Video-assisted Lung Resection Research Articles

Intercostal Cryoablation During Video-Assisted Lung Resection Can Decrease Postoperative Opioid Use.

Pain requiring opioid use remains an issue even with minimally invasive thoracic surgery. The objective of this study was to investigate the effectiveness of intercostal nerve cryoablation (CRYO) for pain control in adult patients undergoing pulmonary resection. A retrospective analysis of patients undergoing pulmonary resection by uniportal video-assisted thoracic (uVATS) approach was undertaken. Patients treated with our usual pain regimen (STANDARD) were compared with those who additionally received CRYO. STANDARD includes intercostal bupivacaine, patient-controlled analgesia (24 h), ketorolac (48 to 72 h), and tramadol. Intraoperative CRYO was performed on 5 intercostal levels. The primary aim was to compare pain scores (range, 0 to 10) and morphine equivalent dosages (MED). Secondary outcomes included length of stay, chest tube duration, presence of an air leak, and adverse events. A p value <0.05 was considered significant. There were 49 patients (34 female, 15 male). The median age was 74 (37 to 90) years. Procedures included lobectomy (n = 32), segmentectomy (n = 7), and wedge resections (n = 10). There were 23 (46.9%) CRYO and 26 (53.1%) STANDARD patients. Baseline characteristics were similar. Mean length of stay (2.9 vs 3.5 days), chest tube duration (2.2 vs 1.8 days), and adverse events (9 of 23 vs 7 of 26) were similar. There were no complications attributable to CRYO. Pain scores were not significantly different on postoperative days (POD) 1 to 4. MED was significantly reduced after CRYO on POD 1 (5 vs 47.24), POD 2 (10.93 vs 25.04), POD 3 (8.13 vs 21.7), and POD 4 (7.08 vs 19.17). CRYO can be performed safely during pulmonary resection and can decrease in-hospital opioid use. The results from this retrospective study will need to be validated in future prospective studies.

Randomized Trial of Modified Chest Tube Placement vs Routine Placement After Lung Resection

BackgroundChest tube placement after pulmonary resection is usually considered a mandatory procedure. However, peritubular leakage of pleural fluid and intrathoracic air is frequent after surgery. Therefore, we separated the chest tube from the intercostal space as a modified placement strategy. MethodsPatients undergoing robotic and video-assisted lung resection were enrolled in this study at our medical center between February 2021 and August 2021. All patients were randomly divided into either the modified group (n = 98) or the routine group (n = 101). The incidence of peritubular leakage of pleural fluid and peritubular air leaking or entering after surgery were the primary end points of the study. ResultsA total of 199 patients were randomized. Patients in the modified group had lower incidence of peritubular leakage of pleural fluid (after surgery, 39.6% vs 18.4% [P = .001]; after chest tube removal, 26.7% vs 11.2% [P = .005]), lower incidence of peritubular air leaking or entering (14.9% vs 5.1% [P = .022]), and fewer dressing changes (5.02 ± 2.30 vs 3.48 ± 0.94 [P < .001]). In patients undergoing lobectomy and segmentectomy, the type of chest tube placement was associated with the severity of peritubular pleural fluid leakage (P < .05). ConclusionsThe modified chest tube placement was safe and had better clinical efficacy than the routine type. The reduction of postoperative peritubular leakage of pleural fluid resulted in better wound recovery. This modified strategy should be popularized, especially in patients undergoing pulmonary lobectomy or segmentectomy.

General anaesthesia with double-lumen intubation compared to opioid-sparing strategies with laryngeal mask for thoracoscopic surgery: A randomised trial

