Thoracoscopic Lobectomy Research Articles

Intensive care unit admissions following enhanced recovery video-assisted thoracoscopic surgery lobectomy.

Video-assisted thoracoscopic surgery (VATS) lobectomy combined with enhanced recovery after surgery (ERAS) protocols has improved postoperative outcomes, yet concerns persist regarding complications and readmissions. Limited research has explored intensive care unit (ICU) admissions and outcomes within this context. This study aimed to analyze ICU admissions following VATS lobectomy within an established ERAS protocol. Consecutive patients who underwent VATS lobectomy between 2018-2023 were included. Patient data were obtained from our prospective institutional database, while ICU data were extracted from electronic patients' records. Of 2099 patients included, 48 (2.3%) required ICU admission. Median-age was 70 (IQR : 64-76), with ICU patients being older and predominantly male (73%). Overall 30-day-mortality was 1.0% with an ICU mortality of 31%. Multiple logistic regression revealed significant associations between ICU admission and male gender (p = <0.001), diabetes mellitus (p = 0.026), heart failure (p = 0.040), DLCO%(0.013). Median time to ICU admission was 4 days (IQR : 2-10). Respiratory failure was the primary reason for ICU admission (60%). Severe surgical complications accounted for 8.3% of all ICU-admissions. In an ERAS setting, the incidence of ICU admission following VATS lobectomy was 2.3%, with a mortality rate of 31%. Respiratory failure was the leading cause of ICU admission.

Impact of remimazolam on postoperative inflammatory markers and complications in thoracoscopic pulmonary lobectomy patients: A retrospective analysis.

Remazolam is widely used for procedural sedation in intensive care units. It has been shown to have anti-inflammatory and organ-protecting properties. However, the changes in inflammatory markers and analgesic effects of remazolam after thoracoscopic pulmonary lobectomy remain unclear. This study aims to assess the effects of the novel drug remimazolam on inflammatory factor levels and postoperative complications in thoracoscopic pulmonary lobectomy patients, providing a scientific basis for clinical use. This retrospective study analyzed 200 thoracoscopic pulmonary lobectomy patients, who were divided into a control group and a remimazolam group based on their anesthesia method. Patients in ramazolam group were anesthetized with ramazolam, while patients in control group were anesthetized with propofol. All patients were performed by the same physician team and anesthesia team. Inflammatory factors (including interleukin-6 [IL-6], C-reactive protein [CRP], including interleukin-8) were measured preoperatively and postoperatively, and postoperative complication rates were compared between the 2 groups. The levels of IL-6 and CRP were significantly higher in the remimazolam group at 7 days postoperatively compared to the control group. No significant differences were observed in preoperative inflammatory factors or postoperative including interleukin-8 levels between the 2 groups. Additionally, there were no significant differences in the overall incidence of postoperative complications or in specific complications such as pulmonary infection, atelectasis, subcutaneous emphysema, pneumothorax, surgical site infection, and arrhythmia. Patients receiving remimazolam had higher postoperative IL-6 and CRP levels compared to the control group, without an increase in postoperative complications. In clinical use, attention should be paid to the control of inflammatory indicators in patients using remazolam. However, due to potential confounding factors and the retrospective design, we cannot establish a causal relationship between remimazolam and elevated inflammatory markers. These findings suggest a possible association that requires cautious interpretation. Further research is needed to assess the clinical relevance and explore the underlying mechanisms.

Clinical and economic benefits of patients undergoing lobectomy with the use of powered vascular staplers—based on China’s real-world data

