Video-assisted Surgery Research Articles

The feasibility of using small biopsy samples from lung cancer for targeted next-generation sequencing.

e20584 Background: As the genomic based personalized medicine has been advanced, biomarker analysis using targeted next-generation sequencing (NGS) becomes crucial diagnostic approach for treatment of lung cancer. Most patients of lung cancer are diagnosed on small biopsy specimen, but the feasibility of the small tissue samples for targeted NGS has not been evaluated. We aimed to investigate the feasibility of using small tissue samples of lung cancer for targeted NGS. Methods: The medical records of the patients who underwent biopsy and targeted NGS were reviewed. Two types of panel for targeted NGS were used which were AmpliSeq Cancer Hotspot panel v2 and Oncomine Focus Assay. Results: A total of 603 biopsy specimens of lung cancer were analyzed from April 2014 to October 2016. The sites of biopsy were lung or bronchus (51.2%), lymph node (26.2%), Pleura (2.3%), liver (2.5%), Brain (1.7%) and the others (adrenal gland, bone, muscle, spleen, stomach, thymus). Percutaneous transthoracic core needle biopsy (PTCNB) was most frequently used method for acquisition of tissue (24.9%). The other methods of biopsy were bronchoscopy (14.4%), endobronchial ultrasound (EBUS, 23.8%), Video-assisted transthoracic surgery (VATS, 9.9%) and so on. The types of tissue samples were formalin-fixed, paraffin-embedded (FFPE, 80.6%) and fresh tissue (19.4%). All of these samples, 398 cases (66.0%) were successfully analyzed using targeted, NGS. In 34% of analysis failure cases, 23.5% were not adequate for DNA or RNA extraction and 10.5% had amount not to be enough. On multivariate analysis, PTCNB was more likely to fail than other methods of biopsy such as bronchoscopy, EBUS (HR 2.31, 95% CI 1.4-3.8, p = 0.001). Conclusions: The biopsy of lung cancer for targeted NGS was taken from a variety of sites via different methods, and the type of tissue samples was mostly FFPE. Considering the yield of our study, small biopsy specimens could be used to investigate genomic characteristics of lung cancer via targeted NGS.

Postoperative pain experiences in Chinese adult patients after thoracotomy and video-assisted thoracic surgery.

To investigate the developing course of postoperative pain in a Chinese sample of patients following thoracic surgery. Chronic postoperative pain following thoracic surgery including both thoracotomy and video-assisted thoracic surgery is often reported. However, research on pain trends concerning this topic is scarce with a notable lack of culturally focused studies by nurses. A prospective observational study. The sample included patients undergoing thoracotomy (n=137) and video-assisted thoracic surgery (n=143). Pain intensity and interference of pain with function were assessed during hospitalisation (day 1 to day 7 postoperatively) and followed up by telephone at 2weeks and then at 1, 2, 3 and 6months after surgery. Moderate-to-severe pain when coughing and moving was reported in over 85% during hospitalisation, and a significant difference in pain was found between those undergoing a thoracotomy (61%) and those having video-assisted surgery (34%). Many patients whose immediate postoperative pain was poorly managed tended to report high pain levels after discharge and continued to have clinically important chronic pain 6months after surgery. The pain intensity mean score during movement in the first five postoperative days was an important predictor of clinically important chronic pain, and those experiencing severe acute pain during hospitalisation had a higher probability of developing chronic pain. Postoperative pain after thoracic surgery warrants greater attention because those experiencing severe acute pain during hospitalisation have a higher probability of developing chronic pain. Aggressive pain management and multimodal analgesia are recommended to prevent long-term suffering in patients. Chronic pain after thoracic surgery remains a challenge in clinical nursing. To improve pain management quality and to prevent the transition of acute postoperative pain to chronic pain, standardised practice protocols and comprehensive physician and nurse education are highly recommended.

