Management of asymptomatic congenital thoracic malformations (CTMs) remains controversial. Early resection may prevent infection or malignancy and promote compensatory lung growth, but its long-term impact is unclear. This study compared long-term cardiorespiratory and psychosocial outcomes after operative versus conservative management of CTMs and evaluated open versus thoracoscopic surgery. Children with congenital pulmonary airway malformation, pulmonary sequestration, or congenital lobar emphysema treated at a tertiary center between 2000 and 2023 were identified retrospectively. Operative patients underwent open or thoracoscopic resection, while conservatively managed children were followed radiologically. Prospective follow-up included the 6-minute run, pulmonary function testing, and psychosocial assessment. Propensity score matching adjusted for gestational age, birth weight, lesion extent, prenatal intervention, and associated congenital diaphragmatic hernia. Among 194 children (median follow-up 8.7 years), 162 underwent surgery and 32 were observed. Surgical patients showed smaller prenatal relative lung volume (51% vs. 79%, p = 0.02) and higher neonatal acuity (ICU admission 78% vs. 54%, p < 0.01). After matching, postnatal length of stay remained longer after surgery (15 vs. 6 days, p = 0.03). Thoracoscopy was associated with shorter postoperative stay, fewer complications and no mortality. Long-term fitness and quality of life were comparable between groups (p > 0.5). Surgical management of CTMs does not impair long-term exercise capacity or psychosocial outcomes. Minimally invasive resection appears safe and may be offered as a preventive option in asymptomatic patients.

This video tutorial demonstrates a right-sided video-assisted thoracoscopic surgery approach for the management of an intralobar pulmonary sequestration in an adult. Although conservative or endovascular approaches exist, surgical resection is recommended to prevent recurrent infections and mitigate the risk of malignant transformation. While anatomical lobectomy has traditionally been the standard, lung-sparing techniques are increasingly preferred to preserve pulmonary function. The procedure emphasizes the isolation and division of the aberrant systemic arterial supply arising from the descending aorta, mitigating haemorrhagic risks. Subsequently, intravenous indocyanine green is administered to achieve real-time, high-contrast near-infrared fluorescence demarcation of the non-perfused sequestered lung tissue. Guided by this distinct intersegmental boundary, a precise parenchymal-sparing wedge resection of the right lower lobe is performed. Final indocyanine green assessment confirms adequate perfusion of the remaining parenchyma and complete resection with negative margins. This approach ensures definitive treatment while optimizing functional outcomes.

Objective: To evaluate the outcomes of thoracoscopic surgery for mediastinal tumors at Viet Tiep Friendship Hospital from 2020 to 2025. Patients and Methods: This was a retrospective descriptive study of patients with mediastinal tumors who underwent thoracoscopic surgery at the Cardiothoracic and General Surgery Departments of Viet Tiep Friendship Hospital, from January 2020 to December 2025. Results: There were 42 patients included in the study. Chest pain was the most common presenting complaint, reported in 16 cases (38.1%). Abnormal findings on chest radiography were observed in 33 patients (78.6%). Computed tomography most frequently demonstrated anterior mediastinal lesions and solid masses, accounting for 66.7% and 47.6%, respectively. Thymoma was the most prevalent histopathological type, identified in 16 patients (38.1%).. There were no deaths recorded during the follow-up period. Overally, postoperative outcomes were favorable in the majority of cases Conclusion: Thoracoscopic surgery is applicable to most locations and types of mediastinal tumors, with early postoperative results demonstrating a low rate of intraoperative events and postoperative complications.

Palpation-Free Robot-Assisted Thoracoscopic Wedge Resection Using Radiofrequency Identification Marking for Synchronous Multiple Primary Lung Cancers.