Background Endoscopic surgery is widely performed with an increasing use of powered vascular staplers (PVS). However, few studies have examined PVS use in China, most of which have focused on clinical effects; fewer studies have examined the economic benefits of PVS. This study evaluated the clinical and economic benefits of the PVS compared to standard-of-care (SOC) staplers in lobectomy using results from a single-arm, multicenter clinical trial conducted in China and actual clinical use in a hospital collected in a real healthcare setting. Methods Patients with lung cancer undergoing thoracoscopic lobectomy were included in the study. The clinical and economic benefits of powered vascular stapler have been evaluated from a hospital’s perspective based on parameters such as bleeding occurrence, hospitalization time, secondary thoracotomy, and hospitalization costs. To compare the bleeding associated with use of PVS and SOC stapler in clinical use, PVS single-arm multi-center clinical trial data is used for the intervention group, and sampling data from hospitals is used for the control group. To ensure the outcome indicators between the two groups are comparable, we set the same inclusion criteria for the two groups of data and then used propensity score matching (PSM) to match two groups of patients according to the baseline characteristics. Results The results show that bleeding incidence in patients with SOC stapler group is 17.33% from hospital sampling data. In contrast, in the PVS group, it is 4.00%, and these rates are statistically different (P = 0.0167). Considering converted to open thoracic surgery, the rate of the SOC stapler group is 5.78% and that of the PVS group is 4.00%. These rates are not statistically different (P = 0.6166). Regarding hospitalization days, the length of the SOC stapler group is 18.97 days, while that in the PVS group is 12.38 days, and these data are statistically different (P = 0.0002). As patients in the PVS group have reduced bleeding, they will require less resource use from blood transfusion, drug services and surgical services. If PVS is used for transection of vessel, it can reduce the bleeding incidence by 13.33% and save 75.47 CNY in blood transfusion costs, 571.36 CNY in drug costs, and 183.38 CNY in surgical service costs per patient. From these three aspects, the hospital saves per patient 830.21 CNY. Conclusions Compared with the SOC stapler group, the PVS group has a lower bleeding incidence and shorter hospital days for lobectomy. In terms of blood transfusion costs, drug costs and surgical service costs, the hospital saves per patient 830.21 CNY.

Introduction of uniportal VATS access when performing lobectomies

Aim. Analysis of surgical indices during monoport thoracoscopic lobectomies in Sakhalin Regional Clinical Oncological Dispensary at different stages of mastering the technique. Materials and methods. Case histories of 251 patients who underwent radical surgical treatment for lung cancer using monoport thoracoscopic access. Patients were divided into two groups: initial (109 patients) and advanced (142 patients). The average surgical time, number of complications and conversions were assessed. Results. Mastering the technique leads to a statistically significant reduction in surgical time. The difference in other parameters, such as the number of postoperative complications and the percentage of conversions at different stages, tends to decrease. Conclusion. Surgical indices improve as the team goes through the learning curve. The technique is adequate and reproducible for surgical treatment of patients with lung cancer.

The clinical effect of thoracoscopic segmentectomy in the treatment of lung malignancies less than 2CM in diameter

ObjectiveTo investigate the clinical effect of thoracoscopic segmentectomy in the treatment of lung malignancies less than 2CM in diameter.MethodsIn this retrospective study, a total of 103 patients with lung cancer who received outpatient or inpatient treatment from December 2020 to May 2022 were selected and divided into the lobectomy group (n = 48) and the segmentectomy group (n = 55) according to different surgical methods. The lobectomy group was treated with thoracoscopic lobectomy, while the segmentectomy group was treated with thoracoscopic segmentectomy. The prognostic effect, complications, blood gas level and respiratory function indexes of the two groups were observed and compared.ResultsThe general data of the two groups of patients, such as gender, age, course of disease, body mass index, lesion diameter, lesion site and pathological type, were analyzed by statistical software. There was no statistical significance in the operation time and the number of lymph node dissection between the two groups (P > 0.05), while the drainage volume and intraoperative blood loss in the segmentectomy group were lower than those in the lobectomy group, and the drainage time and hospital stay were shorter than those in the lobectomy group, with statistical significance (P < 0.05). Before treatment, there were no statistically significant differences in various lung function indexes between the two groups (P > 0.05). After treatment, the values of FVC, FEV1 and FEV1/FVC in each group had different amplitude changes, and the values of FVC, FEV1 and FEV1/FVC in the segmentectomy group were significantly higher than those in the lobectomy group, with statistical significance (P < 0.05). Thoracoscopic segmentectomy showed a lower incidence of respiratory complications (P = 0.042) and higher pulmonary air leak (P = 0.023) than thoracoscopic lobectomy. After propensity score-matched analysis, respiratory complications remained significantly higher in thoracoscopic segmentectomy (P = 0.017). However, the difference in the total complication rate between the two groups was not statistically significant (P > 0.05). There were no differences during the 2-year follow-up (median follow-up in months: 18.4; interquartile range, 14.8–21.3) in terms of overall survival (P = 0.49) and disease-free survival (P = 0.34) between groups (P > 0.05).ConclusionsFor patients with lung cancer less than 2 cm in diameter, thoracoscopic segmentectomy can achieve good short-term efficacy, with rapid postoperative recovery and little impact on lung function, which may be helpful to improve patients’ postoperative quality of life.

