Thoracoscopic Lobectomy Research Articles

Comparison of erector spinae plane block and serratus anterior plane block for postoperative analgesia in uniportal thoracoscopic lobectomy: a randomized controlled trial

BackgroundPostoperative pain remains a significant concern following uniportal thoracoscopic surgery. The analgesic efficacy of erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) in terms of postoperative opioid consumption in uniportal thoracoscopic surgery still needs further studies.MethodsA randomized controlled trial was conducted, enrolling 150 patients who underwent uniportal thoracoscopic lobectomy. The patients were randomly allocated to three groups in a 1:1:1 ratio: the ESPB group (administered 20 ml of 0.5% ropivacaine), the SAPB group (administered 20 ml of 0.5% ropivacaine), and the standard care (control) group. The primary endpoint was the consumption of sufentanil during the first 24 h following surgery. Secondary endpoints assessed the area under the curve (AUC) of pain numerical rating scale (NRS) scores, occurrence of moderate to severe pain, time to initial sufentanil request, and postoperative adverse events.ResultsNo significant difference was observed in the consumption of sufentanil during the first 24 h following surgery between the ESPB and SAPB groups (adjusted difference, 1.53 [95% CI, -5.15 to 2.08]). However, in comparison to the control group, both intervention groups demonstrated a significant decrease in sufentanil consumption, with adjusted differences of -9.97 [95% CI, -13.10 to -6.84] for the ESPB group and -12.55 [95% CI, -15.63 to -9.47] for the SAPB group. There were no significant differences in AUC of NRS scores during rest and movement between the ESPB and SAPB groups, with adjusted differences of -7.10 [95% CI, 1.33 to -15.55] for the rest condition and 5.61 [95% CI, -13.23 to 2.01] for the movement condition. At 6 h postoperatively, there were fewer patients with moderate to severe pain in the ESPB group compared with those in the SAPB group (adjusted difference, -1.37% [95% CI, -2.29% to -0.45%]. The time to first sufentanil request significantly differed among the three groups (ESPB vs Control P < 0.01, SAPB vs Control P < 0.01, ESPB vs SAPB P = 0.015).ConclusionsIn patients undergoing uniportal thoracoscopic lobectomy, although the differences between the two groups are not statistically significant, both the ESPB and SAPB demonstrate effective reduction in postoperative opioid consumption and the need for rescue analgesics compared to the control group. Moreover, the ESPB group experienced a significantly lower incidence of moderate to severe pain at 6 h postoperatively compared to the SAPB group.Trial registrationThe study was registered in the Chinese Clinical Trial Registry (registration No: ChiCTR1900021695, Date of registration: March 5th, 2019).

Internal carotid bulb occlusion by a giant thrombus after thoracoscopic left upper lung lobectomy successfully treated with endovascular stenting: a case report

BackgroundPerioperative acute ischemic stroke following lung resection is relatively rare, though a devastating complication. Specifically, patients undergoing left upper lung lobectomy for lung cancer are likely to develop perioperative acute ischemic stroke.Case presentationA 67-year-old man underwent thoracoscopic left upper lung lobectomy for lung adenocarcinoma; he experienced sudden-onset left hemiparesis and dysarthria on the morning of the second postoperative day. Angiography revealed occlusion of the bulbs of the right internal and external carotid arteries by a giant thrombus, which could not be removed through endovascular thrombectomy. We deployed a stent at the right carotid bifurcation to foist the giant thrombus, achieving revascularization 4 h after the onset. Treatment response was assessed as good improvement with a modified Rankin scale score of 0, and the patient was discharged home 19 days after symptom onset.ConclusionsWe present a unique case of carotid bulb thromboembolism resulting from a giant thrombus following thoracoscopic left upper lung lobectomy, for which endovascular stenting was effective.

