Video-assisted Thoracoscopic Surgery Research Articles

Robot-Assisted Thoracoscopic Surgery Can Be Safely Performed in Patients With Obesity from the Early Stages of Implementation.

This study aimed to compare the perioperative outcomes of robot-assisted thoracoscopic surgery (RATS) and conventional video-assisted thoracoscopic surgery (VATS) for lung cancer in patients with obesity. Anatomical pulmonary lobectomy or segmentectomy performed at a single institution from April 2018 to September 2023 in patients with obesity (body mass index ≥25 kg/m2) were statistically compared in terms of perioperative clinical factors including operative time, blood loss, chest tube duration, pain score, intraoperative events, and early postoperative complications between RATS and VATS. In all, 89 patients were evaluated; 43 underwent RATS and 46 underwent VATS. All RATS procedures were performed using the da Vinci Xi system. Patient characteristics were comparable between the 2 groups. The operative time, blood loss, number of dissected lymph nodes, intraoperative events, and conversion rate to open thoracotomy were similar between the 2 groups. The frequencies of postoperative complications and chest tube placement duration between the groups were also similar. The median pain scores were slightly higher in the RATS group on postoperative day 1 but were equivalent between the 2 groups on postoperative day 7. The RATS group had a shorter postoperative hospital stay than the VATS group (P < 0.01). A surgical team proficient in conventional VATS can safely introduce RATS in patients with obesity and lung cancer with equivalent perioperative outcomes.

Clinical benefits of the 5th intercostal incision in uniportal VATS for female patients.

To assess the clinical benefits of a 5th versus 4th intercostal incision in female patients undergoing uniportal video-assisted thoracoscopic surgery (VATS) lobectomy and lymphadenectomy, focusing on breast tissue preservation, pain, cosmetic outcomes, recovery, and surgical maneuverability. A retrospective analysis of 150 female lung cancer patients was conducted, divided into 4 and 5th intercostal incision groups (n = 75 each). Propensity score matching balanced baseline characteristics. Primary outcomes included breast tissue involvement, postoperative pain (VAS), cosmetic satisfaction (Likert scale), recovery time, surgical maneuverability, and complication rates. Statistical analysis used Mann-Whitney U and Chi-square tests for group comparisons and multivariable regression to adjust for confounders. The 5th intercostal incision significantly reduced breast tissue involvement (10.7 vs. 65.3%, p < 0.01), postoperative pain (VAS: 4.8 vs. 7.2, p < 0.01), and recovery time (5.9 vs. 8.4 days, p < 0.05), while enhancing cosmetic satisfaction (p < 0.01) and improving access to upper pulmonary veins. Incision site infections were notably lower in the 5th intercostal group (2.7 vs. 10.7%, p < 0.05). The 5th intercostal incision provides substantial clinical advantages in uniportal VATS for female patients, including reduced breast tissue involvement, minimized pain, enhanced cosmetic outcomes, and faster recovery. These findings support the 5th intercostal incision as a preferred approach in this patient population, aligning with precision surgery principles to optimize outcomes.

Perioperative and long-term outcomes of bilateral cardiac sympathetic denervation via video-assisted thoracoscopic surgery in patients with refractory ventricular arrhythmias.