The objective of this study is to compare and analyze the clinical data differences between the use of a single ultra-fine 8Fr chest drainage tube and a single 22Fr conventional chest drainage tube, both commonly employed after single-port thoracoscopic lung cancer resection. This comparison aims to evaluate the overall postoperative effectiveness of each method. We retrospectively analyzed 697 patients undergoing this procedure over two years. After exclusions, 665 patients were categorized: Group A (8Fr tube) and Group B (22Fr tube). Propensity score matching (PSM) was then applied to eliminate confounding factors between the two groups. After PSM, 202 pairs (404 patients) were included in both groups. Outcomes compared included postoperative hospital stay, total drainage volume, pain scores (days 1-3), inflammatory markers, complications, Chronic Postsurgical Pain (CPSP), and quality of life (QOL). Group A had significantly lower pain scores on postoperative days 1, 2, and 3 (all P < 0.001), shorter hospital stay (3 [3, 4] vs. 4 [3, 4] days, P = 0.032), and less total drainage volume (180 [130-236.25] ml vs. 255 [170-330] ml, P < 0.001) than Group B. Complication rates and inflammatory markers showed no significant differences (P > 0.05). At one month, Group A reported significantly lower worst/average pain scores (P < 0.001, P = 0.018) and better QOL in activities, mood, work, relationships, and enjoyment (all P < 0.05) compared to Group B. No significant differences existed in mildest pain or walking impact (P > 0.05) or in any pain/QOL measures at 3 months (P > 0.05). Compared to 22Fr tubes, using an 8Fr ultra-fine drain after thoracoscopic lung cancer resection significantly reduces postoperative pain, drainage duration, hospital stay, and total drainage volume. Patients discharged with the 8Fr tube experienced less severe pain and better short-term QOL without increased complications or inflammation. The 8Fr ultra-fine drain is an effective, safe, and clinically valuable alternative.

Background Pulmonary lymphangioleiomyomatosis (PLAM) is a rare progressive interstitial lung disease characterized by diffuse cystic lesions predominantly affecting women of childbearing age. Its clinical manifestations are diverse and nonspecific. Cases of PLAM complicated with pulmonary tuberculosis (TB) are extremely rare. Here, we retrospectively report one case of PLAM with concurrent TB and review the relevant literature to summarize its clinical, imaging, pathological, diagnostic, therapeutic, and prognostic features, with the aim of providing references for the pathological diagnosis and differential diagnosis of PLAM. Case presentation A 36-year-old female was admitted with left pneumothorax and left lung nodules. Chest CT demonstrated a solid nodule in the anterior basal segment of the left lower lobe, tiny nodules in the left upper lobe and bilateral lower lobes, bilateral emphysema, left hydropneumothorax, minimal right pleural effusion, and focal right pleural thickening. Cardiopulmonary function tests, including echocardiography, pulmonary function testing, ECG, and blood gas analysis, were unremarkable. The patient underwent “single-port thoracoscopic wedge resection of the left lower lung lobe + pleural adhesion lysis + pleurodesis”. The resected lesion from the left lower lobe was submitted for histopathological examination, which demonstrated epithelioid granulomas with coagulative necrosis, adjacent parenchymal emphysema and bullae, and spindle/epithelioid smooth muscle-like cells proliferation along cyst walls. Immunohistochemistry was positive for SMA, HMB45, Desmin, PR, and BRAF V600E. Special stains were negative for acid-fast bacilli, PAS, and PASM. Molecular testing confirmed a BRAF V600E mutation. A final diagnosis of PLAM complicated with TB was established. Conclusion PLAM is a rare lung disease characterized primarily by diffuse interstitial lung lesions. It poses challenges in early diagnosis and has a poor prognosis. Its relationship with TB is complex, as the two conditions mutually promote each other and can act as both cause and effect. When the two coexist, the clinical manifestations are diverse. In-depth exploration of their pathological characteristics, diagnosis, and differential diagnosis is conducive to clinical diagnosis and treatment.

Primary pulmonary epithelioid trophoblastic tumor (ETT) without a uterine primary is exceptionally rare, with merely 29 cases documented in the English-language literature. Therefore, a standardized management protocol has yet to be established, and the optimal treatment strategy remains poorly defined. A 31-year-old woman presented to a local hospital with irregular vaginal bleeding and was initially diagnosed with an ectopic pregnancy due to elevated serum beta-human chorionic gonadotropin (β-hCG) levels. Following treatment with diagnostic curettage and methotrexate, her β-hCG levels plateaued. The patient was subsequently referred to our institution for further investigation. Imaging revealed a 1.7 cm × 1.5 cm pulmonary nodule, which was initially suspected to be peripheral lung cancer. Video-assisted thoracoscopic resection and subsequent histopathological analysis confirmed the diagnosis of ETT. The patient received 4 cycles of combined EMA/EP (etoposide, methotrexate, actinomycin D/etoposide, cisplatin) chemotherapy after the surgery. During 3 years of follow-up, her menstrual cycles were normal and there was no evidence of disease recurrence. This case highlights the diagnostic challenges and management strategies for pulmonary ETT, particularly in preserving fertility while ensuring optimal oncological outcomes.

Multicenter study comparing outcomes of robotic versus video-assisted thoracoscopic resection of non-small cell lung cancer following neoadjuvant chemoimmunotherapy.

Patient-reported EORTC QLQ C-30 global health status decline predicts survival after video-assisted thoracoscopic (VATS) lung resection and stereotactic ablative radiotherapy (SABR): A 5year follow-up from the Lilac study.

