Video-assisted Thoracic Surgery Procedures Research Articles

Uniportal Laser-Assisted Video-Assisted Thoracoscopy (U-LA-VATS) for Lung Metastasectomy: Technical Description, Peri-Operative Results and Pertinent Literature Review

Pulmonary metastasectomy (PM) is a well-established treatment that is able to contribute to the cure of oligometastatic cancer. Surgery should adopt the most lung-sparing approach possible to preserve pulmonary function (and, consequently, the quality of life) and to spare the lung for potential additional lung resections. In this framework, laser technology has been introduced in recent decades, but only few experiences combining laser technology with VATS approaches have been reported till now. The main focus of this manuscript is to report our institutional experience in performing lung-sparing laser-assisted PM by uniportal VATS (uniportal laser-assisted VATS: U-LA-VATS). The surgical technique and peri-operative results from our series of patients were herein presented and compared with the pertinent literature. Methods: Between March 2021 and November 2023, among 98 patients who underwent PM, a total of 24 patients (18 men (75%); 6 women (25%); mean age 61.4 years; age range 13–83 years) were treated with laser-assisted PM at our institution. Patients who underwent anatomical resection were excluded for the purpose of the analysis. The U-LA-VATS procedure adopted a modified laser-assisted lung resection technique for performing PM via VATS. Dedicated instruments are used, characterized by a long shape and a curved shape, with distal and proximal articulations. A surgical laser system (Thulium + Diodo OUTPUT 30–10 W, Quanta System S.p.a., Solbiate Olona, Italy) was used, and a 550-μm sterile optical fibre conducted through a specific thoracoscopic handpiece was introduced in the lowest part of the incision. Peri-operative results were analysed in all cohort and compared according to the surgical technique. Moreover, these results were compared with those reported in the literature. Comprehensive research of the literature was conducted on PubMed from 2000 to 2024. A review was performed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: In 12 cases (50%), thulium laser-assisted resection was performed using uniportal video-assisted thoracic surgery (VATS), and in the other cases (12, 50%), a (mini)thoracotomy access was adopted. In the thoracotomy group, the mean duration of surgery was 95 ± 57.7 min; meanwhile, it was 73.5 ± 35.5 in the uniportal VATS group. At the univariate analysis, this difference resulted to be statistically significant (p value 0.025). We did not observe intra-operative complications or remarkable malfunction of the laser system. We also did not report major complications after surgery; also the air-leak rate was 8.3% and 0% after thoracotomic and VATS procedures, respectively. Surgical margins were free from disease in all cases. Major and minor post-op complication rates were similar in both groups. The mean hospitalization after surgery was 2.9 ± 0.3 days for the uniportal VATS group and 3.7 ± 0.9 days for the thoracotomy group, this difference being statistically significant at the univariate analysis (p value = 0.015). Conclusions: U-LA-VATS is a safe and effective procedure, able to combine a parenchymal sparing exeresis with a mini-invasive approach. This procedure is associated with a shorter hospital stay compared with PM performed by a thoracotomic approach. Compared with the selected works for the review, our series is the only one describing the use of laser resection combined with a uniportal VATS approach.

Optimizing anesthesia strategies to NSCLC patients in VATS procedures: Insights from drug requirements and patient recovery patterns.

Understanding the intricate relationship between cancer clinicopathological features and anesthetics dosage is crucial for optimizing patient outcomes and safety during surgery. This retrospective study investigates this relationship in patients with non-small cell lung cancer (NSCLC) undergoing video-assisted thoracic surgery (VATS). A comprehensive analysis of medical records was undertaken for NSCLC patients who underwent VATS with intravenous compound inhalation general anesthesia. Patients were categorized based on histological, chemotherapy, radiotherapy, and epidural anesthesia factors. Statistical analysis was performed to compare the differences between the groups. The results revealed compelling insights. Specifically, patients with lung adenocarcinoma (LUAD) undergoing VATS exhibited higher dosages of rocuronium bromide and midazolam during general anesthesia, coupled with a shorter post-anesthesia care unit (PACU) stay compared to those with squamous cell carcinoma (sqCL). Furthermore, chemotherapy patients undergoing VATS demonstrated diminished requirements for phenylephrine and remifentanil in contrast to their non-chemotherapy counterparts. Similarly, radiotherapy patients undergoing VATS demonstrated a decreased necessity for rocuronium bromide compared to non-radiotherapy patients. Notably, patients who received epidural anesthesia in combination with general anesthesia manifested reduced hydromorphone requirements and prolonged hospital stays compared to those subjected to general anesthesia alone. In conclusion, the findings from this study indicate several important observations in diverse patient groups undergoing VATS. The higher dosages of rocuronium bromide and midazolam in LUAD patients point to potential differences in drug requirements among varying lung cancer types. Additionally, the observed shorter PACU stay in LUAD patients suggests a potentially expedited recovery process. The reduced anesthetic requirements of phenylephrine and remifentanilin chemotherapy patients indicate distinct responses to anesthesia and pain management. Radiotherapy patients requiring lower doses of rocuronium bromide imply a potential impact of prior radiotherapy on muscle relaxation. Finally, the combination of epidural anesthesia with general anesthesia resulted in reduced hydromorphone requirements and longer hospital stays, suggesting the potential benefits of this combined approach in terms of pain management and postoperative recovery. These findings highlight the importance of tailoring anesthesia strategies for specific patient populations to optimize outcomes in VATS procedures.

