Thoracoscopic Surgery Group Research Articles

Minimally invasive technique facilitates early extubation after cardiac surgery: a single-center retrospective study

BackgroundPostoperative time to extubation plays a role in prognosis after heart valve surgery; however, its exact impact has not been clarified. This study compared the postoperative outcomes of minimally invasive surgery and conventional sternotomy, focusing on early extubation and factors influencing prolonged mechanical ventilation.MethodsData from 744 patients who underwent heart valve surgery at the Zhejiang Provincial People’s Hospital between August 2019 and June 2022 were retrospectively analyzed. The outcomes in patients who underwent conventional median sternotomy (MS) and minimally invasive (MI) video-assisted thoracoscopic surgery were compared using inverse probability of treatment weighting (IPTW) and Kaplan–Meier curves. Clinical data, including surgical data, postoperative cardiac function, postoperative complications, and intensive care monitoring data, were analyzed.ResultsAfter propensity score matching and IPTW, 196 cases of conventional MS were compared with 196 cases of MI video-assisted thoracoscopic surgery. Compared to patients in the conventional MS group, those in the MI video-assisted thoracoscopic surgery group in the matched cohort had a higher early postoperative extubation rate (P < 0.01), reduced incidence of postoperative pleural effusion (P < 0.05), significantly shorter length of stay in the intensive care unit (P < 0.01), shorter overall length of hospital stay (P < 0.01), and lower total cost of hospitalization (P < 0.01).ConclusionsSuccessful early tracheal extubation is important for the intensive care management of patients after heart valve surgery. The advantages of MI video-assisted thoracoscopic surgery over conventional MS include significant reductions in the duration of use of mechanical ventilation support, reduced length of intensive care unit stay, reduced total length of hospitalization, and a favorable patient recovery rate.

Comparison of the Efficacy and Safety of Thoracoscopic Surgery and Conventional Open Surgery for Congenital Diaphragmatic Hernia in Neonates: A Meta-analysis.

Thoracoscopic surgery is an increasingly popular surgical technique for the repair of congenital diaphragmatic hernias. We performed a meta-analysis to compare the efficacy, safety of thoracoscopic surgery and the conventional open surgical approach for congenital diaphragmatic hernia in neonates. A systematic search of electronic databases such as PubMed, Google, and Web of Science was performed to identify studies comparing thoracoscopic surgery and open surgery for congenital diaphragmatic hernia. A total of 6 studies with 3348 patients were found. Parameters such as operation time, hospital stay, recurrence rate, postoperative mortality, and postoperative complications were pooled and compared by meta-analysis. Of the 3348 children with congenital diaphragmatic hernia included in the 6 studies, 615 underwent thoracoscopic surgery and 2733 underwent open surgery. All studies were nonrandomized controlled trials. The operation times were shorter for thoracoscopic surgery than for open surgery in three studies, but there was no significant difference (standard mean difference = 1.25, confidence interval [CI] = [-0.48-2.98], P = 0.16). In the thoracoscopic surgery group, the rate of postoperative deaths was significantly lower (95% CI = 1.24-2.75), but the occurrence of recurrences was more frequent (95% CI = 0.08-0.23). The hospital stay varied significantly across studies. There was a statistically significant difference (standard mean difference = -1.47, CI = [-2.24--0.70], P < 0.001) in the overall effect between the groups. The complication rate was significantly lower with thoracoscopic surgery compared to open surgery (odds ratio = 0.26, CI = [0.10-0.66], P = 0.004) for the overall effect between the groups. The thoracoscopic procedure, however, was planned for milder and stable cases. Thoracoscopic repair of congenital diaphragmatic hernia in neonates is associated with a shorter length of hospital stay, fewer complications, and less postoperative mortality than traditional open repair. However, the rate of recurrence was found to be higher in those who underwent thoracoscopic surgery.