Evaluating Modified Ultrasound-Guided Serratus Anterior Plane Block for Enhanced Postoperative Recovery in Thoracoscopic Lobectomy Patients

Evaluating Modified Ultrasound-Guided Serratus Anterior Plane Block for Enhanced Postoperative Recovery in Thoracoscopic Lobectomy Patients

Quality of life after lung cancer surgery: sublobar resection versus lobectomy

BackgroundThis study aimed to compare the postoperative quality of life (PQOL) between non–small–cell lung cancer (NSCLC) patients who underwent video–assisted thoracoscopic sublobar resection (subsegment, segment, or wedge) and lobectomy. Meanwhile, we developed a PQOL scale for patients with NSCLC after optimization.MethodsDeveloping and evaluating the postoperative quality–of–life scale of non–small–cell lung cancer (NSCLC–PQOL) followed by the international principles for developing quality–of–life scale. Therefore, we used the NSCLC–PQOL scale to evaluate the PQOL of patients who underwent different surgeries.ResultsThe overall PQOL of patients who underwent video-assisted thoracoscopic lobectomy and sublobar resection gradually worsened from discharge to 3 months postoperatively and progressively improved from three to 6 months postoperatively. And the sublobar resection group showed better PQOL in chest tightness, breath shortness, breathlessness, cough and expectoration than the lobectomy group, and the differences were statistically significant (P < 0.05). The final version of the NSCLC–PQOL contained three dimensions: “signs–symptoms”, “psychological and psychiatric”, and “social–life” dimensions.ConclusionsThe sublobar resection group showed better PQOL in “chest tightness”, “breath shortness”, “breathlessness”, “cough”, and “expectoration” than the lobectomy group. Twenty–two items formed a well–behaved PQOL scale after being validated satisfactorily. The scale was a suitable rating tool for evaluating the NSCLC–PQOL of patients.Trial registrationAs this study was a retrospective study and not a clinical trial, we did not register this study in the Chinese Clinical Trial Registry.

Outcomes after Conversion from Video-Assisted Thoracoscopic Lobectomy to Thoracotomy

Abstract Background Lung cancer resections are increasingly being performed via video-assisted thoracoscopic surgery (VATS). Conversion to thoracotomy can occur for many reasons and may affect outcomes. The objective of this study was to investigate the impact of VATS conversion on short- and mid-term outcomes and identify reasons for conversion. Methods Consecutive patients undergoing lobectomy for primary non-small cell lung cancer between 2012 and 2019 in a single UK center were included. Primary outcomes were 90-day mortality, intraoperative conversion, and overall survival. Reasons for conversion were defined as bleeding or nonbleeding. Outcomes were compared between groups using univariable analysis. Multivariable logistic regression analysis was performed to identify risk factors for conversion. Results A total of 2,622 patients were included with 20.6% (n = 541) completing surgery via VATS and 79.4% (n = 2,081) via thoracotomy. The rate of completed VATS surgery increased significantly over time (2012: 6.9%, 2019: 55.1%, p &lt; 0.001). Overall conversion rate was 14.3% (n = 90/631) and has reduced significantly over time (p &lt; 0.001). The rate of conversion due to intraoperative bleeding was 31.1% (n = 28/90). Obesity, male sex, and stage III disease were independent risk factors for conversion. The 90-day mortality rate after conversion was not significantly different from the rate for planned thoracotomy (3.3 vs. 3.4%, p = 0.987). There was no significant difference in overall survival between patients experiencing intraoperative conversion and those undergoing planned thoracotomy (p = 0.135). Conclusion This study demonstrates comparable outcomes for patients undergoing conversion from VATS to those undergoing planned surgery via thoracotomy. It remains unclear if reason for conversion is associated with outcomes.

Effects of perioperative electroacupuncture on postoperative gastrointestinal recovery after thoracoscopic lung surgery

ObjectiveTo study whether perioperative electroacupuncture (EA) can improve postoperative gastrointestinal recovery in patients receiving thoracoscopic lung surgery. MethodsThis study was a single-center, prospective, randomized open-label trial. 180 patients who underwent video-assisted thoracoscopic segmentectomy or lobectomy were randomized to EA group (three sessions, 24 h prior to surgery, postoperative 4 h and 24 h) or usual care group (UC group). The primary outcomes were time to first flatus and defecation. Secondary outcomes included incidence and degree of abdominal distention, postoperative nausea and vomiting (PONV) and pain scores within 72 h after surgery, postoperative morphine use, time to ambulation, and length of hospital stay. ResultsTime to first flatus (15.4 ± 3.2 h vs. 17.0 ± 3.7 h, P = 0.004) and time to first defecation (75.9 ± 7.9 vs. 79.7 ± 8.1 h, P = 0.002) in the EA group were significantly shorter than the UC group. The incidences of abdominal distension and PONV postoperative 24 h were significantly reduced in the EA group (P < 0.05). There was no difference in postoperative pain intensity, morphine use, time to ambulation, and length of hospital stay between the two groups (P>0.05). ConclusionElectroacupuncture is a simple intervention for accelerating postoperative gastrointestinal recovery and may be considered as an adjunct strategy in enhanced recovery protocols in thoracoscopic lung surgery.