Image-Guided VATS in the Hybrid Operation Room Facilitates Early Diagnosis and Concurrent Treatment of Subcentimeter Nonpalpable Lung Nodules.

As lung cancer screening increases, the detection of small, nonpalpable lung lesions is on the rise. The hybrid operation room (OR), which combines percutaneous or endobronchial fiducial placement with on-table computed tomography (CT) and fluoroscopic guidance, improves localization and facilitates the diagnosis and treatment of smaller, nonpalpable lung nodules with greater accuracy. In 35 consecutive months, 55 veterans underwent 60 image-guided video-assisted thoracic surgery procedures for lesion resection. Of the cases, 36% were found during lung cancer screening. All patients received their care in the hybrid OR, where cone-beam CT scan technology was used to place an average of 1.6 fiducials percutaneously (n = 55) or via augmented navigational bronchoscopy (n = 5). A total of 66 lesions were resected. The median lesion size was 8 mm with an interquartile range of 6 to 14. The patients underwent nonanatomical resection with lymph node dissection using radiologic guidance. When indicated, an anatomical resection was subsequently performed. Of 47 total non-small cell lung cancer lesions, 83% were diagnosed at stage IA1 or IA2. The median surgical margin was 15 mm; the margin was usually 1.5 times as wide as the lesion. The hybrid OR technology gives a 3-dimensional assessment of the small lung lesions, allowing for a tissue-saving resection while achieving good surgical margins. During lung cancer screening, smaller, nonpalpable lung nodules are frequently found. This technology allows resection of subcentimeter lesions, which would otherwise be unresectable at this early stage, possibly improving survival.

VATS Lung Resection in Bosnia and Herzegovina

Background: Video-assisted thoracic surgery (VATS) for both minor and major thoracic procedures has become routine practice worldwide. In this study, we present our experience with multiportal and uniportal VATS (MVATS and UVATS) in Bosnia and Herzegovina (B&H). MVATS and UVATS procedures were performed in two B&H Clinical Centers: Tuzla and Sarajevo. The first MVATS procedure at Tuzla Clinical Center was conducted in 2004, and the first UVATS lobectomy was performed in 2019. At Sarajevo Clinical Center, the initial MVATS took place in 2005, and the first UVATS lobectomy was carried out in 2020. Methods: We retrospectively analyzed 401 VATS procedures with prospective data, collected between 06/2017 and 04/2023. The VATS technique was employed for wedge resections, partial resections, lobectomies, and other types of resections, including metastasectomy. Results: Out of the 401 patients, 242 (60.34%) were male, and 159 (39.66%) were female, with a mean age of 57.2±23 years. The procedures consisted of 231 UVATS and 170 MVATS. Lobectomy was performed in 61 (15.21%) cases, wedge resections in 216 (51.37%), partial resections in 85 (21.19%), and other types of resections in 39 (9.72%) patients. The median duration of the procedure was 210 minutes for lobectomy, and 77.5 minutes for wedge and other types of resections. Major complications, such as bronchopleural fistula in 22 (5.49%) cases, wound infections in 20 (4.99%), atelectasis in 19 (4.74%), lung infiltrations in 15 (3.74%), and bleeding in 15 (3.74%) patients, were observed. The overall mean hospital stay for all procedures was 6.45 days. Conclusion: Uniportal and multiportal VATS techniques are feasible and safe for various indications in thoracic surgery. VATS can be performed in middle-income countries such as Bosnia and Herzegovina with acceptable results, by thoracic surgeons experienced in general thoracic surgery

Suggested robotic-assisted thoracic surgery training curriculum.