Bilateral cardiac sympathetic denervation (CSD) performed via video-assisted thoracoscopic (VAT) surgery shows potential in managing ventricular tachycardia (VT), thereby reducing arrhythmic burden. In this setting, the scarcity of studies addressing both perioperative and long-term outcomes creates a substantial gap in the optimal management of patients with multiple comorbidities and limited treatment options. This observational study aimed to assess the medical comorbidities, as well as the short- and long-term outcomes of patients who underwent CSD for VT refractory to catheter ablation and medical therapy at a referral tertiary teaching hospital. We retrospectively analyzed data of all patients with VT who underwent bilateral CSD-VAT surgery at a single center. Unadjusted Kaplan-Meier survival curves were generated to analyze the survival rates at 1-year and 2-years following the procedure. Ten consecutive patients were unrolled between August 2014 and March 2024. Bilateral CSD-VAT surgery was successfully performed in all patients. Pre-operative ejection fraction was 33% (26-41). Two patients (22%) suffered cardiogenic shock and 1 vasoplegia. Half (50%) of the patients necessitated inotrope/vasopressor support and 1 an intra-aortic balloon pump. Median hospital stay was 12 (9-19) days. Three (33%) patients required postoperative ICU admission. All patients were alive upon hospital discharge. Neither major surgical complications nor complications typically associated with VAT-CSD (e.g., Horner's syndrome) were observed. The 1-year survival was 80% while the survival at 24months was 60%. CSD-VAT is a feasible rescue treatment in patients with refractory VT and is associated with limited intra- and postoperative complications alongside an acceptable long-term survival rate.

Role of respiratory secretion culture in the surgical outcome prediction of bacterial empyema.

Thoracic empyema is a serious infection. Video-assisted thoracoscopic surgery is a recommended treatment, and pleural fluid and tissue cultures are collected intraoperatively. The combination of a pleural peels tissue culture and a pleural fluid culture improves the positive culture rate. We aimed to investigate the role of respiratory secretion cultures to determine the optimal management for improving surgical outcome. The study analyzed 225 adult patients with phase II/III thoracic empyema who underwent thoracoscopic decortication. Respiratory secretion cultures were obtained and compared with pleural cultures. Key outcomes were culture positivity and pathogen consistency, with secondary outcomes including intensive care unit stay, hospital stay, and mortality. There were 225 empyema patients with either a positive pleural fluid culture or a positive pleural peel tissue culture. Of these, 76 patients had positive respiratory secretion culture findings during hospitalization. The most common pathogen species were Pseudomonas aeruginosa (44%) and Klebsiella pneumoniae (16%) in the respiratory secretion cultures and Streptococcus spp. (38%) and Klebsiella pneumoniae (12%) in the pleural cultures. There were 30 patients having a common pathogen in the respiratory secretion culture and in the pleural fluid/tissue culture. Poor outcome measures were found in these patients, including the longer use of antibiotics preoperatively [2.50 (1.00-6.00) days versus 5.00 (2.75-11.00) days, p = 0.006] and a higher mortality rate during hospitalization (40.0% versus 17.4%, p = 0.002). Respiratory secretion cultures are vital for predicting surgical outcomes in bacterial empyema, and prompt specimen collection can improve patient survival.

An Australian Single-center Cohort of Pediatric Empyema: Incidence, Pathogens and Disease Severity, and the Interaction of the COVID-19 Pandemic.

Empyema is the most common complication of pediatric community-acquired pneumonia, posing a significant morbidity to children. Clinicians have observed an increase in empyema rates and acuity in the years following the COVID-19 pandemic. This retrospective analysis of children managed for empyema in a tertiary pediatric hospital, aimed to compare the incidence and describe the clinical characteristics prepandemic and postpandemic (2017-2023). There were 222 empyema cases, with a median age of 3 years (0.3-15 years). The majority (87.8%) of cases were managed with a chest drain and fibrinolytics. The remaining underwent minimally invasive video-assisted thoracoscopic surgery. Admissions postpandemic were associated with significantly longer lengths of stays (14 vs 12 days, P ≤ 0.001), higher rates of pediatric intensive care unit admissions (32% vs 26%, P = 0.045), and they required higher level of care (inotropes, noninvasive and invasive ventilation). There were also significantly higher rates of Streptococcus pyogenes (28% vs 7%, P ≤ 0.001), while rates of other organisms were not significantly different. We also noted a significant reduction in immunization rates post-pandemic (95.8% vs 83.1%, P < 0.01); however, there was no significant difference in S. pneumoniae serotypes between epochs. This study demonstrates an increased rate and severity of pediatric empyemas in the post-pandemic period. We propose that the increase was secondary to the increased rates of S. pyogenes seen in the postpandemic period. This rise in infection rates may be alleviated with nonpharmacologic measures aimed at reducing transmission; however, such measures are not sustainable and should be avoided.