Chronic postoperative pain after non-intubated uniportal VATS lobectomy.

Patients undergoing thoracic surgery are at increased risk of developing, long-lasting pain. Beyond the non-surgical factors, the type of operation, including the number of incisions, and the anesthetic assessment seemed to be important factors, although some studies are controversial. The aim of our study was to examine the presence of chronic postoperative pain after non-intubated uniportal VATS lobectomy. We examined the difference between the intubated, relaxed and non-intubated spontaneous ventilation surgical approaches in patients who underwent video-assisted thoracoscopic (VATS) uniportal lobectomy. Demographic and postoperative data were retrospectively collected and analyzed, focusing on the use of pain medications, in 67 patients of the 140 patients selected by propensity score matching who underwent intubated (iVATS) or non-intubated (NITS) uniportal VATS lobectomy. This study focused on the use of analgesic medications 3, 6, and 12 months after surgery. Thirty-five intubated and 32 non-intubated patients were compared. Although the analgesic consumption was nearly 2% higher among the iVATS patients during the follow-up period, there were no statistically significant differences at 3 months (15.6 vs. 17.1%) (p = 0.868), at 6 months (9.4 vs. 12.4%) (p = 0.785), and at 12 months (3.3 vs. 5.9%) (p = 0.633) between the NITS and iVATS groups, respectively. More female than male patients reported chronic pain, but the difference was not statistically significant (p = 0.616). Diabetes mellitus was a statistically significant cofactor associated with chronic pain (p = 0.03), while cardiac disease (p = 0.6), perioperative morbidity (p = 0.228), prolonged air leak (p = 0.057), and repeat drainage (p = 0.626) were not. Our study suggests that after non-intubation VATS lobectomies, the postoperative pain was less at 3, 6, and 12 months in NITS patients compared to iVATS patients. The 2% difference was not significant, so it may not be appropriate to claim the advantages of NITS in terms of postoperative pain.

Comparative retrospective review of perioperative analgesia using ultrasound-guided programmed intermittent erector spinae plane block for video-assisted thoracoscopic lobectomy

BackgroundThe retrospective cohort study was conducted to estimate the opioid-sparing anesthesia and limited side-effects with ultrasound (US)-guided ESPB using programmed intermittent bolus (PIB) or continuous infusion (CI) and standard opioid-based anesthesia in patients undergoing video-assisted thoracoscopic lobectomy (VATS).MethodsPatients underwent VATS were stratified into either control group or one of the two ESPB groups in a 1:2:2 ratio depending on whether PIB was implemented or not. The primary endpoint was intra- and post-operative opioids consumption over the first 48 h following surgery.ResultsA total of 180 cases were included in the analysis. Cumulative perioperative opioid administration was found to be significantly different between PIB, CI and control group (both p < 0.001), and between PIB and CI group (p = 0.028). More specifically, the mean was 305.30 ± 51.35 mg, 339.68 ± 56.07 mg and 468.91 ± 79.84 mg in PIB, CI and control group. NRS scores at rest across all postoperative times were comparable in two ESPB groups, while significantly lower than control group, however, scores during exercising at postoperative 3, 6, 12 h were significantly lower in PIB group as compared to CI group. A wider anesthetized dermatomes with PIB was observed at 6, 24 and 48 h as opposed to the CI. The mean of levobupivacaine plasma concentration was significantly lower for PIB at postoperative 0.5, 12, 24 and 48 h after initiation than CI. However, local anesthetic toxicity was not observed in any of the two ESPB groups.ConclusionsWhen US-guided ESPB using PIB was performed preoperatively, it contributed to the minimization of intra- and post-operative opioid consumption due to better analgesia with a wider anesthetic dermatome opposed to conventional CI, whereas, it was also associated with lower risk of local anesthetic toxicity because of lower plasma concentration of levobupivacaine.

MA11.04 Video-Based Artificial Intelligence in Thoracoscopic Lobectomy for Lung Cancer: Surgical Structures Segmentation and Phase Recognition

MA11.04 Video-Based Artificial Intelligence in Thoracoscopic Lobectomy for Lung Cancer: Surgical Structures Segmentation and Phase Recognition

Neoadjuvant Lorlatinib Induces Pathological Complete Response in Advanced ALK-Positive Lung Cancer: A Case Report.