Robotic-assisted surgery, a technological advancement in the field of surgery, has become increasingly popular among surgeons of many specialties over time. Robotic-assisted thoracic surgery (RATS) is comparable to video-assisted thoracic surgery (VATS) in terms of patient care outcomes; however, the perception of increased operative time and a lack of cost-effectiveness have led to controversy regarding its alleged benefits. Nevertheless, robotic surgery is one of the preferred options for minimally invasive surgery by some thoracic surgeon over VATS, due to its ability to provide 3-D vision, precise wrist movements, enhanced magnification, and instrument stability and articulation. Notably, trainees in the field of thoracic surgery experience difficulty gaining knowledge and learning skills associated with RATS due to its complexity, limited access to robotic instruments, the lack of a standardized curriculum for trainees, and lack of mentorship or proctorship, thus leading to a steeper learning curve compared to laparoscopic or VATS procedures that are cost-friendly, easy to learn, and feasible to practice. Nevertheless, focusing on RATS training for thoracic surgeons will keep them familiar with robotic techniques, including the pre-operative setup and intra-operative process, which will ultimately decrease operative times. In this paper, we will review the literature, express and discuss the most viable training curriculum from authors' point of view to help achieve this goal.

Comparison between preoperative hook-wire and liquid material localization for pulmonary nodules: a meta-analysis.

Computed tomography (CT)-guided liquid material (LM) and hook-wire (HW) are usually localized for pulmonary nodules (PNs) before video-assisted thoracic surgery (VATS) resection, but the relative advantages of these 2 techniques remain uncertain. This meta-analysis was conceived to juxtapose the efficacy and safety of HW localization (HWL) and LM localization (LML), both guided by CT, for the preoperative localization of PNs. The PubMed, Web of Science, and Wanfang databases were searched to identify relevant studies published as of March 2023, after which pooled analyses of study outcomes were conducted. A total of 7 studies were included in this meta-analysis from 142 relevant studies. These 7 studies included 551 patients (583 PNs) with CT-guided HWL and 551 patients (612 PNs) with LML. The successful localization rate was significantly higher in the LM group (LMG) than in the HW group (HWG) (p = 0.002). The LMG also exhibited significantly lower pooled total complication and lung haemorrhage rates than the HWG (p = 0.007 and 0.00001, respectively). Pooled localization duration, pneumothorax rates, and VATS procedure duration were comparable in both groups (p = 0.45, 0.15, and 0.74, respectively). Furthermore, the pooled postoperative hospital stay was significantly shorter in the LMG than in the HWG (p = 0.009). Significant heterogeneity was detected in the endpoints of localization duration and pneumothorax rate (I2 = 93% and 66%, respectively). CT-guided LML is safer and more successful than HWL for patients with PNs before VATS resection.

Non-intubated surgical lung biopsies in elderly and frail adults—one shot, two targets: a case report

Background: According to recent data, non-intubated thoracic surgery (NITS) appeared to be a safer and feasible alternative to conventional endobronchial intubation and one-lung positive pressure ventilation for diagnostic minor video-assisted thoracic surgery (VATS) procedures. NITS seems to provide a shorter anesthesiologic time, less postoperative pain, improved recovery, and shorter hospital length of stay, with less postoperative complications or morbidity. Nevertheless, these results in older and fragile adults are controversial. The peculiarity of the reported case is the concomitant presence of two possible pulmonary pathologies in a patient with more than one feature that could contraindicate surgery (age, obesity, restrictive pulmonary pathology, and other comorbidities).

Video-assisted thoracic surgery in critically ill COVID-19 patients on venovenous extracorporeal membrane oxygenation.