Thoracoscopic Approach of Bilateral Chylothorax

Introduction: Chylothorax is a relatively common complication of pediatric cardiac surgery. Although reaching a diagnosis is simple, management is a challenge and consensus is lacking. We report the case of a 10 days old, female newborn, who presented with bilateral chylothorax after surgical correction of congenital transposition of the great vessels and showed no response to medical therapy for a period of 1 month. Materials and Methods: A full-term newborn infant with prenatal diagnosis of transposition of the great vessels underwent arterial switch surgery at 10 days of life, which required two revisions because of bleeding. The patient evolved with a bilateral chylothorax and mechanical ventilation and inotropic medications were required. A neck CT scan showed thrombosis of the right and left internal jugular veins and the right cerebral venous sinus. Multiple conservative treatment measures were implemented. Bilateral pleural fluid was drained, a fat-restricted oral diet supplemented with medium chain triglycerides was instituted, followed later by total parenteral nutrition and intravenous administration of octreotide. Notwithstanding, the chylothorax persisted and, finally, a video-assisted thoracic duct ligation with bilateral pleurodesis was planned and performed, as shown in this video. Once in the operating room, endotracheal intubation was placed and the patient was situated in 3/4 prone position. Three trocars were inserted into the right chest: one on the mid-axillary line at the level of the third intercostal space, the second one on the posterior axillary line at the level of the fifth intercostal space, and the third one on the scapular line, at the eighth intercostal space level. A 5 mmHg CO2 pneumothorax was created to collapse the right lung. Using a 3.8 mm arthroscope with a wide angle lens, dissecting forceps, and a 3 mm aspiration cannula, multiple fibrin partitions were released, and abundant chyle that was trapped in them was drained. After the right pleural cavity was unified, the thoracic duct was identified. It was composed of a main and an accessory trunk that were both dissected, clamped, and sectioned with 5 mm polymer ligating clips. The esophagus was entirely dissected. The thoracic aorta was dissected too, until a particular area of the mediastinal pleura was found, allowing passage to the left hemithorax. Fibrin cysts and partitions were released and chylous content was evacuated, unifying the left pleural cavity. Finally, talcum powder was spread homogeneously on the parietal and the visceral membranes of both pleural cavities and a 12F pleural drainage was placed in each hemithorax. Results and Conclusions: The patient showed improvement and the chylothorax has not reappeared. Video-assisted surgery of refractory cases of bilateral chylothorax is feasible and can be performed safely and effectively using one-sided thoracoscopy. No competing financial interests exist. Runtime of video: 2 mins 14 secs

Evaluation of clinical, morphological and pathohistological characteristics of thymomas - our ten year experience

Background. Thymomas are rare neoplasms arising from tissue elements of the thymus. The objective of the study was to analyse clinical characteristics of patients with thymoma, as well as morphological and patohistological features of neoplasms. Methods: Retrospectively we studied 41 medical records and patohistological material of patients reffered to the Institute for pulmonary diseases of Vojvodina between the January 2005 and December 2014. Results: Patient age at presentation ranged from 19 to 77 years. A slight female preponderance was detected, with 24 (58.5%) females and 17 (41.5%) males being affected. All types of thymoma more often occured in males, accept subtype B1. Patients with type A thymoma and subtype B1 were mainly asymptomatic, while patients with subtype B2 and type presented with dyspnea, dysphagia, pain and cough. Myasthenia gravis often was associated with type A (40%). The most common histologic type was subtype B1. Twenty three (56%) patients had a tumor diameter between 5 and 10 cm. Five patients had malignant thymoma, and the most common types of thymoma that showed signs of capsula invasion or pleural and pericardial implants were type (60%) and subtype B2 (50%). Biopsies of suspected tissue were obtained through a sternotomy, video-assisted thoracoscopy surgery, and video-assisted mini thoracotomy, and after setting a diagnosis on ex tempore analysis, the lesions were removed by thymectomy or extirpation of the tumor mass. Conclusion: Thymomas have variable clinical presentations. Clinical outcome correlates with histological type, size and clinical stage, as well as the ability to achieve complete tumor resection.

Efficacy and safety of single versus repeated stepwise cycling recruitment maneuver during one-lung ventilation in patients with normal pulmonary function undergoing video-assisted thoracoscopic lung surgery: a randomized, controlled trial