Effect of visual lung recruitment manoeuvres guided by trans-oesophageal lung ultrasound on atelectasis after thoracoscopic lobectomy: a randomised, single-blind, prospective study

BackgroundAlthough the incidence of postoperative atelectasis could be reduced using lung recruitment manoeuvres, it remains high. We hypothesised that intraoperative visual lung recruitment guided by trans-oesophageal lung ultrasound would be more effective than the conventional method for managing postoperative atelectasis.MethodsIn this randomised, controlled, prospective study, 84 patients undergoing thoracoscopic lobectomy were recruited from Affiliated Chengdu Fifth People’s Hospital (teaching hospital) in China. Patients were grouped into trans-oesophageal lung ultrasound-guided (Group G, n = 42) and control (Group C, n = 42) groups.MethodsLung recruitment was performed after anaesthesia induction, before chest closure and before the endotracheal tube extubation. In Group C, recruitment pressure was controlled at 30 cm H2O for 10 s (performed thrice); in Group G, the pressure was controlled at 30 cm H2O (performed thrice), and the tidal volume did not exceed 20 ml kg−1 until no atelectasis was detected by trans-oesophageal ultrasound. The primary outcome was lung ultrasound scores measured at the post anaesthesia care unit 30 min after extubation. The secondary outcomes included the oxygenation index (30 min after extubation) and the incidence of atelectasis (30 min after extubation and 3 days after surgery).ResultsThe final analysis included 79 patients. The lung ultrasound score was significantly higher in the control group than in the ultrasound-guided group 30 min after extubation (Group C vs. Group G, 8.6 ± 2.6 vs. 6.5 ± 2.0, P < 0.001). No significant difference in the oxygenation indexes 30 min after extubation was observed between the groups (P = 0.074); however, the incidence of atelectasis 30 min after extubation significantly differed between the two groups (Group C vs. Group G, 57% vs. 33%, P = 0.031). The incidence of atelectasis 3 days after surgery did not significantly differ between the two groups (Group C vs. Group G, 45% vs. 28%, P = 0.122).ConclusionsLung recruitment guided by trans-oesophageal lung ultrasound can reduce lung ultrasound scores and the incidence of atelectasis at the post anaesthesia care unit 30 min after extubation. However, it does not significantly reduce the incidence of atelectasis 3 days after surgery.Trial registrationRegistration number: ChiCTR2200062509. Registered on 10 /8/ 2022.

A comparative analysis of the results of video-assisted thoracoscopic lobectomies and segmentectomies in patients with stage IA non-small cell lung cancer

Objective. To improve the results of surgical treatment of patients with stage IA NSCLC requiring thoracoscopic anatomical resections.Material and methods. One surgical team performed 132 thoracoscopic lobectomies and segmentectomies in one hospital between 2010 and 2020. This study was consecutive, non-randomized and retrospective.Patients after thoracoscopic lobectomies and segmentectomies for stage IA NSCLC were compared. Additionally, an analysis was performed in 4 subgroups of patients: lobectomy (n=45) and segmentectomy (n=21) with a tumor size up to 2 cm; lobectomy (n=55) and segmentectomy (n=11) with a tumor size from 2 to 3 cm.Results. The comparison groups are comparable in main clinical parameters. There was no mortality in both groups. There were no differences in the postoperative hospital day (6.0 and 6.2 days, p=0.58), the number of removed lymph nodes (9.2 and 9.9, p=0.52) and the percentage of complications (15.6% and 21.9%, p=0.75) when comparing segmentectomies and lobectomies.Differences in the groups were revealed in the length of the machine stitch: in lobectomy — 218.5 mm, in segmentectomy — 309.8 mm (p=0.0001). This pattern was the same in the subgroup analysis. In patients with a tumor from 2 to 3 cm, when removing a segment, the size of the mini-access was smaller than during lobectomy (3.3 cm and 4.0 cm, p=0.0087), and the persistent air leak was longer (6.8 and 2.9 days, p=0.0332).When analyzing long-term outcomes, no significant differences were found either in both group and subgroup analysis; however, there was a tendency towards an increase the overall five-year survival after segmentectomies compared with lobectomies in patients with tumor size ≤2 cm, while with tumor size from 2 to 3 cm, on the contrary, the best long-term results were found in patients operated on with thoracoscopic lobectomy.Conclusion. Thoracoscopic lobectomy and segmentectomy are safe and effective for stage IA NSCLC; the short-term outcomes of surgical treatment of patients with stage IA NSCLC after thoracoscopic lob- and segmentectomies with tumor size ≤2 cm are not significantly different; in patients with the tumor size from 2 to 3 cm, the persistent air leak after segmentectomies was significantly higher than after lobectomies (p=0.033); when evaluating long-term outcomes, no significant differences were found between the study groups and subgroups.