Outcomes of single- versus multi-port video-assisted thoracoscopic surgery: Data from a multicenter randomized controlled trial of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer

ObjectivesSurgery through a single port may be less painful because access is supplied by 1 intercostal nerve or more painful because multiple instruments are used in 1 port. We analyzed data collected from the video-assisted thoracoscopic surgery group of a randomized controlled trial to compare differences in pain up to 1 year. MethodsGroups were compared in a prespecified exploratory analysis using direct (regression) and indirect comparison (difference with respect to thoracotomy). In-hospital visual analogue scale pain scores were used, and analgesic ratios were calculated. After discharge, pain was evaluated using European Organization for Research and Treatment of Cancer Quality of Life Questionnaires-Core 30 scores up to 1 year. ResultsFrom July 2015 to February 2019, we randomized 503 participants. After excluding 50 participants who did not receive lobectomy, surgery was performed using a single port in 42 participants (predominately by a single surgeon), multiple ports in 166 participants, and thoracotomy in 245 participants. No differences were observed in-hospital between single- and multiple-port video-assisted thoracoscopic surgery when modeled using a direct comparison, mean difference of −0.24 (95% CI, −1.06 to 0.58) or indirect comparison, mean difference of −0.33 (−1.16 to 0.51). Mean analgesic ratio (single/multiple port) was 0.75 (0.64 to 0.87) for direct comparison and 0.90 (0.64 to 1.25) for indirect comparison. After discharge, pain for single-port video-assisted thoracoscopic surgery was lower than for multiple-port video-assisted thoracoscopic surgery (first 3 months), and corresponding physical function was higher up to 12 months. ConclusionsThere were no consistent differences for in-hospital pain when lobectomy was undertaken using 1 or multiple ports. However, better pain scores and physical function were observed for single-port surgery after discharge.

Computer Tomography (CT)-Based Study to Investigate Feasibility and Efficacy of Thoracoscopic Surgery in the Treatment of Penetrating Chest Wall Tuberculosis.

Chest wall tuberculosis may develop if tuberculous (TB) lesions spread through the chest wall and invade the thoracic cavity. The presence of a mass on the patient's chest wall may be the first indication of TB, and a chest CT scan can help diagnose external penetrating chest wall TB, the incursion of tuberculosis from the lungs into the chest wall. This study examines the safety and efficacy of thoracoscopic-assisted surgery for the treatment of penetrating chest wall tuberculosis as a means of exploring novel concepts of minimally invasive surgery. Our hospital conducted a retrospective study of 25 patients with penetrating chest wall TB who underwent thoracoscopic surgery between January 2020 and June 2021. General demographics, CT scan data linked to surgery, and postoperative patient outcomes were compared between the two groups. The data was also evaluated to determine the range of operation time and the volume of bleeding from different foci in the thoracic cavity. All procedures went well after patients took conventional antituberculosis medication for at least two weeks prior to surgery. CT scans showed that thoracoscopic surgery needed a smaller incision than traditional chest wall TB surgery, with no discernible increase in surgical time. Postoperative tube use, length of hospital stay, and blood loss were all significantly lower than they would have been with conventional surgery. In addition, thoracoscopy was associated with a significantly reduced rate of subsequent treatment. Fibrous plate development and calcification caused the longest operation times in the thoracoscopic surgery group, whereas multiple pleural tuberculomas generated the most hemorrhage. Thoracoscopic surgery usually reveals tuberculous foci hiding in the thoracic cavity. Thethoracic surgery can eliminate the TB focus in the chest wall and intrathoracic while treating penetrating chest wall tuberculosis. The CT scan is a crucial part of the diagnostic process for these patients. Minor surgical trauma, low complication and recurrence rates, and good results. There is a greater distinction between the two surgical approaches for patients with penetrating chest wall TB as opposed to those with basic chest wall tuberculosis.

Effect of da Vinci robot versus thoracoscopic surgery on lung function and oxidative stress levels in NSCLC patients: a propensity score-matched study.

