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

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

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

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

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

Objective To investigate the effect of the amputation order of pulmonary artery and pulmonary artery on pulmonary residual blood volume in total thoracoscopic lobectomy. Methods Sixty-eight patients who were scheduled to underwent total thoracoscopic lobectomy from June 2015 to April 2019 in Beijing Aerospace General Hospital were selected. The patients were divided into first amputation pulmonary artery group and first amputation pulmonary vein group by random envelope method with 34 cases in each group. Five cases in first amputation pulmonary artery group and 4 cases in first amputation pulmonary vein group were excluded because of the procedure modification or the fragmentation of the specimen during the course of operation. In the end, 29 cases were enrolled in first amputation pulmonary artery group and 30 cases in first amputation pulmonary vein group. In first amputation pulmonary vein group, all arteries were ligated before interruption of the veins; and in first amputation pulmonary artery group had a reverse sequence. The perioperative period status were recorded, and the crude pulmonary quality, dry pulmonary quality, pulmonary residual blood volume and adjusted pulmonary residual blood ratio were measured or calculated. Results All 59 patients were operated successfully. No serious complications occurred, no perioperative death occurred, and no patients needed blood transfusion. There was no statistical difference in the incidence of minor complications between first amputation pulmonary artery group and first amputation pulmonary vein group: 27.6% (8/29) vs. 33.3% (10/30), P>0.05. There were no statistical differences in operative time, transoperative bleeding volume, pulmonary residual blood volume, crude pulmonary quality, dry pulmonary quality, adjusted pulmonary residual blood ratio, hemoglobin difference before and after surgery, postoperative drainage time and postoperative hospitalization time between 2 groups (P>0.05). Conclusions The amputation order of pulmonary artery and pulmonary vein sequence of vessel interruption during total thoracoscopic lobectomy has no effect on the pulmonary residual blood volume, can be reasonably selected according to the intraoperative situation. Key words: Pneumonectomy; Thoracoscopes; Pulmonary veins; Pulmonary artery

Objective To evaluate the anesthesia efficacy of laryngeal mask airway for spontaneous breathing under sevoflurane anesthesia in patients undergoing video-assisted thoracoscopic surgery (VAST). Method s Sixty-five patients undergoing VAST were randomly divided into propofol group (group 1, n=33) and sevoflurane group (group 2, n=32). Indexes such the heart rate (HR), mean arterial pressure (MAP), PETCO2, postoperative recovery time, and the incidence of anesthesia complications were recorded and compared between the two groups. Result s HR and MAP of patients in both groups mostly decreased after anesthesia (P<0.05), but the levels of HR and MAP of sevoflurane group were higher than those of propofol group (P<0.05). The incidence of anesthesia complications in sevoflurane group was 18.75%, which was lower than that in propofol group (24.24%). The postoperative recovery time, extubation time, the time of OAA/S grading reaching grade 5 of sevoflurane group were shorter than those of propofol group (P<0.05). Conclusion Laryngeal mask airway for spontaneous breathing under sevoflurane anesthesia, maintains the steadiness of haemodynamics, is more effective and safer, has a faster postoperative recovery than intravenous propofol anesthesia in thoracoscopic operation. Key words: Laryngeal mask airway; Sevoflurane; Propofol; Thoracoscope

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

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

Objective To investigate the clinical efficacy and prognosis of radical thyroidectomy via oral endoscopic surgery. Methods A retrospective analysis of 150 patients with thyroid cancer from January 2016 to December 2017 was divided into the traditional group with open surgery and the oral group with radical endoscopic radical thyroidectomy, 75 cases each. The data were processed by SPSS 22.0 statistical software. All indexes, postoperative pain scores and quality of life scores were expressed by (±s), and compared with independent t test, and complication rate was detected by χ2 test, P<0.05 meant the difference was statistically significant. Results The operation time, hospitalization time, intraoperative blood loss, postoperative drainage volume, postoperative pain score, and postoperative complication rate were lower in the oral group than in the traditional group (P 0.05). The postoperative 6 months and 12 months after surgery were significantly higher than those at the time of discharge the traditional group (P<0.05); the follow-up period of 1 year, the oral recurrence rate, cervical lymph node metastasis rate, distant metastasis rate were lower than the control group, the difference was statistically significant (P<0.05). Conclusion Oral endoscopic radical thyroidectomy for thyroid cancer has a better clinical outcome, and the prognosis is more ideal. It can be used as the preferred treatment. Key words: Thyroid neoplasms; Thoracoscopes; Thyroidectomy; Treatment outcome; Prognosis

