVB combined with TPVB at the end of operation group (P3 group). In group P1, TPVB was performed at T4, 6 points on the affected side under ultrasound guidance before anesthesia induction, and 0.5% ropivacaine 10 ml was injected in total.In group P2, TPVB was performed at T4, 6 points on the affected side under ultrasound guidance at the end of operation, and 0.5% ropivacaine 10 ml was injected in total.In group P3, TPVB was performed at T4, 6 points on the affected side under ultrasound guidance before anesthesia induction and at the end of operation, and 0.5% ropivacaine 10 ml was injected each time.The analgesia pump was connected at the end of operation in three groups.The patients were followed up after operation, and 5 ml solution extracted from the analgesic pump was intravenously injected when VAS score was greater than or equal to 4.The occurrence of postoperative chronic pain in the 3 groups was recorded though telephone follow-up at 6 and 12 months after surgery, and the effect of pain on daily life and treatment measures were scored.A concise health-related quality of life scale was used to evaluate patients′ quality of life, and the physical and mental health scores were calculated. Results There was no significant difference in the incidence of chronic pain at 6 and 12 months after surgery among the three groups (P>0.05). The physical and mental health scores were significantly decreased at 12 months after surgery than at 6 months after surgery in the three groups (P<0.05). Compared with P1 and P2 groups, the scores of effect of pain on daily life and treatment measures were significantly decreased, and the physical and mental health scores were increased at 12 months after surgery in group P3 (P<0.05). Conclusion The combination of preoperative TPVB and TPVB at the end of operation can effectively improve postoperative long-term quality of life in the patients undergoing thoracoscopic radical resection of lung cancer. Key words: Nerve block; Thoracoscopes; Lung neoplasms; Quality of life

A Case of Thoracoscopic Extended Segmentectomy Using Infrared Thoracoscopy with Intravenous ICG and VAL-MAP with ICG

A Case of Thoracoscopic Extended Segmentectomy Using Infrared Thoracoscopy with Intravenous ICG and VAL-MAP with ICG

Efficacy of TEAS for general anesthesia preserving spontaneous breathing in patients undergoing thoracoscopic surgery

Objective To evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery. Methods Forty patients of both sexes, aged 18-67 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with Mallampati physical status Ⅰ or Ⅱ, scheduled for elective thoracoscopic lobectomy, were divided into 2 groups (n=20 each) using a random number table method: general anesthesia preserving spontaneous breathing group (group GS) and TEAS plus general anesthesia preserving spontaneous breathing group (group TE+ GS). Anesthesia was routinely induced and maintained, a laryngeal mask was placed, and patients kept spontaneous breathing in two groups.The bispectral index value was maintained at 45-60.Patient-controlled intravenous analgesia was used after operation, and visual analogue scale score was maintained<4 points.In group TE+ GS, Xinshu and Feishu acupoints ipsilateral to the operated side and bilateral Hegu and Neiguan acupoints were stimulated with a disperse-dense wave, frequency 2/100 Hz and intensity 5-15 mA starting from 30 min before anesthesia induction until the end of surgery.The mean arterial pressure (MAP), heart rate (HR) and respiratory rate (RR) were recorded before induction of anesthesia, immediately after start of operation, during thoracic exploration, immediate after lobectomy , and at 30 min and 1 h after lobectomy.The intraoperative MAP, HR, and RR were recorded when clinically significant events occurred in two groups.Central venous blood samples were simultaneously collected for determination of concentrations of cortisol, norepinephrine, epinephrine, and blood glucose in serum (by enzyme-linked immunosorbent assay). The highest value of PETCO2, the lowest value of SpO2, and consumption of anesthetic drugs were recorded.Duration of post-anesthesia care unit stay, time to first flatus, ambulation time, occurrence of nausea and vomiting, chest tube drainage time, development of surgical complications, length of postoperative hospital stay and hospitalization expenses were recorded. Results MAP, HR and RR all fluctuated within the normal range, and no clinically significant events occurred in two groups.Compared with group GS, the highest value of PETCO2 was significantly decreased, the lowest value of SpO2 was increased, the MAP and HR were decreased, the consumption of propofol and remifentanil was decreased, the cortisol, norepinephrine, epinephrine, and blood glucose concentrations in serum were decreased, the time to first flatus, ambulation time, chest tube drainage time and length of postoperative hospital stay were shortened, and the incidence of nausea and vomiting and hospitalization expenses were decreased in group TE+ GS (P<0.05). Conclusion TEAS can reduce the amount of opioids consumed in the perioperative period, effectively inhibits intraoperative stress responses, and is helpful in improving the early outcomes when used for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery. Key words: Electric stimulation therapy; Anesthesia, general; Thoracoscopy