BACKGROUND Chemotherapy has been the conventional treatment method for advanced non-small-cell lung cancer (NSCLC). Nevertheless, the identification and comprehension of oncogenic driver alterations have paved the way for targeted therapies, significantly enhancing patient outcomes. The management of locally advanced NSCLC that is positive for ALK presents a challenge due to the lack of reported randomized controlled trials. The efficacy of neoadjuvant and adjuvant targeted therapy in this context remains uncertain. CASE REPORT A 54-year-old man was diagnosed with stage IIIB (pT1N3M0) upper right lung adenocarcinoma carrying the EML4-ALK fusion gene. Clinically, the patient had multiple enlarged lymph nodes in the right hilum and mediastinum, with the largest measuring approximately 28×19 mm by CT scan and we found that the L4 lymph node was invaded by metastasis. Then, the patient received 1 cycle of chemotherapy with paclitaxel in combination with nedaplatin and subsequently received maintenance treatment involving lorlatinib. Two months later, clinical evaluations revealed progressive reduction of the lesions, especially the reduced size of the mediastinal lymph nodes. Therefore, the patient underwent thoracoscopic partial lobectomy and lymphadenectomy and achieved pathological complete response (pCR). After 3 months, a follow-up CT scan was similar to the first postoperative CT scan and no tumor was found. CONCLUSIONS This case demonstrates the potential advantage of lorlatinib as a neoadjuvant therapy in advanced ALK-positive NSCLC. It emphasizes the importance of identifying new therapeutic targets by next-generation sequencing (NGS) and implementing precise treatment strategies in clinical practice.

Evaluation of Thoracoscopic Lobectomy in Infants for Congenital Lung Lesions: Earlier Is Better!

ObjectivesThis study evaluates the safety and efficacy of thoracoscopic lobectomy for congenital lung lesions in infants less then 4 months of age. Materials and methodsFrom January 1997 to October 2022, 194 patients under 4 months of age and weight less then 5.6 Kg underwent video-assisted thoracoscopic lobe resection for CPAM, Sequestration, and CLE. All procedures were performed by or under the direct guidance of a single surgeon. Results195 of 196 procedures were completed thoracoscopically. Operative times ranged from 25 min to 195 min (average, 82 min). There were 50 upper, 8 middle, and 136 lower lobe resections. There were 4 intraoperative complications (2.1 %), of which 1 (0.5 %) required conversion to an open thoracotomy. The postoperative complication rate was 3.1 % Hospital length of stay ranged from 1 to 8 days (Avg 1.8) for those admitted for surgery. There were no conversions to open or blood transfusions in the last 15 years. ConclusionsThoracoscopic lung resection congenital lung lesions in infants is a safe and efficacious technique and avoids the morbidity of a thoracotomy. Early intervention allows surgery before clinical infections or symptoms occur. Newer instrumentation and techniques allow the operation to be safely performed in the first few months of life with shorter operative times, fewer complications, and decreased hospital stays. The minimal morbidity of this procedure should be considered when considering non-operative management of these patients. Level of Evidence3.

The influence of different sequences of vessel ligation on long-term survival during video-assisted thoracoscopic lobectomy for non-small cell lung cancer: A matched cohort study.

In lobectomy of patients with lung cancer, the principle of operation is to cut off the pulmonary vein first, but it is often not taken seriously in clinical practice. We conducted this research to compare the impact of different sequences of pulmonary vessel ligation on the long-term survival of patients. This cohort study included 1239 patients treated surgically with video-assisted thoracoscopic lobectomy from January 2015 to December 2019 at The Second Affiliated Hospital of Nanchang University. Survival and perioperative indicators were compared between a Vein-first group (VF) and an artery-first group. After matching, 364 patients were included in each group for analysis. VF was associated with better overall survival (hazard ratio: 1.96 [1.4~2.74], P < .0001) and disease-free survival (hazard ratio: 1.65 [1.22~2.24], P = .0011). Meanwhile, the survival advantage of VF was achieved in almost all subgroups, particularly in the pathological tumor node metastasis stage I-II group and squamous cell carcinoma group. We obtained no significant differences in perioperative indications (operation time, hospital stay, etc) between VF and artery-first group. With better overall survival and disease-free survival, especially for pathological stage I-II squamous cell carcinoma, vein-first ligation should be strictly observed in lobectomy for patients with non-small cell lung cancer.