Analysis of the role of the sternal retractor combined with artificial pneumothorax in diaphragmatic nerve preservation during thoracoscopic anterior mediastinal tumor resection

ABSTRACT Primary cardiac lipomas are rare benign tumors that are usually indolent but may cause compression or arrhythmia when large. We sought to describe the safety and feasibility of a totally thoracoscopic, off‐pump approach for their resection. A 33‐year‐old asymptomatic woman was found to have a 5.1 × 3.6 cm fat‐density mass at the roof of the right atrium compressing the superior vena cava. Under general anesthesia, a three‐port right‐sided thoracoscopic resection was performed on the beating heart without cardiopulmonary bypass. The tumor was completely excised with an intact capsule. Operative time was 120 min and blood loss was 50 mL. Histopathology confirmed a mature cardiac lipoma. The patient was discharged on postoperative day 5 and remained recurrence‐free at 1‐month echocardiographic follow‐up. A totally thoracoscopic, off‐pump technique is a safe, minimally invasive alternative to median sternotomy for selected right‐atrial lipomas, providing shorter recovery and superior cosmesis. Early elective resection is warranted when the tumor reaches ≥ 5 cm or causes compression, even in asymptomatic patients.

PurposeChronic postsurgical pain (CPSP) is a common complication of video-assisted thoracoscopic surgery (VATS) and substantially impairs postoperative quality of life. We evaluated whether intercostal nerve block (ICNB) with liposomal bupivacaine provides superior chronic pain control compared with ropivacaine.Patients and MethodsWe conducted a retrospective cohort study of 1325 adult patients who underwent elective VATS lung resection with ICNB administered using either liposomal bupivacaine or ropivacaine at the end of the surgery between September 2023 and August 2024. The primary outcome was the incidence of CPSP at 3 months postoperatively, defined as a numerical rating scale (NRS) pain score ≥1, a sensitive threshold to capture any postoperative pain. Secondary outcomes included NRS pain scores at rest at 24 and 48 hours postoperatively, cumulative opioid consumption within 48 hours, time to independent postoperative activities, length of hospital stay, and incidence of postoperative neuropathic pain at 3 months. Confounding was addressed using 1:1 propensity score matching with a 0.1 standard deviation caliper.ResultsThe median age was 61 years, and 59.9% were female. After propensity score matching, ICNB with liposomal bupivacaine was associated with a significantly lower incidence of CPSP at 3 months compared with ropivacaine (33.5% vs 42.3%; adjusted odds ratio, 0.68; 95% CI, 0.52 to 0.88; P=0.004). Patients receiving liposomal bupivacaine had reduced rest NRS pain scores at both 24 hours (3[2, 4] vs 4[3, 4]; P=0.002) and 48 hours (3[2, 3] vs 3[2, 4]; P=0.038). No significant differences were observed in other secondary outcomes.ConclusionICNB with liposomal bupivacaine was associated with reduced incidence of CPSP following VATS lung resection. These findings highlight the potential long-term analgesic benefit of liposomal bupivacaine and support the need for further randomised controlled trials evaluating long-term CPSP outcomes.

Postoperative complications of mediastinal tumors significantly impact patients’ quality of life and long-term outcomes; however, a notable gap in the development of predictive tools for their occurrence remains. This study aimed to develop and validate a machine-learning model predicting thoracoscopic resection complications. Patients who underwent thoracoscopic mediastinal tumor resection at Southwest Hospital (January 2014 to April 2024) were retrospectively enrolled (n = 302) and randomly divided into training (70%) and validation (30%) sets. An additional 21 patients from Banan Hospital who underwent the same procedure (October 2023 to April 2024) were included as an external test set. The primary endpoint was postoperative complications within 90 days, with severe complications (Clavien-Dindo grade ≥Ⅱ) as the secondary endpoint. Fifteen predictive models were constructed using three feature selection methods and five machine learning algorithms. Model performance was assessed by AUC, and interpretability was analyzed using SHAP. The optimal model was selected based on the highest AUC values in validation set. Among the 302 patients in the main center, postoperative complications were observed in 92 (43.6%) in the training set and 40 (44.0%) in the test set. The Lasso-random forest model performed best, incorporating features like maximum tumor diameter, past medical history, surgical approach, myasthenia gravis, and hypertension (ranked by SHAP-derived feature importance). It achieved an AUC of 0.799 (95% CI: 0.700–0.897), showing robust discrimination and classification ability. The first web-based machine learning predictive model was developed to guide perioperative management and intraoperative decision-making for high-risk patients.