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

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

Objective To perform a retrospective analysis of neonates with congenital diaphragmatic hernia (CDH) and to summarize the dilemmas of thoracoscopic repairing. Methods From April 2014 to April 2019, a total of 27 CDH neonates underwent thoracoscopy. Due to an excellent visual field of pulmonary dysplasia, hernia viscera was sequentially returned into abdomen. Sharp instruments should not be directly compressed for restoring spleen along with stomach and colon. For severe defect of posterolateral diaphragm, suturing diaphragm margin-intercostal muscle-diaphragm margin and moderately tightening wire knot are employed for repairing diaphragm muscle and preventing recurrence. For severe diaphragmatic defect, continuous suture should be performed for closing defect as much as possible. And the size of weak defect was measured. Customized mesh was placed into chest cavity and fixed mesh tightly attached to weak diaphragm by interrupted suturing with 4-0 proline thread. Results The involved side was left (n=25) and right (n=2). Twenty-three cases were diagnosed prenatally. The average gestational age of prenatal diagnosis was (28.2±5.1) weeks, the average gestational age (37.5±2.7) weeks and the average birth weight (2.90±0.70) kg. Thoracoscopic repairs were successful (n=23) and converting into open operation (n=4). Among 23 survivors, the average operative age was (41±40) hours and the average operative duration (159±14) min. The average durations of ventilator supports and hospitalization were (5.1±1.2) and (18.0±4.0) days respectively. Three cases complicated with chylothorax were cured after conservative measures. There was one case of recurrence. However, based upon illness severity and operative duration, the prognoses of different groups showed no significant statistical differences. Conclusions Thoracoscopic repair is both safe and feasible for severe congenital diaphragmatic hernia in neonates. If a surgeon has extensive experiences, thoracoscopy may be selected as a first choice and completed successfully with patching. When cardiopulmonary functions are unstable and PaCO2 is continuously higher than (65-75) mmHg, thoracoscopy should be converted timely into open surgery. The thoracoscopic tolerance of low-weight premature infants is no less than that of full-term infants. Key words: Hernia, diaphragmatic; Neonate; Thoracoscopy

Objective To summarize our experiences of multidisciplinary treatment (MDT) for infants with congenital diaphragmatic hernia (CDH) and explore its effect on outcomes. Methods The medical records were retrospectively reviewed for 152 CDH infants from January 2001 to December 2018. The relevant clinical data included gestational age at diagnosis and delivery, Apgar score, types of hernia, birth weight, site of liver, admission arterial blood gas analysis, types of surgery, duration of mechanical ventilation and length of hospital stay. They were divided into two groups of non-MDT from January 2001 to February 2008 (n=8) and MDT from March 2008 to December 2018 (n=144). Their clinical parameters were compared and analyzed. Results There were 80 boys and 72 girls. And the involved side was left (n=120) and right (n=32). A total of 135 children were operated. In non-MDT group, all patients underwent open surgery. In MDT group, 17 patients died of cardiorespiratory failure without surgery. Among 127 surgical infants, open (n=66) and mini-invasive (n=78) operations were performed. Compared with counterparts in non-MDT group, those infants in MDT group were more likely to delay in surgical timing [(4.8±2.3) vs. (1.1±0.4) days], higher utilization of thoracoscopy (0 vs. 48.0%) and a higher survival rate (75.0% vs. 37.5%)(all P<0.05). However, no inter-group differences existed in gender, birth weight, site/size of defect, types of surgery or prenatal diagnosis. Conclusions MDT provides an feasible and effective model for diagnosing and treating CDH with better outcomes. Key words: Hernia, diaphragmatic; Multidisciplinary treatment; Treatment model; Prognosis