Efficacy and safety of thoracoscopic-guided multiple paravertebral block for video-assisted thoracoscopic lobectomy surgery: a randomized blinded controlled study

BackgroundParavertebral block (PVB) has been increasingly popular for postoperative analgesia. However, few studies estimated the efficacy and safety of multiple PVB using thoracoscope-assisted technique for intraoperative analgesia and postoperative pain management for video-assisted thoracoscopic lobectomy (VATS LOBECTOMY).MethodsA total of 120 patients scheduled to undergo VATS LOBECTOMY were randomly assigned into two groups: a placebo group and a PVB group in a ratio of 1:2. Thoracoscopic-guided multi-point PVB was carried out with 0.5% ropivacaine (PVB group) or 0.9% NaCl (placebo group) at the beginning and the end of surgery. The primary endpoint was consumption of intraoperative opioid.ResultsConsumption rate of intraoperative opioids was significantly lower in the PVB group (878.14 ± 98.37 vs. 1,432.20 ± 383.53 for remifentanil; 123.83 ± 17.98 vs. 266.42 ± 41.97 for fentanyl). Postoperatively, significantly longer duration of using patient-controlled intravenous analgesia for the first time, reduced times of analgesic pump pressing, and less rescue analgetic consumption were observed in the PVB group. Visual analog scale scores at rest and during exercising were significantly lower in the PVB group at all time points within the first 48 h after surgery. The PVB group was also associated with significantly higher total QoR-40 scores and lower incidence of analgesia-related adverse events.ConclusionsThoracoscopic-guided multiple PVB was a simple and effective technique in controlling pain both intra- and postoperatively for VATS LOBECTOMY. It was also associated with the absence of detrimental effects attributed to opioid overuse and benefits of the early resumption of activity and physical function recovery. Therefore, this regional anesthesia technique should be advocated as part of a multimodal analgesia protocol for VATS LOBECTOMY.

Acute cardiac tamponade following thoracoscopic lobectomy: a case report and literatures review

Thoracoscopic lobectomy is a common surgical procedure for the treatment of lung cancer. With the continuous development of surgical techniques and medical devices, complications after thoracoscopic lobectomy are less and less, and cardiac tamponade is even rarer. This case is a 62-year-old woman who underwent thoracoscopic left upper lobectomy for a left upper lobe nodule. The patient developed acute cardiac tamponade on postoperative day 2, and symptoms resolved after pericardiocentesis. However, 20 h later, the patient underwent emergency surgery for re-developed acute cardiac tamponade, which was found to be a coronary tear. A review of the literature suggested that cardiac tamponade is more common in left lung surgery than right lung surgery. Pericardiocentesis can resolve initial acute cardiac tamponade, but pericardiotomy may be urgently needed after recurrence.

Preservation vs. dissection of inferior pulmonary ligament for thoracoscopic upper lobectomy: a prospective randomized controlled trial

ObjectivesThe proper procedure for inferior pulmonary ligament (IPL) during upper lobectomy remains a topic of debate. To address this matter, we carried out a trial comparing the clinical outcomes of IPL preservation versus IPL dissection during thoracoscopic upper lobectomy (TUL).MethodsPatients undergoing thoracoscopic left/right upper lobectomy (TLUL/TRUL) were assigned to either the dissection group (Group D) or the preservation group (Group P). Our primary objective was to quantify and compare the alterations in postoperative residual bronchial angle and lung volume changes between the two groups. Our secondary objective encompassed the assessment of various other intraoperative and postoperative outcomes.ResultsFollowing adherence to the inclusion and exclusion criteria, we enrolled 100 patients (41 left and 59 right) in Group P and 108 patients (41 left and 67 right) in Group D for the study. Our findings revealed that in TLUL, Group P was able to reduce the degree of postoperative residual bronchial angle change (P < 0.05). Conversely, the situation was distinct for TRUL. We found no notable disparity between the two groups (P > 0.05) with regard to alterations in lung volume or the occurrence of postoperative complications—except for the duration of postoperative hospital stay (P < 0.05).ConclusionsOur study suggests IPL preservation especially for TLUL when compared to TRUL, which have important implications for the clinical management of patients undergoing upper lobectomy.