Pneumothorax After VATS for Pleural Empyema in Pediatric Patients

(1) Background: In children, bacterial pneumonia is the most common cause of parapneumonic pleural effusions which can eventually lead to pleural empyema. Treatment is varied and is a combination of antibiotic therapy, chest tube drainage, fibrinolytics and video-assisted thoracoscopic surgery (VATS). Postoperative complications of the latter include pneumothoraces and bronchopleural fistula (BPF). The aim of this study is to investigate the incidence and duration of pneumothoraces during the perioperative period and follow-up (FU) to elucidate their progression following video-assisted thoracoscopic surgery (VATS) to start to create an evidence-based standardized FU protocol. (2) Methods: This retrospective study included all patients who underwent VATS for pleural empyema between January 2013–May 2023 at the University Medical Center Hamburg-Eppendorf (UKE) and the Hamburg Children’s Hospital Altona (AKK). (3) Results: We identified 47 patients with pleural empyema who underwent VATS. A proportion of 43% of patients were found to have a pneumothorax with 55% of those being unresolved at discharge. At the end of FU, 27% of those had a “pneumothorax ex vacuo”. No surgical interventions were needed. (4) Conclusions: The majority of pneumothoraces after VATS in pediatric patients can be managed conservatively. In the context of follow-up care, it is recommended that X-ray examinations should be used sparingly, while sonographic follow-up examinations should be conducted more frequently. If the pneumothorax persists, further thoracoscopy for resection of the visceral pleura and treatment of bronchopleural fistula may be the next step in treatment.

Thoracoscopic management of a giant horseshoe shaped oesophageal leiomyoma: a case report

Benign oesophageal tumours are considered rare, and most common are leiomyomas with the incidence of 0.005%. Many cases are asymptomatic, up to 15%–50%, and most cases are discovered incidentally. These may vary in size but are typically smaller than 3 cm. Giant esophageal leiomyoma is defined as tumour greater than 10 cm in diameter. Traditionally, open thoracotomy and enucleation have been the primary treatment modalities for oesophageal leiomyoma. However, in recent years, video-assisted thoracoscopic surgery (VATS) enucleation has gained recognition for its proven advantages as a minimally invasive surgical option. Herein we present our experience with patient presenting with cough rather than dysphagia as a main symptom, who was diagnosed to be having giant oesophageal leiomyoma. VATS guided enucleation was accomplished successfully. Size of lesion was 10.0×8.0×7.0 cm. Postoperative recovery was uneventful.

Long-term survival from a randomized controlled trial of lobectomy by video-assisted thoracoscopic surgery versus thoracotomy for early-stage lung cancer.

We previously did a randomized clinical trial of lobectomy by VATS or thoracotomy for early-stage lung cancer and found that patients who underwent VATS had less postoperative pain and better quality of life compared with thoracotomy. VATS has since been regarded the preferred surgical method for early-stage lung cancer. It is assumed that long-term survival is not influenced by surgical approach, but this assumption primarily rests on non-randomized comparative studies. We decided to do a long-term follow-up of patients who entered our previous randomized trial. Between 2008 and 2014 we randomly assigned 206 patients to VATS (n = 103) or anterolateral thoracotomy (n = 103) for proven or suspected early-stage NSCLC. Records from patients with NSCLC on final pathology were identified in the national electronic patient-record system and the Danish Lung Cancer Registry. Overall, disease-free, and cancer-specific survival were estimated using the Kaplan-Meier method and log-rank test was used to compare the two interventions. A total of 196 patients had NSCLC on final histopathology. Four patients were lost to follow-up and the remaining 192 were included in this follow-up study with 128 events used for overall survival analysis, 100 events for disease-free survival analysis and 79 events for cancer-specific survival analysis. VATS was used in 99 patients versus 93 by thoracotomy. Median age at time of surgery was 66 years (range 41-85 years). After a median follow-up time of 12.8 years (range 9.9-15.8 years), 33% of patients were alive. Overall, disease-free, and cancer-specific survival were not significantly different between VATS and thoracotomy: Overall survival (p = 0.29), disease-free survival (p = 0.17) and cancer-specific survival (p = 0.31). We did not find any statistically significant differences in overall, disease-free, or cancer-specific survival between VATS and thoracotomy. However, larger trials with better power for survival analysis are needed to fully explore if there are differences. Alternatively, differences in survival between thoracotomy and VATS for early-stage NSCLC could be investigated by pooling survival data from two similar randomized trials that have since been published.