Effects of clinical nursing pathway chart in perioperative patients with thoracoscope pneumonectomy

Objective To explore the effects of clinical nursing pathway chart in rehabilitation of perioperative patients with thoracoscope pneumonectomy. Methods From January 2017 to December 2018, we selected 105 patients with thoracoscope pneumonectomy. All of the patients were randomly divided into observation group (n=52) and control group (n=53) . Observation group carried out perioperative nursing according to the clinical nursing pathway chart, while control group implemented routine nursing. We compared the pain, respiratory recovery effect and treatment compliance of patients after surgery. Results The scores of pain of patients in observation group 24 and 48 hours after surgery was (4.85±0.42) and (3.74±0.30) respectively lower than those in control group with statistical differences (t=5.594, 13.105; P<0.05) . Five days after surgery, the blood oxygen saturation of observation group and control group was (95.78±0.29) % and (91.73±0.33) % respectively with a statistical difference (t=4.603, P<0.05) . Patients with the high level of treatment compliance in intraoperative period accounted for 73.08% in observation group and 45.28% in control group with a statistical difference (Z=4.891, P<0.05) . Conclusions Application of clinical nursing pathway chart in rehabilitation of perioperative patients with thoracoscope pneumonectomy relieves the postoperative pain and improves rehabilitation effects as well as treatment compliance. Key words: Perioperative nursing; Thoracoscopes; Pneumonectomy; Rehabilitation; Chart; Clinical nursingpathway

Totally endoscopic mitral valve repair with Loop technique

Objective To investigate the clinical effect of totally thoracoscopic Loop technique in the treatment of mitral valve prolapse. Methods From October 2014 to October 2018, 27 patients with mitral valve prolapse in Wuhan Asia Heart Hospital and PKU care Zhuzhou Kind Cardiovascular Disease Hospital were treated with totally thoracoscopic Loop technique (n=27). According to the preoperative computed tomography (CT) measurements of the patients, the artificial chordae tendineae were prefabricated, and the artificial chordae tendineae were placed under the total thoracoscopy and the pericardial annulus was used to shrink the mitral valve. The number of chordae tendineae used, the length of chordae tendineae, aorta occlusion time, transit time and operation time were recorded. The left ventricle diameter, left atrium diameter and cardiac blood reflux before and after treatment were observed. In addition, the overall incidence of complications from thromboembolism and infective endocarditis was monitored. Results After treatment, all patients had no operative deaths, no reoperation, and no important organ complications. After total thoracoscopic Loop technique, the indexes of left ventricular diameter (5.01±0.21) cm and left atrial diameter (3.91±0.21) cm were significantly lower than those before surgery LV (6.17±0.16) cm, LA (5.33±0.18) cm, with significant statistical significance (t=10.100, P<0.01). Transesophageal echocardiography (TEE) examination was performed immediately after surgery. All the cases had mild reflux or no reflux. No postoperative thromboembolism and complications of infective endocarditis occurred, and the overall incidence was significantly lower than that of 7 cases (25.93%) before surgery (χ2=8.043, P<0.05). Conclusion Thoracoscopy can better expose the mitral valve and papillary muscle, and totally thoracoscopy Loop technique is more effective in the treatment of mitral valve prolapse. Key words: Thoracoscopy; Loop technique; Mitral valve prolapse