Video-assisted Thoracoscopic Resection Research Articles

Management of the spontaneous pneumothorax in children

Introduction. Emphysematous changes in the lung tissue are the main cause of pneumothorax in children. To restore the lung function is one of the most challenging tasks in pediatric surgery.Purpose. To confirm the effectiveness of videothoracoscopy in the treatment of children with spontaneous pneumothorax.Material and methods. A retrospective analysis of case histories of 12 patients with spontaneous pneumothorax was made. Outcomes of treatment were monitored in patients during their stay in the hospital. Time of air release cessation, expansion of the lung, complications and length of stay in the hospital were analyzed.Results. In the first group of patients (n=7) only the drainage technique was used; aerostasis was achieved by the end of the second week (14.3±1.5 days). The drainage was in place till the air leakage was eliminated. The length of patient's stay in the hospital was 20.3±2.3 days. In the second group (n=5), the resection intervention was made. The complete lung expansion was achieved on the first day. Lung hermeticism was achieved by 4.2±1.3 day (p0.05). There were no any bronchopulmonary complications. The length of stay in the hospital was 14.1±1.1 days (p0.05).The advantage of the thoracoscopic technique applied for the treatment of spontaneous pneumothorax is in creating conditions for faster elimination of the source of air leakage, in accelerating functional recovery and in shortening the length of patient's stay in the hospital. The combination of thoracoscopic lung resection with pleurectomy in children can significantly reduce the risk of pneumothorax recurrence.Conclusion. To eliminate the prolonged air release in case of confirmed bullous changes in the lungs, when minimally invasive techniques are ineffective, surgical treatment in the form of video-assisted thoracoscopic resection can be applied early, even with the first episode of pneumothorax.

Effect of balanced opioid-free anaesthesia on postoperative nausea and vomiting after video-assisted thoracoscopic lung resection: protocol for a randomised controlled trial

IntroductionOpioid-free anaesthesia (OFA) may reduce opioid-related side effects such as postoperative nausea and vomiting (PONV) and hyperalgesia. This study aims to investigate the effects of balanced OFA on PONV and...

Cost and effectiveness of microwave ablation versus video-assisted thoracoscopic surgical resection for ground-glass nodule lung adenocarcinoma.

PurposeTo retrospectively evaluate the cost and effectiveness in consecutive patients with ground-glass nodules (GGNs) treated with video-assisted thoracoscopic surgery (VATS; i.e., wedge resection or segmentectomy) or microwave ablation (MWA).Materials and methodsFrom May 2017 to April 2019, 204 patients who met our study inclusion criteria were treated with VATS (n = 103) and MWA (n = 101). We calculated the rate of 3-year overall survival (OS), local progression-free survival (LPFS), and cancer−specific survival (CSS), as well as the cost during hospitalization and the length of hospital stay.ResultsThe rates of 3-year OS, LPFS, and CSS were 100%, 98.9%, and 100%, respectively, in the VATS group and 100%, 100% (p = 0.423), and 100%, respectively, in the MWA group. The median cost of VATS vs. MWA was RMB 54,314.36 vs. RMB 21,464.98 (p < 0.001). The length of hospital stay in the VATS vs. MWA group was 10.0 vs. 6.0 d (p < 0.001).ConclusionsMWA had similar rates of 3-year OS, LPFS, and CSS for patients with GGNs and a dramatically lower cost and shorter hospital stay compared with VATS. Based on efficacy and cost, MWA provides an alternative treatment option for patients with GGNs.

Ischaemic stroke associated with pulmonary arteriovenous malformation

Pulmonary arteriovenous malformation (PAVM) is considered a rare cause of ischaemic stroke in young patients. In this article, we present a case series of 5 patients with PAVM-associated ischaemic stroke. We discuss pathophysiology, clinical presentation, diagnostic approaches, and secondary prevention. In addition, two of the aforementioned cases are provided in detail: the one of 32-year-old female with ischaemic stroke associated with sporadic PAVM, the latter being treated with embolization, and the one of 24-year-old male with hereditary hemorrhagic telangiectasia (HHT) who developed PAVM-associated ischaemic stroke, who was treated with intravenous thrombolytic therapy and mechanical thrombectomy on admission, followed by video-assisted thoracoscopic PAVM resection.