Long-term retention of the pedicled thymic flap after bronchial stump coverage.

This study aimed to assess the feasibility and retention rates of pedicled thymic flaps to enhance understanding of bronchial stump coverage. A retrospective analysis of 22 consecutive patients who underwent anatomical lung resection followed by bronchial stump coverage with pedicled thymic flaps between January 2017 and December 2022 was conducted. The procedure was performed using a minimally invasive 3-port video-assisted thoracoscopic surgery technique for all patients with no complications related to graft harvest or fixation. Postoperative retention of the engrafted flaps was evaluated in the 16 patients who underwent thin-slice computed tomography (CT) at least once after surgery. The majority of the postoperative CT examinations were performed for surveillance of lung cancer recurrence. The retention rates of pedicled thymic flaps were 100% at 60 days, 87% at 180 days, and 70% at one year post-surgery. Pedicled thymic flaps can be safely harvested using a minimally invasive approach, and the majority of engrafted flaps remain adjacent to the bronchial stump for more than one year. This technique may be a viable option for patients at high risk of a delayed bronchopulmonary fistula.

Propensity score matched comparison of lymph node upstaging in early-stage lung cancer: open versus minimally invasive surgery with standardized lymphadenectomy

BackgroundLymph node upstaging represents a quality criterion for standardized lymphadenectomy in lung cancer surgery. The aim of the study was to compare whether the quality of standardized lymphadenectomy in lung cancer surgery is comparable in minimally invasive (video-assisted thoracoscopic surgery) and the open approach (thoracotomy). Furthermore, factors associated with lymph node upstaging were assessed, as was its impact on overall survival and progression-free survival.MethodsThis retrospective study reviewed data of all patients undergoing lobectomy at the Lung Tumor Center Munich between 2011 and 2020. Inclusion factors were non-small cell lung cancer without nodal involvement (N0) or metastasis (M0) and standardized lymphadenectomy. A propensity score matched analyses was performed. Frequency of categorical outcomes was compared with Chi [2]-test, mean values with t-test. We used logistic and Cox regression models to assess factors associated with upstaging, overall survival and progression-free survival, restrictively.ResultsOf 1691 patients undergoing lobectomy, 637 met our inclusion criteria. After propensity score matching 198 patients remained in each group. Univariate analysis showed no significant difference in lymph node upstaging between the two groups. (p = 0.12). Overall affected lymph nodes (p = 0.45) and overall affected lymph node stations (p = 0.26) were not significantly different. Multivariate Cox regression analysis showed that overall survival and progression free survival were also independent of the surgical approach. L1 status was the only factor associated with progression-free survival.ConclusionMinimally invasive approaches achieves comparable lymph node upstaging in patients undergone standardized lymphadenectomy.

"Deviceless" Video-Assisted Thoracoscopic Lobectomy: Is It Feasible?

We demonstrate that performing anatomical pulmonary resection by video-assisted thoracoscopic surgery withoutstaplers or energy devices is feasible. This technique is an alternative for surgeons with limited access to expensive technologies.