Thoracoscopic Lobectomy for Congenital Lung Malformation in Children: Evolving Management Strategies and Their Impact in Outcomes

BackgroundThe aim of this study was to determine the incidence of complications after thoracoscopic lobectomy in children according to a verified classification. Secondary aim was to evaluate the modifications made in our management protocol in order to decrease the rate of complications. MethodsRetrospective study of pediatric patients in whom a lobectomy was performed for congenital lung malformation (CLM) in our institution between 2003 and 2021. The following data were collected: demographics, preoperative clinical symptoms, surgical technical details, and postoperative complications following the Clavien-Dindo (CD) classification. Main outcome measure was the presence of complications in the first month after lung lobectomy. Results90 lobectomies were performed in 89 patients. There were 46 girls (51.6%) and 43 boys with a median age of 12.4 months. Most patients (86.6%) remained asymptomatic until the surgical procedure. Postsurgical complications were detected in 26 cases (28.8%) and distributed into their respective category according to CD classification. In our experience, closure of the bronchial stump with interrupted suture or placement of an endoloop showed a statistically significant association with complications (p = 0.022 and p = 0.006 respectively). Moreover, patients in which a device combining sealing and section was used showed significantly fewer complications (p = 0.006). ConclusionsThoracoscopic lobectomy continues to be a challenging procedure. The CD grading system for postoperative complications has proved to be useful in this setting. Evolving surgical strategies and new miniaturized endosurgical devices have enabled a safer and quicker procedure with a positive impact in the development of complications. Level of EvidenceIII.

Neoadjuvant immunotherapy for lung cancer and hilar fibrosis during thoracoscopic lobectomy: Can we improve postoperative outcomes?

Neoadjuvant immunotherapy for lung cancer and hilar fibrosis during thoracoscopic lobectomy: Can we improve postoperative outcomes?

A case of neoadjuvant targeted therapy with pralsetinib for locally advanced lung adenocarcinoma with RET fusion mutation

This case report details the successful treatment of a 68-year-old male patient with locally advanced RET-rearranged lung adenocarcinoma using neoadjuvant pralsetinib. The patient initially presented with a suspicious right upper lobe nodule, which was later diagnosed as lung adenocarcinoma following genetic testing that revealed a RET exon 12 fusion. After 2 months of neoadjuvant treatment with pralsetinib, a significant radiological response was observed, with a reduction in tumor size and metabolic activity. Subsequently, the patient underwent video-assisted thoracoscopic right upper lobectomy and mediastinal lymph node dissection. Postoperative pathological analysis revealed a major pathological response, with only 5% residual tumor cells in the primary lesion and no viable tumor cells in the lymph nodes. Postoperative pathological staging of TNM was ypT1aN0M0, stage IA1(AJCC, 8th edition). The patient recovered well after surgery, demonstrating the potential efficacy of neoadjuvant pralsetinib in locally advanced RET-rearranged lung adenocarcinoma. However, further clinical validation is required to establish the role of neoadjuvant targeted therapy and postoperative adjuvant therapy in this patient population.