To evaluate the short-term efficacy, lung function, and oxidative stress levels between the robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery group (VATS) for non-small cell lung cancer (NSCLC). We conducted a retrospective cohort study, selecting 248 NSCLC patients who underwent minimally invasive lobectomy at the Department of Thoracic Surgery, Gansu Provincial People's Hospital, from August 2019 to February 2023. There were 105 patients in the RATS group and 143 patients in the VATS group. The patients in the two groups were subjected to 1:1 propensity score matching analysis (PSM), and the perioperative indicators were recorded. The levels of oxidative stress factors (superoxide dismutase, SOD; malondialdehyde, MDA) and inflammatory factors were measured 1day before surgery and 3days after surgery, respectively. Pulmonary function and patient quality of life were measured at 1day preoperatively and 3months postoperatively. There are 93 patients in each group after PSM. Compared to the VATS group, the RATS group had shorter operation time, less intraoperative blood loss, greater number and groups of lymph nodes cleared, and shorter postoperative hospital stay. The SOD level in the RATS group was higher and the MDA level was lower than that in the VATS group after surgery. Postoperative inflammatory cytokine levels were less elevated in the RATS group than in the VATS group. At 3months postoperatively, FVC%, FEV1%, and GQOLI-74 scores were higher in the RATS group than in the VATS group. Compared to VATS lobectomy, RATS lobectomy has the advantages of shorter operative time, lesser bleeding, more lymph node dissection, faster postoperative recovery, and lesser impact on postoperative lung function. It is also capable of reducing the postoperative oxidative stress and inflammatory response, which can improve patients' quality of life.

Surgery for bronchiectasis-destroyed lung: feasibility of video-assisted thoracoscopic surgery, and surgical outcomes.

To provide the experience of surgical treatment for bronchiectasis-destroyed lung (BDL) and evaluate the feasibility of video-assisted thoracoscopic surgery (VATS). BDL patients underwent surgical treatment between January 2013 and June 2018 were included. Logistic regression was performed to assess factors for major complications, and Cox's regression was performed to assess factors affected symptomatic outcome. Totally, 143 patients were treated by VATS (n = 64) and thoracotomy (n = 79). Nine (14.1%) cases scheduled for VATS were converted to thoracotomy for dense adhesions (n = 6) and frozen hilum (n = 3). The VATS group had a median chest tube duration, hospitalization and a time of returning to full activity of 4 days, 5 days and 1.5 months, respectively. Major complications occurred in 28 (19.6%) of all patients, 50.0% after pneumonectomy and 13.4% after lobectomy/extensive lobectomy. Multivariable analysis identified pneumonectomy [odds ratio, 3.64; 95% confidence interval (CI), 1.18-11.21] as a significant predictor for major complications. Overall, 141 (98.6%) patients benefitted from surgery (completely asymptomatic, n = 109; acceptable alleviation, n = 32). Thirty-four patients experienced relapse of the disease, including 13 with productive cough, 11 with haemoptysis and 10 with recurrent infections. Pseudomonas aeruginosa infection [hazard ratio (HR), 3.07; 95% CI, 1.38-6.83] and extent of remanent bronchiectatic areas (HR, 1.03; 95% CI, 1.00-1.05) were independent risk factors for shorter relapse free interval. VATS for BDL is feasible in well-selected patients. Pneumonectomy increased the risk of postoperative major complications. Removing all BDL lesions contributed to satisfactory prognosis.

Safe thoracoscopic repair of recurrent congenital diaphragmatic hernia after initial open abdominal repair.

The optimal surgical approach for recurrent congenital diaphragmatic hernia (CDH) remains controversial. We compared the surgical outcomes of a thoracoscopic approach versus an open abdominal approach for recurrent CDH after initial abdominal open repair. The subjects of this comparative study were patients who underwent open abdominal or thoracoscopic surgery for recurrent CDH following an initial open abdominal repair. Among 166 patients with Bochdalek-type CDH, 15 underwent reoperation for recurrent CDH following an open abdominal repair. Seven patients underwent open abdominal surgery (group O) and eight underwent thoracoscopic surgery (group T). The operative duration was similar for the two groups, with less blood loss (17.2ml/kg vs. 1ml/kg, P = 0.001) and fewer intraoperative complications in the T group (n = 6 vs. n = 0 cases, P = 0.001). There was no significant difference in the number of postoperative complications (n = 1 vs. n = 1, P = 1.0) or in the number of patients with a second CDH recurrence (n = 2 vs. n = 1, P = 0.569) between the two groups. Thoracoscopic surgery is preferable to the open surgical approach for recurrent CDH following an initial abdominal open repair.