Background One-lung ventilation (OLV)-associated hypoxemia is a major concern and a challenge for the anesthesiologist. Lung recruitment maneuvers (RMs) are ventilator strategies in which the main goal is to restore the functional residual capacity and improve arterial oxygenation. Hemodynamic side effects are mainly associated with ‘fast’ RM not with ‘slow’ cycling RM and their effects are self-limited; therefore, they must be performed repetitively. Aim The aim of this study was to evaluate the efficacy and safety of single versus repeated stepwise cycling RMs during OLV in patients with normal lung function. Settings and design The study design is a randomized, double-blinded, controlled one. Patients and methods Sixty adult patients of ASA I–II who were scheduled for elective thoracoscopic lung surgery were randomized into groups C, single recruitment maneuver (SRM), and repeated recruitment maneuver (RRM) comprising 20 patients each. Group C patients received standard ventilation protocol: volume-controlled ventilation mode, VT 6 ml/kg, I : E ratio 1 : 2, positive end expiratory pressure (PEEP) 5 cmH2O, and respiratory rate 10–12 breaths/min. SRM patients received standard ventilation protocol with one alveolar RM 10 min after initiation of OLV with a PEEP of 10 cmH2O until end of surgery. RRM patients received standard ventilation protocol with first RM 10 min after initiation of OLV and then repeated every 30 min during OLV and a PEEP of 10 cmH2O until end of surgery. The following were assessed: hemodynamic parameters – heart rate, mean arterial blood pressure, and central venous pressure; respiratory mechanical parameters – peak airway pressure (Paw-peak), plateau pressure (Paw-plat), and static lung compliance; and oxygenation parameters – partial arterial oxygen tension (PaO2), PaO2/FiO2, and oxygen saturation (SpO2). Results PaO2 and PaO2/FiO2 ratio increased in the SRM and RRM groups after RM from T2 (10 min after first RM) to T4 (45 min from first RM), with a significant difference compared with group C (P Conclusion Single or repeated cycling RM was considered effective with high safety profile in patients with normal pulmonary function undergoing thoracoscopic lung surgery using OLV.

Less invasive video assisted cardiac surgery a comparative study with the conventional approach

Background-Vertical median sternotomy has been the best approach to cardiac surgery. While the conventional approach is traumatic, with many complications, using a video camera in surgery offers smaller incisions. Methods - Our study was a prospective and comparative one. Our sample consisted of 57 patients, divided into 2 groups, including 30 patients operated by vertical median sternomtomy and 27 patients operated by minimally invasive video-assisted surgery. Preoperative, operative and postoperative data were collected and analyzed. Results -The patients’mean age was 49.5+16.3 years in the minimally invasive video-assisted group and 43.4+16.7 in the vertical median sternotomy group. The most common sign among these patients was dyspnea. Asymptomatic patients represented 11% in the vertical median sternotomy group and 43% in the minimally invasive video-assisted group. Mitral valve surgery was in 63% patients of minimally invasive video-assisted and 66.6% of vertical median sternotomy group. The mean time of cardiopulmonary bypass was 119.52+44.5 min in the minimally invasive video-assisted group and 84.53+34.2 min in the vertical median sternotomy group. The mean time of aortic clamping in the minimally invasive video-assisted group was 94.56+40.8 min while it was 59.53+25.5 min in the vertical median sternotomy group. The mean time of mechanical ventilation was 4.7+1.8 hours in the minimally invasive video-assisted group and 7.9±2.4 hours in the vertical median sternotomy group. Postoperative pain disappeared on the 2nd postoperative day in (73%) of the minimally invasive video-assisted group cases and on the 5th day in (70%) of vertical median sternotomy group cases. The average hospital stay was 8.67+3.8 days in minimally invasive video-assisted and 13.8+5.0 days in vertical median sternotomy group. Faster recovery of physical activities after minimally invasive surgery was reported. Conclusion - The minimally invasive video-assisted is a simpler, safer and more effective procedure with excellent results and low morbidity. This procedure results in a short -er recovery time.

P2.04-001 A Comparative Analysis of Long-Term Outcome of Thymoma between Video-Assisted Surgery and Open Resection from Multi-Center Study Data: Topic: Thymic Malignancies Clinical and Translational

P2.04-001 A Comparative Analysis of Long-Term Outcome of Thymoma between Video-Assisted Surgery and Open Resection from Multi-Center Study Data: Topic: Thymic Malignancies Clinical and Translational

Atuação da enfermagem em cirurgia cardíaca minimamente invasiva videoassistida*

Objetivo: Relatar a atuação da enfermagem no perioperatório da cirurgia cardíaca minimamente invasiva videoassistida. Método: Trata-se deum relato de experiência da equipe de enfermagem no perioperatório dessa técnica cirúrgica, realizada em um hospital-escola que é referência em cardiologiano Estado de São Paulo. Resultados: Observa-se a importância da atuação da enfermagem no preparo do centro cirúrgico (CC), recepção dopaciente, assistência ao ato anestésico, preparo do paciente para a cirurgia, atendimento à equipe no período intraoperatório e na saída do paciente desala operatória (SO), atendendo às demandas desta modalidade cirúrgica inovadora. Conclusão: A enfermagem de centro cirúrgico (CC) deve ser capacitadaa acompanhar a evolução das técnicas cirúrgicas, tanto no manuseio dos novos materiais e equipamentos como na assistência direta ao paciente,visando à segurança cirúrgica.

