Treatment Of Thoracic Disease Research Articles

A uniportal right upper lobectomy by three-arm robotic-assisted thoracoscopic surgery using the da Vinci (Xi) Surgical System in the treatment of early-stage lung cancer.

Minimally invasive techniques, typified by video-assisted thoracoscopic surgery, are widely practiced in the treatment of thoracic diseases all around the world, and video-assisted thoracoscopic surgery has been recognized as a standard treatment method for early staged lung cancer. Among them, robotic-assisted thoracoscopic surgery, which has the advantages of providing a three-dimensional view and better maneuverability, has emerged as a next-generation technique in the field of minimally invasive surgery and is also gaining its popularity with the idea of Enhanced Recovery After Surgery deeply rooted in patients’ minds. Up to now, robotic-assisted thoracoscopic surgery usually requires 3 or 4 ports with 1 or 2 additional access incisions. Meanwhile, traditional video-assisted thoracoscopic surgery can now be completed with uniportal method, with less postoperative pain and higher patient satisfaction with respect to the number of incisions in comparison with the multi-port technique. To inform the integration of these new minimally invasive techniques, here, we present a case in which uniportal right upper lobectomy was performed using the 4th generation da Vinci Robotic Surgical System (Xi). With continuous innovation in robotic minimally invasive techniques and improvements in surgical skills, we believe more patients will benefit from robotic-assisted thoracoscopic surgery with single port in the near future.

Complete Uniportal Thoracoscopic Anatomic Lung Resection With Systematic Mediastinal Lymphadenectomy for Non-Small Cell Lung Cancer: Personal Experience of 326 Cases.

With its growing popularity and potential outcome, complete uniportal thoracoscopic (CUT) surgery has been used in the treatment of thoracic diseases. This study aimed to summarize a personal experience of CUT anatomic lung resection with systematic mediastinal lymphadenectomy (CUT-ALR-SML) for non-small cell lung cancer (NSCLC) and to evaluate the feasibility and safety of CUT-ALR-SML in our institute. A total of 326 patients with NSCLC were chosen to undergo CUT-ALR-SML in our institute from August 2013 to July 2018. Data such as clinicopathologic characteristics and perioperative outcomes were reviewed in this article. For the 326 cases of ALR, the specific procedures and the corresponding number of cases were as follows: segmentectomy, 90; lobectomy, 218; sleeve lobectomy, 9; ipsilateral lobe combined with segment resected synchronously (i-L+S), 6; and pneumonectomy, 3. A total of 31 cases required conversion to open surgery, and 4 cases were converted to multiportal thoracoscopic surgery. All patients underwent SML. The average mediastinal lymph node stations and mediastinal lymph nodes dissected under CUT-ALR-SML were 3.3±1.4 and 9.6±8.4, respectively. Approximately 99.7% of the patients acquired free resection margins. A total of 42 (12.9%) patients suffered from postoperative complications, and 1 patient died of pneumonia during the perioperative period. Complete uniportal ALR, particularly for segmentectomy and lobectomy is safe and feasible with low complication rates and excellent free resection margin rates. SML during complete uniportal thoracoscopic surgery adequately assesses the N2 lymph node. However, further studies need to be conducted to evaluate the role of CUT-ALR-SML in the treatment of NSCLC.

Prof. Johan F. Vansteenkiste: bring immunotherapy to frontline therapy in order to cure more patients

The 1st China-Eastern Europe International Forum on Thoracic Disease was successfully held in Shanghai, China during Nov. 2–3, under the cooperation among Shanghai Chest Hospital, Shanghai Hospital Association, and General University Hospital in Prague, Czech Republic. Centered novel technologies and research advances in the diagnosis and treatment of thoracic disease, world-renowned experts came together, talking and sharing the latest progress, aiming at promoting the academic communication.

Feasibility of Subxiphoid Anatomic Pulmonary Lobectomy in a Canine Model.