IntroductionCoronavirus disease 2019 (COVID-19) leads to thoracic complications requiring surgery. This is challenging, particularly in patients supported with venovenous extracorporeal membrane oxygenation (VV-ECMO) due to the need for continuous therapeutic anticoagulation. We aim to share our experience regarding the safety and perioperative management of video-assisted thoracic surgery for this specific population.MethodsRetrospective, single-center study between November 2020 and January 2022 at the ICU department of a 1.061-bed tertiary care and VV-ECMO referral center during the COVID-19 pandemic.Results48 COVID-19 patients were supported with VV-ECMO. A total of 14 video-assisted thoracic surgery (VATS) procedures were performed in seven patients. Indications were mostly hemothorax (85.7%). In eight procedures heparin was stopped at least 1 h before incision. A total of 10 circuit changes due to clot formation or oxygen transfer failure were required in six patients (85.7%). One circuit replacement seemed related to the preceding VATS procedure, although polytransfusion might be a contributing factor. None of the mechanical complications was fatal. Four VATS-patients (57.1%) died, of which two (50%) immediately perioperatively due to uncontrollable bleeding. All three survivors were treated with additional transarterial embolization.Conclusion(1) Thoracic complications in COVID-19 patients on VV-ECMO are common. (2) Indication for VATS is mostly hemothorax (3) Perioperative mortality is high, mostly due to uncontrollable bleeding. (4) Preoperative withdrawal of anticoagulation is not directly related to a higher rate of ECMO circuit-related complications, but a prolonged duration of VV-ECMO support and polytransfusion might be. (5) Additional transarterial embolization to control postoperative bleeding may further improve outcomes.

Improvements in perioperative outcomes for non-small cell lung cancer: a decade-long analysis.

Video-assisted thoracic surgery (VATS) procedures for non-small cell lung cancer (NSCLC) have steadily increased and have become the gold standard, but their prognostic advantage compared with thoracotomy has not been elucidated. This study retrospectively evaluated perioperative characteristics of VATS for NSCLC over time. We collected the clinical data of 760 patients with NSCLC who underwent pulmonary resection over the past decade, classifying patients into early (2011-2015) and late (2016-2020) periods. Changes in NSCLC patient characteristics, surgical approaches, perioperative factors, postoperative morbidities, and prognoses were analyzed. Patients in the late period were older (p = 0.01), had more comorbidities (p = 0.01), and had earlier-stage cancer (p < 0.01) than those in the early period. The late period had significantly fewer surgical procedures for lobectomy or extended resection beyond lobectomy (p < 0.01), open thoracotomies (p < 0.01), postoperative (p = 0.02) and severe morbidities (p < 0.01), and a significantly shorter postoperative hospital stay than the early period. Surgical procedures of lobectomy or extended resection beyond lobectomy (p < 0.01) were significant risk factors for postoperative morbidity, and being in the early period (p < 0.01) and surgical procedures of lobectomy or extended resection beyond lobectomy (p < 0.01) were significant risk factors for severe postoperative morbidities. The overall survival prognosis significantly differed between the groups (p = 0.02) but progression-free survival did not (p = 0.89). The incidence of postoperative morbidities decreased over time in older patients and patients with more comorbidities. The prognosis of patients with NSCLC did not change with increasing VATS or sublobar resection.

Patient risk factors for conversion during video-assisted thoracic surgery-the Epithor conversion score.

Intraoperative conversion from video-assisted thoracic surgery (VATS) to thoracotomy may occur during anatomical lung resection. The objectives of the present study were to identify risk factors for intraoperative conversion and to develop a predictive score. We performed a multicentre retrospective analysis of French thoracic surgery departments that contributed data on anatomical lung resections to the Epithor database over a 10-year period (from January-2010 to December-2019). Using univariate and multivariate logistic regression analyses, we determined risk factors for intraoperative conversion and elaborated the Epithor conversion score (ECS). The ECS was then validated in a cohort of patients operated on between January- and June-2020. From January-2010 to December-2019, 210,037 patients had been registered in the Epithor database. Of these, 55,030 had undergone anatomical lung resection. We excluded patients who had upfront a thoracotomy or robotic-assisted thoracoscopic surgery (n = 40,293) and those with missing data (6,794). Hence, 7943 patients with intent-to-treat VATS were assessed: 7100 with a full VATS procedure and 843 patients with intraoperative conversion to thoracotomy (conversion rate: 10.6%). Thirteen potential risk factors were identified among patients' preoperative characteristics and planned surgical procedures and were weighted accordingly to give the ECS. The score showed acceptable discriminatory power (area under the curve: 0.62 in the development cohort and 0.64 in the validation cohort) and good calibration (P = 0.23 in the development cohort and 0.30 in the validation cohort). Thirteen potential preoperative risk factors were identified, enabling us to develop and validate the ECS-an easy-to-use, reproducible tool for estimating the risk of intraoperative conversion during VATS.