First Hands-On Experience with the Application of a Newly Designed Double-Branched Thoracic Catheter for Thoracic Interventions.

Background We investigated the technical handling of a y-shaped double-branched thoracic catheter with the aim of combining the effect of two separate catheters and the ease of use of a single one. Methods A total of 20 catheters were placed consecutively in 20 patients. Results In all patients, it was technically simple to position the catheter, whether in open or video-assisted surgery. The handling during removal corresponded to that of a single drain. Conclusion This type of drain appears to hold a lot of potential compared with the use of a single drain. Further studies with defined and larger patient populations should be performed.

Transanal video-assisted surgery: Indications, technical options and results. The experience of a colorectal cancer surgical division

Transanal video-assisted surgery: Indications, technical options and results. The experience of a colorectal cancer surgical division

Laparoscopy in the Treatment of Children with Intussusception

Intussusception is one of the main causes of intestinal obstruction in children that requires timely treatment. Despite the high efficacy of therapeutic methods of intussusception reduction, some patients need the surgery. The question of the surgery method choice, namely open laparotomy or laparoscopy, is still under debate.The objective of the research was to summarize own experience of laparoscopy in children with an intussusception.The research was grounded on the results of treatment of 28 children operated in the first surgical department of the Lviv Regional Children’s Clinical Hospital «OHMATDYT» during 2008-2015. Optical system Strayker 1088 HD (Germany) with the 3-, 5-mm laparoscopic equipment was used for laparoscopy. The reduction of intussusception was performed by the retrograde traction of small intestine with the sliding catches.Laparoscopic intussusception reduction was successful in 67.9% of patients, conversion was conducted in 32.1% of patients. The main reasons for the conversion were the necrosis of intestinal loop needing resection, presence of the complex intussusception, and the presence of polyp clear to the ileocecal valve. In 10.7% patients the laparoscopic reduction was supplemented by per rectum pneumoreduction with the help of Richardons’ system. During the last year, in cases of intestine resection need, the video-assisted operations were applied, when the intestine mobilization was performed laparoscopically and anastomosis was applied extraperitonealy. Complications during laparoscopic reduction and in the postoperative period were not observed.Laparoscopy is the safe and effective method of patients with the intussusception treatment. Thorough selection of patients for the laparoscopic intussusception reduction makes it possible to decrease the rate of conversion.

A comparative study of the surgical outcomes between video-assisted and open lateral neck dissection for papillary thyroid carcinoma with lateral neck lymph node metastases

PurposeVideo-assisted lateral neck dissection (VALND) for papillary thyroid carcinoma (PTC) with lateral neck lymph node metastases (LNM) has been described previously, however, the advantages and drawbacks of VALND have not been demonstrated in previous studies. The aim of this study was to compare the surgical outcomes of video-assisted and open lateral neck dissection for PTC with lateral neck LNM. Materials and methodsBetween May 2013 and November 2014, 92 consecutive patients with PTC and lateral neck lymph node metastases underwent total thyroidectomy with central compartment neck dissection and unilateral lateral neck dissection. These included 54 individuals who underwent video-assisted surgery, and 38 in whom an open approach was used. The two groups were retrospectively compared with respect to their clinicopathological characteristics, surgical outcomes and oncological completeness. ResultsThe mean follow-up period was 18.6months. The mean tumor size, tumor stage, mean numbers of retrieved lymph nodes, mean postoperative serum thyroglobulin levels, complication rates, and mean postoperative hospital stay were similar between the two groups. The mean operation time was longer (p=0.0001) and mean age was lower (p=0.0354) in the video-assisted group. The cosmetic results, evaluated by numerical scale and verbal response scale, were in favor of the video-assisted group (p=0.0003 and p<0.0001, respectively). ConclusionsThe safety and oncological completeness of VALND was similar to that of open procedures, but the VALND resulted in improved cosmetic results. VALND is an effective treatment for the selected cases of PTC with lateral neck LNM.