Development and validation of a prediction model for chronic post-surgical pain risk: a single-center prospective study of video-assisted thoracoscopic lung cancer surgery

BackgroundChronic post-surgical pain (CPSP) is a common complication following video-assisted thoracoscopic surgery (VATS) that significantly impacts the quality of life of patients. Although multiple risk factors have been identified, no systematically validated prediction model exists to guide clinical decision-making.ObjectivesThis study aimed to develop and validate a risk prediction model for CPSP in patients undergoing VATS for lung cancer.MethodsThis prospective cohort study included clinical data from 400 patients with non-small cell lung cancer who underwent VATS from June 2022 to June 2023. Patients were randomly assigned to a training cohort and an internal test cohort and assessed for sleep quality, psychological status, and pain levels. A nomogram prediction model was established based on variables significantly associated with CPSP in the training cohort. The model was internally validated in the internal test cohort to evaluate its discrimination, calibration, and clinical utility.ResultsIndependent risk factors for CPSP included female gender, severe acute pain post-surgery, lymph node dissection, and cold pain sensation, while paravertebral nerve block was identified as a protective factor. The AUC values were 0.878 in training cohort and 0.805 in internal test cohort, respectively, indicating that the model performed well in identifying patients at risk for CPSP. The calibration curves in both cohorts showed a good fit, indicating that the model’s predictions were reliable. And the DCA curve showed that using our model to guide decisions resulted in a higher net benefit compared to a strategy of not screening or treating all patients.ConclusionAn effective risk prediction model for CPSP was successfully developed and validated in this study. This model can aid physicians in conducting more accurate assessments of CPSP risk in patients prior to surgery and in offering personalized strategies for managing CPSP.Clinical registration numberRegistration website: https://www.chictr.org.cn/. Registration date: 2022/5/21. Registration number: ChiCTR2200060196.

One-stage versus two-stage thoracoscopic surgery for synchronous bilateral pulmonary nodules: a propensity score-matched analysis

BackgroundThe aim of this study was to compare the surgical efficacy of one-stage and two-stage video-assisted thoracoscopic surgery (VATS) for bilateral multiple pulmonary nodules (BMPNs).MethodsA retrospective analysis was made of 156 patients, 84 who underwent one-stage and 72 who underwent two-stage VATS for BMPNs at our department between January 2019 and December 2022. Perioperative and long-term outcomes were compared between the two groups using propensity score-matched (PSM) analysis.ResultsThere were 48 patients in each group after PSM. No significant difference was observed in operation time, blood loss, rates of overall complications, and 3-year overall survival (p>0.05) between one-stage and two-stage groups. The one-stage procedure was associated with shorter length of stay (5 days [IQR 4-5.75 days] vs. 9 days [IQR 7–10 days]; p<0.001), as well as lower total cost (14626.3 ± 4149.4 vs. 18975.9 ± 3720.8 USD, p<0.001) compared to the two-stage procedure. The one-stage group was associated with better 3-year RFS compared with the two-stage group (90.7% vs. 75.3%, p = 0.039).ConclusionOne-stage and two-stage VATS for BMPNs are both safe and feasible in selected patients. One-stage procedure possess potential advantages in reducing hospital stay and cost, as well as preventing tumor progression.

Comparison of the efficacy of subxiphoid and intercostal uniportal video-assisted thoracoscopic surgery in patients with early-stage non-small cell lung cancer