Efficacy and safety of intraoperative cone-beam CT-guided localization of small pulmonary nodules.

OBJECTIVESThis study aimed to evaluate the efficacy and safety of intraoperative cone-beam computed tomography-guided video-assisted thoracoscopic surgery wedge resection of impalpable small pulmonary nodules.METHODSThis was a single-centre phase 2 trial conducted between April 2018 and March 2019. Peripheral small pulmonary nodules, defined as either ground-glass opacity-dominant (>50%) nodules measuring ≤3 cm in diameter (ground-glass opacity-dominant type) or nodules measuring ≤2 cm in diameter located deeper than the nodule diameter from the visceral pleura (deep solid type), were eligible for resection using a cone-beam computed tomography-guided thoracoscopic manner. The primary end-point was macroscopic complete resection, and secondary end-points were: nodule extraction rate, operation time, localization time, marking accuracy, microscopic complete resection and safety.RESULTSTwenty-two nodules, in 9 men and 11 women with a mean age of 64.3 years, were visualized and resected. The nodules were located in the right upper, middle and lower lobes in 3, 1 and 5 patients, respectively, and in the left upper and lower lobes in 5 and 8 patients, respectively. Seven nodules were ground-glass opacity-dominant types, and 15 were deep solid types. Cone-beam computed tomography could clearly image all nodules. The mean time for localization was 17.4 min. The mean operation time was 110.7 min. Macroscopic complete resection was accomplished in 21 nodules (95.5%). Microscopic complete resection was achieved in all nodules (100%). Postoperative air leakage and bleeding were observed in 1 patient (5%).CONCLUSIONSCone-beam computed tomography might be a safe and useful guide for video-assisted thoracoscopic surgery wedge resection of impalpable peripheral pulmonary nodules.Date and number of IRB approval15 November 2017, 381.Clinical trial registration numberUMIN 000030388.

Decreased postoperative complications, neuropathic pain and epidural anesthesia-free effect of uniportal video-assisted thoracoscopic anatomical lung resection: a single-center initial experience of 100 cases

BackgroundWe aimed to analyze perioperative complications, postoperative neuropathic pain, and the necessity of epidural anesthesia in uniportal video-assisted thoracoscopic surgery (U-VATS) compared to conventional multiportal VATS (M-VATS) for anatomical lung resection.MethodsThis retrospective study included all patients who underwent elective VATS lobectomy and segmentectomy between April 2016 and December 2019. The exclusion criteria were as follows: age ≤19 years, planned thoracotomy, re-operation in thoracic surgery, median sternotomy, robot-assisted thoracic surgery, simultaneous resection of extrathoracic organs, locally invasive lung tumor with bronchoplasty or angioplasty, past or current neuropathic pain, and a large tumor with a minimum diameter ≥5 cm. M-VATS had 4 ports approach. U-VATS port positions were placed by extending the thoracoscope port of M-VATS.ResultsU-VATS patients showed significant differences compared to M-VATS patients: smaller intraoperative bleeding (1 vs. 30 mL; P=0.0010), shorter operative time (141 vs. 183 min; P<0.0001), post-hospitalization (5 vs. 8 days; P=0.0002), fewer complications (23.9% vs. 40.9%; P=0.048), less acute pain, less postoperative neuropathic pain (32.4% vs. 52.1%; P=0.027) and shorter duration of neuropathic pain (30 vs. 60 days; P=0.041). For the postoperative neuropathic pain and pain score until postoperative day 5, there were no differences between the groups with and without epidural anesthesia.ConclusionsAs a single-center initial experience, U-VATS lobectomy and segmentectomy seemed safe and minimally invasive based on not only postoperative neuropathic pain and complications but also time management. U-VATS would provide better pain control, without epidural anesthesia.