Purpose Transthoracic thoracoscopic approach is the gold standard in surgical treatment for thoracic disease. However, it is associated with significant chronic postoperative wound discomfort. Currently, limited data are available regarding the subxiphoid approach to the thoracic cavity. The present study is aimed to evaluate the performance of a subxiphoid anatomic pulmonary lobectomy (SAPL) in a canine model. Methods The SAPL procedure was performed in 10 beagle dogs using a 3-cm incision over the xiphoid process. After thoracic exploration, SAPL was performed under flexible bronchoscopy guidance. The pulmonary vessel was divided with Ligasure and secured with a suture ligature. The bronchus was divided with endostapler. Surgical outcomes were evaluated by the success of SAPL and operative complications. Results SAPL was successfully completed in 9 animals. One animal required conventional thoracotomy to resuture the pulmonary artery stump. Another animal encountered small middle lobe laceration after SAPL and died at 8 days postoperation due to respiratory distress. Conclusion Subxiphoid anatomic pulmonary lobectomy is technically feasible. Refinement of endoscopic instruments combined with more research evidences may facilitate the development of subxiphoid platform in thoracic surgery.

Mediastinal tumor resection via open or video-assisted surgery in 31 pediatric cases: Experiences at a single institution

BackgroundVideo-assisted thoracic surgery (VATS) has been increasingly used for the diagnosis and treatment of thoracic diseases. Pediatric mediastinal tumors are often difficult to resect because of their proximity to important organs. For this reason, VATS is not established as a standard surgical approach for such tumors. We compared the efficacy and safety of mediastinal tumor resection in children using open thoracotomy (OT) and VATS. MethodsA total of 31 children underwent mediastinal tumor resection (21 by VATS and 10 by OT). These nonrandomized approaches were retrospectively compared for incidence of operative complications, morbidity, and mortality. ResultsTumor sizes and operation times were similar between groups. However, the VATS group required significantly fewer blood transfusions and shorter durations of thoracic drainage and hospital stays (p<0.05). Complications greater than grade 2 on the Clavien–Dindo classification occurred in four patients treated by VATS and OT. No delayed effects were noted in the survivors of either group. A patient with clear cell sarcoma of the kidney who underwent OT relapsed and died. ConclusionAlthough complication rates were similar between the two approaches, VATS was suggested as less invasive because of fewer blood transfusions required, and shorter thoracic drainage and hospital stay durations.

Nonintubated thoracoscopic surgery using regional anesthesia and vagal block and targeted sedation.

Thoracoscopic surgery without endotracheal intubation is a novel technique for diagnosis and treatment of thoracic diseases. This study reported the experience of nonintubated thoracoscopic surgery in a tertiary medical center in Taiwan. From August 2009 through August 2013, 446 consecutive patients with lung or pleural diseases were treated by nonintubated thoracoscopic surgery. Regional anesthesia was achieved by thoracic epidural anesthesia or internal intercostal blockade. Targeted sedation was performed with propofol infusion to achieve a bispectral index value between 40 and 60. The demographic data and clinical outcomes were evaluated by retrospective chart review. Thoracic epidural anesthesia was used in 290 patients (65.0%) while internal intercostal blockade was used in 156 patients (35.0%). The final diagnosis were primary lung cancer in 263 patients (59.0%), metastatic lung cancer in 38 (8.5%), benign lung tumor in 140 (31.4%), and pneumothorax in 5 (1.1%). The median anesthetic induction time was 30 minutes by thoracic epidural anesthesia and was 10 minutes by internal intercostal blockade. The operative procedures included lobectomy in 189 patients (42.4%), wedge resection in 229 (51.3%), and segmentectomy in 28 (6.3%). Sixteen patients (3.6%) required conversion to tracheal intubation because of significant mediastinal movement (seven patients), persistent hypoxemia (two patients), dense pleural adhesions (two patients), ineffective epidural anesthesia (two patients), bleeding (two patients), and tachypnea (one patient). One patient (0.4%) was converted to thoracotomy because of bleeding. No mortality was noted in our patients. Nonintubated thoracoscopic surgery is technically feasible and safe and can be a less invasive alternative for diagnosis and treatment of thoracic diseases.