BackgroundGeneral anaesthesia for thoracoscopic lung surgery can be performed with the opioid-sparing strategies without intubation and may reduce the risk of glottic injury and enhance recovery after surgery. We therefore tested the primary hypothesis that avoiding intubation reduces glottic injury. MethodsAdults having elective thoracoscopic lung resections were randomised to: (1) intubated group: routine general anaesthesia with a double-lumen tube intubation; or, (2) non-intubated group: a bundle of opioid-sparing strategies, which included paravertebral blocks and total intravenous anaesthesia with minimal remifentanil infusion from 0.05 to 1.0 ng/mL (avoid sufentanil unless the respiratory rate exceeds 25/min or the systolic blood pressure exceeds 30% of the baseline value), no muscle relaxation, and spontaneous ventilation through a laryngeal mask. The primary outcome was glottal injury as determined by transnasal bronchoscopy one hour after removal of the laryngeal mask or double-lumen tube. ResultsTwo hundred seventeen patients were assessed for the primary outcome. Sufentanil use was reduced 96% and remifentanil was reduced 40% in non-intubated opioid-sparing patients. The incidence of glottal injury was 9% (10/109) in the non-intubated vs. 37% (40/108) in the intubated patients (RR: 0.25; 95%CI: 0.13–0.47, P < 0.001). The non-intubated group also had less postoperative sore throat (8% vs. 39%; P < 0.001) and hoarseness (3% vs. 19%; P < 0.001). Postoperative pulmonary complications and lung injury biomarkers did not differ between the groups. Compared to the intubated group, the non-intubated group had less postoperative pain, faster recovery, and improved quality-of-life scores. ConclusionsNon-intubated opioid-sparing strategies for video-assisted lung resections reduce airway injury and promote postoperative recovery. Clinical trial number and registry URLChiCTR1800018198https://www.chictr.org.cn/showproj.aspx?proj=30780

Surgical Treament of the Patients with Pulmonary Tuberculosis using Videothoracoscopic Interventions

Introduction. Pulmonary tuberculosis is a serious problem as in Ukraine as throughout the world. The number of patients with pulmonary tuberculosis is increasing year by year, which is due to the difficulties in early detection of this disease. The aim. To determine the effectiveness of surgical treatment of patients with pulmonary tuberculosis by using video-assisted thoracoscopic interventions. Methods. In the Department of Thoracic Surgery of the State University "National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky NAMS of Ukraine" from 2008 to 2022 140 video assisted lung resections were performed in a planned manner for phthisis-surgical patients. The distribution according to the type of resection intervention was as follows: atypical segmental resection - in 30 (21.4 %) cases, typical segmentectomy – in 50 (35.7 %), lobectomy - in 52 (37.2 %), bilobectomy – in 3 (2.1 %), pulmonectomy – in 5 (3.6 %). The results. The average duration of operative VATS resection interventions was (75.1 ± 22.3) min., intraoperative blood loss was (85.4 ± 1.6) ml, duration of narcotic analgesics prescription in patients with video-assisted thoracoscopic lung resections was (2.20 ± 0.04) days. Early mobilization of patients recorded in 112 (80.0 ± 3.4) cases. The average length of stay of the patient in the intensive care unit after video-assisted thoracoscopic lung resection was (2.6 ± 0.8) days, length of stay of the patient in the hospital in the postoperative period was (12.4 ± 0.5) days. Intraoperative complications were diagnosed in 7 (5.0 ± 1.8) % of patients. The rate of postoperative complications was 22 (15.7 ± 3.1) % of observation. There was no postoperative mortality after minimally invasive surgical interventions. The overall efficiency of performing video-assisted thoracoscopic lung resections was 97.1 %. Conclusion. The use of video-assisted thoracoscopic is a convenient, effective and low-traumatic method in the treatment of patients with pulmonary tuberculosis. The overall effectiveness of video-assisted thoracoscopic methods for pulmonary tuberculosis was 97.1 %. An adequate assessment of the possibility of performing video-assisted thoracoscopic and the use of methods to prevent complications ensures a predictable course of the intra- and postoperative periods and increases the effectiveness of surgical interventions.

Vessel sealing system for video-assisted lung resection for cancer reduces chylothorax and bleeding.