Objective: To compare the efficacy of subxiphoid and intercostal uniportal video-assisted thoracoscopic surgery (VATS) in patients with early-stage non-small cell lung cancer (NSCLC). Methods: We performed a retrospective chart review of patients with early-stage NSCLC who underwent subxiphoid uniportal video-assisted thoracic surgery (SA-VATS) or intercostal uniportal VATS (IA-VATS) at Shidong Hospital in Shanghai from November 2020 to May 2023. Perioperative conditions including surgical duration, intraoperative blood loss, postoperative catheterization duration, time to first off-bed activities, and number of lymph node dissected were compared between the groups. Degree of pain, preoperative and postoperative lung function, prognosis, and incidence of complications were also compared between the groups. Results: Records of a total of 128 patients were included. Of them, 72 patients underwent SA-VATS and 56 patients underwent IA-VATS. The duration of SA-VATS was longer, while the intraoperative blood loss and catheterization times were lower compared to those of IA-VATS (P&lt;0.05). Visual analogue scale (VAS) score of patients after SA-VATS was significantly lower than after IA-VATS (P&lt;0.05). There was no significant difference in forced expiratory volume in one second (FEV1) between the two groups before the surgery, and one- and 12 months after the surgery (P&gt;0.05). The prognosis and the incidence of complications were comparable in the two groups after the surgery (P&gt;0.05). Conclusions: Compared with IA-VATS, SA-VATS is associated with lower intraoperative blood loss, shorter postoperative catheterization and time to first off-bed activities, and less postoperative pain in surgical treatment for early-stage NSCLC. However, there was no significant difference in prognosis and complications between the two approaches. doi: https://doi.org/10.12669/pjms.41.2.11096 How to cite this: Fu Z, Wang L, Hu W, Zhou Y, Zhou Q. Comparison of the efficacy of subxiphoid and intercostal uniportal video-assisted thoracoscopic surgery in patients with early-stage non-small cell lung cancer. Pak J Med Sci. 2025;41(2):359-365. doi: https://doi.org/10.12669/pjms.41.2.11096 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The comparison of uniportal versus multiportal video-assisted thoracic surgery for esophageal cancer: a propensity-weighted analysis.

The utilization of uniportal video-assisted thoracoscopic surgery (VATS) has become prevalent, notwithstanding, there are few studies exploring its application specifically in esophagectomy. A retrospective analysis was conducted on data collected from patients diagnosed with clinical stage T1-3/N0/M0 thoracic esophageal cancer, who underwent surgery between January 2017 and December 2020. To evaluate the outcomes, an analysis was conducted utilizing the inverse probability of treatment weighting (IPTW) method. This study identified 55 patients who underwent uniportal VATS and 212 patients who underwent multiportal VATS. Postoperative complications classified as Clavien-Dindo grades 1-2 occurred less frequently after uniportal than multiportal VATS in both unadjusted and IPTW-adjusted analyses (10.1% versus 28.8%, respectively; P = 0.018). Upon IPTW analysis, it indicated that the rate of pneumonia (grades 1-2) in the uniportal VATS group was 7.3%, notably lower than the corresponding rate of 23.2% observed in the multiportal VATS group (P = 0.037). Patients in uniportal VATS group had a shorter postoperative length of stay comparing with those in multiportal VATS group (9 versus 10days, P = 0.006 after IPTW). The visual analog scale (VAS) was administered within 7days following surgery and scores were significantly lower in uniportal VATS group (P < 0.001). No surgery-related mortality was observed in uniportal VATS group. The survival benefit observed between two groups was comparable before (P = 0.320) and after IPTW analysis (P = 0.824), indicating no significant difference. The utilization of uniportal VATS for esophagectomy demonstrated a reduced occurrence of postoperative complications, accompanied by mitigated postoperative pain, thereby presenting as a viable and practical approach for treating esophageal cancer patients.

Outcomes of internal rib fixation through complete video-assisted thoracoscopic surgery for multiple rib fractures and flail chest in severe chest trauma

BackgroundSurgical stabilization of rib fractures (SSRF) is a standard treatment for multiple rib fractures and flail chest. The aim of this study is to evaluate the outcomes of internal rib fixation through complete video-assisted thoracoscopic surgery (VATS) for multiple rib fractures and flail chest in patients with severe chest trauma.MethodsThirty-nine patients with multiple rib fractures caused by severe chest trauma were divided into two groups according to the surgical approach used. Twenty-one patients were diagnosed with flail chest. In the thoracoscopic surgery group, 17 patients underwent internal rib fixation through complete VATS. In the open surgery group, 22 patients underwent surgery with open reduction and internal fixation. Surgical variables, such as operation time, intraoperative blood loss, chest tube drainage volume, complications, visual analog scale (VAS) of pain score, postoperative ventilator days, Intensive Care Unit (ICU) stay and hospital stay, were compared between the two groups.ResultsThere were no differences in operation time, intraoperative blood loss, chest tube drainage volume, postoperative ventilator days, ICU stay or hospital stay between the two groups (P > 0.05). Although there was no significant difference in overall postoperative complications (P = 0.358), the incidence of postoperative pleural effusion was lower in the thoracoscopic surgery group than in the open surgery group (P = 0.025). The VAS score in the thoracoscopic surgery group was also significantly lower than that in the open surgery group on the seventh day after surgery (P = 0.014).ConclusionsInternal rib fixation through complete VATS is a feasible and safe approach for treating multiple rib fractures and flail chest in patients with severe chest trauma.