Surgical treatment of lung metastasis in patients with refractory gestational trophoblastic neoplasia: A retrospective study

PurposeThe lungs are the most common site of metastasis in patients with gestational trophoblastic neoplasia. We investigated surgical management and prognostic factors of patients with refractory gestational trophoblastic neoplasia to assess the value of lung metastasis resection. Patients and methodsThe clinical data of patients with refractory gestational trophoblastic neoplasia and lung metastasis treated at Peking Union Medical College Hospital from January 2005 to December 2020 were retrospectively analyzed. Surgical characteristics and survival outcomes were analyzed. ResultsIn total, 213 patients with refractory gestational trophoblastic neoplasia and lung metastasis were screened, and 148 patients who underwent unilateral lung resection were analyzed. Patients' median age was 32 years. Lobectomy was performed in 65.5% of patients, while wedge resection was performed in 34.5%. The rate of postoperative complications was 12.2%. The pathological rate was 66.2%. Video-assisted thoracoscopic surgery showed better surgical characteristics than thoracotomy did. Compared with lobectomy, wedge resection had a shorter operative time, shorter duration of chest tube placement, shorter postoperative hospital stay, and fewer postoperative complications. The median follow-up period was 36 months. During follow-up, 90.5% of patients achieved complete remission. The 5-year disease-free and overall survival rates were 80.4% and 92.6%, respectively. More previous chemotherapy courses and failure to achieve normal β-human chorionic gonadotropin levels postoperatively were predictors of poor prognosis. ConclusionsSurgical treatment of lung metastasis is valuable and safe for patients with refractory gestational trophoblastic neoplasia. The minimally invasive video-assisted thoracoscopic approach and wedge resection are recommended.

Clinical analysis of extralobar pulmonary sequestration with torsion in children: report of 6 cases

BackgroundExtralobar pulmonary sequestration is an uncommon congenital pulmonary malformation. Clinically, pedicle torsion of extralobar pulmonary sequestration is extremely rare. Due to inadequate awareness of its atypical presentation and imaging characteristics, clinical diagnosis is very difficult, and it is extremely easy to misdiagnose.Case presentationThere were 6 children (3 males and 3 females), aged 3–12 years old. The main clinical symptoms of the children were abdominal and chest pain (3 cases), abdominal pain (1 case), chest pain (1 case), and vomiting and abdominal distension (1 case). Two cases were accompanied by fever. Preoperative ultrasound revealed a well-bordered mass with soft-tissue density, accompanied by pleural effusion. On contrast-enhanced computed tomography scans, the mass showed no obvious enhancement. A blood supply was only present in 1 case, and there was no feeding artery shown in the other 5 cases. Extralobar pulmonary sequestration with haemorrhagic infarction was pathologically confirmed. On postoperative days 2–6, the children were discharged uneventfully. There were no complications during the median follow-up of 4 months.ConclusionsTorsed extralobar pulmonary sequestration usually occurs in childhood or adolescence, with abdominal and/or chest pain as the primary symptoms. Imaging examination shows a well-defined soft-tissue mass without enhancement. The feeding vessel is not clearly displayed in the mass, and extralobar pulmonary sequestration is accompanied by varying amounts of pleural effusion. Video-assisted thoracoscopic surgical resection is associated with excellent prognosis.

A case of surgical treatment of lobar emfysema in a newborn

Lobar emphysema still remains a significant issue of pediatric surgery. It accounts for 14% of all congenital anomalies of the respiratory system. The development of intra-thoracic tension syndrome leads to a critical oxygen supply disorder. The main method of treatment of congenital pathology in case of severe respiratory disorders is operative. However, an unrecognized anomaly of lung development leads to incorrect surgical tactics. A clinical case of surgical treatment of a newborn with lobar emphysema of the lung complicated by intra-thoracic tension syndrome is presented. Video-assisted thoracoscopic resection of the lower lobe of the left lung was performed. Six months after the intervention, a complete restoration of the function of external respiration was detected. Timely full-fledged surgical treatment contributed to the elimination of the cause of the development of an urgent condition in congenital lung abnormality, effective restoration of organ functions and favorable outcome.