BackgroundThe objective of this study was to analyze the efficacy of the LigaSureTM vessel sealing system for lung cancer resection with node dissection, as this has not been sufficiently evaluated.MethodsFrom 2004 to 2018, 948 patients underwent anatomical pulmonary resection with node dissection for non-small cell lung carcinoma (NSCLC) via the video-assisted thoracoscopic surgery (VATS) approach. Medical records of these patients were reviewed retrospectively. Univariate and multivariate analyses were conducted to determine the risk factors for chylothorax and blood loss.ResultsOf the 948 patients, 318 (33.5%) who underwent anatomical lung resection with node dissection by conventional methods without vessel sealing system and 630 (66.5%) who underwent lung resection with node dissection with the vessel sealing system were included. The median intraoperative blood loss was 100 mL. Postoperative chylothorax occurred in 9 (2.8%) patients in the conventional method group with 2 (0.3%) patients in the vessel sealing system group (P=0.001). Patients in the vessel sealing group who developed chylothorax were cured by conservative treatment. Univariate and multivariate analyses identified male sex [odds ratio (OR) 2.053; 95% confidence interval (CI): 1.494–2.820; P<0.001] and the use of vessel sealing system (OR 0.342; 95% CI: 0.256–0.457; P<0.001) as independent predictors of intraoperative blood loss. The univariate and multivariate analyses identified the use of the vessel sealing system (OR 0.108; 95% CI: 0.023–0.504; P=0.005) as an independent predictor of chylothorax incidence.ConclusionsVessel sealing system for lung cancer resection could decrease chest tube duration, amount of intraoperative bleeding, and incidence of chylothorax in patients who undergo lung resection with node dissection.

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Pulmonary tuberculosis surgery is characterized by a number of aspects associated with adhesions in the pleural cavity, fibrosis of the lung root, destruction of the parenchyma, which contribute to the development of intra- and postoperative complications such as residual pleural cavity and reactivation of tuberculosis in operated lung due to compensatory tissue distortion. Aim: to improve video-assisted lung resection (VATS) in tuberculosis patients with the presence of pleural cavity obliteration. Materials and methods. The developed method of VATS for tuberculosis patients with pleural cavity obliteration is based on separate intubation of right and left main bronchi for mechanical ventilation of one lung, placement of thoracic port, performing revision of pleural cavity using video-assisted thoracoscopy, performing mini-thoracotomy and resection of lung with separate treatment of anatomical structures in required volume by means of disposable stapler or regular open thoracotomy instruments, pleural cavity draining and layered wound closure. Computed tomography of chest is performed during the operation in order to assess the extent and severity of pleural adhesions and to locate safe position of thoracic ports. Hydraulic needle preparation of parietal pleura is performed in severe adhesions area. Hemorrhage is treated using hemostatic plate Surgicel Fibrillar made of restored cellulose. Phrenicotripsy, pleural cavity drainage and, finally, artificial pneumoperitoneum are performed. The proposed method of video-assisted lung resection was used in 41 patients, 25 patients underwent video-assisted resection according to the prototype method. Results. The proposed method reduced duration of the surgical intervention by 52.7 minutes; the frequency of intraoperative complications by 14.4%; the incidence of postoperative complications by 14.2; the duration of patient�s stay at the hospital by 5.8 days and increased of overall treatment efficiency by 14.5%. The proposed method of VATS for patients with pulmonary tuberculosis and pleural cavity obliteration is safe, effective, simple to implement and can be performed at thoracic surgery departments of various pulmonary hospitals of city and regional level. Key words: pulmo

Validation and clinical utility of the Korean version of the Quality of Recovery-15 with enhanced recovery after surgery: a prospective observational cohort study

BackgroundThe 15-item Quality of Recovery (QoR-15) scale is a validated patient-reported outcome questionnaire that measures the quality of postoperative recovery. This study aimed to validate a translated Korean version of QoR-15 (QoR-15K) in a broad range of surgical patients. MethodsAfter Korean translation of the original English version of the QoR-15, we performed psychometric validation of the QoR-15K to evaluate the quality of recovery after surgery. The validity, reliability, responsiveness, and clinical feasibility of the QoR-15K were evaluated. A subgroup analysis in patients with video-assisted lung resection was performed. ResultsAmong 193 patients, 188 (97.4%) completed the QoR-15K after surgery. We found good convergent validity between the postoperative QoR-15K and the global QoR visual analogue scale (ρ=0.61, P<0.001). The negative correlation between the QoR-15K score and the extent of surgery (ρ=–0.33, P<0.001), the duration of surgery (ρ=–0.33, P<0.001), and the severity of postoperative pain (ρ=–0.40, P<0.001) supported construct validity. The postoperative QoR-15K showed good internal consistency (Cronbach α=0.90), split-half reliability (0.81), and test–retest reliability (0.95; 95% confidence interval [CI], 0.94–0.96). The QoR-15K score decreased from 140 (preoperative, inter-quartile range [IQR] 128–146) to 100 (postoperative day 1, IQR 75–122), median difference –36.5 (95% CI, –41 to –32.5; P<0.0001). The QoR-15K indicated excellent responsiveness with Cliff's effect size –0.78 (95% CI, –0.84 to –0.71). Subgroup analysis yielded similar results. ConclusionsThe QoR-15K is valid and has excellent reliability, a high degree of responsiveness, and clinical feasibility as a metric of quality of recovery in Korean surgical population. Clinical trial registrationNCT04169087.