Utilising uniportal video-assisted thoracoscopic surgery for pericardial window: A 12-year single-centre experience in the diagnosis and treatment of pericardial effusion.

Uniportal video-assisted thoracoscopic surgery (Uni-VATS) is an effective minimally invasive technique for pericardial drainage, biopsy and window creation in cases of pericardial effusion (PE). This retrospective study evaluated 73 patients with PE who underwent pericardial window procedures between 2012 and 2024. Intraoperative and post-operative data related to Uni-VATS were assessed. The mean age of the patients was 53.79 ± 17.79 years (10-82 years), with 34 (46.6%) females and 39 (53.4%) males. The mean volume of pericardial fluid drained after window creation was 446.23 ± 199.81 cc (75-1100 cc). The mean operation time was 42.87 ± 12.79 min, and chest drain removal occurred after an average of 1.8 ± 1.2 days. The mean duration until discharge or referral to the follow-up clinic was 5.98 ± 2.14 days. In addition to the pericardial window procedure, pleural biopsy was performed in 12 patients, mediastinal mass biopsy in eight patients and wedge resection for parenchymal nodules in six patients. Microbiologic and virologic cultures of the fluids were negative in all cases. Among the 41 patients with benign cytology, pericardial biopsy results indicated tuberculosis in four patients (5.4%), amyloidosis in one patient (1.3%) and chronic or subacute nonspecific pericarditis in the remaining patients. Uni-VATS is a novel and safe technique that may be the preferred choice for pericardial window due to its diagnostic and therapeutic efficacy, ability to perform simultaneous procedures, favourable impact on operation duration/hospital stay, low complication rates and superiority compared to traditional methods.

Predictive Value of Preoperative Peak Oxygen Uptake for Postoperative Pulmonary Complications in Lung Cancer Patients with Chronic Obstructive Pulmonary Disease: A Single-center Retrospective Cohort Study.

The relationship between preoperative peak oxygen uptake/weight (VO2/W) and postoperative pulmonary complications (PPC) in lobectomies, including video-assisted thoracoscopic surgery, remains unclear. Traditional pulmonary function tests are often unreliable in this group, necessitating alternative predictive methods. Therefore, this study aimed to clarify the predictive value of preoperative peak VO2/W for PPC and explore factors related to PPC in lung cancer patients with chronic obstructive pulmonary disease (COPD). This single-center retrospective cohort study included 40 patients with lung cancer complicated by COPD who underwent a preoperative cardiopulmonary exercise test between January 2017 and March 2024. Patients were divided into those with and without PPC (PPC and non-PPC groups, respectively). Clinical parameters such as surgical approach, pulmonary function, low attenuation area, and peak VO2/W were compared between the groups. The association between these parameters and PPC was analyzed using multivariate logistic regression. The preoperative % diffusing capacity of the lung for carbon monoxide (%DLCO) and peak VO2/W were significantly lower in the PPC group than in the non-PPC group (p<0.01 and p<0.001, respectively), while the ventilatory equivalent/ventilatory carbon dioxide (VE/VCO2) was significantly higher in the PPC group than in the non-PPC group (p<0.05). In the multivariate logistic analysis including the %DLCO, peak VO2/W, VE/VCO2, and forced expiratory volume in 1 second, only peak VO2/W was identified as a significant independent factor for predicting PPC. The area under the receiver operating characteristic curve of peak VO2/W to predict PPC was 0.93, with a cutoff value of 14.6 mL/min/kg, sensitivity of 78%, and specificity of 95%. This study revealed that peak VO2/W was the most important parameter for predicting PPC in lung cancer patients with COPD. Incorporating cardiopulmonary exercise tests into preoperative assessments could improve risk stratification and perioperative management, potentially reducing the incidence of PPC in this high-risk population.