Comparison of Perioperative Results of the Use of a Double-Lumen Tube and Laryngeal Mask Airway in Video-assisted Thoracoscopic Wedge Resection: A Retrospective Clinical Study

Comparison of Perioperative Results of the Use of a Double-Lumen Tube and Laryngeal Mask Airway in Video-assisted Thoracoscopic Wedge Resection: A Retrospective Clinical Study

Trends and factors affecting approach choice to pulmonary resection.

The development of an advanced robotic platform in 2014 led to increased adoption of minimally invasive (MI) approaches in thoracic surgery. Due to dataset reporting lag, a comprehensive assessment of trends in thoracic approaches has not been analyzed to date. We queried the National Cancer Database (NCDB) for patients with Stage I-III who underwent lung resection from 2010 to 2018. Most published NCDB analyses on lung cancer using pre-2015 data. Overall treatment trends were analyzed, with geographic, institutional, and socioeconomic characteristics evaluated for approach. There were 162 335 lung resections, and 131 958 were anatomic. Robotic resection saw a steady increase through 2012 but plateaued in 2013-2014. From 2015 to 2018, another increase correlated with the release of a new platform. Video-assisted thoracoscopic surgery lung resection plateaued in 2014 and decreased in 2018. Open resection steadily decreased. Tumors requiring neoadjuvant radiation had an increase in MI approach with corresponding decreases in the open. On multivariable analysis, African-American race, low volume, Medicaid insurance, and nonacademic setting were associated with a lower likelihood of MI surgery. The open approach has decreased since 2010. More than 65% of anatomic resections are now performed inMI. As this trend will continue, it is important that all patients are afforded the opportunity of the least invasive approach.

Chest Tubes Are Painful

A No-Chest-Drain Policy After Video-assisted Thoracoscopic Surgery Wedge Resection in Selected Patients: Our 12-Year ExperienceThe Annals of Thoracic SurgeryPreviewPostoperative pleural drainage omission after video-assisted thoracoscopic surgery (VATS) for wedge resections may facilitate faster recovery. This retrospective cohort study presents our 12-year experience with omitting thoracic drainage in patients who underwent a VATS wedge resection, aiming to assess its safety and efficacy. Full-Text PDF

Comparison of Chronic Postsurgical Pain Between Single-Port and Multi-Port Video-Assisted Thoracoscopic Pulmonary Resection: A Prospective Study.

Background Little is known about the prevalence of chronic postsurgical pain (CPSP) among patients receiving single-port video-assisted thoracic surgery (SP-VATS) compared with those undergoing multi-port VATS (MP-VATS). This study aimed to compare the incidence of CPSP between SP-VATS and MP-VATS lung resection and assess how the pain affected the daily living activities of this patient population. Methods We prospectively collected data regarding the demographic features, clinical factors during surgery, the intensity of acute postoperative pain, and complications after surgery among patients receiving elective SP-VATS or MP-VATS lung resection at our institution between June 2015 and August 2018. At 3-, 6-, and 12-months following surgery, the patients were followed up through a telephonic interview. The Brief Pain Inventory-Short Form was adopted to assess the incidence, severity and location of the CPSP, analgesic consumption, as well as the interference of pain with daily activities. Results In total, 476 patients were screened for eligibility, 411 patients were followed up for 12 months and included in final analysis. Among these, 190 patients had undergone an SP-VATS pulmonary resection and 221 had an MP-VATS pulmonary resection. At both 3 and 6 months, the incidence of CPSP in the SP-VATS group was lower than that in the MP-VATS group (25.3 vs. 38.0%, p = 0.006; 11.1 vs. 19.0%, p = 0.026, respectively). At 12 months after surgery, the prevalence of CPSP was comparable between groups (4.7 vs, 9.0%, p = 0.089). In addition, the SP-VATS technique alleviated pain interference with the daily living activities of patients with CPSP in several domains, including sleep, mood, and enjoyment of life compared with the MP-VATS technique. The two predictive factors for CPSP at postoperative 3 months were the MP-VATS technique (odds ratio [OR] = 1.792, p = 0.019) and postoperative chemotherapy (OR = 1.718, p = 0.033). Conclusions This study indicated that the SP-VATS technique reduced the prevalence of CPSP at 3- and 6-months post-pulmonary resection compared with the MP-VATS technique. The SP-VATS technique also significantly alleviated pain interference with the daily living activities of the patients.