Feasibility of electromagnetic navigation bronchoscopy-guided lung resection for pulmonary ground-glass opacity nodules.

BackgroundRecent advances in imaging modalities and recommended low-dose computed tomography screening programs have made it easier to diagnose early lung cancer. However, the diagnosis of small ground-glass nodules (GGNs) has been problematic due to inappropriate specimen procurement and failure of conventional percutaneous core needle biopsy. Thus, we aimed to evaluate the usefulness of electromagnetic navigation bronchoscopy (ENB)-guided video-assisted lung resection for not only the diagnosis but also treatment of GGNs.MethodsFrom 2017 to 2019, 110 patients with suspicious lung cancer lesions that were not diagnosed by conventional procedure underwent ENB-guided lung resection. Among 35 cases of GGNs, 33 cases of localization were included in this study (two cup biopsy cases were excluded). We used SuperDimension™ for the ENB procedure. After general anesthesia, indigo carmine (0.3–0.5 mL) was injected, and GGNs were resected through video-assisted thoracoscopic surgery.ResultsOf the 33 GGNs, 16 were pure (2 adenocarcinomas in situ, 5 minimally invasive adenocarcinomas (MIAs), 3 adenocarcinomas, and 6 benign lesions) and 17 were mixed (1 MIA, 11 adenocarcinomas, and 5 benign lesions). The mean size of all lesions was 11.2±7.78 mm, mean distance to the pleura was 11.2±14.2 mm, and mean ENB procedure time was 18.8±8.88 minutes. Dye localization and surgical resection of GGN were successful in all cases. There was no procedure-related complication.ConclusionsENB is a feasible and highly accurate localization method for minimally invasive lung resection of small GGNs.

Results of treatment of bilateral destructive pulmonary tuberculosis patients using mini-invasive surgical interventions.

There were analyzed case-histories of patients operated on bilateral destructive pulmonary tuberculosis who underwent treatment at pulmonary-surgical unit of CI “DRCCTPA” Phthisiatria” from 2010 to 2018. Case histories of 259 patients’ were included in the study, in complex treatment of which, surgical stage of treatment was used. Analyzing direct results in 2 months after surgery, the estimation based on clinical, roentgenologic and laboratory studies by criteria of destruction cavities closure, bacterioexcretion termination and clinical stabilization of the tuberculosis process was used. In carrying out a research patients were divided into 2 groups: the main group consisted of 129 patients who underwent mini-invasive methods of surgical treatment with mini-access under the control of video-thoracoscopy (single-step or staging bilateral video-assisted lung resection – 58 patients, collapse-surgical video-assisted single-step or staging interventions – 53, staging mini-invasive pleuropneumonectomy – 18). The comparison group included 130 patients operated according to standard approaches with conventional methods. Comparison groups did not differ reliably (p&gt;0,05) by the gender and the age, by tuberculosis forms, by disease duration, by functional parameters, by main prevalence and severity of tuberculosis. A biggest number of complications in both groups was noted after pleuropneumo­nectomies, lobectomies and thoracoplasty. In the comparison group postoperative complications were observed in 32 (24.6%) patients, that is 2.2 more often (p=0.002). In the main group, bronchopleural complications occurred in 8 cases (6.2%), and in the comparison group – in 16 (12.3%), that is 2 times less frequently, exacerbation of tuberculosis process was noted 3.8 times more often in patients of comparison group. Performed analysis of the nature of postoperative complications in both groups confirms the effect of traumatism of access not only on the course of the wound process, but also on the frequency of pleural, pulmonary and functional complications. A complete clinical effect in the patients of comparison group was achieved in 82 cases (63%), that is by 1.4 times less than in the main group (p&lt;0.001). Abacillation, while maintaining destruction in one of the lungs, occurred at the time of discharge from the hospital in 12 (9.3%) patients of the main group and in 21 (16.5%) – of the comparison one. There were 3 (2.3%) patients discharging bacteria in the main group and 20 (15.4%) patients in the comparison group.