Comparison between coil and hook-wire localization before video-assisted thoracoscopic surgery for lung nodules: a systematic review and meta-analysis.

IntroductionBoth coil and hook-wire localization techniques are commonly employed prior to video-assisted thoracic surgery (VATS) resection in patients with lung nodules (LNs), but the relative advantages of each remain uncertain.AimThis meta-analysis was performed to explore the relative safety and efficacy of coil localization (CL) and hook-wire localization (HWL) for patients with LNs.Material and methodsThe PubMed, Embase, Cochrane Library, Wanfang, and CINK databases were searched to identify relevant studies published as of February 2022, after which pooled analyses of study outcomes were conducted.ResultsIn total, 8 studies met the inclusion criteria for the present meta-analysis. Successful localization rates were higher for the CL group relative to the HWL group (p = 0.0001). The CL group additionally exhibited significantly lower pooled total complication, pneumothorax, and lung hemorrhage rates relative to the HWL group (p = 0.01, p = 0.0001, p = 0.0009). Pooled duration of localization, VATS procedure duration, and wedge resection duration values were comparable in both groups (p = 0.69, p = 0.16, p = 0.76), as were chest pain scores (p = 0.06). When specifically analyzing the subset of patients with ground-glass LNs, pooled pneumothorax rates were significantly lower in the CL group relative to the HWL group (p = 0.03). Significant publication bias was detected with respect to rates of lung hemorrhage (Egger test, p = 0.029), but was not evident for other analyzed variables.ConclusionsThese results suggest that the coil-based localization of LNs before VATS resection is safer and more effective than hook-wire localization.

The space between: pneumothorax or bulla

Background: Distinguishing between a bulla and pneumothorax can sometimes be difficult especially in the absence of preexisting lung disease, leading to inappropriate intervention. Case Presentation: We report the case of a well 32-year-old male who presented with a year&amp;apos;s history of insidious onset breathlessness. A routine chest radiograph was thought to show a large pneumothorax. He had chest drains placed with no radiological improvement. A video-assisted thoracic surgery procedure revealed a giant bulla. Conclusion: This case highlights the importance of correlating clinical assessment with radiological findings. Early Computerised Tomography (CT) imaging should be considered prior to pleural intervention in clinically stable patients.

Lobectomy with pulmonary artery angioplasty for lung cancer using video-assisted thoracic surgery versus open thoracotomy: a retrospective propensity matched analysis.

BackgroundPulmonary artery angioplasty (PAA) is an important surgical procedure to complete radical resection with maximum preservation of functioning pulmonary tissues when the pulmonary artery is involved. In this study, we aimed to evaluate the short- and long-term outcomes of PAA using video-assisted thoracic surgery (VATS) versus open thoracotomy (OT) in lung cancer surgery.MethodsWe retrospectively reviewed 214 patients who underwent PAA between November 2005 and October 2016. Propensity score matching (PSM) was applied to reduce confounding effects. The survival outcomes were assessed using Kaplan-Meier estimates and Cox regression analysis.ResultsThe final sample included 203 patients (28 patients in the VATS group and 175 patients in the OT group). There were no differences between the two groups in operative time, blood loss, duration of chest tube drainage, postoperative hospital stays, margin status, postoperative morbidity and mortality, and number of N1 and N2 stations or number of N1 and N2 lymph nodes both before and after matching. At a median follow-up period of 43 (range, 6 to 158) months, the 5-year overall survival (OS) and recurrence-free survival (RFS) of the overall cohort were 47.9% and 42.1%, respectively. The 5-year OS and RFS were comparable between the VATS and OT groups both in the overall cohort and the matched cohort. The VATS procedure was found not to have a prognostic impact on either OS (hazard ratio, 1.17; 95% CI: 0.60 to 2.30, P=0.647) or RFS (hazard ratio, 1.14; 95% CI: 0.62 to 2.10, P=0.666).ConclusionsVATS PAA is associated with comparable short- and long-term outcomes in selected patients with lung cancer compared with OT.