Free of choice on anterior and posterior chest tube position after lung cancer resection.

OBJECTIVESThe optimal location to insert a chest tube for postoperative drainage has not been identified. We performed a retrospective equivalence study to identify whether the efficiency is similar regarding anterior or posterior position of chest tube in thoracic cavity after video-assisted thoracoscopic surgery for non-small-cell lung cancer.METHODSA retrospective review of 4263 patients undergoing non-small-cell lung cancer resection from October 2009 to August 2019 in the Western China Lung Cancer Database was conducted. Propensity score matching was performed to balance baseline characteristics between anterior and posterior groups. Chest tube duration, drainage volume, postoperative complications and hospitalization cost were compared. Equivalence margin was defined as (−1, 1) in 95% confidence interval of the mean difference of chest tube duration.RESULTSAfter propensity score matching, we investigated 2912 patients with anterior or posterior (1456 vs 1456) chest tube location following lung cancer resection. The mean time to chest tube removal was 3.39 days in the anterior group and 3.38 days in the posterior group (P = 0.52), while the mean difference and 95% confidence interval were 0.02 (-0.17, 0.20). The mean postoperative hospital stays in 2 groups were 5.47 vs 5.24 days (anterior vs posterior, P = 0.02). No significant differences were identified regarding the drainage volume during the first 3 postoperative days, postoperative complications and hospitalization cost.CONCLUSIONSThe comparison of clinical outcomes between anterior and posterior location of chest tube met the criteria for equivalence. For lung cancer patients undergoing video-assisted thoracoscopic surgery resection, it was free choice on anterior or posterior single-tube insertion.

Intramuscular stimulation as a new modality to control postthoracotomy pain: A randomized clinical trial

ObjectivePostoperative pain after thoracic surgery primarily hinders patients’ mobility, decreasing the quality of life. To date, various modalities have been suggested to improve postoperative pain. However, pain alleviation still remains a challenge, resulting in continued reliance on opioids. To tackle this problem, this study introduces a needle electrical twitch obtaining intramuscular stimulation (NETOIMS) as a new effective treatment modality for postoperative pain after thoracoscopic surgery. MethodsThis randomized clinical trial analyzed patients receiving video-assisted thoracoscopic surgery pulmonary resection between March 2018 and June 2020 at a single institution. A total of 77 patients (NETOIMS, 36; intravenous patient-controlled analgesia, 41) were included. NETOIMS was conducted on the retracted intercostal muscle immediately following the main procedure, just before skin closure. Postoperative pain (numeric rating scale) and oral opioid morphine milligram equivalent were assessed daily until postoperative day 5. ResultsThe NETOIMS group had a significantly lower numeric rating scale score on postoperative day (POD) 0 (P < .01), POD2 (P < .001), POD4 (P < .001), and POD5 (P = .01). The predicted time to complete pain resolution was 6.15 days in the NETOIMS group and 20.7 days in the intravenous patient-controlled analgesia group. The oral opioid morphine milligram equivalent was significantly lower in the NETOIMS group on POD0 (P < .001) and POD1 (P < .001). ConclusionsNETOIMS appears to be an effective modality in alleviating postoperative pain after thoracoscopic surgery, thereby reducing the reliance on opioid use.

Effect of Lung Protective Ventilation Combined With Flurbiprofen Axetil on Immune Function During Thoracoscopic Radical Resection of Lung Cancer.