Epidural analgesia versus systemic opioids for postoperative pain management after VATS: Protocol for a systematic review.

Postoperative pain following video-assisted thoracoscopic surgery (VATS) remains a significant challenge. While epidural analgesia is still the gold standard, other types of regional analgesia are gaining popularity because of perceived less risk of complications. The efficacy of systemic opioids as an alternative to epidural analgesia has not been thoroughly explored. This systematic review and meta-analysis aims to evaluate and compare the efficacy of systemic opioids versus epidural analgesia in managing postoperative pain after VATS. We will conduct a systematic review and meta-analysis in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) checklist. A comprehensive search will be conducted in MEDLINE, EMBASE, and the Cochrane Library supplemented with Scopus citation searches, search for gray literature using Google Scholar and a search for ongoing studies. We will include studies based on the PICO methodology without restrictions regarding study type. Two independent reviewers will screen studies, extract data, and assess study quality using the Cochrane Risk of Bias tools. The primary outcomes will be postoperative pain intensity at rest and during activity at 24, 48, and 72 h. Secondary outcomes will include use of "rescue" opioids, hospital length of stay, and adverse events. If feasible, a meta-analysis will be done, otherwise we will perform a descriptive analysis. The results will provide a comparative analysis of the effectiveness of systemic opioids versus epidural analgesia in managing postoperative pain in VATS patients. Data synthesis will include pooled estimates for pain scores, opioid consumption, and adverse events, possibly with subgroup and sensitivity analyses conducted to explore heterogeneity across studies. This systematic review will offer valuable insights into the optimal pain management strategy for patients undergoing VATS. The findings may guide clinical practice in selecting the most effective and safe analgesic approach, improving postoperative recovery, and patient outcomes.

Outcome of Pleural Empyema Treated With Video-Assisted Thoracoscopic Surgery in Patients With Severe Co-Morbidities: An Observational Study.

Empyema patients with poor physical condition and severe comorbidities face a significant challenge, with difficulties in choosing appropriate treatment methods, limited treatment outcomes, and a high rate of complications and mortality. To comment on the indications and to evaluate the treatment outcomes of pleural empyema in patients with poor physical condition and severe comorbidities by thoracoscopic surgery. An observational study on 12 patients treated at the Department of Thoracic Surgery - Military Hospital 103, from January 2017 to December 2022. The mean of age was 63.4 ± 12.4 years old, with a male/female ratio of 5/1. In this study, 83.3% of cases were presented with stage II empyema. The mean Karnofsky score was 50.0 ± 6.1. Some comorbidities contained chronic obstructive pulmonary disease (COPD) (25.0%), spontaneous esophageal perforation (16.7%), liver cancer, cirrhosis, esophageal cancer, end-stage renal failure - chronic dialysis (8.7%). The surgery procedures were efficient with a short duration (65.6 ± 9.4minutes), low incidence of blood transfusion (8.3%), and lower rate of postoperative complications (surgical wound infection 8.3%). The length of postoperative stay was 16.8 ± 9.9 days. Pleural drainage was removed in 11 out of 12 cases after an average of 60.1 ± 8.5 days, while one patient had their drainage retained due to esophageal cancer. The total recovery rate at the 1-year follow-up was 91.7%. Video-Assisted Thoracoscopic Surgery (VATS) exhibits positive outcomes in treating stage I and II pleural empyema patients who incurred severe comorbidities.