Clinical Application of Vectorial Localization of Peripheral Pulmonary Nodules Guided by Electromagnetic Navigation Bronchoscopy in Thoracic Surgery

背景与目的随着计算机断层扫描技术（computed tomography scans, CT）的广泛应用，越来越多的肺小结节被发现，一些需要外科手术处理的结节数量也在增加。胸腔镜手术中对于不可直视及触摸到的肺外周小结节的准确定位较为困难。虽然目前一些常用的定位技术能够带来比较好的定位效果，如CT引导的穿刺定位和电磁导航支气管镜（electromagnetic navigation bronchoscopy, ENB）系统引导的亚甲兰染色定位，但同时仍存在着气胸、出血及定位不准确的问题。ENB引导的矢量定位法是我中心首创的一种新型定位技术，该技术避免了前两种方法可能出现的胸膜损伤或者定位区域扩大的问题，为ENB引导的定位技术提供了一定的指导。本文回顾性分析胸腔镜术前通过ENB引导矢量定位的临床结果来确定该方法的临床应用价值。方法回顾性分析2017年10月-2018年10月于青岛大学附属医院胸外科行ENB矢量定位法进行胸腔镜手术前定位的患者资料，统计患者临床资料、肺小结节影像学特征，评估该方法临床应用的安全性及有效性。结果我们成功实施了22例患者的22个肺外周结节在ENB引导下矢量定位和腔镜下楔形切除（22/22, 100%）。结节平均大小为（11.0±3.6）mm，距脏层胸膜表面距离为（16.5±6.2）mm；ENB系统显示屏导航定位装置（locatable guide, LG）与病灶距离为（14.5±10.1）mm，离体标本标记与病灶距离为（15.3±11.0）mm，ENB矢量定位平均时间为（17.5±4.2）min，无定位点LG发生移位（0.0%）。手术过程无中转开胸（0.0%），患者术中及术后未见明显并发症（0.0%），术后平均住院时间为（3.8±1.2）d，无围手术期患者死亡（0.0%）。术后病理结果为恶性肿瘤者19例，均得到了完全切除。结论我们应用ENB引导的矢量定位法在肺外周小结节术前定位和微创切除的初步经验提示该方法安全、可行、有效，可作为ENB操作中可选的一种定位方式。胸外科临床医师可以进一步研究该方法并应用到临床操作中。

Diagnosis and outcome of resected solitary pulmonary nodules after liver transplantation.

Solitary pulmonary nodules after liver transplantation are challenging clinical problems. Herein, we report the causes and clinical courses of resected solitary pulmonary nodules in patients who underwent liver transplantation. We retrospectively obtained medical records of 68 patients who underwent liver transplantation between March 2009 and June 2016. This study mainly focused on patients with solitary pulmonary nodules observed on computed tomography scans during follow-ups that were conducted until their deaths or February 2019. Computed tomography scans revealed solitary pulmonary nodules in 7 of the 68 patients. Definitive diagnoses were obtained using video-assisted lung resection in all seven patients. None experienced major postoperative complications. The final pathologic diagnoses were primary lung cancer in three patients, pulmonary metastases from hepatocellular carcinoma in one patient, invasive pulmonary aspergillosis in one patient, post-transplant lymphoproliferative disorder in one patient, and hemorrhagic infarction in one patient. The three patients with lung cancer were subsequently treated with standard curative resection. Solitary pulmonary nodules present in several serious but potentially curable diseases, such as early-stage lung cancer. Patients who present with solitary pulmonary nodules after liver transplantation should be evaluated by standard diagnostic procedures, including surgical biopsy if necessary.