The decreased immune function of patients with lung cancer has always been the focus of clinical attention. However, the stress response caused by surgery, anesthesia and pain will further reduce the body's immune function and affect the prognosis of patients to a certain extent. It was found that both protective ventilation and flurbiprofen ester pretreatment could reduce the immunosuppression caused by stress response. In this study, 120 lung cancer patients treated with video-assisted thoracoscopic radical resection were divided into group A, group B, group C and group D, which were treated with conventional mechanical ventilation, lung protective ventilation, conventional mechanical ventilation + flurbiprofen axetil and lung protective ventilation + flurbiprofen axetil, respectively. The results showed that the levels of CD3+, CD4+, CD4/CD8+, and NK in groups A, B, and C were lower than T0 on T1, T2, and T3, while those indicators in group D were lower than T0 on T1 and T2 (P < 0.05). The above indicators in group D were higher than those in the other three groups on T1, T2, and T3 (P < 0.05). The above indicators were statistically significant compared with those in group A and group C, group B and group D, and group A and group B at T1, T2, and T3 (P < 0.05). The comparisons of CD3+, CD4+, CD4/CD8+, and NK among the four groups within different time groups, and the repeated - measures analysis of variance (repeated - measures ANOVA) showed that there were interactions among time, group, and between groups × within groups (P < 0.05). It was confirmed that lung protective ventilation combined with flurbiprofen axetil could alleviate the immunosuppression of patients undergoing thoracoscopic radical lung cancer, providing a new idea for clinical treatment.

Comparative early results of a robotics-assisted endoscope holder in single port thoracoscopic surgery in the era of COVID-19.

BackgroundInnovations in surgical instruments have made single-port surgery more widely accepted and lead to a reduced demand for surgical assistants. As COVID-19 has ravaged the world, maintaining minimum medical staffing requirements and proper social distancing have become major topics of interest. We sought to evaluate the feasibility of applying the unisurgeon approach in single-port video-assisted thoracoscopic surgery aided by a robotic camera holder.MethodsOperative time, blood loss, setup time, postoperative hospital stays, and the number of participating surgeons in single-port video-assisted thoracoscopic lung resections were gathered for investigation after the introduction of the ENDOFIXexo robotic endoscope holder system. In this cohort, we collected 213 patients who underwent single port video thoracoscope surgery, including 57 patients underwent robotic endoscope arm assisted surgery and case-matched 52 patients in the robotic arm–assisted group with patients in the human-assisted group through propensity score–matched analysis.ResultsIn wedge resection, a single surgeon was able to completely operate on all lobes of target lesions. However, for anatomical resections, namely segmentectomy, the success rate was 95%, and for lobectomy, the success rate was only 64%. No significant differences between setup times, blood loss, or operative times between the two groups were observed.ConclusionsWhen an experienced uniport surgeon is assisted by a robotic endoscope holder, wedge resection is the most suitable procedure to be performed through unisurgeon single-port video-assisted thoracoscopic surgery without increasing setup time, operative time, or short-term complications. Verification of the technique’s applicability for use in anatomic resections requires further investigation.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00464-022-09054-8.

Взаємозв’язок патофізіологічних процесів, що відбуваються в плевральній порожнині при згорнутому гемотораксі та аутогемоплевродезі