Single-incision versus conventional three-port video-assisted surgery in the treatment of pneumothorax: a systematic review and meta-analysis.

Single-incision thoracoscopic surgery (SITS) has been applied in the treatment of pneumothorax. To establish the feasibility of SITS in comparison with conventional three-port video-assisted thoracoscopic surgery (3P-VATS), we conducted this meta-analysis. Relevant studies were searched in PubMed, Cochrane Library, SpringerLink and ScienceDirect. Studies that compared the outcomes between SITS and 3P-VATS were included for analysis. Nine eligible studies with 768 participants were included. Our analysis indicates that when compared with 3P-VATS, SITS was associated with less postoperative pain (weight mean difference, WMD = -0.67, 95% confidence interval, CI = -1.11 to -0.22, P = 0.004 for postoperative pain at 24 h; WMD = -0.62, 95% CI = -1.11 to -0.12, P = 0.01 for postoperative pain at 72 h), lower paraesthesia rate (odds ratio, OR = 0.09, 95% CI = 0.04-0.21, P = 0.01) and shorter hospital stay (WMD = -0.34 days, 95% CI = -0.60 to -0.08, P = 0.01). No significant association was found in operative time, mean duration of chest tube, complications and recurrence rates. SITS was a safe and efficient procedure for the treatment of pneumothorax with less postoperative pain and faster recovery. The complication and recurrence rates were equivalent when compared with 3P-VATS.

Video-assisted thoracoscopic surgery is a safe option for benign lung diseases requiring lobectomy

Lobectomy for benign lung disease is renowned to be technically complex and to be subjected to an increased complication rate. The objective of this study was to evaluate whether the results obtained with video-assisted surgery (VATS) in benign disease are comparable to those obtained in oncologic surgery, where VATS has been validated. We have reviewed the files of 246 consecutive patients who underwent VATS lobectomy from January 2012 to August 2015. The cohort was divided into two groups according to pathology (benign or malignant). Outcome parameters on scrutiny were demographics, pathology, duration of air leak, drainage and hospital stay, conversion, and perioperative complication rate. Comparisons were made with the χ 2 test and Student's t test; any p value ≤0.05 was considered as significant. Group 1 (36 patients) included patients who underwent lobectomy for benign disease and group 2 (210 patients) patients affected by lung cancer or pulmonary metastases. The two groups differed with reference to age (p<0.001), history of cancer (p<0.001), history of stroke (p=0.05), and the presence of pleural adhesions (p=0.03). There was no difference for duration of air leaks, chest tube drainage and hospital stay, conversion rate, and perioperative complication rate. We conclude that pathology did not impact on outcomes after VATS lobectomy. This study suggests that VATS is as a safe option in selected patients with benign disease requiring lobectomy, despite a more complex technical context.

Application of thoracic paravertebral nerve block in video-assisted thoracosopic surgery: a randomized controlled trial

To investigate the effect of a single dose of ropivacaine combined with sufentanilfor thoracic paravertebral block (TPVB) on pain and enhanced recovery after surgery (ERAS) in patients undergoing video-assisted thoracosopic surgery. Sixty patients undergoing video-assisted thoracosopic surgery were randomly divided into three groups to receive intravenous combined general anesthesia (group C), a single dose of ropivacainefor thoracic paravertebral block before surgery combined with intravenous and general anesthesia(group T1), or a single dose of ropivacaineand sufentanilfor thoracic paravertebral blockcombined with intravenous and general anesthesia (group T2). None of the patients used postoperative analgesia pump, and tramadol hydrochoride injection (100 mg) was given in cases with NRS scores > 4 after the surgery. The data were recorded including analgesics used for nerve block before the operation, intravenous dosage of sufentanilduring operation, total dose of sufentanilused (intravenous+nerve block), intravenous remifentanil dose during operation, NRS scores at 4, 6, 24, 48 h after the surgery, rescue analgesia in the first postoperative 24 h after surgery, ICU stay and hospital stay after the surgery. Compared with those in group C, the intravenous sufentanildose, total sufentanildose, intravenous remifentanildose during operation, NRS scores at 4 and 6, 24 h, and ICU stay and hospital stay after the surgery were significantly decreased in groups T1 and T2 (P<0.05). The total dose of opioids during the operation and NRS scores at 4 and 6 h were significantly lower in group T2 than in group T1 (P<0.05), but the total dose of sufentanil, ICU stay and hospital stay were simialr between the two groups. A single dose of ropivacaine combined with sufentanilfor thoracic paravertebral blockbefore surgery can reduce the total dose opioids, produce the optimal analgesic effect, and promote postoperative recovery of the patients.