Thoracoscopic Versus Open Repair for Oesophageal Atresia: A Retrospective Cohort Study of 359 Patients at a Single Center

BackgroundThis study aimed to define the effectiveness of thoracoscopic versus open repair of gross type C oesophageal atresia (EA) based on the experience of a single centre over a decade. MethodsThis retrospective cohort study included patients who were admitted to Hunan Children's Hospital between January, 2010 and December, 2021 and underwent repair surgery for type C EA. ResultsA total of 359 patients underwent type C EA repair during the study period, of which 142 were completed via an open approach and 217 were attempted via a thoracoscopic approach (seven converted to open surgery). There were no differences in the demographics or comorbidities between the patients of thoracoscopy and thoracotomy (open repair) groups. The median operating time was 109 [90, 133] min in the thoracoscopic surgery group, which was slightly shorter than that in the open repair group (115 [102, 128] min, p = 0.059). Anastomotic leakage occurred in 41 (18.9%) and 35 (24.6%) infants in the thoracoscopic and open surgery groups, respectively (p = 0.241). Thirteen patients (3.6%) died in the hospital without significant differences in the repair approach. With a median follow-up of 23.7 months, 38 (13.6%) participants had one or more anastomotic strictures requiring dilatation, without significant differences in the repair approach (p = 0.994). ConclusionsThoracoscopic repair of congenital EA is safe, and has perioperative and medium-term outcomes similar to those of open surgery. This technique is recommended only in hospitals with experienced teams of endoscopic paediatric surgeons and anaesthesiologists.

Effects of da Vinci robot versus thoracoscopic surgery on body trauma and lymphocyte subsets in lung cancer patients: A propensity score matching study.

To assess the impact of da Vinci robot versus thoracoscopic surgery on body trauma and lymphocyte subsets in lung cancer patients. Retrospective analysis of 352 patients with lung cancer treated by minimally invasive surgery completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from October 2019 to October 2022. According to the surgical procedure, the patients were divided into a robotic-assisted thoracic surgery (RATS) group (n = 159) and a video-assisted thoracoscopic surgery group (VATS) (n = 193), respectively. Propensity score matching (PSM) analysis was performed in both groups, and perioperative indicators were recorded. Levels of inflammatory markers (C-reactive protein, CRP; interleukin-6, IL-6) and lymphocyte subsets (CD3+ , CD4+ , CD8+ , andCD4+ /CD8+ ) were measured 1 day before surgery and 1, 3, and 5 days after surgery, respectively. To compare the effects of the two surgical procedures on the trauma and lymphocyte subsets of the patient's organism. One hundred and thirty-eight patients in each group after PSM. Compared with the VATS group, the RATS group had shorter operative time (p < 0.001), less intraoperative bleeding (p < 0.001), less postoperative chest drainage (p = 0.029), shorter postoperative chest drainage time (p = 0.008), and shorter postoperative hospital stay (p = 0.005). The levels of CRP and IL-6 increased in both groups after surgery compared with those before surgery, and the increase was less in the RATS group than that in the VATS group. Postoperative T-lymphocyte levels were lower in both groups compared with preoperative levels, and T-lymphocyte levels were significantly lower in the VATS group compared with the RATS group. Compared with VATS for treating lung cancer, RATS has advantages in short-term efficacy, and smaller surgical trauma to patients, which can reduce the body's inflammatory response. It also has less impact on T lymphocyte subpopulations, which can better protect patients' immune function.