EP.07A.07 Comparison of Inpatient Opioid Use and Pain Control Following Thoracoscopic Segmentectomy Versus Lobectomy for Non-Small Cell Lung Cancer

EP.07A.07 Comparison of Inpatient Opioid Use and Pain Control Following Thoracoscopic Segmentectomy Versus Lobectomy for Non-Small Cell Lung Cancer

Uniportal left middle lobectomy in a patient with situs inversus totalis: a case report

BackgroundSitus inversus totalis (SIT), a rare recessive autosomal disease, involves the complete transposition of the thoracic and abdominal viscera in the left-right axis. Patients with SIT combined with lung cancer are extremely uncommon.Case presentationWe present a case of a 57-year-old woman with SIT who underwent uniportal video-assisted thoracoscopic left middle lobectomy for adenocarcinoma of the lung. The procedure was performed safely with adequate anatomical identification and careful intraoperative manipulation based on the preoperative three-dimensional-computed tomography bronchography and angiography (3D-CTBA). The patient’s perioperative period was uneventful, and no recurrence was observed 2 year postoperatively.ConclusionWith the preoperative planning of the 3D-CTBA, uniportal video-assisted thoracoscopic lobectomy in lung cancer patients with sit can be performed safely and effectively.

Clinical significance of postoperative thrombocytosis after vats lobectomy for NSCLC

ObjectivesThrombocytosis is a clinical condition generally associated with poor prognosis in patients with cancer. Thrombocytosis may be present after lung cancer resection, but the clinical significance of thrombocytosis remains unclear. Herein, we evaluated whether postoperative thrombocytosis was a negative prognostic factor in patients undergoing thoracoscopic lobectomy for lung cancer.MethodsIt was a retrospective monocentric study including consecutive patients undergoing thoracoscopic lobectomy for lung cancer from January 2020 to January 2023. The outcome of patients with postoperative thrombocytosis (defined as platelet count ≥ 450 × 10^9/L at 24 h after the surgery and confirmed at postoperative day 7) was compared with a control group. Postoperative morbidity, mortality, and survival were compared between the two groups to define whether thrombocytosis negatively affected outcomes.ResultsOur study population included 183 patients; of these, 22 (12%) presented postoperative thrombocytosis: 9 (5%) mild thrombocytosis (451–700 × 10^9/L), 10 (5%) moderate thrombocytosis (701–900 × 10^9/L), and 3 (2%) severe thrombocytosis (901–1000 × 10^9/L). No significant differences were found regarding postoperative morbidity (p = 0.92), mortality (p = 0.53), overall survival (p = 0.45), and disease-free survival (p = 0.60) between the two study groups. Thrombocytosis was associated with higher rate of atelectasis (36% vs. 6%, p < 0.001) and residual pleural effusion (31% vs. 8%, p = 0.0008). Thrombocytosis group was administered low-dose acetylsalicylic acid for 10 days and no thrombotic events were observed. In all cases the platelet count returned to be within normal value at postoperative day 30.ConclusionsPostoperative thrombocytosis seems to be a transient condition due to an inflammatory state and it does not affect the surgical outcome and survival after thoracoscopic lobectomy.

“Trimming the VAT(S)”: maximizing value delivery in thoracoscopic lobectomy—a narrative review

“Trimming the VAT(S)”: maximizing value delivery in thoracoscopic lobectomy—a narrative review

Predictive model for intraoperative decision-making in video-assisted thoracoscopic lobectomy: optimizing chest drain placement for high-risk patients.