Objective To investigate the feasibility and security of fluorescence method in thoracoscopic anatomical segmentectomy, compared with modified inflation-deflation method. Methods Department of thoracic surgery of the First Medical Center, Chinese PLA General Hospital from Mar. 2017 to Sep. 2019, we performed thoracoscopic anatomical segmentectomy for 157 patients (fluorescence group, 41 females and 19 males, aging from 36 to 76; modified inflation-deflation group, 62 females and 35 males, aging from 27 to 85). In the fluorescence group, to distinguish intersegmental plane, indocyanine green was injected into peripheral vein after the targeted segmental artery cut off. In the modified inflation-deflation group, after the targeted segmental bronchus cut off, the bilateral ventilation was started, and then unilateral ventilation was restored. The intersegmental plane would be formed after more than 10 minutes. Clinical data of the two groups were collected and analyzed. Results Compared with the modified inflation-deflation group, the fluorescence group showed shorter display time and shorter operational time [20 s(8-25)s vs 1 008 s(884-1 200)s, P=0.031, (103.3±7.3)min vs (132.8±10.4)min, P=0.021]. There were no significant differences in bleeding volume, the number of lymph node dissection, drainage time, hospitalization time and morbidity between the two groups (all P>0.05). Conclusions Compared with modified inflation-deflation group, it is quicker and more accurate to distinguish intersegmental plane in fluorescence group. It needn′t to inflate and deflate lungs repeatedly. Fluorescence method is safe and efficient. Key words: Thoracoscopy; Segmentectomy; Fluorescence; Indocyanine green; Modified inflation-deflation

Objective To explore the efficacy and safety of medical thoracoscopy in the treatment of refractory pneumothorax. Methods The data of 14 patients with refractory pneumothorax treated in the Department of Respiratory Medicine, the Second Affiliated Hospital of Guangxi Medical University from 2012 to 2018 were retrospectively analyze.The treatment included high-frequency electric knives, argon plasma coagulation, and biopsy forceps under medical thoracoscopy. Results Among the 14 patients with refractory pneumothorax, there were five cases of type Ⅱ pulmonary bullae, four cases of type Ⅲ pulmonary bullae, and six cases of diffuse pulmonary bullae.A total of 42 pulmonary bullae were found.After medical thoracoscopy therapy, there was no air leakage on chest X-ray.The effective rate was 100% in short term and long term. Conclusions The medical thoracoscopy in the treatment of refractory pneumothorax has the advantages of less trauma, less pain and faster recovery after operation, which is worthy of clinical promotion. Key words: Medical thoracoscopy; Refractory pneumothorax; Pulmonary bullae

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

Objective To explore the special situation in subxiphoid uniportal VATS surgery and summarize the treatment strategies. Methods In September 2014, the subxiphoid uniportal VATS surgery was carried out. Up to now, our research team has completed more than 300 subxiphoid uniportal VATS operations, especially including 242 cases of subxiphoid uniportal VATS segmentectomy and 22 cases of subxiphoid uniportal VATS mediastinal tumor resection. Some special situations were encountered during the operation, including cardiac arrest, pericardial tamponade, innominate venous injury, severe arrhythmia, difficulty in positioning the lung segment, and difficulty in positioning the small nodule et al. Results Some patients changed the surgical procedure during surgery due to intraoperative emergencies such as severe arrhythmia, heart problems, intraoperative bleeding. Postoperative complications mainly included thoracotomy and hemostasis, continuous air leak after operation, pulmonary hematoma, arrhythmia, and no perioperative death. Conclusion Under the subxiphoid uniportal VATS surgery is an important manifestation of the minimally invasive technique of the chest. It is safe and feasible to select suitable cases, master the thoracoscopic technique and special surgical techniques. Special situations during subxiphoid uniportal VATS surgery should be known. Key words: Thoracoscopy; Uniportal; Subxiphoid; Operative complications

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

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