Thoracic surgery. The surgical treatment of thoracic diseases. By Howard Lilienthal, M.D., F.A.C.S., Consulting Surgeon to Mount Sinai and Bellevue Hospitals; Professor of Clinical Surgery, Cornell University Medical College, etc. Two volumes. Royal 8vo. 1925. Pp. 1294 (with 904 illustrations, 13 in colours). Philadelphia and London: W. B. Saunders Co. 90s. net per set

Thoracic surgery. The surgical treatment of thoracic diseases. By Howard Lilienthal, M.D., F.A.C.S., Consulting Surgeon to Mount Sinai and Bellevue Hospitals; Professor of Clinical Surgery, Cornell University Medical College, etc. Two volumes. Royal 8vo. 1925. Pp. 1294 (with 904 illustrations, 13 in colours). Philadelphia and London: W. B. Saunders Co. 90s. net per set

Endobronchial Ultrasonography

Endobronchial ultrasonography (EBUS) allows visualization of the tracheobronchial tree with real-time ultrasound and permits visualization of the internal structure of pulmonary lesions, which may narrow the differential diagnosis. The indications for EBUS are to (1) determine the depth of tumor invasion of tracheobronchial lesions, (2) define positional relationships with the pulmonary artery and veins and hilar structures and determine the extent of tumor invasion, (3) visualize paratracheal and peribronchial lymph nodes and metastatic lesions and enable EBUS-guided transbronchial needle aspiration (TBNA), and (4) localize and diagnose peripheral pulmonary lesions (benign or malignant). New and evolving applications of EBUS will increase the cost-effectiveness of EBUS in the diagnosis and treatment of thoracic diseases.

General thoracic surgery and the Southern Thoracic Surgical Association: the second 25 years

When one reviews the most recent 25 years of general thoracic history several subjects predominate: video-assisted thoracoscopy (VATS), lung transplantation, lung volume reduction surgery, and the use of new tools in the staging of thoracic malignancies such as positron emission tomography (PET), endoscopic ultrasonography (EUS), and molecular staging. Members of the Southern Thoracic Surgical Association (STSA) as well as invited speakers at the annual meetings have contributed greatly to these subject areas. However a perusal of the program books reveals another important STSA contribution: the appreciation and value of collected reviews and series that highlight the wisdom and experience gained by individuals and institutions. It is this balance that the STSA has and will continue to foster. One remembers when it was claimed that all thoracic surgery would be done by VATS. We have watched the pendulum swing far and in fact it is still swinging but in a less erratic manner. Southern thoracic surgeons have usually heeded the caution of “not throwing out the baby with the bath water.” Embracing new concepts and techniques, pushing the limits of known surgical premises but heeding the lessons of past history have brought balance to the annual meetings, to the literature, and to the field of general thoracic surgery. Although thoracoscopy was first performed by Jacobaeus in 1910, video technology in the late 1980s and early 1990s expanded the operative possibilities for thoracoscopy. “Minimally invasive surgery” has certainly been the buzz word of the past decade. Although controversy remains over its ultimate role in certain procedures, VATS has become a standard component of the general thoracic surgeon’s repertoire. Members of the STSA were very early contributors to the role thoracoscopy could play in the diagnosis and treatment of thoracic disease [1–3]. Special mention should be made of

Thoracoscopic Surgery of the Spine.

Anterior approach to the thoracic spine has been limited by the morbidity of a thoracotomy. By a thoracoscopic approach, a majority of thoracic spine procedures can now be performed from the anterior approach including diskectomy for herniation, release for correction of spinal deformity and corpectomy for tumor. Although experience is limited and results still short term, the thoracoscopic approach appears to be a promising one for the treatment of thoracic spine disease.

Videothoracoscopy: Diagnosis and treatment of thoracic diseases

Videothoracoscopy: Diagnosis and treatment of thoracic diseases

Video-assisted Thoracic Surgery: Manipulation Without Trocar in 112 Consecutive Procedures

Since learning of the video-assisted thoracoscopic techniques in the treatment of thoracic diseases, we have encountered many problems and difficulties because of the limited trocar space and lack of suitable instrumentations. Since March 1992, we have found a simple and easier way to perform this procedure, that is, manipulating through the extended incisional wound without using a trocar. Endoscopic and conventional thoracic instruments are able to pass through the incisional channel freely and manipulate similarly to the technique used in open thoracotomy. All the patients had less postoperative pain, reduced operative time, and prompt return to employment. The technique is effective and is herein described.