This study aimed to compare the clinical outcomes and costs of robotic-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) in patients undergoing minimally invasive anatomical resection for primary lung cancer. A retrospective analysis was conducted on 2,086 patients who underwent surgery at a single institution from January 2017 to July 2020, including 134 RATS and 1,952 VATS cases. Propensity score matching (PSM) was applied, resulting in 268 matched patients (134 RATS and 134 VATS). Cost data were obtained from hospital billing files, encompassing 20 categories, including total hospitalization fees, anesthesia fees, surgery fees, costs of surgical instruments and materials, and general examination fees. After PSM, RATS patients had a shorter median postoperative stay (5 days vs. 6 days, p = 0.009) and lower thoracotomy conversion rate (1.5% vs. 14.9%, p < 0.001) than VATS. However, RATS incurred higher total costs by an average of $1,230 (p < 0.001), mainly due to increased surgical expenses ($1,163, p < 0.001). In multivariate analysis, RATS (12.41%, p < 0.001), neoadjuvant therapy (13.3%, p = 0.005), complications (4.2%, p < 0.001), and length of stay (2.0%, p < 0.001) were found to be associated with higher costs. Although RATS has been shown to reduce the thoracotomy conversion rate and length of hospital stay, it incurs higher costs than VATS, primarily due to increased surgical expenses. The justification for RATS should be further evaluated through sustainability and cost-effectiveness studies with long-term follow-up.

Tumors originating from the thymic epithelium are distinctly uncommon, and within this already rare group, atypical Type A thymoma represents an exceptional pathological diagnosis. Fewer than 20 well-substantiated cases have been documented in the international literature, with only isolated reports emerging from the Indian subcontinent. We present a rare case of atypical Type A thymoma identified following surgical excision of an anterior mediastinal mass in a middle-aged patient. Radiological evaluation revealed a localized thymic lesion without distinctive features suggestive of aggressive or atypical histology, underscoring the inherent limitations of pre-operative assessment in such neoplasms. The patient underwent complete thoracoscopic resection with curative intent. Detailed histopathological analysis of the excised specimen demonstrated architectural and cytological features diagnostic of atypical type a thymoma, a conclusion that could only be established after complete tumor removal. The post-operative course was uneventful, and resection margins were free of disease. This report highlights the diagnostic obscurity and extreme infrequency of atypical Type A thymoma, emphasizing the indispensable role of surgical excision in establishing an accurate diagnosis. Given the scarcity of reported cases and the limited representation from India, this case contributes meaningful insight to the existing body of evidence and may aid in improving recognition, pathological interpretation, and clinical understanding of this exceedingly rare thymic epithelial tumor

Non-intubated spontaneous ventilation anesthesia is increasingly used in adult thoracoscopic surgery, but pediatric evidence remains limited. To compare perioperative outcomes between two anesthetic regimens in children undergoing thoracoscopic anatomical lung lesion resection: a laryngeal mask airway-assisted non-intubated spontaneous ventilation anesthesia and a conventional endotracheal intubation anesthesia. This single-center retrospective cohort study included children undergoing thoracoscopic anatomical lung lesion resection for pulmonary sequestration or congenital pulmonary airway malformation between April 2024 and May 2025. Children received either a conventional endotracheal intubation anesthesia or a laryngeal mask airway-assisted non-intubated spontaneous ventilation anesthesia. One-to-one propensity score matching was performed. The primary outcome was the overall incidence of postoperative pulmonary complications before discharge. Secondary outcomes were conversion to endotracheal intubation, intraoperative lowest peripheral oxygen saturation, highest end-tidal carbon dioxide, postanesthesia care unit length of stay, chest tube indwelling time, and postoperative length of hospital stay. Other perioperative variables were exploratory. Among 198 eligible children, 50 matched pairs were analyzed. Postoperative pulmonary complications occurred in 6 of 50 children (12.0%) in the endotracheal intubation group and in 0 of 50 children (0%) in the non-intubated spontaneous ventilation group (absolute risk reduction 12.0%, 95% confidence interval 3.0-21.0; p = 0.027). In a sensitivity analysis using Firth's logistic regression model adjusting for thoracic paravertebral block, the non-intubated regimen remained associated with a lower observed incidence of postoperative pulmonary complications (adjusted odds ratio 0.06, 95% confidence interval 0.0004-0.76; p = 0.029). No child in the non-intubated spontaneous ventilation group required conversion to endotracheal intubation. Secondary outcomes showed modest between-group differences in unadjusted analyses. However, after Holm-Bonferroni adjustment, adjusted p values for secondary outcomes ranged from 0.060 to 0.208. In this retrospective propensity-score-matched pediatric cohort, a laryngeal mask airway-assisted non-intubated spontaneous ventilation anesthesia was feasible and was not associated with worse perioperative outcomes than a conventional endotracheal intubation anesthesia. A lower observed incidence of postoperative pulmonary complications was noted. Given regimen-level differences, prospective studies with standardized analgesia are needed to confirm safety and potential benefits.