Future Medicine Services Robotics

It is an entry technique in use recently, albeit in selected centers and represents a further step in the field of minimally invasive surgery. Basically it has the same indications but, at present, is reserved for selected patients. Compared to traditional video-assisted surgery presents some important differences. The surgeon is physically distant from the operative field and sits at a console, equipped with a monitor, from which, through a complex system, controls the movement of the robotic arms. These are fixed the various surgical instruments, tweezers, scissors, dissectors, that team shall present to the operating table to introduce into the cavity operative site. The use of mechanical arms has the advantage of allowing a three dimensional view an image with more stops and to make the most delicate maneuvers purposes and also because the tools are articulated to the distal end. The disadvantage is related to the times longer operative and the difficulty of determining the strength (as can happen in giving the right tension to a surgeon's knot). In the future it can be assumed that robotic surgery will allow, with the development of the experience, the spread of the equipment and improvement of telecommunication systems and data, to operate at ever greater distances. If you think that today, the space centers, you can operate the robots sent to the moon or farther away, it is not hard to believe that it will become usual to operate from side to side of the area, providing you with all the best and specific skills. The first surgical robot called da Vinci, in honor of Leonardo da Vinci, was developed in Silicon Valley by Intuitive Surgical and in 2000 he obtained the authorization of the American Food and Drug Administration (FDA) for use in laparoscopic surgery. The present paper wishes to show briefly several models of the main robots placed in the service of human medicine.

How Surgical Care is Changing in the Technological Era

It is undoubted that in the last 20 years technology has changed surgical care, which is now evolving rapidly following the introduction and expansion of minimally invasive surgery and the utilization of tablets and smartphones to communicate between patients and doctors, or between doctors themselves (mobile healthcare). In this article, I try briefly to analyze how these two major changes may bring a new dimension to the future of worldwide healthcare, using the example of thoracic surgery. To begin, the introduction in 1998 of the ‘uniportal’ surgery today permits us to perform many operations in thoracic and abdominal surgery through a single small skin incision [1–6]. Uniportal video-assisted surgery is more and more often used worldwide, and is currently performed by a team formed by one or two surgeons. This is less than 20 years ago, and therefore it can be envisioned that in the future we could certainly need fewer surgeons [7]. Moreover, the fact that surgical skills needed to operate through a small incision must be prominent, it will be necessary for the surgeon to undergo specific training to acquire the necessary elevated surgical capability to operate on patients [2]. I envisage, for the benefit of our patients, that every complex operation could be watched by ‘expert surgeons’ who, in a supervisory room, act as live councilors for when an intraoperative doubt arises – this could decrease intraoperative risks and give better long-term results. Of note here is that use of smaller incisions to treat cancer should never place patients at risk, and the uniportal surgery would require approval by scientific societies following evidence of improvement of patient outcomes, or at least maintenance of the same outcomes, for benign and malignant diseases. I agree with the unpublished words of T Treasure that these techniques are not for every surgeon to explore, but if proven to be in a patient’s best interests, they should not be avoided but adopted. The big question is therefore how to test whether innovations are true improvements, using randomized trials. Another point of future discussion is how to train our next generation of surgeons, who must use both hands to operate through a small entry in the chest or abdomen; of course, this will be facilitated in the case of robotic surgery as the surgeon will operate via the console. Next, we will consider the use of mobile technology such as smartphones or tablets in medicine, which permit that images files (x-rays, CT-scan, angiography etc.) could be transferred through social media applications such as Whatsapp; the consultant can therefore see the images within a few seconds from home or wherever he\she is, and consequently medical opinions can be delivered to the resident without hesitation and without the need to reach the hospital, as was How surgical care is changing in the technological era

Uniportal video-assisted thoracic surgery.