SAT208 Hypercalcemic Crisis In Metastatic Parathyroid Carcinoma: An Unusual Presentation Of A Rare Endocrine Disease

Abstract Disclosure: A. Barnett: None. T. Sliker: None. R.J. Harper: None. G. Elshimy: None. Introduction: Hypercalcemia can be life-threatening with a wide differential, including parathyroid carcinoma (PC), which accounts for only 0.005% of all malignancies in the U.S. Maintaining an index of suspicion for PC in PTH-mediated hypercalcemia is vital for improving long-term survival and outcomes. Frozen section can be misleading when PC is suspected. We describe a case of hypercalcemia due to recurrent metastatic PC 9 years after initial diagnosis. Case: A 57-year-old male presented for endophthalmitis and altered mentation. Records revealed primary hyperparathyroidism with calcium 11.7 mg/dL, PTH 337 (11.1-79.5pg/mL), and 24-hour urine calcium 810 mg/day. Sestamibi showed right lower parathyroid adenoma and a possible right upper parathyroid adenoma. Right superior parathyroidectomy revealed PC invasive into adipose tissue, increased vascularity and positive margins. A hemithyroidectomy and central neck dissection was performed with intraoperative report noting normal-appearing right inferior parathyroid affixed to thyroid, confirmed by frozen section biopsy. The right inferior parathyroid was minced and re-implanted into the right strap muscle. Patient did not return for follow-up. Recent admission labs showed calcium 15.2 mg/dL, ionized calcium 6.8 (4.5-5.3mg/dL), PTH 546 pg/mL, creatinine 1.54 mg/dL, 25-OH vitamin D 21.64 ng/mL, and phosphorus 1.9 mg/dL. He was treated with intravenous fluids, zoledronic acid, and calcitonin. Due to a high suspicion of locally recurrent or metastatic PC, further imaging obtained. A Neck CT and US showed no abnormalities of right surgical bed or cervical lymphadenopathy. Sestamibi revealed a right lower lung lobe nodule, measuring 2.3cm, with intense immediate and delayed uptake concerning for metastatic or primary lung neoplasm and mild focal retention in the right paratracheal region, suspicious for tumor recurrence. PTHrP was negative. He underwent video-assisted thoracoscopic right lower lobectomy that showed an ovoid, well-circumscribed 2.5 x 2.3 x 2.3cm tumor, which stained positive for PAX-8 and synaptophysin, consistent with PC. Discussion: Clinicians should suspect PC in cases with severe hypercalcemia or absolute PTH above 500mg/dL to allow for better surgical planning. Complete en bloc resection is the standard treatment to improve long-term outcomes and reduce disease recurrence. Diagnosis of PC following incomplete surgical resection has increased recurrence rates of greater than 50%. Our patient’s recurrence was 9 years after diagnosis, but most recurrences occur within 2-3 years and occasionally more than 20 years later. The ipsilateral parathyroid was re-implanted based on frozen section results in this patient, which may have been misleading. Frozen sections of parathyroid tissue are notoriously difficult to distinguish normal parathyroid versus PC and only diagnostic in 15% of cases as described in one case series. To reduce the risk of recurrent disease, physicians shouldn’t entirely depend on these results when there is high suspicion for PC. Presentation: Saturday, June 17, 2023

Effect of oxycodone combined with ultrasound-guided thoracic paravertebral nerve block on postoperative analgesia in patients with lung cancer undergoing thoracoscopic surgery: protocol for a randomised controlled study

IntroductionPostoperative pain is a main component influencing the recovery of patients with lung cancer. The combination of patient-controlled intravenous analgesia (PCIA) and paravertebral nerve block for postoperative analgesia in patients...

Non-intubated versus intubated video-assisted thoracoscopic lobectomy for lung cancer patients