Effect of da Vinci robot-assisted versus traditional thoracoscopic bronchial sleeve lobectomy

ObjectiveTo analyze the short-term effect of Da Vinci robot-assisted thoracoscopic (RATS) bronchial sleeve lobectomy, so as to summarize its safety and effectiveness. MethodsIt was a retrospective single-center study with the inclusion of 22 cases receiving RATS lobectomy and 49 cases of traditional thoracoscopic surgery. Further comparison was performed focusing on the baseline characteristics and perioperative performance of the two groups. ResultsCompared with the traditional thoracoscopic surgery group, RATS group had more advantages in the number of lymph nodes dissected (P = 0.003), shorter postoperative length of stay in the hospital (P = 0.040), shorter drainage time (P = 0.022), reduced drainage volume (P = 0.001). Moreover, this study found for the first time that there was a shortening in the operation of sleeve lobectomy by using Da Vinci robot-assisted surgical system (P = 0.001). The operation cost of RATS group is more expensive (96000 ± 9100.782 vs 63000 ± 5102.563 yuan; P＜0.001). ConclusionCompared with the traditional thoracoscopic bronchial sleeve lobectomy, RATS lobectomy shows advantages of higher operating sensitivity, shorter operation time, faster postoperative recovery, and more lymph nodes dissected. Collectively, RATS bronchial sleeve lobectomy is safe and effective in operation.

Comparison of short-term results of subxiphoid and conventional video-assisted thoracoscopic surgery in diagnostic wedge resections.

This study aimed to compare early results in patients who underwent subxiphoid wedge resection with those operated on using a multiportal approach. We retrospectively evaluated 151 patients who underwent diagnostic wedge resection for suspected interstitial lung disease. Patients who underwent wedge resection via subxiphoid video-assisted thoracoscopic surgery and conventional video-assisted thoracoscopic surgery were compared. The study included 90 men (59.6%) and 61 women (40.4%) with a mean age of 54.8 ± 12 years. Of these, 127 patients underwent conventional video-assisted thoracoscopic surgery and 24 patients underwent subxiphoid video-assisted thoracoscopic surgery. Postoperative complications occurred in 13 patients (8.6%), with no significant difference according to surgical technique. Sex was a significant factor in the rate of complications (12.2% in men vs. 3.2% in women). There was no intraoperative mortality; the 30-day mortality rate was 4% (n = 6). Five nonsurviving patients were in the conventional video-assisted thoracoscopic surgery group and 1 was in the subxiphoid video-assisted thoracoscopic surgery group (p = 0.95). The results of this study indicate that the subxiphoid approach reduced procedure time and length of hospital stay in the early period, while there was no significant difference between the techniques in terms of complications or mortality. Based on these findings, we conclude that surgical outcomes were as successful with the subxiphoid approach as with conventional video-assisted thoracoscopic surgery.

A single-center study of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors.

To study the feasibility, safety, and efficacy of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors, and summarize the treatment experiences and surgical skills. A single-center retrospective analysis of 37 patients with pediatric mediastinal neurogenic tumors was conducted. Clinical charactersistics and postoperative complications were all analyzed. All the operations were successfully completed. There was no statistically significant difference in tumor diameter between the two groups (p> 0.05). The open surgery group had an average operation time of 96.5± 32.38 min, while the thoracoscopic surgery group had an average operation time of 78.3± 24.51 min (p< 0.05). The thoracoscopic surgery group had significantly lower intraoperative blood loss than the open surgery group (p< 0.05). In addition, the duration of the postoperative thoracic drainage tube was 5.43 ± 0.76 days in the open surgery group, which was longer than the 2.38 ± 0.87 days in the thoracoscopic surgery group (p< 0.05). Furthermore, the postoperative length of hospital stay was an average of 10.23 ± 1.43 days for the open surgery group, longer than for the thoracoscopic surgery group (4.36 ± 0.87 days) (p< 0.05). Thoracoscopic surgery has several advantages in the treatment of pediatric mediastinal neurogenic tumors and is worthy of clinical popularization and application. For giant mediastinal malignant neurogenic tumors, puncture biopsy and adjuvant chemotherapy can be performed before surgery to lessen the tumor volume and enlarge the operation space, which would reduce bleeding and complications.