For years, it has been the common and widely accepted practice in thoracic surgery to place apical and basal drains after a lobectomy to completely drain the pleural cavity. With the development of thoracoscopic technology, it became apparent that the use of a single chest tube provided the same clinical results. However, sometimes tension pneumothorax occurs with the need for additional pleural drainage. The aim of this study was to develop a prognostic model to identify high risk patients intraoperatively and to insert additional pleural drainage to prevent the development of pneumothorax after video-assisted thoracoscopic surgery (VATS) lobectomy. This was a retrospective multicenter study of patients (registry data was analyzed) who underwent VATS lobectomy via a standardized multiport approach between 2014 and 2022. In all cases, a single drain was used postoperatively. We used a machine learning algorithm and data synthesis to expand patient selection according to Riley's method. A total of 418 cases were analyzed in this study. After determining the prognostically significant factors, we performed a binary logistic regression analysis using reverse step-by-step inclusion of variables according to the Akaike information criterion. After validation of the model by bootstrap (400 iterations) and with the original dataset, a nomogram with a specific point distribution for each risk factor was created. The rate of tension pneumothorax was 4.53% (n=66). The most significant variables associated with the need for additional drainage were adhesions, intraoperative lung suturing, fused interlobar fissure, enlarged intrapulmonary lymph nodes, chronic obstructive pulmonary disease (P<0.001). The C-index of the model was 0.957, the mean absolute calibration error was 0.6%, and the slope of the calibration curve was 0.959. A score of 26 points indicated a 95% risk of postoperative tension pneumothorax. The nomogram achieved good predictive performance for tension pneumothorax after minimally invasive lobectomy. High-risk patients could be identified, and additional drainage may be placed intraoperatively to reduce the risk of lung collapse in the postoperative period.

A case report of a bleeding case after removal of chest drain after lung surgery.

Postoperative bleeding after lobectomy is relatively rare. By analyzing and discussing the case history and management of hemorrhagic shock caused by chest tube removal after lobectomy, we can achieve the purpose of preventing postoperative bleeding after thoracic surgery and reducing postoperative complications, which can help avoid the risk of second surgery, shorten the patient's hospital stay, reduce the cost of medical care, and improve the patient's quality of life. A case of bleeding from tube removal after lobectomy. The bleeding from chest drain removal on the 3rd day after thoracoscopic lobectomy resulted in hemorrhagic shock, which was stopped by thoracoscopic exploration again under active antishock, and there was no recurrence of bleeding after the operation, and the patient was discharged from the hospital after chest drain removal. Enhanced computed tomography of the chest revealed a space-occupying lesion in the middle lobe of the right lung. Thoracoscopy was performed again on the condition of active anti-shock. On the third day after thoracoscopic lobectomy, the patient underwent removal of the chest drain and subsequently experienced hemorrhagic shock. Given the necessity of maintaining anti-shock measures, the patient was subjected to a second thoracoscopic exploration with the objective of halting the hemorrhage. Following this procedure, the patient did not present with any further episodes of bleeding. Subsequently, a new chest drain was placed, and once the drainage flow had diminished to an acceptable level, the chest drain was removed. The patient subsequently made a full recovery and was discharged from the hospital. Even if the safely inserted drain tube is removed, the thoracic surgeon must be aware of possible vascular bleeding.

Application of tissue pneumoperitoneum technique around lymph nodes in thoracoscopic lung cancer resection.

Thoracoscopic surgery is a primary treatment for lung cancer, with lobectomy and mediastinal lymph node dissection being the predominant surgical approaches for invasive lung cancer. While many thoracic surgeons can proficiently perform lobectomy, thorough and standardized lymph node dissection remains challenging. This study aimed to explore a safer and more efficient surgical method for mediastinal lymph node dissection in lung cancer. A prospective randomized controlled study was conducted, involving 100 patients with right lung cancer who were admitted to our hospital from January 2021 to April 2024 and met the inclusion criteria. These patients were randomly divided into an observation group (tissue pneumoperitoneum technique around lymph nodes group) and a control group (conventional surgery group). Thoracoscopic lobectomy and mediastinal lymph node dissection were performed. Intraoperative and postoperative related indicators were observed to validate the effectiveness and safety of the tissue pneumoperitoneum technique around lymph nodes. The observation group showed a significantly shorter lymph node dissection surgery time compared to the control group, with a statistically significant difference (p < 0.05). The number of lymph nodes dissected in the observation group was significantly higher than that in the control group, with a statistically significant difference (p < 0.05). Although the observation group had slightly more mediastinal lymph node stations dissected than the control group, the difference was not statistically significant (p > 0.05). The total drainage volume within three days postoperatively was comparable between the two groups, with no statistically significant difference (p > 0.05). The observation group had shorter chest tube indwelling time and postoperative hospital stay than the control group, with statistically significant differences (p < 0.05). The incidence of surgical complications was similar between the two groups, and there were no perioperative deaths. The tissue pneumoperitoneum technique around lymph nodes is a more efficient method for mediastinal lymph node dissection in lung cancer, demonstrating safety and feasibility, and is worthy of promotion.