Early Versus Late Paravertebral Block for Analgesia in Video-Assisted Thoracoscopic Lung Resection. A Double-Blind, Randomized, Placebo-Controlled Trial

Paravertebral local analgesia is effective in providing pain relief after video assisted thoracoscopic surgery. This randomized, double-blind pilot clinical trial investigated the effect of early perioperative delivery of paravertebral local analgesia to reduce postoperative pain after video assisted thoracoscopic lung resection and the feasibility of a larger trial. Double-blind, randomized, placebo-controlled trial. University hospital, single institution. Patients over 18 years of age having video assisted lung resection surgery. 90 patients undergoing video assisted lung resection were randomized to receive bupivacaine via paravertebral catheter either before lung resection (early; n = 47) or at the end of the operation (late; n = 43). The primary outcome measure was pain on coughing during the first 24 postoperative hours. The 95% confidence interval for a median difference was calculated using the Hodges-Lehman median difference method. There was no difference in pain scores between groups over the first 24 postoperative hours. The median (range) morphine equivalent consumption after 24 hours was 34 (7.3-105) mg with early paravertebral bupivacaine and 40.7 (3-91) mg after late paravertebral bupivacaine. The prevalence of chronic pain at 12 months postoperatively was 8.7% with early paravertebral bupivacaine and 25.8% with late paravertebral bupivacaine; the difference was not statistically significant. The authors found no difference in acute postoperative pain, but the decrease in morphine consumption and prevalence of chronic pain with early paravertebral bupivacaine, although not statistically significant, may warrant further investigation with a larger trial.

Minimal-invasive thoracic surgery in pediatric patients.

During the last two decades, there was a tremendous development of video-assisted thoracoscopic surgery (VATS), especially in the field of video-assisted lung resections. This article describes the actually state of this surgical technique in the treatment of pediatric patients. The problems in practical application are illustrated as well as clinical results, like they are presented in literature.

Using Electromagnetic Navigation Bronchoscopy and Dye Injection to Aid in Video-Assisted Lung Resection

Small (2 cm) peripheral lung lesions and ground glass opacities remain a difficult subset of lung lesions for the diagnosis and management of lung cancer. Surgical biopsy is more difficult for these lesions because intraoperative localization has to be made without the aid of direct visualization or manual palpation. Electromagnetic navigation bronchoscopy can be used in the operating room to identify a small peripheral lesion and marked using an injection of methylene blue, which can be seen on the visceral pleura of the lung. We present our initial experience using this technique. The sample was eight patients who had peripheral lesions with an average size of 19 mm. Surgical wedge biopsy was diagnostic in all cases, with an average procedure time of 28 minutes. There were no complications from this procedure. In conclusion, these data suggest that electromagnetic navigation bronchoscopy can be performed safely with high diagnostic accuracy by the operating thoracic surgeon, but further data are needed to establish its utility and safety.

Management of the Therapy of Pulmonary Sequestration: A Retrospective Multicentre Study

Pulmonary sequestration is a rare pulmonary malformation whose complex pathogenesis is not completely understood. Extrapulmonary sequestrations are always hereditary malformations and are usually diagnosed during childhood. Some intralobar sequestrations in adults, by contrast, seem to be acquired. The clinical presentation is non-specific and often misinterpreted, which results in delayed diagnosis. Surgical resection continues to be the gold standard. Despite the low incidence, new technologies developed in the past few decades, e.g. preoperative interventional angiology procedures and video-assisted lung resection, have changed the management of the disease. A prospective data collection was performed on adult patients who had undergone surgical resection of a pulmonary sequestration in four different centres during a period of 23 years. These data were retrospectively analysed. A total of 14 patients with intralobar sequestrations (n = 11, 79 % left lower lobe) underwent surgical resection. The male/female ratio was 8/6 (median age 50 years). Non-specific pulmonary symptoms such as recurrent infections had a high prevalence (n = 6, 42 %). Two patients had haemoptysis. Three patients were asymptomatic. All patients had a chest CT, 7 patients had an additional abdominal CT, while 10 underwent angiography. Preoperative embolization was performed in 5 of these patients (branches of the thoracic aorta: in 2 cases, branches of abdominal aorta: in 2 cases, and branches of both: in 1 case). Resection was mostly performed with an open surgical approach (n = 12, 86 %). Most patients had a non-anatomic pulmonary resection (n = 8, 57 %). In 7 patients, a microbiologic examination revealed a superinfection with Streptococcus pneumoniae, while 1 patient had an invasive mycosis with Candida albicans. In patients with non-specific pulmonary symptoms and undetermined lesions, especially in the lower lobes, pulmonary sequestrations must be considered in the differential diagnostic evaluation even in adult and elderly patients. If there are no contraindications, surgical removal is basically recommended and may be minimally-invasive in selected cases. The planning of the resection can be facilitated by preoperative evaluation of the arterial supply (branches of the thoracic or abdominal aorta, or both). In cases with haemoptysis or blood supply over the abdominal aorta, preoperative embolization is indicated.