431. THORACOSCOPIC ESOPHAGEAL CANCER SURGERY IN THE LEFT LATERAL POSITION WITH EMPHASIS ON SAFETY AND RADICAL CURE

Abstract Compared with thoracoscopic esophagectomy in the prone position (PP), the conventional thoracoscopic esophagectomy in the left lateral position (LL) with artificial pneumothorax is slightly more difficult for dissection of the middle and lower mediastinum, but is superior to PP because the operation can be performed with good visual field in the upper mediastinum. The purpose of this study was to clarify the safety and curative potential of this technique. We retrospectively reviewed 246 cases of thoracic esophageal cancer surgery from April 2012 to December 2018. Thoracoscopic surgery (group V) was performed in 154 patients and open right thoracotomy (group O) in 92 patients. When this procedure was judged to be feasible, it was started thoracoscopically, and when it was judged to be unfeasible, a small thoracotomy of about 10–15 cm was added to allow one hand to enter. Thoracoscopy not only reduces the invasiveness of the procedure, but also allows us to share the anatomy, and improves the maneuverability of esophageal transfer and ensures safety in emergency situations. Postoperative complications with Clavien-Dindo classification II or higher were 40% in group O and 51% in group V. In group V, anastomotic leak was 15 (9.7%), vocal cord paralysis 34 (22%), pneumonia 17 (11%), SSI 16 (10%). The mean postoperative hospital stay was 20 days. 8 (8.7%) patients in the O group had anastomotic leak, 10 (11%) had vocal cord paralysis, 8 (8.7%) had pneumonia, 12 (7.8%) had SSI. The mean postoperative hospital stay was 28 days. Of 27 salvage procedures, 14 (52%) were performed thoracoscopically. Thoracoscopic surgery was completed in 10 cases and combined thoracotomy in 4 cases. Short-term outcomes of thoracoscopic surgery show an increase in vocal cord paralysis compared to open surgery. The procedure does not improve infectious complications. This technique has the advantage of easy conversion to open thoracotomy, including in emergency situations, and is more advantageous in advanced cancer, and can be a curative and safe treatment for highly advanced cancer.

Long-term outcomes of transaxillary versus video-assisted first rib resection for neurogenic thoracic outlet syndrome.

OBJECTIVESThis study compared the long-term outcomes in terms of clinical examinations and patient-reported outcome measures, between transaxillary and video-assisted thoracoscopic techniques for first rib resection in patients with neurogenic thoracic outlet syndrome.METHODSThe study population comprised patients who underwent first rib resection for neurogenic thoracic outlet syndrome at our institution between 2009 and 2016. All patients were recruited in a follow-up assessment in 2019, and those who agreed to participate were included in this study. Outcomes included examinations at the outpatient clinic and patient-reported outcome measures: Disabilities of Arm Shoulder and Hand Score and Cervical Brachial Symptom Questionnaire. The completeness of the rib resection was assessed on chest X-rays.RESULTS:A total of 60 first rib resections (30 transaxillary + 30 video-assisted fully thoracoscopic approaches) were performed for neurogenic thoracic outlet syndrome in 47 patients between 2009 and 2016. Of these, 32 patients participated in the study including 18 who had transaxillary and 22 who had video-assisted thoracoscopic procedures. The mean follow-up was 5.9 (standard deviation: 2.2) years. The outcome was good or excellent after 15 (83.3%) and 17 (77.3%) procedures in the transaxillary and video-assisted thoracoscopic surgery groups, respectively (P = 0.709). There were no differences in patient-reported outcome measures between the 2 groups. Furthermore, the length of the residual first rib stump was similar in both groups.CONCLUSIONSWe found no differences in the long-term outcomes between the study groups. These results indicate that both transaxillary and purely thoracoscopic approaches offer favourable long-term outcomes following first rib resection in patients with neurogenic thoracic outlet syndrome.

The 12 steps to a thoracoscopic anterior segment segmentectomy: Oncologically safe and sound.

The 12 steps to a thoracoscopic anterior segment segmentectomy: Oncologically safe and sound.