IntroductionVideo-assisted thoracoscopic surgery (VATS) lobectomy has been shown to be a standard treatment for lung cancer patient due to less pain, post-operative complication and faster recovery. In recent years, Non-intubated video-assisted thoracoscopic surgery (NIVATS) is become an alternative approach for various types of thoracic surgery with a benefit on fewer complication from mechanical ventilation. Out study is aimed to study outcome compare between NIVATS lobectomy and to general anesthetic video assisted thoracoscopic surgery (GAVATS) lobectomy. MethodsThis is a retrospective cohort study conduct in Vajira hospital, Navamindradhiraj University, Bangkok, Thailand between January 2019 to September 2022.152 lung cancer patients underwent lobectomy. However, lung cancer patients whom needed to convert to GAVATS, open thoracotomy or emergency surgery were excluded from this study. In this study, we compare lung patients whom underwent NIVATS lobectomy and those whom underwent GAVATS lobectomy. These two groups are compared in term of pre-, intra- and post-operative outcomes. The inverse-probability weighting propensity score is used to identify the treatment effects of NIVATS. ResultsIn total, there are 132 cases patients including in this analysis. There are 54 and 78 patients in the NIVATS and GAVATS respectively. Intra-operative outcome, induction and operative time are lower in the NIVATS lobectomy group (25 vs 30 min, p < 0.001 and 90 vs 120 min, p = 0.003). There is no difference regarding number of node resection, station of lymph node dissection, arrhythmia, postoperative complications, and pain visual analogue score (VAS) in both groups. Postoperative outcome, length of hospital stay is shorter in NIVATS lobectomy group (4 vs 5 days, p < 0.001). There is no patient which needed to convert from NIVATS to GAVATS. The treatment-effect analyzed by using inverse-probability weighting propensity score has shown benefits of NIVATS in terms of shorter hospital stays (coefficient −2.31, 95%CI -3.65 to −0.97, p = 0.001), and shorter chest tube duration (coefficient −1.59, 95%CI -2.93 to −0.26, p = 0.019). ConclusionNIVATS lobectomy could be an alternative approach for lung cancer patients with benefits of lesser in hospital stays and duration of chest tube.

Retrospective cohort study on application of acupuncture-aided anesthesia technique to patients undergoing thoracoscopic lobectomy

To compare the clinical effect of "initial scheme" and "improved scheme" of acupuncture-aided anesthesia for patients undergoing thoracoscopic lobectomy. A retrospective analysis about 2 groups ("initial scheme" and "improved scheme") of patients (40 cases in each group) who underwent thoracoscopic lobectomy was conducted in the present paper. Patients of the "initial scheme" group received thoracoscopic operation with three incisions under acupuncture-aided anesthesia i.e., electroacupuncture (EA) stimulation of bilateral Hegu (LI4), Neiguan (PC6), Houxi (SI3) and Zhigou (SJ6), combined with Lidocaine and ropivacaine epidural anesthesia and propofol intravenous anesthesia from January of 2013 to December of 2017. Patients of the "improved scheme" group received thoracoscopic operation with single incision under acupuncture-aided anesthesia by EA, combined with ropivacaine paravertevinal block and lidocaine and remifentanil intravenous anesthesia from August 2018 to August 2021. The incidence of intraoperative deep breathing, resuscitation time, ambulatory rate on day after surgery and postoperative incision pain of the two schemes were compared. The incidence of intraoperative deep breathing and the degree of postoperative incision pain were significantly lower (P<0.05), the postoperative resuscitation time was obviously shorter (P<0.05), and the ambulatory rate on day after surgery was higher (P<0.05) in the "improved scheme" group than in the "initial scheme" group. The "improved scheme" is better than the "initial scheme" in stabilizing the patient's breathing during thoracoscopic lobectomy operation, shortening the resuscitation time, and ameliorating the postoperative recovery state and pain reaction, thus being a better technical solution in clinical practice.

Analgesic effect of thoracic paravertebral block on patients undergoing thoracoscopic lobectomy under general anesthesia.

To investigate the analgesic effect of thoracic paravertebral block (TPVB) in patients undergoing thoracoscopic lobectomy under general anesthesia (GA). Clinical records of 82 patients who underwent thoracoscopic lobectomy under GA from October 2021 to October 2022 in the General Hospital of Southern Theater Command were retrospectively analyzed. The patients were divided into two groups according to the method of anesthesia used: general anesthesia group (Group-G, n=37), and TPVB plus GA group (Group-T, n=45). The analgesic effect, mean arterial pressure (MAP), heart rate (HR) and the rate of adverse events in both groups were compared. Visual analogue scale (VAS) scores of patients in Group-T at 12h, 24h and 48h after the operation were significantly lower compared to Group-G (P<0.05). MAP and HR the time of tracheal intubation induction (T1), single lung ventilation (T2), skin incision (T3), operation completion (T4), and 20 minutes after the extubation (T5) were lower in both groups compared to T0, and were significantly higher in Group-T compared to Group-G (P<0.05). The rate of adverse events in Group-T was 6.67%, significantly lower compared to Group-G (24.32%) (P<0.05). TPVB combined with GA can improve the analgesic effect, improve MAP and HR during the operation, and reduce the incidence of adverse events in patients undergoing thoracoscopic lobectomy.