Role of video-assisted thoracic surgery in T4 NSCLC

: For many years, T4 lung tumors have been considered less suitable for surgery, because of their local extension invading central structures or vertebral bodies. To date, many studies have confirmed the advantages in terms of survival of a multimodality approach made up of surgical resection associated with neoadjuvant and/or adjuvant therapy for selected patients with advanced lung cancer. In those patients, in fact, minimally invasive surgery could improve overall survival rates while promoting faster recovery, faster access to adjuvant therapies and preserving a better functionality of the immune system. Because of the difficulty in collecting data on patients with T4 lung tumors amenable to minimally invasive surgery, published evidences only come from case reports which prove the feasibility and the possible advantages of video-assisted thoracic surgery (VATS) procedures. The aim of this literature review is to collect the published experiences of skilled surgeons dealing with T4 tumors invading central structures or chest wall, to analyze concerns and new opportunities of treatment and proving the feasibility and advantages of the VATS approach.

Establishment of Minimally Invasive Thoracic Surgery Program.

The establishment of minimally invasive surgery is a complex and difficult task. Video-assisted thoracic surgery (VATS) refers to a minimally invasive surgical technique that represents a less invasive approach to thoracic surgery using thoracoscopy. For lung cancer or esophageal cancer surgery, planning and establishing a team for minimally invasive surgery for the first time is not a simple task. Technical advances in surgical devices and the enhanced skill of surgeons are cornerstones of the development of minimally invasive surgery. Here, we review the meaning of minimally invasive thoracic surgery and discuss how to establish a team approach for VATS procedures.

Retrolaminar versus epidural block for postoperative analgesia after minor video-assisted thoracic surgery: a retrospective, matched, non-inferiority study.

BackgroundThe role of thoracic epidural analgesia (TEA) for postoperative analgesia after video-assisted thoracic surgery (VATS) is still controversial. Some studies have reported the efficacy of ultrasound-guided retrolaminar block (RLB) for the postoperative management of pain after chest wall surgery. The purpose of this study was to compare the postoperative analgesic efficacy and adverse effects of ultrasound-guided RLB with those of TEA in patients undergoing minor VATS procedures.MethodsA total of 192 relevant records of patients were enrolled in this study. We reviewed electronic medical records of patients undergoing minor VATS procedures under general anesthesia. The primary outcome was the median differences in the numerical rating scale (NRS) scores during rest between the groups at the morning of postoperative day 1 (POD 1m). A propensity-matched analysis incorporating preoperative variables was used to compare the efficacy of postoperative analgesia in two groups.ResultsOverall, 94 patients were identified for analysis. Propensity score matching resulted in 47 patients in each group. There were no significant differences in the NRS scores between the two groups. The median differences in NRS scores during rest between the two groups at POD 1m were under 1, which indicates non-inferiority of RLB. There were no significant differences in the incidence of adverse effects and rescue dose of analgesic consumption between the two groups.ConclusionsThe analgesic effects of continuous ultrasound-guided RLB were non inferior to those of TEA for minor VATS procedures.

Video-Assisted Thoracic Surgery for Late Recurrence of Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia (CDH) is often diagnosed and treated in the perinatal period. Recurrence is a known complication that may very rarely occur years after the operation. We report here the case of a patient who had an operation for a CDH at birth that then recurred in adulthood. Given the risk of complications and the symptomatology of the patient, we decided to treat the patient surgically. We successfully performed a video-assisted thoracic surgery (VATS) procedure during which we reduced the hernia and closed the breach. Given the recurrent nature of the hernia, we decided to reinforce the repair with a mesh.

Bronchial Blocker Provides Hemodynamic stability for One Lung Ventilation in Right Video-Assisted Thoracoscopic Surgery: An Observational Study

Background: Double lumen endotracheal tubes (DLT) and bronchial Blockers (BB) have been both beenused for lung isolation in video-assisted thoracic surgery (VATS) with some inherent demerits. Objective: The aim of this study was to observe the quality of lung deflation of a bronchial blocker forone lung ventilation &amp; the hemodynamic stability in video-assisted thoracic surgery(VATS). Materials &amp; methods: A total forty adult patients have been assigned to observe the effects &amp; hemodynamicstability of BB who undergoing VATS procedure for mediastinal mass surgery. Correct placement ofairway was confirmed by fiber optic bronchoscopy. The variables assessed were: 1. Time required forcorrect placement of device, 2. Time taken for lung collapse, 3. Quality of Lung collapse, 4. Number oftimes of airway mal-positioned, 5. Changes of blood pressure and heart rate at baseline (T1) and immediatebefore (T2) and after (T3) intubation and one minute after (T4) intubation, 6. Number of patients withhypoxemia (Spo2 &lt;90%) during one lung ventilation, and 7. Post-operative complication like hoarsenessof voice, sore throat and lung infection. Result: Results were observed for MAP &amp; HR at T1, T2, T3 &amp;T4. It was shown that HR decreasedafter induction than the baseline (T1) &amp; came near baseline one min after intubation(T4). Just afterintubation at T3, HR increased from the baseline &amp; immediate before induction (T1&amp;T2). MAP wasalso increased at T3 than T1 &amp; T2. Time taken for right lung collapse with BB was (4.76±0.61) similarand comparable to other studies. Total 36 patients were achieved total collapse of the lung and incidenceof device malposition was observed in case of 5 patients. On the other hand, hypoxaemia was observedin case of 1 patient. Conclusion: Result showed that BB could be a better and effective alternative in VATS Procedureconsidering a longer time to achieve complete lung collapse with minimum hemodynamic changes andwith minimum post-operative complications. JBSA 2021; 34(1): 38-42