Anesthetic Management of a Patient with Saber-Sheath Trachea

Saber-sheath trachea is a deformation of the trachea characterized by a tracheal index of less than 0.67, commonly found in patients with chronic obstructive pulmonary disease (COPD). This condition can lead to symptoms such as shortness of breath, coughing, and recurrent respiratory infections, which may necessitate surgical intervention. We present the case of a 72-year-old male with a left upper pulmonary lobe tumor scheduled for thoracoscopic lobectomy. The patient exhibited severe emphysema and had a tracheal index of 0.28, indicating a significantly narrowed intrathoracic trachea. Preoperative assessments revealed stable vital signs and low risk for perioperative complications, allowing for standard noninvasive monitoring during the procedure. Anesthesia was induced while maintaining spontaneous breathing using inhalation anesthetics. A left-sided double-lumen endotracheal tube was successfully placed for lung isolation. Throughout the surgery, airway pressures remained below 20 cm H&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt;O, and the patient tolerated ventilation well. Following the procedure, fiberoptic bronchoscopy confirmed the absence of airway complications. The patient experienced a smooth recovery, was discharged after 6 days, and reported feeling well at the 3-month follow-up. This case underscores the importance of careful anesthetic management in patients with saber-sheath trachea undergoing thoracic surgery.

Periareolar approach in video-assisted thoracoscopic surgery for right middle lobectomy: a novel technique

BackgroundUniportal thoracoscopic right middle lobectomy (RML) poses greater technical challenges than other lobectomies. Although two-port thoracoscopy offers convenience, it results in heightened surgical trauma and scarring. The periareolar incision is rarely used in lobectomy while known for its cosmetic advantages. This study presents the periareolar access (combining a periareolar port and a 1-cm port) for video-assisted thoracoscopic surgery (VATS) in RML, comparing it with the traditional uniportal technique in both male and female patients.MethodsEighty patients who underwent RML were randomly divided into two groups: the periareolar VATS (PV) approach (n = 40) and the uniportal VATS (UV) approach (n = 40) from August 2020 to February 2023. All patients were followed up for 1 year and clinical data were collected and analyzed.ResultsNo significant differences in complications, blood loss, duration of chest tube placement, and length of postoperative hospital stay were observed between two methods. However, the PV group exhibited significantly shorter operative time, reduced postoperative visible scarring and lower visual analogue scores (VAS) for postoperative pain (P < 0.05). Additionally, the PV group demonstrated significantly higher cosmetic and satisfaction scores at the 6-month postoperative assessment (P < 0.05). Notably, breast ultrasound follow-up revealed two cases injuries of the mammary glands in female patients, and sensory function of most nipple and areola remained intact except two cases in all PV group patients.ConclusionsPeriareolar VATS emerges as a promising alternative approach for RML, providing clear benefits in pain management and cosmetic outcomes, while maintaining safety and convenience.Graphical

Cardiopulmonary crisis caused by bronchial blocker malposition in a patient with aberrant tracheal anatomy: a case report

BackgroundDouble-lumen tubes (DLTs) and bronchial blockers (BBs) can be used to establish one-lung ventilation (OLV) for thoracic surgery. BBs are a good alternative when DLTs are not suitable or patients have difficult airways. However, BBs are more prone to malposition, leading to adverse events.Case presentationWe present a 68-year-old male patient who was scheduled for thoracoscopic left lower lobectomy. The patient was not expected to have airway malformation preoperatively. When the DLT could not be inserted into the bronchus after general anesthesia induction, we used a BB to perform OLV. During surgery, malposition of the BB resulted in the development of an “incomplete balloon valve”, leading to a cardiopulmonary crisis.ConclusionsPreviewing chest computed tomography scans to assess the airway anatomy before thoracic surgery is essential. Three-dimensional reconstruction of the airway can provide a more intuitive assessment of airway anatomy. During OLV with BBs, we should pay attention to balloon malposition to prevent cardiopulmonary crises.