Актуальність. Незважаючи на широке впровадження в торакальну хірургію малоінвазивних методів резекції, плевродез залишається у ряді випадків єдиним визначальним методом радикальної хірургічної корекції. Особливо яскраво це проявляється при операціях у хворих із поширеними формами бульозної емфіземи легенів. У той же час існуючі види плевродезу викликають серйозні супутні ускладнення. З урахуванням цього був розроблений метод аутогемоплевродезу, заснований на патофізіології процесів, що виникають у плевральній порожнині після попадання в неї крові, в основу якого були покладені процеси, характерні для розвитку і перетворення згорнутого гемотораксу. Метою дослідження стало вивчення патофізіології плевральної порожнини при штучному створенні в ній гемотораксу. Матеріали та методи. Контрольну групу склали 36 хворих, у яких гемоторакс був викликаний проникаючими колото-різаними пораненнями грудної клітки. Із них у 21 пацієнта відзначався малий або середній гемоторакс, у 15 хворих у зв’язку зі згорнутим гемотораксом була виконана його ВТС-евакуація. Основну групу склали 40 хворих, у яких гемоторакс виникав унаслідок виконання їм ВТС-резекції легені і плевродезу з приводу бульозної емфіземи, з них у 24 був виконаний коагуляційний східчастий плевродез, у 16 — аутогемоплевродез за розробленою методикою. Як основний показник, що відображає процеси формування фібрину і фібринолізу в плевральній порожнині, досліджувався плазміноген, відсоток активності якого визначався в сироватці крові і плевральному ексудаті триразово: через 1 годину і 24 години після операції, а також на 5-ту післяопераційну добу. Результати. У перші години після операції відбувалося зниження рівня плазміногену крові в усіх хворих, окрім тих, яким була виконана ВТС-резекція зі східчастим плевродезом. Через добу після операції в групі хворих із малим і середнім гемотораксом розпочиналося повільне відновлення рівня плазміногену, через 5 діб його концентрація в крові повністю відновлювалася. У пацієнтів, що перенесли евакуацію згорнутого гемотораксу, через 1 годину після операції відзначалося стандартне зниження плазміногену. На 5-ту добу рівень плазміногену в крові відновився тільки наполовину. Такі ж значення плазміногену в часових проміжках 1 година та 5 діб були в групі хворих, яким після ВТС-резекції був виконаний аутогемоплевродез, а через 24 години після аутогемоплевродезу вже починалося відновлення рівня плазміногену. У плевральному ексудаті відзначалося помірне зниження плазміногену в пацієнтів, що перенесли ВТС-резекцію зі східчастим плевродезом і ПХО з дренуванням плевральної порожнини через 1 годину після операції, та потім його рівномірне відновлення до 5-ї доби. У хворих зі згорнутим гемотораксом було більш глибоке падіння рівня плазміногену через 1 годину після операції і рівномірне, але не остаточне його відновлення до 5-ї доби. Аутогемоплевродез призводив до різкого зниження плазміногену в плевральному ексудаті через 1 годину після операції, та його рівень не виріс до 5-ї доби. Висновки. Зниження плазміногену в плевральному ексудаті стало прямим відображенням виснажуючої дії аутокрові. Аутогемоплевродез є втручанням, що моделює процеси, які відбуваються в плевральній порожнині при згорнутому гемотораксі в більш м’якому варіанті; при ньому відбувається пригнічення лікворного фібринолізу, аналогічне такому при згорнутому гемотораксі.

Prolonged air leak following video-assisted thoracoscopic major lung resection: newer avenues to manage an age-old problem.

Over the period of a decade or so, video-assisted thoracoscopic surgery has established itself as a modality of choice not only for the early-stage lung cancers, but also for the primary pulmonary and mediastinal diseases. But prolonged air leak is a well-known morbidity of lung resection surgery, and thoracoscopic technique is no exception. Primary indication of any minimally invasive surgery is lesser trauma and eventual early post-operative recovery. The prolonged air leak compromises in attaining those goals and often becomes a reason of delayed discharge from the hospital. This review reflects on this relevant problem of air leak and its management in brief.

Evaluation of Short-Term Outcomes and the Learning Curve Wherein a Thoracic Resident Doctor Performed Video-Assisted Thoracoscopic Anatomical Lung Resection for Lung Cancer.

Purpose: The surgical approach for anatomical lung resection includes open thoracotomy, video-assisted thoracoscopic surgery, and robot-assisted thoracoscopic surgery. We evaluated the short-term outcomes and the learning curve wherein a thoracic resident doctor consecutively performed video-assisted thoracoscopic anatomical lung resection for lung cancer.Methods: We retrospectively reviewed 91 cases of consecutive video-assisted thoracoscopic anatomical lung resections for lung cancer performed by a thoracic resident doctor between November 2017 and March 2020. The thoracic resident doctor had no previous experience performing video-assisted thoracoscopic or open anatomical lung resection.Results: Lobectomy was performed in 80 cases. Simple segmentectomy was performed in 11 cases. No cases required intraoperative conversion to open thoracotomy. The median operative time and blood loss were 148 min and 10 ml, respectively. There were no serious postoperative complications or deaths 30 days after surgery. The learning curve was examined using the cumulative sum method with operative time as a factor, and it took 21 cases to attain experience.Conclusion: Our resident doctor safely performed video-assisted thoracoscopic anatomical lung resections and it took 21 cases to stabilize the surgical technique. The surgical technique was possibly stabilized earlier than previously reported, although this was a study of a single resident doctor.