Even though the development of thoracoscopic procedures has a history of over a hundred years, it is only in the last two decades that interest in minimally invasive thoracic surgery has been renewed by two key technological improvements. These are the development of endoscopic cameras offering a panoramic view and the availability of new endoscopic instruments such as mechanical staplers. As a result of these advances, video-assisted thoracic surgery (VATS) was born. In 1992, there was a revolution in thoracic surgery when the first anatomic lung resection was performed by VATS through small incisions and with no rib spreading. In the following years, the progress of VATS was slow and accompanied by constant criticism until studies showing clear benefits of VATS over open surgery started to be published. From that point on, the technique spread throughout the world and variations of the technique regarding the number and placement of incisions, surgical approaches and new surgical instruments started to emerge. The information available on the Internet, live surgical events and experimental courses were important factors facilitating the rapid learning curve for minimally invasive surgery during the last decade. While initially slow to catch on, the traditional multi-port approach has evolved into a single-port (uniportal) approach that mimics open surgical vantage points while utilizing a non-rib-spreading, non-thoracotomy micro-incision. The early development of uniportal VATS was focused on minor procedures until the second phase of uniportal VATS started in 2010 with application of the technique to major pulmonary resections. In a period of only five to six years, experts have been able to apply the uniportal VATS technique to more complex procedures such as bronchial sleeve and carinal resections as well as vascular reconstructions. In contrast, non-intubated thoracic surgical techniques, described since the early history of thoracic surgery, peaked in the decades before the invention of the double-lumen endotracheal tube and have failed to gain widespread acceptance following their re-emergence over a decade ago thanks to improvements in video-assisted thoracoscopic techniques. In addition, experienced uniportal VATS surgeons are able to explore new and even less invasive approaches. Recently, the aim to avoid intercostal nerve damage by the transthoracic incision has led to the use of the technique through a single subxiphoid incision. It’s interesting to note that from the first thoracoscopic procedure performed more than a century ago, the biggest developments have taken place in the last five years. Several factors are responsible for this. The Internet has provided an invaluable platform to share knowledge. The development of specialized websites to which videos can be uploaded and scientific journals that include videos have contributed enormously to the dissemination and learning of minimally invasive techniques, especially uniportal VATS. The development of modern, narrowed and angulated endostaplers and other specialized surgical instruments have also been key factors contributing to the growing interest in uniportal video-assisted surgery in the last few years. At the same time, advances in the technology of ultra-high definition cameras, 3D technology and precise robotic systems have contributed to the progressive adoption of minimally invasive surgery throughout the globe. This special issue provides a summary of different aspects of uniportal VATS including several articles written by some of the best world experts in this technique. Areas covered range from the early experience of several groups to reports from the most experienced surgical teams, as well as emerging techniques such as uniportal non-intubated and subxiphoid approaches. Alongside medical and radiation oncology, which are advancing rapidly due to the development of more effective chemotherapeutic agents with less toxicity and novel radiation techniques such as stereotactic body radiation therapy (SBRT), the role of the surgeon is to offer the patient the best oncologic procedure with the least invasive approach possible. During the last couple of years, rapid progress in instrument design and technology have triggered the development of narrower and more angulated endostaplers, sealing devices for vessels and other refined thoracoscopic instruments. We truly believe in the use of the least invasive techniques such as the uniportal approach combined with modern ‘naked eye’ 3D image systems, wireless cameras and improved robotic technology to perform major pulmonary resections. Further advancements in technology will facilitate the adoption of single-incision minimally invasive techniques worldwide in the upcoming years. Video Uniportal video-assisted thoracic surgery.

内視鏡補助下に頸部外切開で切除した気管内毛細血管腫の1例

内視鏡補助下に頸部外切開で切除した気管内毛細血管腫の1例

Video-assisted surgery in the diagnosis and treatment of thoracic and abdominal injuries

to prove the efficacy and safety of video-assisted techniques in diagnosis and treatment of victims with thoracic and abdominal trauma. It was analyzed treatment of 249 patients with thoracic (n=82), abdominal (n=122) and thoracoabdominal injuries (n=35) who were divided into 2 groups depending on treatment. Control group of conventional diagnosis and treatment included 130 (52%) patients. Group 2 consisted of 119 (48%) patients in whom differentiated surgical approach combined with current technologies was applied. Video-assisted techniques did not reveal thoracic (n=9) and abdominal (n=7) injuries in 16 out of 103 cases. There was conversion to open surgery in 20 patients. In group 2 conventional thoracic (n=15) and abdominal (n=22) interventions were made in 37 (36%) cases while endoscopic surgery was used in other 66 (64%) patients. Postoperative complications after endoscopy were observed in 8 patients. There were 2 deaths. Rational and effective use of video-assisted surgery for thoracic and abdominal trauma significantly improves outcomes in these severe patients.