Personalized positive end-expiratory pressure (PEEP) based on pulmonary compliance may improve intraoperative hemodynamics and postoperative outcomes in thoracic surgery. This study aimed to evaluate the effect of individualized, compliance-guided PEEP titration on cardiac output (CO) and postoperative pulmonary complications (PPCs) in patients undergoing video-assisted thoracoscopic pulmonary resection. In this prospective randomized controlled trial, 80 patients scheduled for thoracoscopic pulmonary resection were allocated to either an individualized PEEP group (Group N) or a fixed PEEP group (Group C). Group N received dynamic PEEP titration starting at 15 cmH2O, adjusted to optimize compliance; Group C received a fixed PEEP of 5 cmH2O. Hemodynamic parameters including CO, heart rate (HR), and systemic vascular resistance (SVR) were recorded at five time points: baseline after admission (T1), 20min after initiating two-lung ventilation (T2), 30min following PEEP implementation (T10), 60min post-PEEP adjustment (T11), and upon completion of one-lung ventilation (T12). PPCs and postoperative pneumonia incidence were also recorded. Seventy-six patients completed the study (n = 38 per group). At T11, T12, Group N showed significantly higher CO than Group C. The optimal PEEP range for compliance was 7-13 cmH2O. Compared to 5 cmH₂O PEEP of individualized PEEP during OLV resulted in better lung compliance, lower driving pressure, and higher mean airway pressure, without differences in peak airway pressure or PETCO2. Postoperative pulmonary complications (PPCs) occurred more frequently in Group C (42.1% vs. 13.2%, p = 0.004). No significant differences were observed in overall SVR trends between groups, except at T11, T12. Compliance-guided individualized PEEP improves cardiac output and may reduce postoperative pulmonary complications in patients undergoing thoracoscopic lung resection. This approach holds promise for enhancing perioperative respiratory and hemodynamic stability.Trial registration: ChiCTR2100048201, intervention study, registered on 04/07/2021.

To compare the clinical efficacy of the progressive suspension method and conventional thoracoscopic pulmonary resection in right upper lobectomy. A prospective cohort study was conducted involving 60 patients admitted to the Department of Thoracic Surgery at Cangzhou Central Hospital from January 2024 to March 2025. Patients were randomly divided into the observation group (n = 30, using the progressive suspension method, including 15 cases of trans-thoracic puncture fixation and 15 cases of intra-thoracic suture fixation) and the control group (n = 30, conventional thoracoscopic pulmonary resection). Surgical field exposure, operative fluency, lymph node dissection, perioperative indicators, and hospitalization costs were compared between the two groups. The observation group demonstrated significantly superior surgical field exposure (83.3% vs. 50.0%, p = 0.008) and operative fluency (73.3% vs. 33.3%, p = 0.002). The operative time [(87.5 ± 23.2) min vs. (112.4 ± 35.6) min, p < 0.001], intraoperative blood loss [50 (20, 50) mL vs. 80 (50, 120) mL, p < 0.001], postoperative drainage [150 (100, 200) mL vs. 250 (180, 300) mL, p = 0.003], VAS pain score [(3.2 ± 1.1) vs. (4.8 ± 1.5), p < 0.001], and hospitalization costs [(4.5 ± 0.8) vs. (5.2 ± 1.1) ten thousand yuan, p = 0.009] were all significantly better in the observation group. The number of lymph nodes dissected [(10.3 ± 3.1) vs. (8.5 ± 2.8), p = 0.021] showed a statistically significant difference, while the complete lymph node resection rate (93.3% vs. 80.0%, p = 0.143) and complication rate (16.7% vs. 33.3%, p = 0.132) showed no significant difference. No statistical differences were observed between the two suspension subgroups (p > 0.05). The progressive suspension method in thoracoscopic right upper lobectomy provides superior surgical field exposure, improved operative fluency, higher surgical efficiency, and better postoperative recovery compared to the conventional method, making it a safe and effective surgical approach.

Robotic-Assisted Approaches to Chest Wall Resection: Considerations and Operative Techniques.

Effect of Remimazolam or Propofol Combined With Esketamine on Anesthesia and Early Perioperative Neurocognitive Disorders in Patients Undergoing Thoracoscopic Partial Lung Resection: A Randomized Clinical Trial.