Thoracoscopy for staging of lung cancer

The recent advancements in diagnosis and treatment of thoracic disease have been made mostly in line with advancements in endoscopic equipment design and refinement of thoracoscopic surgery techniques. Between March 1992 and February 1993, video thoracoscopic procedures were performed in 50 patients. Twelve of the 50 patients were diagnosed with lung cancer. Thoracic staging was performed in 6 patients (clinical diagnosis of suspicious intrapulmonary metastasis, 3 patients; intrapulmonary metastasis and/or lymph node metastasis, 1 patient; interlobar pleural effusion, 1 patient; and pleural dissemination, 1 patient). There were no complications or mortality associated with these procedures. Our initial experience has indicated that thoracoscopic staging for lung cancer is a safe and effective procedure.

Present role of thoracoscopy in the diagnosis and treatment of diseases of the chest

Since thoracoscopy was originally described in 1910, the application has been limited mainly to the diagnosis and treatment of pleural disease. Recent advancements in endoscopic equipment and refinement of surgical techniques have expanded the application of this procedure. Using video thoracoscopic techniques in 70 patients over the past 9 months, we have been able to perform a variety of procedures previously accomplished by “open” techniques. These procedures include (1) wedge resections of pulmonary nodules in 21 patients, using endoscopic mechanical stapling devices; (2) excision of the pericardium and drainage of the pericardial space in 6 patients; (3) dorsal thoracic sympathectomy in 6 patients; (4) apical blebectomy and pleurodesis in 6 patients; and (5) lung biopsies for diagnosis of diffuse lung disease in 5 patients. Additional procedures performed include biopsy of hilar masses (3), biopsy of esophageal mass, excision of a mediastinal cyst, and the drainage of a spinal abscess. The remaining 20 procedures were performed for the diagnosis and treatment of pleural disease. There was no mortality associated with the procedure and morbidity was lessened, compared with standard thoracotomy procedures. The postoperative hospital stay after elective procedures performed in well patients averaged 3 days and was often as short as 1 day. Our experience indicates a markedly expanded role for thoracoscopy in the diagnosis and treatment of thoracic diseases with less postoperative morbidity.

Problems in thoracic surgery.

The problems encountered in the treatment of thoracic diseases have increased as our knowledge of the various pathologic conditions has accumulated. Surgical treatment is now of a definitive nature, the attack direct and of sufficient intensity to remove the offending lesion. At our present state of knowledge any other type of therapy is mentioned only to be condemned. Constant vigilance for newer and more effective methods of treatment is obligatory if progress is to continue.

The Clinical Significance of Pulmonary Hemorrhage: A Study of 1316 Patients with Chest Disease

1)A study of 1,316 patients with thoracic disease has been presented, 497 of whom had suffered pulmonary hemorrhage. 2)The clinical significance of pulmonary bleeding has been statistically evaluated. 3)This symptom predicates serious underlying disease in 90 per cent of patients presenting it and demands immediate and intensive investigation. 4)The relative frequency of the occurrence of hemoptysis in individual disease entities has been noted. It may occur in any disease associated with bronchial ulceration or compression. The relatively higher incidence in bronchogenic carcinoma, bronchiectasis and lung abscess than in pulmonary tuberculosis has been stressed. The occurrence of bleeding with mediastinal lesions and tumors metastatic to the lung is emphasized. 5)Emphasis is laid upon the importance of any variation from the usual type of hemoptysis seen in acute pneumonia, and the need for investigation to rule out possible underlying neoplasm. 6)No correlation can be made between the type of hemoptysis and the underlying disease, other than a tendency to more copious hemorrhage in patients with pulmonary abscess. 7)The importance of the patient's subjective localization of the bleeding site is stressed, and the methods of clinical investigation outlined and discussed. 8)With the addition of staining methods for the study of tumor cells in the sputum and the intelligent use of exploratory thoracotomy, a decrease in the hemoptysis, etiology undetermined group is to be expected. 9)It is hoped that this analysis may aid in a better understanding of the clinical significance of pulmonary hemorrhage and thus lead to the earlier recognition and treatment of thoracic disease, especially tumors.

Recent Progress in the Treatment of Thoracic Disease

Recent Progress in the Treatment of Thoracic Disease

Recent Progress in the Treatment of Thoracic Diseases

Recent Progress in the Treatment of Thoracic Diseases

Recent Progress in the Treatment of Thoracic Diseases

Recent Progress in the Treatment of Thoracic Diseases

Report on Progress in the Treatment of Thoracic Diseases

Report on Progress in the Treatment of Thoracic Diseases