Effects of robot- and video-assisted thoracoscopic lobectomy experiences on the learning curve of lobectomy.

Background This study aims to investigate the effects of robot- and videoassisted thoracoscopic lobectomy on the learning curve of lobectomy. Methods Between September 2013 and February 2020, the first 68 consecutive patients (28 males, 40 females; median age: 71 years; range, 33 to 86 years) who were operated for lung malignancies and scheduled for robot-assisted thoracoscopic lobectomy were retrospectively analyzed. The characteristics of the patients and operative data were analyzed, and the operation times of the first 51 cases of video-assisted thoracoscopic lobectomy were compared with those of robot-assisted thoracoscopic lobectomy performed by a single surgeon. Results Of the patients, 62 had primary lung cancer and six had metastatic lung tumors. The majority of primary lung cancer patients (87.1%) had an adenocarcinoma. The most common clinical stage was IA1 (30.9%). There was no emergent conversion to thoracotomy in any of the patients. The median operation time was 223.5 min, and console time was 151 min. The most common complication was an air leak. All patients were alive. Compared to video-assisted thoracoscopic lobectomy, the median operation time was significantly longer in the robot-assisted thoracoscopic lobectomy group (p=0.0002). Similar to the operation time learning curve of the video-assisted thoracoscopic surgery group, the operation time learning curve of the robotassisted thoracoscopic surgery group increased from the first to ninth case (Phase 1), plateaued from the 10th t o 14th c ase ( Phase 2 ), and decreased from the 15th case (Phase 3). There was a statistically significant decrease in the operation time between Phase 1 and Phase 3 (p=0.0063). Conclusion The results of robot-assisted thoracoscopic lobectomy by a single surgeon show that this surgery has a longer operation time, but the perioperative outcomes are satisfactory. The learning curve of this surgery may be gradual for experienced video-assisted thoracoscopic surgeons.

Total thoracoscopic repair of ventricular septal defect: A single-center experience.

ObjectivesTo explore the safety and efficacy of total thoracoscopic repair of ventricular septal defects (VSD). We compared clinical outcomes of VSD via a total thoracoscopic approach with those of mini‐sternotomy.MethodsWe retrospectively reviewed clinical data from patients with VSD from 2012 to January 2019. According to the surgical pattern, they were divided into two groups: the total thoracoscopic surgery group (36 patients, 27 females, aged 29 ± 9.52 years), and a mini‐sternotomy group (31 patients, 12 females, aged 28 ± 8.67 years).ResultsThere were no deaths in either group. In the thoracoscopic group, cardiopulmonary bypass (CPB) time and aortic cross‐clamping (ACC) time were significantly longer than those of the mini‐sternotomy group (CPB time: 112 ± 23.16 min vs. 78 ± 37.90 min, respectively, p < .001; ACC time: 65 ± 19.94 min vs. 50 ± 24.90 min, respectively, p < .001). postoperative hospital stay time (5.11 ± 2.48 days vs. 5.90 ± 6.27 days, p = .488) and chest drainage (139.86 ± 111.71 ml vs. 196.13 ± 147.34 ml, p = .081) tended to be lower in the thoracoscopy group, although there was no significant difference. No residual shunt or tricuspid regurgitation was found at follow‐up.ConclusionsTotal thoracoscopic repair is safe and effective in patients with VSD, with or without tricuspid regurgitation.

Comparison of short-term quality of life in patients undergoing video-assisted thoracoscopic surgery versus thoracotomy.