胸腔鏡下肺切除術にて治癒切除と組織学的確証が得られた思春期発症の肺子宮内膜症の1例

胸腔鏡下肺切除術にて治癒切除と組織学的確証が得られた思春期発症の肺子宮内膜症の1例

Video-Assisted Lung Resection Using Radiofrequency Ablation in a Porcine Model

The aim of this study was to assess the feasibility, efficacy, and safety of video-assisted lingula resection using radiofrequency ablation (RFA) with internally cooled electrodes in a porcine model. Six domestic pigs underwent RFA-assisted thoracoscopic lingulectomy. RFA was the only aerostatic and hemostatic method applied throughout the operation. After 30 d, the animals were sacrificed for the study of the macroscopic and microscopic effects of the technique. No signs of pneumothorax, blood loss, or infection were observed up to 1 mo postoperatively. There was no mortality either during or after surgery. The histopathology of the lung revealed three clearly demarcated zone lesions. Our study demonstrates that thoracoscopic lingulectomy using RFA energy is technically feasible. RFA energy is an effective and safe aerostatic and hemostatic method in the porcine model.

Thoracoscopic procedures for intrathoracic diseases: the present status.

Thoracoscopic operations, alternatively termed as video-assisted thoracic surgery (VATS), are replacing the variety of surgical procedures which have been otherwise performed by open thoracotomy. The minimally invasive nature of the procedure, reduced postoperative pain, shortened hospital stay, and reduced cost, are the potential advantages of VATS. While these merits are being proven, the limits to this technique are also getting clearer. In fact, VATS has already become a standard treatment of choice in several diseases, such as bullectomy for spontaneous pneumothorax and biopsy for indeterminate nodule and diffuse interstitial lung disease, while others, such as major video-assisted lung resection for lung carcinoma and resection of metastatic lung tumour, await further evaluation of their roles in terms of oncological and technical aspects. Three issues that currently need to be addressed as the present role of thoracoscopy evolves are instrumentation, economics, indication, and end results in certain procedures.

Major pulmonary resection by video assisted mini-thoracotomy. Initial experience in 35 patients.

Video-assisted thoracic surgery is emerging as a viable approach to increasingly complex intrathoracic therapeutic procedures. From February to July 1993, 35 patients (25 male, 10 female; mean age = 60 years, range: 17-74) underwent a major pulmonary resection using a video-assisted technique: lobectomy (n = 30) or pneumonectomy (n = 5). Pathology disclosed bronchogenic carcinomas (n = 26), metastases (n = 3), and miscellaneous disorders (n = 6). All procedures required one 10.5 mm port for the video-camera, one 3.5 to 5 cm utility thoracotomy through which surgical instrumentation was inserted and the operative specimen removed, and one occasional supplementary 12 mm port. Lung resections were performed with separated dissection and division of each component of the pedicle. The mean operative time was 145 min (SD: +/- 17). There were two postoperative deaths (5.7%) that were not directly related to the technique. Seven patients (20%) experienced non-fatal complications. After lobectomy, the mean duration of chest tube placement was 7.3 days (SD: +/- 1.6). The mean hospital stay was 11 days (SD: +/- 3). All the patients experienced minor postoperative chest pain. We conclude that video-assisted lung resections are technically feasible without an increased risk.