Safety and efficacy of video assisted thoracoscopic surgery for non-malignant pathologies: a prospective observational study

Background: Video-assisted thoracic surgery (VATS) had been widely accepted because of its low complication rate, tolerable postoperative pain and early recovery of pulmonary function. Hence the present study was undertaken to assess safety and efficacy of VATS and also analyze the surgical outcomes of VATS procedures for non-malignant thoracic pathologies.Methods: A total of 32 patients with non-malignant pathologies of thorax to undergo VATS lobectomy and thoracotomy conversion cases initially approached by VATS lobectomy were enrolled. Demographic data and surgical information were noted and compare between infection and non-infection group. Primary outcomes were thoracotomy conversion rate, period of thoracic drainage, length of hospital stay, and complications.Results: The majority of patients were in the age group of 36-45 years (28.12%) with female predominance (62.50%). The commonest clinical presentation was hydropneumothorax (28.12%). Most common infective and non-infective aetiology was lung hydatid (28.12%) and benign nodule (18.75%) respectively. The commonest surgical procedures conducted using VATS were lobectomy (34.37%), and decortication (25%). The mean blood loss among the cases was 315.9±36.46 ml. Mean operative time was 157.18±12.37 minutes. Among 6.25% cases thoracotomy was conducted in view of difficult hilar dissection, while among 3.12% cases each of indistinct anatomy and bleeding. Mean duration of thoracic drainage was 6.78±1.69 days and mean hospital stay was 8.2±3.2 days. 6.25% cases had fatal complications while 21.87% cases had milder complications. Only one case recurred while 96.87% cases cured.Conclusions: VATS lobectomy for benign disease is feasible and effective in selected cases, regardless of the presence of infection.

Report from the European Society of Thoracic Surgeons database 2019: current surgical practice and perioperative outcomes of pulmonary metastasectomy.

We report an overview of surgical practices and outcomes in patients undergoing pulmonary metastasectomy based on data from the European Society of Thoracic Surgeons database. We retrieved data on resections performed for pulmonary metastases between July 2007 and July 2019. We evaluated baseline characteristics, surgical management and postoperative outcomes. Open and video-assisted thoracic surgery (VATS) procedures were compared in terms of surgical management, morbidity and mortality. We selected 8868 patients [male/female 5031/3837; median age: 64 years (interquartile range 55-71)] who underwent pulmonary metastasectomy. Surgical approach consisted of open thoracotomy in 63.5% of cases (n = 5627) and VATS in 36.5% (n = 3241), with a conversion rate of 2.1% (n = 69). Surgical resection was managed by wedge or local excision in 61% (n = 5425) of cases and anatomical resection in 39% (n = 3443); lobectomy: 26% (n = 2307); segmentectomy: 11% (n = 949); bilobectomy: 1% (n = 95); pneumonectomy: 1% (n = 92)). Lymph node assessment was realized in 58% (n = 5097) [sampling: 21% (n = 1832); complete dissection: 37% (n = 3265)]. Overall morbidity and mortality rates were 15% (n = 1308) and 0.8% (n = 69), respectively. Median duration of stay was 6 days (interquartile range 4-8). The rate of VATS procedures increased from 15% in 2007 to 58% in 2018. When comparing VATS and Open surgery, there were significantly (P < 0.001) fewer anatomical resections by VATS (24% vs 49%), lymph node assessments (36% vs 70%), less morbidity (9% vs 18%) and shorter durations of stay (median: 4 vs 7 days). We report a good overview of current surgical practices in terms of resection extent and postoperative outcomes with a gradual acceptance of VATS.