Background This study aims to compare the short-term quality of life of patients undergoing video-assisted thoracoscopic surgery versus thoracotomy. Methods A total of 96 patients (58 males, 38 females; mean age 58.4±11.7 years; range, 18 to 80 years) who underwent video-assisted thoracoscopic surgery or thoracotomy in our hospital between March 2018 and March 2019 were retrospectively analyzed. Demographic and clinical characteristics and comorbidities of the patients were recorded. Quality of life of the patients was evaluated using the Short Form-36 health survey at the first postoperative month. Results Of the patients, 43 (44.8%) were treated by video-assisted thoracoscopic surgery and 53 (55.2%) by thoracotomy. Complications occurred in nine (20.9%) patients following video-assisted thoracoscopic surgery and in 12 (22.6%) patients following thoracotomy (p=0.840). At one month postoperatively, the patients in the video-assisted thoracoscopic surgery group had a better quality of life than those in the thoracotomy group (p<0.05). Conclusion Our study results suggest that both recovery and short-term quality of life seem to be better in patients undergoing video-assisted thoracoscopic surgery than in those treated by thoracotomy.

Predicting a Prolonged Air Leak After Video-Assisted Thoracic Surgery, Is It Really Possible?

Validation of predictive risk models for prolonged air leak (PAL) is essential to understand if they can help to reduce its incidence and complications. This study aimed to evaluate both the clinical and statistical performances of 4 existing models. We selected 4 predictive PAL risk models based on their scientific relevance. We referred to these models as Chicago, Bordeaux, Leeds and Pittsburgh model, respectively, according to the affiliation place of the first author. These predicting risk models were retrospectively applied to patients recorded on the second edition of the Italian Video-Assisted Thoracoscopic Surgery Group registry. Predictions for each patient were calculated based on the logistic regression coefficient values provided in the original manuscripts. All models were tested for their overall performance, discrimination, and calibration. We recalibrated the original models with the re-estimation of the model intercept and slope. We used curve decision analysis to describe and compare the clinical effects of the studied risk models. Better statistical metrics characterize the models developed on larger populations (Chicago and Bordeaux models). However, no model has a valid benefit for threshold probability greater than 0.30. The Net benefit of the most performing model (Bordeaux model) at the threshold probability of 0.11 is 23 of 1000 patients, burdened by 333 false positive cases. One of 1000 is the Net benefit at the threshold probability of 0.3. The use of PAL scores based on preoperative predictive factors cannot be currently used in a clinical setting because of a high false positive rate and low positive predictive value.

Comparison of video-assisted thoracoscopic surgery with thoracotomy in bronchial sleeve lobectomy for centrally located non–small cell lung cancer

ObjectivesThe aim of this study was to investigate the adequacy of bronchial sleeve lobectomy by video-assisted thoracoscopic surgery in perioperative outcomes and its oncological efficacy by comparing with thoracotomy in a balanced population. MethodsA total of 363 patients who received bronchial sleeve lobectomy for non–small cell lung cancer from January 2013 to December 2017 were included and placed in the thoracotomy (n = 251) and video-assisted thoracoscopic surgery (n = 112) groups. Statistical analyses were performed to compare patients' demographics, perioperative outcomes, and survival between the 2 groups. ResultsA total of 116 thoracotomy cases were matched with 72 video-assisted thoracoscopic surgery cases by propensity score. Compared with thoracotomy, patients in the video-assisted thoracoscopic surgery group after matching had less intraoperative blood loss (P < .01) and length of postoperative hospital stay (P < .01), duration of chest tube drainage (P < .01), and intensive care unit stay (P = .03) despite comparable operative time, complication rate, and 30- to 90-day mortality rate. The overall survival and recurrence-free survival were similar in patients who received sleeve lobectomy by thoracotomy and video-assisted thoracoscopic surgery (log-rank, P = .24 and .20, respectively) at 3 years. Although advanced TNM stage was independently associated with worse overall survival and recurrence-free survival in multivariable analysis, older age was only predictive for worse overall survival (hazard ratio, 1.04; 95% confidence interval, 1.01-1.07; P = .02). Body mass index was also found be a predictive factor (overall survival: hazard ratio, 0.93; 95% confidence interval, 0.86-0.99, P = .03; recurrence-free survival: hazard ratio, 0.93; 95% confidence interval, 0.87-0.99, P = .02). ConclusionsWith appropriate patient selection and continued experience, video-assisted thoracoscopic surgery appears to be safe in the short-term perioperative period and does not appear to comprise oncologic outcomes in performing sleeve lobectomy.